06050166CITY OF CUPERTINOsl�n
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• BUILDING DIVISION PERMIT
RUILDING ADDRESS:
COSMOS ROOFING
PERMITNO-06050166
898.HYDE AV
OWNER'S NAME:
PERMRISUBDATE
CLAIRE ARNOLD
1901 OLD MIDD
Et
SANITARY NO. CONTROL NO.
(650)969-7663
ARCHITECT/ENGINEER:BUI
DING PERMIT INFO
'BLDG
ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
p
I hereby affirm that 1 am licensed under provismas of Chapter 9 (colnnscrmiry
withSection701RBof Division Jaf the BusinesAin dipafesames Codoaed my license is
in Tull form andefro" /d SyL/�
TEAR OFF FOAM & B.U,R. ADD B.U.R. WITH GRAVEL
Damn 9�y Lk.«
Dam Canlrcmr
CLASS A
AR CTSO ON a
l wberslameml 1 e Iic
Ep
FINAL
C■■aa a■�a/j��
Lkmnsed Pmfcssional -
Oa
L
OWNER -BUILDER DECLARATION
(Tirm that 11. escmpl Tom the Contractor's : my c taw Tar de
exempt r
Ig 7031.5. 1.4 and Pmfesalum Cade: Any city of county
in
Julio �
Mase .
moon. (Sadao
n. 4heas
which mquima a permit re ammuun, slten improv, d , or repair anyed auuaum
which
)
L
permit dgrwM sutemcm
Inion m issuance. Wu requires Ute applicarralor Tar rah permit LOk
Conoacmr'a Lkmiste taw (Chapter
Sq. Ft. Floor Area
Valera[ ®585
dol he is licensed pursoanuo este provisions or the s
s l p
(commencing with Section 7000) of Division 3.1' the Businnssad Profession Cade) ar
1;
1 ill rim sh.
that M Is exempt themfmm and the bash for she alleged exemption. Any violation of
Section 7031.5 by any applicant for a permit subjects the appbanl an a civil penalty of
!eev� 7v} }�j r
�� VOU
0y ryl
an`r_:Y a' pe
not mart Ihm fin hundred dollars ($300).
3 / 0 8 0 0
/ J77
01. u owner of the property, on my employees with wages a their sola eumpenadon,
Required Inspections
will do the wank and du: aouctum is net intended or offered fee ask (Sat. 7044. Ea.
and Pmrcadam Cod. The Commodes License Law does not apply m an owner of
property who WiWsmimproven t emem,alewandoeaouch work hi nwifm Uwugh his
own employees, provided that such Improvements art not intended muffoomd far We IL
however• the huldingor hapovemerd Is sold within ort year ofeamplcuon. de awwm�
builder will have Ilse burden of posing that he did not build or improve for purpose of
ask.).
❑ 1, as awns of the property. am eseluuwly consisting with RceneW ¢macs so
common the Preject (See. 7044. Business and Profession Cade:) The Conoacmrs U.
Mede taw does 001 apply m an owner of property what builds or impmwa common. Lm.
who emnaana for such projects with a comsat") Earned pursuant m the Conoactars
'
License law.
❑ I am exempt under see . B d: P C for lith moon
Owner Dam
WORKER'S COMPENSATION DECLARATION
I hereby aBirm under pemlty of perjury, one, of Ue fallowing declummor.
1 hew and will maintain a CenlOcete of Cement to self-Wum for Wurkera Compeer
ar.n, u provided for by Section 3700 of the labor Code, far the pmAmos. of the
work for which this permit is issued.
1 had an will maintain Workers CompeasWon Insurance. u acquired by Schon
700 ofine tabor Code, far the performance ofdm work fmwhich mit permit is laved.
'
My Workers Com'oe'o"s�ulen lnpy�ra��� curia and Policy number are:
11'jS�
Carrier. S•'T e�-sl_. PolicyNo e:71-040
CEImFlCATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
,
(Ibis sceum treed net ism completed if the permit Is fecom hundred doUaa ($100)
or ern)
1 amify dint in the performance of Ute work for which this permit is tasted. I shall oat
s
employ any person in any counter an as in become subject to the Workcrr Compemadon
Laws o(Caiifomia. Date
pp cant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you Nauta
NOTICE
become subject in the Workers compensation provisions of the labra Cade, you mot
' forthwith comply with such provisions or this permit shall be deemed revoked.
ON IEN, =in,i NCY
CONSTRUCTION
eo I for the performers« of
is a c
1 hereby aRirm that then h ,.y
(Sce. 3n
, CN. .)
the wart fm which rola Permit h issued (Sat. 7091, Civ. C.)
' s
'
iLanders Name
Lenders Address
i I cmlify that I have read this app Ica ion sed sum that the abaw information h
'
correct. I agree un comply with all city and county ordinances and aura laws relating to
building conswnian. and hemby authori¢ rtpreaenulives or this city to enter upon the
above-mentioned property for inspection purposes.
(We) agree to an. indemnify sod kap harmless the City of Cupeniw against
Imbiliues. judgmenu,cos sod expemea Whit err in soYway se em agmasi said City
in consequence of the un of Ni
• APPLICANT N N D I C P I NPOINT
_
Issued by: Date
souRCERE ,J
Re -roofs ell
Type Roof
Signatureof Appllun /Conranar Date
HAZARDOUS MATERIALS DISCLOSURE
of
Will Use applicam or future building eaupantamrt orhandle haardou material
as defined by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety
Cade. Section 23532407
All roofs shall be inspected to any roofing material being installed.
Oyes ON.
prior
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building oaupant use equipment at devices which
.mit hasuMm air conumimna as defined by the Bay Am Air Quality Management
all new materials for inspection.
