04070005 is-.1...
`CITY OF CUPERTINO ate °' 7777777777� ''7 TN'�j f�- '�xl�
eU1LDINC DIVISION PERMIT �+ +w'"''^�O^t^"•^ ""'p"^ Tap -
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BUILDING ADDRESS: COSMOS ROOFING PERMIT N%4070005
18921 P U
OWNER'S NAME: PERMIT ISSUE DATE
Alk CLAUDIA ZORNOW
NE: � SANITARY NO. CONTROL NO.
(415)493-6373
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDO ELECT PLUMB MECH
u00 LICENSED CONTRACTOR'S DECLARATION lob DOSCrIptlOn�BAn
yd u 1)Wrathy affirm that 1 am licensed a Wer provisions of Chapter 9(commencing 'yy`p
;jc� wiNSeaion7M))of Divislon3ofthe Businnsand Profession, ac.andm license is tlC�
<o. bmfull ach"s 5441 .,C3 • REROOF
n'�b paenm��as-
1q�. ARCH CTS DECLARATIO Z��®
I a� I undemand my plans shall w used As public records
DyU
2 Licensed Professional
S OWNER BUILDER DECLARATION 63'
1 herchy affirm on 1 1. exempt from the Cssions o e:Any c Law co the •g'g®pR�
X2O following mason. emits 7f13sr Business and Profession Code:Any city s.fumy - 1�
tA$tui which requires a Permit re cores the alter,improve,h im itu or repair any structure
FZe that he its issuance,also requires tho,ish .ofant for such Pct."Lile a a.La.(Chaptcm
MFF (commincingwJpursueo70the orDivision3the oftheBusiness ndPr,.Law(Chap(cr9 Sq.Ft. Floor Area Valuation
N (cat he is(commencingwithSection7000)of basi.on3 oftheeged comps Professinm O'f
3� Nat he is exempt thcre(mm and the bazia for the alleged emmption.Any=of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of er0 0 Occupancy Type
not mom than 0m hundred dollars($500).
Q 1,as owner of(he prop.ny,or my employees with wages as Noir sole compensation,
will do Ne work end the ahaalure Isnot intended or offered for tale(Sec.7044,Businss
and Professions Code:The Comment's License Law does not apply to an owner of Required Inspections
property who builds or improves thereon,end who does such work himself or through his
own employees,provided thosuch impromments are nmimmnded droll formic.if.
however,lie building or improvement is sold within one year of mmplcdon.the owner
builder will have rise burden of proving that he did not build or improm for purpose of
sale.).
Q 1,as owner of the property,am exclusively Announcing with licensed contractors to
construct the pmject(Sec.7W.Business and Professions Code:)The Conuacmr't U.
came Law docs not apply to an owner of property who builds or impmma Nemon.and
who contracts for such projects with a contractor(s)licensed pursuant in the Conuacmr's
License Law.
Q 1 am exempt under Sec. .B At P C for this mason
Owner Dem -
WORKER'S COMPENSATION DECLARATION
1 hereby anon under penalty of perjury one of the following imelarafion:
1 hem and will maintain aCenifnw of Consent to selGinum for Work)rs Camper-
-afar,As provided for by Sam..3700 of the labor Code,far Ne perfarmmm)of the
work for which this permi(is Bsuctl.
1 ban and will maintain WOACr'S Compenation Insurance,As required by Section
of Ne labor Code.for Ne performance of the work for which this permit is iuued. -
7-9
"I
y Workers Cnm nsolon Insunnm carrier and Policy number aO 1
Cerner. .S Policy N.5 +
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu.1i..need no(Mcamplocd Vital permit isforanc hundred dollar(SIM)
0r less.)
1 certify that in Ne Performance of Ne work for which this permit is issued,I shall not
employ any pcnon in any meaner an as in become subject to the Workms'Compensadon
Laws of California.Dam
Appliwnl
NOTICE TO APPLICANT.If,after making this Cei ificue of Exemption,you should
become subject m the Worker's Compensation provisions of the labor Code,you must
C),Z forthwith comply with such previsions or this permit shall be decmad revoked.
