05100142 CITY OF CUPERTINO :�,�^ ;� .r
BUILDING DIVISION PERNIIT .y C®NTTt:A.CT=URINFORMATIf3N:
BUILDING ADDRESS: COSMOS ROOFING PERMRNOD 5100142
OWNER'S NAME: PERMIT`ISSUE DATE
STEVE [SON DUANE E ANT) ANN-1. 3901 Qln MIDDLEFIELD Wy 10/19/200S
NE: SANITARY NO. CONTROL NO.
650 969-7663
ARCHITTICT/ENGINEER: BURRING PERMD'INFO
BLDG ELECT PLUMB MECH
LOo LICENSED CONTRACTOR'S DECLARATION lob Description
OF1 heroby A10rm that I ata locemsed under provisions of Chopwr 9(commencing
wlNBeedan7")ofDiA.i..3ofdro Bud...d Pralcesimu andmylicenxia
n� ioCcusameAnd e 8s / T�0 SHINGLES . RESHEET O ADD PRESIDENTIAL
,M4 onoaclW �s4 cu g COMP SHINGLES
,0 t.mallWase CLARA ION
y I understand my plans shall ARCHITECTS used As public records
dJ /!)1'
ud LicensedProfessional Alto
H Oe,I am exempt
road DECLARATION V
E 0 f hream .(Tian that 1 I.S.exempt from ti r Contractors License Ac Law for the /��[�O
O O following ulama.(Section 7U31. Bualnpt and improve.
dca il Code:Any city at county o5
Z�i which mqusra a permit cmamc4 ataL tmpmse,h permit i or repair ed tanmam d
—iy priormitaocaedpuruantto the the
ovisio ant soffancehpertnitmie se sign
ed
< (c thathepursuant to the provisions of theeBmismidProfssio C Code)or
Sq.Ft.Floor Area �rq- Valu$t1pR525
qF C (sal he Is ing with Sectionren,and Use
Division f 3nflW egad exe and on.Any vi Colo)sir ZA p-,®
6 3� that he le exempt therefrom and Ne bub for the alleged exemption.Any violation of 4 Y, 7 `U
Section 7031.3 by Any appReAm for a permit ubjects the Applicant to a civil penalty of APN Number `,-Occ i2 pansy Type
not mom than 11.hundred dollars(5700).
❑I.As owner brain property,army employee with wage As their sole compensation, 31633082 ' 00
will do the vada And the structure bent Intended or offered foraele(Sec.7014,Business Required Inspections
And Proferions Cade:The Cammmo/a Ltanse Law don not Apply m m awtar of q P
property who buildsorimproma thereon,andwho doessuch work himself or Waugh his
own employers,provided Net each impremo ents are notimenmal oro@red fortak.If,
however,the building or improvement is sold within ora you of completion,the owner.
builder will have the burden of proving Nat he did act Wild or improve for purpose of
els.).
C 1.as owner of to property,am exclusively contracting with licensed contractors to
construct W preject(Sec.7064.Business and Profaaeions Count:)The Coanswun s,1l-
came law don not apply to on owner of property.who Wilds or improve Unumn,And.
who contacts for such projects with a contractor(s)licensed Pension,to W ComMote
License Law.
C 1 em exempt under Sts. .B k P C for this maven
nu Dow
WORKERS COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury ma of the following dalam ions:
C 1 haw and will maintain a Certificate of Consent in self-insure far Workers Compen.
sAOon,a provided for by Section 3700 of the Labor Code,for the performance of W
work for which this Permit is Issued.
have and will maintain Worker's Compensation Instuance,u required by Section
700 of the labor Codd,for the perforaimec of the work far which this permit is lace0.
My Workers Compenutim Insurance nam er and Policy number a:
Carter, SR5� Policy HIM S
Zo 1z5�E
OF EKEMPnON FROM WORKERS'
COMPENSATION INSURANCE
ri section need no,W complcwd if the Permit is fnonchundred dollars(SIM)
or lee.)
1 certify that In the performance of the work for which this permit is issued.I shall not
employ any person In my manoer.e as to become subject to the Workers'Compensation
Law.of C.lif..I..Dam
Applicant
NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you should
become tubjec,to W Worker's Compensation provisions of the Labor Code,you mart
.JO forthwith comply with each provisions or this Permit shall W manual n+roked.
'Z CONSTRUCTION LENDING AGENCY
Et4. I hereby alfhrm that thea Is a canswction lending agency for the performance of
Ci> the work for which this pem,it is laced(Sts.3097,Civ.C.)
