02030054 NO
`cut DING upviSiONPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
18844 HUNTER WAY COSMOS ROOFING 02030054
OWNER'S NAME: APPLICATION SUB DATE
KATHY GOULD 1901 OLD MIDDLEFIELD WY 03/13/2002
t PHONE:
(415) 493-6373 SANITARY NO, CONTROL NO.
rc0 p ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
�?d LJ L-J LJ I__]
s= LICENSED CONTRACTOR'S DECLARATION
= Job Description
y z e 1 hertby aIRmI that I am licensed under provisions of Ch r mr 9 escrp(commencing
=CLL with Section 7000) fDivi,hm 3ofine Busmessaod ProfesimuCodeand my license RE-ROOF
is m full force on ff C /
0,a License .IaSs C� Lic,o .5
3 3 LL N Oma U Comroaor
ARCHITECT'S DECLARAT ON
.u O g 1 umicmand my plans shall be used as public records
a
S p O Licensed Professional
'c c OWNER-BUILDER DECLARATION
L-w I hereby offnn,hot I am exempt frim the Contractor's License Law far the
L
z< following reamn.(Section 7031.5,Business and Professions Code:Any city or comity $3925
4 S O which requires perm t, .t , Iter,improve,demolish,o an
pair y stmcturc
t1i 3C$ _pno ,o its u.suaduc.also Inquires the applicant for such Permit to File a signed statement __.- ..__
_..
,ha,he 31 ttnsFi puniem In,the provisions fifth,ComncmLltt
rs nu La (Chapter 9 r a Valuation
(cam ee,g ,mSeoq 7000)ofD ioofine
or that he a axe nrc0
pi thcon vnd the hal i,s for the alleged awiip,bit.Any vinlmmn
-of Seninn 7031.5 by any appliwm far a permit subjens the vpplicam m a civil penalty\
:ofnot morethan avehundred dollars(s5Ln). 30k9"PN� E II n' n. Occupancy Type
01,as owner of me property,or my employer.,with wages.,their sole compensation,
'will do the work,and the'smucmm is not intended or offered for-sale'(See.7W,-
Business
014-Business and Professions Cade:The Conwcmr's License Law does not apply,o an 601 - ROOF TEMgLdr t-Inspections',(",".,:,. "
w r of pnipeny Who bunds or improves thcram,and who does such work himself
o rte
qr menu h his ower empinyeer.pmv,dcdildir -or wen Improvements are not mmlidea or 6 0 2 - ROOF PLYWOOD NAIL
-comp) or ialr'he co howcam\the Imddmg or nden of
i.,sold he did one year or 603 — ROOF BATTENS x', '`Tk"
completion,'he owner-builder,will have the M1urden of proving that he did not build or "
improve for purpose of aale.). _ 604 - ROOF IN-PROGRESS
0I _ er oe p(Set,7vn exdus. lye tai i dI' ache t metier constructie pes ct(See 7toan Busnes Jen fsonsil )Th Contractor's
hn, 1)
License I.aw Aces not apply roan owner of pmpcny who builds of seimproves thereon, - '
_end who.Commoa foomch projects with o contmctor(s)licensed pursuam to _
Contractor'sLicenseI Vw.,. FINALE®
❑Iem exemP,under Sec; 't :B&PCfortisnnwn -
own r R ENS MAR 2 5 2002
WORKER'S COMPENSATION DECLARATION
• ' -I hereby affirm under pamiltyof perjury mic of the following declarations:
0 1 have and will maintain v Cenifcale of Consent to self-insurt for Worker's BUILDING
Compensation, as:provided for by Section 7700 of he Labor Code, for the
PJer:formance of the work for which this permit is issued.
Ips have'and will mdiniam Worker's Cainpeiiistion Insurance,ai icquired by section
9]00 of the-Labor Code for He performance 7 the work'fici which this perm,is
Issued My W r eta Compc i o IgJ In wince came a d Poli y n eche e: " -
Came 's r^�l.Policy No . 7/ 0. 2. s , !I t, -..... -._v: ..,, .. _.. ..• _ _ ,..
CBRTINICAtON OF EXEMIfION FROM;WORKERS' ('„_ s ) Ii,�Q-ty{Ikpe`ol,g l+y,�k''!: �'ilil11 L10I1
-'..� COMPENSATION_INSURANCE.' " s -. .. .._._.__.._ /_ .— y.,
6 :1 Oj Is section orad not be,completed if the permit is for one hundred dollon '( '' " N sF i h 'h t;I
(SI00)or Jr..) '
I prof,thin fit the ped nuance ofd work far which'his'print is issued,1
.shall nm dm to erson in an '- -I •I ;cf.,:,impl.,any p y manner so as,o necbme'suh3em io the Workers
Compensation Laws of Celilnmie.Date.