Dissict7
❑Yet ❑Nu
Ihawmad the haudsamated5,2lQ3enn534,1 L
mmdthalfdmWildin
nit HcalN&SafclyC Satires 21307,23 3rmanal34,Iwngry ft the Wilding
fthe
dna set cunemly warn. i' mspolWh' ymmiry Ne secs lof sow
myuiremc w nstbd ri lo of rdE Dec. r
Signature of Applicant Date
� —
All roof coverings to be Class "B" or better
ownerenwharixd sgcm Date ate
!m 2 of 2
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 37539008.00
DATE ISSUED.......: 05/18/2006
RECEIPT #.........: 34455
REFERENCE ID # ...: 06050166
SITE ADDRESS .....: 898 HYDE AV
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OWNER ............: CLAIRE ARNOLD
ADDRESS ..........:
CITY/STATE/ZIP ...: ,
OPERATOR: amyw
COPY # : 2
RECEIVED FROM ....: BONITA JENKINS
CONTRACTOR .......: COSMOS, RICHARD LIC # 18844
COMPANY ..........: COSMOS ROOFING
ADDRESS ..........: 1901 OLD MIDDLEFIELD WY
CITY/STATE/ZIP ...: MOUNTAIN VIEW, CA 94043
TELEPHONE ........: (650)969-7663
�EE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL
---------- ----------------------------------------------------- ----------
BPERMFEE VALUATION 10,000.00 169.56 0.00 169.56 0.00
BSEISMICRE VALUATION 10,000.00 1.00 0.00 1.00 0.00
TOTAL PERMIT : 170.56 0.00 170.56 0.00
METHOD OF PAYMENT AMOUNT NUMBER
------------- = --------------- ------------------
OTHER 340.35 VISA,
TOTAL RECEIPT 340.35
•
•
C,
J
May 17 06 09:25a
CO'IPEkTINO
C: q
Cosmos Roofing (6501969-9905 p.1
- W vv I/ vv I
C
1030OTanAvatm
Cha CA M14
TakpkM ON) 777.3228
Fa (408) 777.3333
vE
X I am not using any subcontractors;
Cabinets & Millwork
Cemeat g
Elecgieal
fixcavation
OTS Ill Mu tMetal
Sheet Metal
Sheet Rock
Tile
MI
-S-046
Date
s /7 46
Date
Community Development Department
Building Division
City of Cupertino
• {., - 10300 Torre Avenue
CITY OF Telephone: (408) 777-3228
_—� NO Fax: (408) 777-3333
C � ��
„K"!!' Building Department
Subject: Re -roofing policy for the City of Cupertino
1. Prior to permit issuance, you must agree to comply with 1997 UBC Standards
IMPORTANT:
1. Flat roofs must have a minimum of 1/4" per foot slope and demonstrate
that there is no ponding.
2. An I.C.B.O. report is required to be on the job site at the time on inspection.
I understand and will comply with the above
//stated policy on re -roofing.
Homeowner's Name:
Job Site Address:
Roofing Company
Applicant's Signature:L e, AL,, Date:Q e,
• Greg Casteel
Building Official
Revised 11/2/04
Pri.,:N1 nn ,9e, i•.^Trl Pnnr•
and manufacturers specifications on re -roofing.
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 re -roofing
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) Pre -inspection 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,a proper City inspection can be performed.
7.
NOTE: If you call for a plywood nail inspection and the job is not ready,
you will be charged a re -inspection fee of $176.18. The re -inspection fee must
be paid before another inspection can be scheduled.
IMPORTANT:
1. Flat roofs must have a minimum of 1/4" per foot slope and demonstrate
that there is no ponding.
2. An I.C.B.O. report is required to be on the job site at the time on inspection.
I understand and will comply with the above
//stated policy on re -roofing.
Homeowner's Name:
Job Site Address:
Roofing Company
Applicant's Signature:L e, AL,, Date:Q e,
• Greg Casteel
Building Official
Revised 11/2/04
Pri.,:N1 nn ,9e, i•.^Trl Pnnr•
(GC.
OCUcin of
CUPERTINO
E
CITY OF CUPERTINO
_001
PERMIT APPLICATION FORM
ao5o1(OU
APN #
000
BUILDING
Date:
Energy
ZJJ
BSEISMICRE
Seismic Fee Res
Building Address: (? F
BSEISMICOM
Seismic Commercial
Owner's Name:aazta,
n „�
W2�Vt.v Phone
Plan Check Fee
Phone #: 7%
� G _/7y 6
Contractor:
#:
BUILDING
License #:
650
9G9-76 63
7F5Lf�1
Contact:
Phone #:
Cupertino Business r,tcense #:
/
Type of Roof Covering:
Existing:
Proposed:
'X Built -Up Roof
V Built -Up roof
❑ Asphalt Shingles
❑ Asphalt Shingles
❑ Wood Shakes
❑ Wood Shakes
❑ Wood Shingles
❑ Wood Shingles
❑ Other (Specify)
❑ Other (Specify)
Number of existing coverings
❑ Provide I.C.B.O. Report #
❑ To be Removed
❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will ComEly With Cu
ertino's Tear Off Policy:
Job Description: T104-
V .
/e
Residential IA.
Commercial ❑
Fire Zone: Yes ❑ No ❑
Confirmed with Planning Dept. if
there are anrestrictions: 15
Cost of rojec.
o fCotnsstruction: Occu ancy group:
Type
Qty. if
Applicable
Fee ID
Fee Descri tion
Fee Grou
BPERMFEE
Bldg Permit Fees
BUILDING
BENERGY
Energy
BUILDING
BSEISMICRE
Seismic Fee Res
BUILDING
BSEISMICOM
Seismic Commercial
BUILDING
BPLANCHK
Plan Check Fee
BUILDING
BUSLIC
Business License
BUILDING