Z O CONSTRUCTION LENDING AGENCY
�y+ Ihereby oRrm Ne(Nero is a construction lending agency for the Performance of
!Yi 7 the work fur which Nu permit is issued(Sec.3097.Civ.Q
QLa.der's Name
z lender's Address
O Q I canify Nat I he.mad Ihia application and show Net Ne above information is
LL concur.I agree to comply with all city and county ordinances and stew law,relating to
0 U building construction,and hereby authorise MPmsenm(ims of this City to crier upon the
E above mentioned property for inspection purposes.
(Wm)agree N sees,indemnify and keep harmless the City of Cupertino against
,.y y liabilities,judgments,costs and expenses which may in any way accrue against said City \
U Z mmmiep.ime. Negranting ofib i roil. "�f•�J-\
^ APPLICAN DYST WILL PLYNITH�LI,fNOON.PINT Issued by:3 Date
SOU E I /
Re-roofs
Signatureof Applican✓Commom Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant smrc or handl.hazardous mawrlal
As defined by fie Cupenino Municipal Code,Chapter 9.12.and the Health and Safety
cW.,S)mon25532(a)? � - All roofs shall be inspected prior to any roofing material being installed.
Q Ye05
Will the applicant or future building accup t use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mit havard0us air canmeninams As defined by the Bay Arca Air Quality Management all new materials for inspection.
District?
QYcs ..VA-
I have mad the hasardous materials requirements under Chapter 6.95 of Ne Califon
ria Hcdon&Safety Code.Scctiona25505.25533 and 25534.1 undemand thoifthe building
docs Pat cA.AOr Ove a tenant,that It y mspon( ili(y N toffy Ne occur.,of Nc
reyuiremAn,,why usl,bcm n a due,or •inmwak of Occup eX Signature of Applicant Date
• 0
Owner or authmdsnd agent Dam All roof coverings to be Class "B"or better
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
aClOF Fax(408)777-3333
�UPEkTINO
Building Department
JOB ADDRESS:( PERMIT#
z/ pe,*�5c"5t */I'-- 04-0� 6 00
OWNER'S NAME: q,,, PHONE # Z55 -Z-302
GENERAL CONTRACTOR FAX #
I am not using any subcontractors: 7 j' 0 W
Sigifafure Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring. Carpeting
Linoleum/ Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
, " q�� *7It
vOw er/Contr ctor SigLture � Date
Community Development Department
Building Division
City of Cupertino
+ 10300 Torre Avenue
i
CITY OF Telephone: (408)777-3228
U P E kT I N 0 Fax: (408)777-3333
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.
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 com/p�ly/with the above stated policy on re-roofing.
Homeowner's Name: (irl.a�oec-aJ/� Z D?ir�e-r.J
Job Site Address: 9a-
Roofing
a-Roofing Company Name: v4_
Aplicant's Signature: Date: 7/7 U
• Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF �,C C a �C
CUPER INO PERMIT APPLICATION FORM
APN# 3 7r 3 3 032— Date: 7/1/a r
Building Address:
Owner's Phone#:
Contra or: Phone#: License#:
&50 969 -74 6,3FIS C/
Contact: C1 Phone#: Cupertino BusinessI ;cense#:
FBI�
Type of Roof Covering:
Existing: Proposed:
Built-Up Roof X Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
I�lumber of existing coverings ❑ Provide I.C.B.O.Report#
l�C To be Removed ❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description: 1 n T QwC/ may
Residential Commercial ❑
Fire Zone: .Yes ❑ No ❑ Confirmed with Planning Dept. if
there are anrestrictions: LJ
Cost of Project: Type of Construction: Occupancy group:
5-7 R0 Jv
Qty. if
Applicable Fee'ID Fee Description Fee Group
/ 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
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