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031101200 z z r r fn Da Q �z UO � F U �a U CI'T'Y OF CUPEIVI'INO ' a � '.s ° �` ,•' z�:'�.�., "'�:';a' � '., . BUILDING DIVISION PERMIT CONTRACTOR INFORMATION Ae .-�.�.. . ,VA,,hk BUILDING ADDRESS: 0653 MINETTE DR COSMOS ROOFING PERMITNOO 3 110 12 0 OWNER'S NAME: PERMITLSSUEDATE ZILAT HAIDER 1901 OLD MIDDLEFIELD WY 11/20/2003 NE: SANITARY N0, CONTROL NO. (415)493-6373 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDGELF.CI' PLUMB MECH (� ( ! E (� LICENSED CONTRACTOR'S DECLARATION 1 hereby ef0rm Nal I am liftr�sCQ und9r provisions of CM1apmr Y (commencing with Semip�7�0(gr (Division Sof Ne BuIS¢eys led Professions Code. and my license is - ]obD r.rv�al� LfiellenfbmbafiJcfojcst..� 9 ✓`r 7S,gyy./ •• REROOF . License Ca/ieia� �� �� DEC 1 9 2003 ,y.C.on,�.e`c�t�O5'05 a IundcranenJ my plan50- s haul he u'C�M puOfRATOds B BUILDING Licensed Pmfusionel OWNER -BUILDER DECLARATION Y 1 hereby affirm Nal 1 exempt from the Contractor's License Law for the following moon. (Section ](131.0. Business and o am 1. mu Code: Any city ser County improve de or sig any nmctum structure whip rtquina a perosn re cnnnmcL alter, imrotsu 5100 h Acorea t prior mits issuance, alwntto the the vision offer such Damen noolessigned nammcm ea k the nl the Littnu li C Duction Sq. Ft. Floor Area Valuation (that commeslicensed of Divisio ode).1 (commencing with Section ]BBB) of Division 3.r the Business and Crate) ore 7 eBonn. me Ad, vi Out W h eaempl therefrom and the basis for Ne alleged csemplion. Any violation of 3lir Occupancy Type Section 7071.5 by any applicant for a permit subjects Me applicant to a civil penalty of not more Nan five hundred dollars (5500). 0 1, u owner often property, Mary employees with wages As their sole compensation, Required Inspections will do Ne work, and Ne swctum is not Intended or offend formle (Sec. 71144, Business Licse Law due, nut apply an owner of and Professions Code: The Conuact.h en .. property who builds or impowu thereon, and who does such work himself or through his awn employees, provided Nat such improwmenu art oat intended orotered for ole. IL however, the building or improvement is sold within one year of completion, Ne owner. builder will bars the burden of proving Nn be did not Wild or improve for puriose of sal'.). 0 I, es owner of the property, am exclusively contracting with licensed contractors to conswet the project (Sec. 7004, Business and Profusions Codc:) The Con actors U. Genu law does not Apply to an owner of pmpeny who Wilds or improves Memon, and - who contracts for such projects with a contractor(s) licensed pursuant to the Contactors License Law. 0 1 em eaempl under Sec. . B k P C far thi, oum. Owner Data WORKER'S COMPENSATION DECLARATION I hereby slams under penalty of perjury one of Ne fallowing Mishmashes: I hese and will mainuin a Certificate of Consent o se r.usuer for Workers Corepen. on, u provided for by Section 3700 of the Labor Code, for Me performance of the work for which this permit is issued. 0 I low and will maintain Workers Compensation Insurance, As required by Section 37W of Ne labor Code. for lite pc unnance of the work for which Nis permit is issued. My Work.,'. CnmLpen anon Insure tt carrier ondiiul y umber ort: 3 b09fr. .S7LL ,{ Ung Poli,A'T+10..:'.57/-OJO//r%s 0 �G CERTIFIC AWORKERS' ' COMPENSATION INSURANCE (This actin. need not becumplemd If 1 W nnit la fn ... c hundred dollars (510()) , or less.) 1 mify, Chet in the performancc of the work for which this permit u issued, l shall nut employ any Noun in Ally mN.tr an As w become subject to be Workies Comperiation ' Laws of California. Data Applicant NOTICE TO APPLICANT: If, after making this Certificate of Eacm prion, you should become subject 0 the Worker's Compo notion previsions of the laWr Code. you mut forthwith comply with such provisions or this Permit mall W deemed revoked. CONSTRUCTION LENDING AGENCY 1 hereby affirm Nat Nen is a construction lending agency for Ne performance of to work for which this permit is issued (Seo. 3W7, Civ. C.) Lender's Name Lenders Address 1 certify Nu 1 have read this application and sats Nat the hove information is correct. I agree to comply with all city and county ordinances and sum laws relating to - buildingconswction. and hereby mourner rcpmcnadwv of this city to enter upon Ne alwvcmentiuncd property for inspection purposes ' (We) Agree to cave, indemnify and keep harmless the City of Cepcninoapinst liebilinies.judgmenu, c.am and espcnus which may In any way Accrue ageinn said City in consequence of Ne gaming of this permit. APPLICANT UNDERSTANOS AND L 0MPLY WITH ALL NON -POINT Issued by: Date SOURCE E LATIONS. � �-20-Q Re -roofs G7 lit Type of Roof umof Ap can .n nor Data AZARp0U5 MATERIA DISCLOSURE Will the applicant or town Wr 'ng D...... rc or handle hA'r4rdous memrid u dcnncd by the Cupertino Municipal o c. Chapter 9.17, and the Hcalth and Safely nor. Section 25537(.)] O Yes (;K. All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree.to remove Will the applicant or future Wilding occupant use equipment or devices which It haardous air contaminanu u defined by the Bay Area Air Quality Management all new materials for inspection. iYlliCly IN. ' ❑Vas I have mad the ha nodous materials requirements under Chapter6.95 of the Califor. nia Heahhgr Safety Cada, Sections 25505,75533 and 25534.1 undersand than ifthc Wilding - does not currently haw a cement that In is my res 'ility w nudfy Me occupant of the nod O` requimmen w chmustbere psi ole CIltydw Qcupan,y. gnaturepp cant Date /incy All roe verings to be Class "B" or better ,r oramho i age. Date I ( ., �CITY OF UPERTINO Community Development Department Building Division City of Cupertino 10300 Torre Avenue Building Department Telephone: (408) 777-3228 Fax: (408) 777-3333 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. 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: F Z / l4 74 Job Site Address: /OIPS 3 /-11,7e7T Roofing Company Name: ` GS1vOS 160-701n Arelic" teal Building Official Revised 1/30/03 Printed on Recycled Paper Date: L ao CUPEkTINO CITY OF CUPERTINO REROOF PERMIT APPLICATION FORM 03�/ 0 / ZO APN # Bldg Permit Fees BUILDING Date: Building Address: /©l053 111ne-7�7�e D/', BUILDING Owner's Name: Seismic Fee Res BUILDING Phone #: Contractor:Phone #: BPLANCHK License #: (10sM0s iso -9 - 7�sv Contact: d / 6511�105 Phone #: Cupertino Business License #: is ich SO- W- 76 63 Type of Roof Covering: Existing: Proposed: ❑ Built -Up Roof -R, Built -Up roof ❑ Asphalt Shingles ❑ Asphalt Shingles ❑ Wood Shakes u 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 Cupertino's Tear Off Policy: ❑ Job Description: servo✓e rep/ace Cxlsf,n _ roo� Residential Commercial ❑ Fire Zone: Yes ❑ No ❑ Confirmed with Pl t. if there are anz trictions: Cost of Project: ca Type of Construction: Occupanc grou Ste Dw 4eloof Qty..i Annlfcable Fee ID Fer DPscrintinn PPP (:rnnn 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 7. ��