05120095 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR+INFORMATION '
BUILDING ADDRESS: COSMOS ROOFING PERMIT NO.05120095
8891 PE.NnF.RC.AqT AVE.
OWNER'S NAME: PERMIT ISSUE DATE
BILL LAKE 1901 OLD MIDDLE 12/15/2005
NE: SANITARY NO. CONTROL NO.
(650) 969-7663
ARCHITECT/ENGINEER: BUILDING PERMIT IWO
BLDG
PLUMB MECH
ELECT'
0 0 0 0
�Op LICENSED CONTRACTOR'S DECLARATION
I hereby affirm Nat I am licensed under provision of Chapin Job Description
9(Commencing p
with So:upn 7")alDivision 3 of the Business and Pro(essiggs Codi,,and my license is
imfull force and efj�3 /� fie REROOF-T/O BUR W/ GRAVEL, ADD BUR W/GRAEL
�= Dame-Contractor
44
ARCHITECTS DECLARATION
W 1 undcraanJ my piens shall W used as public records
J
g0� Lianud Pmfcssional
OWNER
am exempt
form
DECLARATION
00 I maxo .(firm than cusin (rpm Ni,Contractors Anyc Law for the
5OO following moon,(Badu.]0J L5,business endue.dr ndi Cam:Any city orcounty
K$ which myvirts a permit m ennswct,eltoa improv.OemolvN.m repair anY siruelure $8160
yiy prior teas issuame,also requires the applicant for such permit to file a signed su¢menl
< the he is licensed p..am,.the provisions Of Ni,COntrxtprY license Lsw(Chapter 9 Sq.FL Floor Area Valuation
.�a (commencing with Section 70W)of Division J of WC Business and Professions Code)or
y Nat he is exempt therefrom and the basis for the alleged exemption.Any violadon of
Section 7031.5 by any applicant for a pestis subjects the applicant to a civil penally of
am mart Nan five hundred dollars(5500L F Occupancy Type
❑1,as owner of the property Or mY uoployen with wag.u Ihev ole eompewtlon,
will do the..,end the awmure is;not intended in offered fimidde,(Sec.706/,Buirwvv
and Professions code:The conussers License Law don not apply to an Owner of Required Inspections
property who bas ilds m improve thereon,and who does swh work h imself or through his
Own employee,provided that such improvements arc not intended mpictired for miser. B�
however.the building or den of provinissaidwithinot year of completion,de owe of
builder will have the burden of proving that he did ml Wild o improve far purpose of
SaIeJ.
O 1,as Owner Of the property am exclusively contracting with licensed contractors in qq
Construct the project(Sec.704,1,Business and Pretensions he sions Code:)TContractor's Li- SAN oat
cee law does not apply to in owner of pve mpeny.who Wilds or improthereon,and
who contracts for such projects with a contraclm(s)licensed pursuant to the COerutoes 200�a
License law. t��
lam exempt undo Sec. ,B k P C for this tenon
Owner Data
WORKERS COMPENSATION DECLARATION 4�y H�rJIVUjB�1\tsV�i{
I hereby affirm under penally of perjury arc of flue following declarations:
1 have and will maintain a Certificate of Consent to self-inane for WmkcYaCompen-
7Y711
an,as provided for by Section 3700 of the Labor Code,fm she performvrce of the
rk fpr which this permit is issued.
Ihave and will maintain Worker's Compensation Insurance,as required by Section
of the Labor Code.for the performance of the work for which this permit is issued.
WarkeYa Com on In nce cortin andPoli number artS , 71 -oSIt ZSrtier. I^ Polity No.:
CE I TEOF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not W completed if IW permit is Intone hundred dollars(SIM)
or less)
I ceNfv that in the Performance of Ni,work for which this Permit is issued,l shall not
employ any peon.In any mMner ail as to WYpme aubje,I to flax Worker$Compendium
Laws of California.Data
Applicant
NOTICE TO APPLICANT.Ir,after making this Ceniricate of Exemption,you should
become subicet to the Workers Compensation provisions of the labor Code,you moa
.Jz forthwith comply with such provisions or this permit alaall W domed revoked.
'ZO CONSTRUCTION LENDING AGENCY
P: Ihereby affirm that there isaed(SeConstruction lending agency l'nr the perfprmancc of
C'v7 IW work fpr which this permit Is issued(Sec.3097,Civ.C.)
6W.z Lenders
D z 4nder's Add Addm..
U Q 1 malty Nat I have read this application ma sum Nat the aW W.information u
w FcortecL I agree to comply with all city and county ordinances and sum laws mlaling to
DU building cpnswetion,and hereby authome mpreaenWives of this city to enter upon the
W aWvcmcnudgmenancd mpcnsfor inspection purposes.
F,a. (We)agree to Save,indemnify and keep harmless the City of Cupertino against
N liabilities,judgments.cars;and Of mISexpenses;
permit. may In any wayattne agalnstsud City
U z A consequence of the RSTAgrobiting of Nis permit
ati APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NO POINT Issued by: Date
SOURCE REGyLATIOp'
_ A/ gam f 5�o j Re-roofs
Sgnaurt a(App lica (acanUCon or Dam
HAZAFB3OUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future Wilding Occupant nom or handle hasallou material
as defined by the Cupertino Municipal Code,Chapter 9.13.and the Health and Safety
otic, Eyes 25332(a)? �^ All roofs shall be inspected prior to any roofing material being installed.
❑Yu
Will the applicant ar fuwm Willing OCCopant use cyuipment m Jevias which If a roof is installed without first obtaining an inspection,I agree to remove
emit ha ardous air Containment u dcfancd by the Bay Area Air Quality Management all new materials for inspection.
Diono7
p YO, No
I have real Ne hmsrdous maerials regpia mane under Chapter 6.95 of the Califur.
nu Hcshh A Safety Cade,Seeumu 75505,25533 mil 25534.1 oWcrsuM this ifdc Wilding )
doe not curtcndy have is monsagn1l mm it u myagrtsppnsiM1ililY to wofy dac gaup t of
requirements ch muyb apnorwissu aruficam of Occupan
/��Ic-2is.✓II �> Signature of Applicant Date
Owner orauthpdred agent I All roof coverings to be Class "B" or better
Ooc 07 05 09:49a Cosmos Roofins (650) 969-9905 p. 4
C�10300 ieem AVOM
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IOH ADD Buildin De artment
18891 PEtiDC✓z6gg` UE- Sf Z
C+ENERALODNTAHCDOR
X I am not usingany dors;
lr oy
Please check® lieaWe sabeontrai and pate
9UIiCON'I'RACTOR �� infrnatadan:
BUSINESS NAME BUSINESS LICENSE it
dela Ek Millwork
sherd inbl�t(g
Plated
Excavown
PSB
FI
Unaktmm/wood
am/
Heating
bmulation
metal Skeet Meta!
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Roof}ng
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Owe+et/Con
Date
Community Development Department
Building Division
p City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
!1kI�O Fax: (408)777-3333
R
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 stated policy on re-roofing.
Homeowner's Name: !.?�liGf/J
Job Site Address: "9
Roofing Company Name: o—
Applicant's Signature: Date: l ! S/d S
• Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
CITY OF CUPERTINO
REROOFCOF
CUPERTINO PERMIT APPLICATION FORM
APN# J 2s- 73 3� g Date: /1 5r
J / 2( /0 5
Building Address:
Owner's Name: gyp,` Phone#:
Contractor: Phone#: License M
650 -7G G _2e541z1,1
Contact: Phone#: Cupertino $ i�Lic nse#:
Type of Roof Covering: /
Existing: Propo ed:
Built-Up Roof Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
N tuber of existing coverings 1 ❑ 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
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Project: a_ Type of Construction: Occupancy group:
�/G O
Qty. if
A licable Fee ID Fee Description Fee Group
MBPLANCHK
BldgPermit Fees BUILDING
Ener BUILDING
Seismic Fee Res BUILDINGSeismic Commercial BUILDINGPlan Check Fee BUILDING
Business License BUILDING