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05110010 ,CITY OF CUPERTINO >u�x ,l � ' Y°r%�'�'' °'`'` }` - '•' `e BUILDING DIVISION PERMIT ,, NT ,�,Ta' '.T, �' - BUILDINGADDRESS: COSMOS ROOFING "c"m1 ND'05110010 -22741 MEnTNA IN OWNER'S NAME: PERMIT ISSUE DAIS DIANE THOMAS 1901 OLD NE: SANITARY NO. CONTROL NO. (650) 969-7663 ARCHr1ECTIENGINEER: BUILDING PERMIT INFO 'BLDG ELECT PLUMB MECH 0 0 0 LICENSED CONTRACTOR'S DECLARATION Job Description t I hereby by slams tem 1 w ta licensed under pmvsfiaof Ceapm 9(commencing with Section Tow,arDividon S Older BusisemW Professions Cade,and my liar le +� ifull raa.ndQe<(f{t:i�jr�wjj REROOF--T O WOOD SHAKER, ADD COMP Licence Clma�Lle.N?R-5q' / Dan: Conu>mar p ARCHITECTS DECLAR TIO f I understand my plans Nall k used an public meord, va Licensed Pm(essianal OWNER-BUILDER DECLARATION S 1 hereby.aim that 1 1. eumpt from Ne CUime,Co Licence Law for me 0 o following moon.(Sudan 703 construct, Busies and wn.de oli Cole:Any city or county $15660 9 which its Wa a demit re ctmruct alter.nnprow,demolkh,er e poly any aceneert Zr that he I.lu+wrc0.almet to the the applicant for such Cmeracmttm rig Law(mmcment y €< (commis licensed mmUon to the of Division 3NC Conummrand Proflaw(Chapm9 Sq.Ft.Floor Area Valuation s (commendnSwiNSecdon70adthe baision3 them Bmissondon.MyoviCode)onof — that k m nwnpt therefrom and Ute bum fa the alleged...—ptidt MY violation of Semon 7031.!by airy appliant(er a pewit mbjuu Ne tpplkant m a dNl penalty of - cupancy Type cot mom than Bw hundred dollars 15300). 0 0 1,an owam of No property,army employs with"gas u dteirmk comp umation, AN will do tkwak.an4 thearoctme m cot intended erOffered fared.(Sm.7044.Business and Profesdarm Code:The Conlractora License Law ds Out apply W an owxr,of U d Chong property who buildsorimpms Unseen,andwhodoessuch work himselforthrough his �pw� awnemploys,Provided that such Improvements w not intended oroRered fords U. 1,7T/vC\ however,the building or improvement is mid within cam year of ma pkeon.Ne oww- L builder will bane Ute burden of proving that k did not build Or Improve for purpose of ❑1,u mrsr or Ute Property,w exclusively contracting with Beenud contractors W carrousel the project(See 7044,Buena and Profte sir Cod.)The CoourWs U, cease law ds not apply to an owner of propenYwhu builds or improves shaman.and, who contracts for such projects with a contractor(s)licensed pursued m the Commemes License law. 0 l am umnpt under See .B h P C for this renov Owner Data WORKER'S COMPENSATION DECLARATION 1 thereby affirm under penalty of PadmY tiro often following dedarmiov: I have mW wRI mainWnaCeNrmam a(Cansent s self-luume far Worker'sCompen- sedan,u provided for by=on 7700 of the Labor Code.for W performance of the svmh far which Its permit is imud. I have and will maintain Worker's Compemadon luunnce,u required by Sedan of the labor Cous,far Ne perfarmwme of Out work for which this permit in Wood. My WorkeYafta7115 Nim uwic and Policy number tae: Carder. �7'' M x Policy No.4 71—0 S w// LS CERTIFIG7E OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This Mellon sed oat k emnpkmd If use permit is furone hundred dogma($100) or leve) I certify that in the performance of the work for which this permit is Wood.I shall am employ any permn in any mannoran m in become subject in Uewarkem'Compenmdon Laws of Califomia.Dam Applicant NOTICE TO APPLICANT:If,after making this Cerin^,^of Esemption.you dmuW become subject in Ne WarkeYa Cnmpensaunn provisions or the Kiser code you a= .J O forthwith comply with such provision or this permll Nall the deemed revoked. zy CONSTRUCTION LENDING AGENCY (.n Ikrehy am.that Nes is a eonmttetinn lending agency for the lterlo^na^ce of ai > the wort for which this permit Is(stud(Sec.3097.Civ.Cd a . I..-Oes Nsmc .7. z Lender+Address U0 mI aNthat m I have read this application Nm ion and the above in(omadun is U.U coet I agree m Ordinances with all city and county Ordinaand state laws relent m O building construction,and hereby worodse mprucrOL"M of Nk cicy to enwupnn One W ahwe-mentiamd property fm inspection purposes (We)agree m save,indemnify and keep hamleh the CnY Of Capenino agent cA IiabiliUu,judgmenu,cuts and expenses which may In my way mese against said City U z in COmmiave of the totaling of this Permit. ., APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REG S. :1 /%(/09 Re-roofs Sigmund a( pplican u Dim AZARDOUS MATERIALS DISCLOSURE Type of Roof W(11 Ilan applicant or future building aapant mom or handle ha>nduus material an dented by the Cupertino Municipal Code.Chapter 9.11,and the Haws and Safety ode.Sedan25532(a)? All roofs shall be inspected prior to any roofing material being installed. [:]Y. feia�` Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove mit hazard.us dr contaminants u dented by the Bay Ams Air Quality Management all new materials for inspection. District? DYns QsYY� I haw mad Ute hazardous materials mquimmew under Chapter 6.95 of ft Cali(or•a tenI•y 1 nix Health&Ssfmy Cade,Secds25505,25533 end ISS34.I undermand Nnlfdte building /� t 1Qs Js seat monody how ant dant It is my responsibility m notify the of Ne rtyutrtmenuwh dpoor miu ar.cerdnama„ Signature of Applicant Date ei Owns armNanxdagDow All roof coverings to be Class"B"or better 11/01/2005 09:35 7075297663 PERMIT SERVICES INC PAGE 03 Nov at CS 09:50e Cosmos Roofing (650] 969-9905 p. 4j CO==� �VV I/VVI 109dv ne" (40 Gbpm )? .3014 'lY&OYooe(10.)777•)28 C� 1N0 FU(40t)777.3737 Building De arbncnt JOB ADD11Ti6S: 2•Z l E.�I.NA LAq� �RhtIT DSllaol0 OnTW NAA IAL)& Tli B 4e 4U6-f L4$ DS F IJ AXN X I am not using any subconitRctm s Date Piee.edwk appamwesa O0 SUBCONTRACTORBUSWL86 NAME BUsvft UCEN6B 8 Gabh�&MRwark canwrt pin ffiecMai JB�awvatton fl unoteam/wove 1-]ea • hunlation dsstamosuat Sbeermeal w Septk TU& z Shan Rock OWMI tun / / Date Community Development Department Building Division City of Cupertino 10300 Torre Avenue Telephone: (408)777-3228 OCITY OF Fax: (408)777-3333 UPEkTINO 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 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 sta ed policy on re-roofing. Homeowner's Name: Job Site Address: 7 7 Roofing Company Name: Applicant's Signature: Date: ! D S • Greg Casteel Building Official Revised 11/2/04 Printed on Recycled Paper � CITY OF CUPERTINO GUS- REROOF 2 CUPEkTINO PERMIT APPLICATION FORM APN# 02 30 0 -S, Date: /l//� � O--s Building Address: 227 sir �'►n ecP.w; La,,.= _ — pyo �-N Owner's N e: Phone#: Y 4C _ 6'2-44 $ Contractpq e# License#: � IdA, CSS G 9-76 63 785`! V I Contact: ,/� Phone : Cupertino Business License#: Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles >C 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 Comply With Cu ertino's Tear Off Policy: // Job Description.' escriptio �a, ,Q �c2 s- 4 �/� 50 7+ Q�14 Residential Commercial ❑ Fire Zone: Yes ❑ No @- Confirmed with Planning Det. if there are any restrictions: LJ Cost of Project: Type of Construction: Occupancy group: /,57 6Go . w Qty. if Applicable Fee ID Fee Description Fee Group BPERMFEE Bldg Permit Fees BUILDING BENERGY Ener BUILDING BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING As � z3s . �