W�Q Lender'&Name ,
.7 z Lender',Addrns
V Q I certify that i haw mad this Application arm slaw that the above Information is
IT" comma.I agree to comply with all city and county ordinances and sea Iowa misting m
Q building construction,and hereby authodee mprosentatiwa of this city to enter upon the
tT7 .hove-mention Property for Inspection Purposes
gL (We)agme to ave,indemnify and keep harmless the City of Cupertino against
Toy Ilabilltiu,Jumgments,cats and expenses which may in my my amus again,said City
(,)7
r7 SOf da g t.
Date16;—1 f--41 dr-USnDWCO TH ALNON-POINT Issued by:
_
Le-c,-- Re-roofs
Str mum of Applicant/Conbactor Dow -
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will we appill",ar future building occupant nom or handle haadoa material
As deflud by the C.Penino Municipal Cade.Chapter 9.12,and W Health and Safety
Cade,Section 27732(4)7 All roofs shall be inspected prior to any roofing material being installed.
0Yu
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
ami,h.,urd.. I,cmtaainm a defined by W Bay Area Air Quality Management all new materials for inspection.
DistrictT
❑Yes CHI
1haw mall the haardoa materials m33and 55under Chapter 6.95 lof itheCatifor-
does not currently
ren tl yhave 4 tensa,2771176 my responsibility md273J6.1 understand a occup Wor tng
he J
tau not currently haw t ante I Nat It b my toCei m ur of W occupant of W
myulmmcn mhmust met wlaamevyr,ncwrmnaprof�Pln�/es Signature of Applicant Date
_AAIYli� • / l
own orath90 gem ° � foam All roof coverings to be Class"B"or better
CITY OF CUPERTINO
]• 2 of 2 PERMIT RECEIPT OPERATOR: kiersaw
COPY # 2
Sec: Twp: Rng: Sub: Elk: Lot:
APN . . . . . . . . : 31633082.00
DATE ISSUED. . . . . . . : 10/19/2005
RECEIPT #. . . . . . . . . : 31669
REFERENCE ID # . . . : 05100142
SITE ADDRESS . . . . . : 10446 PRUNE TREE LA
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : STEVENSON DUANE E AND ANN L
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2023
RECEIVED FROM . . . . : BONITA JENKINS
CONTRACTOR . . . . . . . : COSMOS, .RICHARD LIC # 18844
COMPANY . . . . . . . . . . : COSMOS ROOFING
ADDRESS . . . . . . . . . . : 1901 OLD MIDDLEFIELD WY
CITY/STATE/ZIP . . . : MOUNTAIN VIEW, CA 94043
TELEPHONE . . . . . . . . : (650) 969-7663
OE ID UNIT QUANTITY AMOUNT PD-TO-DTTHIS REC NEW BAL
_____ _____________ __________ __________ __________ __________ __________
BPERMFEE VALUATION 12, 000.00 191.16 0.00 191.16 0.00
BSEISMICRE VALUATION 12, 000.00 1.20 0.00 1.20 0.00
---------- ---------- ---------- ----------
TOTAL PERMIT 192.36 0.00 192.36 0.00
METHOD OF PAYMENT AMOUNT NUMBER
_________________ ------------ ______-___________
OTHER 395.62 M/C
TOTAL RECEIPT 395.62
•
10/18+2005 07:16 7075287663 PERMIT SERVICES INC PAGE 05
Ucc 17 05 0346719 Cosmos Roofing (6501969-9906
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SUBCONTRACTOR BUSINgSS NAME
4 Alfflaazlc BUSIN68S TLICENSE M
Cement
. Flestrk;el
E+aesoation
ILwieam/Wood
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Omaw tm SUeetblow
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CITY OF CUPERTINO
00 \4a1)
REROOF
ITY OF
W-UPEkTINO PERMIT APPLICATION FORM
APN# 31�O — 3,5—
2 _ L Date:
J ,7
Building Address:
/0 Y q 60 -
Owner's N e: Phone#:
4•G0,
Contractor• Phone#: License#:
(�56 9 ,6 - 2 6 A 3 Ztf� l
Contact: Phone#: Cupertino Business License #:
650 V ao - 2-0 /q G��� '�
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ')i(� Asphalt Shingles
`A 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.
hi Have Read, Understand and Will Comply Wilk Cu ertino's Tear Off Polic :
ob Descriptio 7—/,: ^ � — 05 6 — O T L
Residential 12� Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning De t. if
there are any restrictions: LI
Cost of Project: Type of Construction: Occupancy group:
S zs
Qty. if
Applicable Fee 1D 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
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
C�^/���I�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.
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 " 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: o �
job Site Address: /D 4/C/ t,�
Roofing Company Name: a"",
Applicant's Signature: Date: /D
• Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper