03030061 CITY OF CUPERTINO '�" °`'� "� ` • ? r s ''
auamvco,v,s,oN PERMIT SCO „ CTRIkORMATIONi
PERMIT NO,
BUILDING ADDRESS: - COSMOSI; ROOFING
PERMIT ISSUE 3 0 0 61
OWNER'S NAME: 1901 OLD MIDDLEFIELD WY
BILT. T.T SANITARY NO. Nis.
(415) 493-6373-
- BUILDING PERMIT INFO
ARCHITECT/ENGINEER; BLDG ELECTPLUMB MECH
pZ LICENSED CONTRACTOR'S DECLARATION lob Description
O I borcby affirm the 1 em limned under provisions of Chapter 9(commencing f� �p
with Scott10003ofDivlAloa3ofdm Businuemd Professions CCudeand my license is _ a—�tl�����
'< in full foheeand err - '1 O�'�y� a'- N
z Umnse Cos Lie.IS REROOF� "
Dam L Can. T�O TAR & GRAVEL ADD TAR & GRAVEL
ARCHITECTS DECLARATION Big 2 2003.
1 understand my plans abet W used a public Mmrda
�p Licensed Pmfcssionat OWNER-BUILDER DECLARATION - BUILDIIYtIa
f I hereby afn.Net I em ewmft from Contractor,License law for the
p O following reconns.(Section 7(01.5,Business end ftImanCalc:Any city or county
`�$9 which Mantra a permit to construct,elm"Improve,dcmolm,Of repair my atmctem
Z� prior to its issuance.alto requires the applicant for such Permit to filo a signed statement S Ft.Floor Area Valuation
that ha is licensed pursuant ONe provlainna of the Conuumis License law(Chapter q• -
(commencing with Section 7000)of Division 3 of the Business And Professions Code)or
that he Is"emit themfrom and the buil for the alleged exemption.Any violation of O Type .
Section 7031.5 by any applicant fm m A Permit subjects the Applicant a civil penalty of APN Number
not mem Nu five hundred dollen(,SOD).
1,u"sena of Ne pmpeny.m my employees with wigs u theh vele compensation,
126-32011 00
will do Ain,.,V,and Ne structure is col intended oraaend mrale(Sm.7D44,Baaircie Required Inspections
And p,Rauhns Code:The ContrutorA License Lew does wt Apply W an Owner of 3 0 5 -' FRAME
propenywho build,or impmv"themon,and whadmsswh work himselfor through his _ -
ownemployw,provided that such improvements Art not innsdedoroffuun No nor 307 - INSULATION '
however.the Wilding or Improvement is sold within Armco P
builder wiB have the burden of proving that bo did oat Wild or improve fee purpose of 601 ROOF TEAR OFF
ale.). 602 - ROOF PLYWOOD NAIL .
❑
I.as owner of the Property.am"elusively MmM,,Hng with licensed comm cWn to -
construct the pmject(Seo.7044.Business and Professions Code:)TW Contractors U- 603 — ROOF BATTENS
came law dos nm apply W an owner of property who Wilds or imPM—thereon.and, 604 ROOF IN-PROGRESS.
who contracts for such prejeN wIN e<ontnetpr(e)licensed pursuant m the CanuactarA
License Lew.
❑lam"empt under Sec .B IS P C for this moon - -
DWlmr Data
WORKERS COMPENSATION DECLARATION -
1 WMby efion under penalty of perjury ane of the following dedantions:
I
and will maintain a CaNOam of consent to sel6insum fmworkersComport-
urian,u provided for by Section 3700 of the,Labor Code,for the performance of the '
work for which this permit h issued
have and will maintain Workers Cmep nation Insurance,u Betrothed by Section
700 of the labor Cuda,for the performance of the work for which this permit Is laved. ,
My Workers Co em Ian lmunnmc rtlu and Policy number W.
Carrier:�policy Na.S 7/^d�
CERTIFICA EOF EKEMPT70NFROMWORKERS'
COMPENSATION INSURANCE -
(Ihta sectionneed not becmnPlewd little Permit U foram Mom and doll"s B I H AB
or leu.)_
this In the performance of the work for which Nie Permit I,Issued,label[not
fccniFyemploy any peon in any manner.AS M bceomc subject o the Worker'Compersatlon -
LAm of Callfami.DAM -
Applicant _
NOTICE TO APPLICANT.IL After making this CeninnW of Exemption,you Should
become subject to the Workers Compensation previsions of the labor Code,you most -
forthwith fowith comply with such provisions or this Permit Shall W demand revoked. ,
z 0 CONSTRUCTION LENDING AGENCY
'f~ Thereby 01.that there iso commotion lending Agency for the performance of
Ni? the work for which this permit Is lensed(Sec.3097,Civ.C.)
W Q Lender,Name /✓//(/`/J'/_/--.—J�)
Lenders Address
1 dify that 1 he.need this application annt d same that the eWw informed-is
U
«cortem.I agree to comply with all city and county ordinances and state fowl Misting to
p buildingconstruction,
10andhcreby icandrhutlzeepr bormolOverof Cite city menwrorpon against W ehwc-mentioned property for Inspection purposes.
FL (We)igme W taw,indemnify sed hich bArmbu OM City of Cupertino egalnat
D,) IhUilttsequenc of
oading expenses which may In my wyAcerue against old City
V inconsequence of the Brmtin6 of this perms( Date •/�f (/
a APPLICANT UNDERSTANDS-A1 WILL COMPLY WITH ALL NQN-POINT Issued by:
SOURCE REGULATIONS.,•( /
3 f%,/a) Re-roofs r
Signature of AppllcAnUCanmcmr
HAZARDOUS MATERIALS DISCLOSURE Dam Type of Roof
will the Applicant or future Wilding moupwt store orhandle haardou material
AS defined by the Ceperdno Municipal Code.Chapter 9.17.And the Health sed Safety
Ade,Scotian 75537(a)7, , �_ All roofs shall be inspected prior to any roofing material being installed.
A ❑Yon
Will the appRant or future building mcupam use equipment or devices,which If a roof is installed without first obtaining an inspection,I agree to remove
II howNous or
ronuminma u denncd by Ne Bay Area At,Quality Management all new materials for inspection.
imicl7 / '
Ihacmw LhehaurdrwsmawdalsmquimmenuunderChapwr6.95ofthe Celifor-
nia Hcal"Safety Cab,SecWm25505,25533md25534.lundcmndthatlfthc WlWing
dose rent morally hew A wnent,then it IS my responsibility W nosily 1W oceuPms of the �� �o�
requlmmemwhic priormluum ofaCWfcalatr Om an Signature of Date
1� ° All roof coverings to be Class"B"or better
Owner or ens odmd.c, Dow
P3/12/2CO3 21: 27 51053C'3202 !_EGALITIES INK PAGE @4
BuildingDlvision
'a
10300 Torre Avenue
CSipertino.CA 95014-3255
Telephone: (408)777-3228
CpEkTI O Fax (408)777-3333
Building Depart nent
Subject Rerdlofing policy for the City of Cupertino.
I. Prior to pekmit issuance,you must agree to comply with 1997 UBC Standards
and manufactures specifications on reroofing.
2. .New roof cpverings shall not be applied without fust obtaining all inspection
'and writteri 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 ' final sign off from the City the following steps are required.
1) Pre=pejct. n and/or tear off approval
2) In progriss inspection approvaL
3) Final inspection approvaL
a) Sparta arrester installation.
5. If plywood 0 installed,a plywood nail inspection is required.
6. Any roofing which is applied without first obtaining an inspection,will
require the femoval of all new material down to the sheathing so that the
proper Cit'y'inspeclion can be performed.
IMPORTANT:
1. Flat roofs m{rst have a minimum of:Vi"per foot slope and demonstrate that
there is no p�nding.
2. An I.C.B.0. $eport is required to be on the job site at the time of inspection.
We undesstandithe above policy on reroofing and will comply with this policy.
Homeowners Name:
Address: Ze G iF 7
Reroofing Company Name:
APPlicants Signature•
Date.
00 9
Joe Antonuccti
(Chief Building Cffficial)
6125101