Applicant
NOTICE TO APPLICANT.Ifvfter iiwking oris Certificate ofEemptio 'you should ,,,si. •,a
Q 0 ischia Nhjecun the Workers Componsauon pmvizions Deme Tubae Code,you must
fonhw-idi comply with such provisions or this permit shall be droned revoked.
L'Za � - .._. . . .... _. ...._ _.. ... .. - ... ............ ..
"(CONSTRUCTION LENDING AGENCY ,r
for
which this,hart Is u c tiid(S c lM7.C igen),fo ,he performance
�A' wQa 1.the work for which this permit is issued(Sec J097.Civ.C.)
;D 0 -Lender's Nome-4 • .�'. � .:.:r-_a.�_,.�._..1_,... ..d: 'c\ '
Lenders Address' .. . . _\ _. __\-. .. _ _..____ —_ _— - -..
_ (certify to compve rcud t hippy add
o county
s,a canes and
stat laws
cation is
W F
pattern I agree to ebony a d he all Gary odd coumy ominanns and state laws enter
upon
>',V the moimg constriction,andhcrtinspetion piepardes.vn of misciry toenmr upon
>.:W ,he above-memioned properly for inspection puryoses.
FI IZ) 1 W) g to idem fy and kttp h 1 zi me C iy f C penin,i tit ai,
Fn U] (lobi( 3 de ms c i. and menses which m y,n any w y ego!nst said
t V � City n c-mGuence of the gram og of this permit ' ' I t" Issued by:by: Date
OI /`�
APPLICANT UNDERSTANDS A���ppp WILL COMP Y WfTH ALL NON PT�' V
SOURCE REGULATTONS. (ll q
Sigwt ofAPPhcantlCom ro 3 "" - ; wte'.— Re-roofs
d _" , HAZARDOUS MATERIALS DISCLOSURE I '",
"•" Wll lh vppldam r t b king win rnamaltna:a:e rime ;l _.'Pfpe of Roof,
as defined by th Cpcnn Mu pICiO Ch pt 912 and the He hh dSafety -""' '''''•"" \' `- -="'
Cade $Cell n 255320 , r• t-
is
.i
" 4
,.. ❑Yes I t,> aJ 'tiZ a.l - X4 3 ti 's ? - 1
ll,roofs shall be ms acted poor to any roofing matenal being installed.
,. wum wPur , rt rtlmming p mu cgalp t ede
as which If a roof Is installed'.without first obtainingan ins ection',I a see"toremove
emit hazard s air con ummams a defined by the Bay A ca'Aa O al ty Management ]3 g
°"'^°by
ee " all new materials for inspection. Applicant understands and will comply with
p all non-point source regulations:".,
p C oeq y e abs m25 met t(lel`m de Chapter ri 95 or Ne
i ec,ens on.that
853)and 25534 1 it do toad mm
Cacti am h&Safcty
s s
1 ha dread the hazardous matanals rt mrcm no un
Hevh CW S
fthebutlJln e s not rrt 0 ha y time I.f. tonohrythe - '-- - -
ocoatofthe uiidmems hihm ssuonce alae nifcatp of `•
+ D._p � 3r Z Signature of Appli ant Date
Owns forbad arm, All roof coverings to be Class "B" or better
E `
-OFFICE
V 1 Building Division
10300 Torre Avenue
Cupertino, CA 95014-3255
u Telephone: (408)777-3228
16CITY OF Fax: (408)777-3333
PEkJ1N0
Building Department
Subject: Reroofing policy for the City of Cupertino.
1. Prior to permit issuance, you must agree to comply with 1997 UBC Standards and
manufactures specifications on reroofing.
2. New roof coverings shall not be applied without first obtaining all inspection and
written approval from the building inspector. A final inspection and approval shall
be obtained from the building inspector when the reroofing is completed.
3. All roofs shall be inspected prior to any roofing installation.
4. To receive a final sign off from the City the following steps are required.
1) Preinspection and/or tear off approval.
2) In progress inspection approval.
3) Final inspection approval.
a) Spark arrester installation.
5. If plywood is installed, a plywood nail inspection is required.
6. Any roofing which is applied without first obtaining an inspection, will require the
removal of all new material down to the sheathing so that the proper City inspection
can be performed.
We understand the above policy on reroofing and will comply with this policy.
Homeowners Name: J��t, (2,
Address: JC/`t-�, Gw Q
Reroofing Company Name: ) � y-
Applicants Signature: <- / 1�
Joe Antonucci
(Chief Building Official)
6/13/00