05090015 c CITY OF CUPERTINO 7777FT777,�,n
BUILDING DIVISION PERMIT C� � �R I �iti1wil�. vlV. �4
BUILDING ADDRESS: COSMOS ROOFING PERMITNOO 5090015
v OWNER'S NAME: PERMIT ISSUE DATE
MIKE ZHANG 1901 OLD MID 2005
ONE: SANITARY NO. CONTROL NO.
(650) 969-7663
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDGO ELECTO PLO O
�oMECH
o LICENSED CONTRACTOR'S DECLARATION lo..b.Description
1 Mreby*(firm that I am licensed under provisions of Chapter 9(commencing yy-b py�a
with Section 70110).(Division 3 of the Business and Profusion.Code,and my license is H. J +11. 9 A4!A
U, mraartaoff e Lie I S J2EROOF-T/O SHAKES/AI'�D HEA�7,Y��fF.17iT HAKES
] ? License lis
L'
Dai n
ARCHT E
'I� 1 undcrnanJ my plea shsil be d u public rtcnrN SEP 20051
6V
o
Licensed Proressiunal
OWNER-BUILDER DECLARATION `'�s
EMO I hereby.(Siem on 11. exempt from Ne Contractors o License:law for de 1 s
EMO following moan. erott ](131.5,Businw andve.de um Code:Any city or county Bull
-
$� which requires a Permit w emtssrie4 eller.Improve.demolish,or repair any structure (� W 16 3 0 0
Fri Pdorwits iuuance.a4u requlr"tiw aPPlicant(orsuch permitw Bleasiencd atalcment
zFF< On he is licensed pursuamwthe Previsions ofmccontracwrsLsanse Law(Chaper9 Sq. F[. FIOorArea alua[ion
s$ (commencing with Section 7000)of Division 3 of the Business and Professions Cook)or
3 Nat he is exempt therefrom and she bu4 An Out alleged exemption.Any violation of
Section 7031.5 by any applicant fm a permit ubjects the applium to a civil penalty of araC(]CCU r{,
not mare than five hundred dollars(M), Occupancy TYpe
❑I,as owner or the property,army employe"with wages as anlecompewtion,
will do thework,and On swcture is notimended oreQered(orale(Sec.7W.Businen
mood Pro!"siom Code:The Conhsewe,Lison Law don not apply to a owner of Required Inspections
propend,who builds or improwa thereon,and who does tach work himself or through his
own cmplaycra,Provided Nes wen ImprovemenB tae not Intended"nQeend f"We.If.
however,then building or Improvement Is sold within one year of completion,the owner.
builder will hew the burden of proving that he did sot build or improve f"purpose of
ale.).
❑I,as owner of the property.an"elusively contracting with licensed caauacwa to
eonalose t Use project(Sec.7044,Business and Profeveions Cade:)The Contractor's Ls-
cuue Law does not apply w an owner of property who builds or improves themmn,and
who contracts for such projects with a conuactar(s)licensed paramount to the Canlracto'a
License Law.
❑lam manin under See .B At P C for this moan
Owner Data
AAL WORKER'S COMPENSATION DECLARATION
I hemby eRlrm under penalty of pedury one of declaration:
following declaron:
1brcands, as
a CaNfiute of Cansem to self-snos.to,WorkersCompen-
Other.u provided for by Section 3700 of the labor Code,f"the peRormarra or Oc
work for which this permit ss named.
16 1 have and will maintain Workers Compassman Insurance,as required by Section
137110 of the labor Code.for the performance of she work for which this permit its)bound.
My Workers Com Malian InNRnco"vier and Polley nem�tnbyg yC:�aS /1 Z
Carder. Policy No.:G / 1
-CE TIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section mrd nmbecomplewd if the Permit is faronc hundmoddollam(SIW)
to kion)
I anily On in the performance of the work for which this permit Is issued,l shall not
employ any p ore n in any manner an u in become subject m the Worken'Cempemaden
Laws of Califomis.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to she Worker's Compensation provisions of the labor Code.you must
z O foMwith comply with such provisions at this permm
)uhall be deemed revoked.
V) CONSTRUCTION LENDING AGENCY
[-r 1 hereby arfrrm dot dart is a eonsuuctian Icndsng agency for Ne Performance of
�i she work far which this permit is issued(Sm.3097,Civ,CJ
Q landars Name
7 Z IcMer's Add.
U 0 I c"tiry the I haw rand Ws application and sew Na the above information B
ly !" cosrett I mgr"w comply with all city and county ordinances and state laws relating w
0 rV^ building conwuaion,and hereby suNodx mpssematima of this city w ens"upon Ne
[21 above-mentioned property for impact em PurPoos.
C (We)agree to saw,indemnify ad kap bloodless she City of Caparison almost
TA
liabilities, casts and exp.""which may In any way acmue against said City
O7 ineomeganag
ef theraniingo(th rmst. "
r1• APPLICA NDERST WILL MPLI WITH ALL NON-POINT Issued by:
JRC U Date
SO
9 2 �t25 Re-roofs ✓ r�
Signal of ApplieanUConuanor D
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will de apPliunt ur future building occupant nom w handle heaNaus mewdsi
as defined by the Cupertino Municipal Cade,Chapter 9.12.and the Health and Safety
aJe.Scetien 2ss32(a)? �- All roofs shall be inspected prior to any roofing material being installed.
❑Ya.
WIII the applicant or future building occupant uta equipment or devims which If a roof is installed without first obtaining an inspection,I agree to remove
It hanolou aireontaminants as deBmd by the Bay Am Air Quality Management all new materials for inspection.
laurel?
❑Yes BNe--
I have med the harardrms materials requirements undcrChaper 6.95 of the Calsfor- ^
ata Hcelth&Sa(ctyCada,Secdom 25505,25533 and 255361 undemand On lfsle building z QS
docs not tura ave•tun N my rtspo hiliiy w notify Ute up softie
requsremen mom " or issuance CeniMawo(fk �y/ Signature of Applicant Date
Owner authodvnd.gem `71 D,e All roof coverings to be Class"B"or better
08/30/2005 07:16 7075287663 PERMIT SERVICES INC PAGE 09
Rug 29 05 03: 49p Cosmos Roofing 16501969-9905 p. 21
Rug 26 05 06tOlp p. 1
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Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
&CITYOF'
Telephone: (408)777-3228
C U PE INTI NO 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 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: -/ " z .//Z." , n ,
Job Site Address: 100 Z O �QQ� 1
Roofing Company Name: z=t� `L
L
Applicants Signature: - Date: 'MAS
Greg Casteel
Building Official
Revised 11/2/04
p,inlnA nn peni.nln n'pone,
CITY OF CUPERTINO
REROOF
ICUPE0
tPERMIT APPLICATION FORM
APN# 3s D 9 D S� Date: l OS
Building Address: /O O
Owner's Name: Phone#:
� 2�l 2- q8 3 /
-Contractor -. --- -- Phone#: License#:
-- ./Q-� _ . 65a 96 -2663
Contact: n Phone#: _ Cupertino Bus' License #:
Type of Roof Covering: X
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
Asphalt Shingles '0 Asphalt Shingles
WWood Shakes
Wood Shakes
13Wood 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 Com 1 With Cu ertino's Tear Off Polic ❑
01
Job Description: i v Commercial
Residential ❑
Fire Zone: Yes El No F-1there
with Planning Det. if
there are any restrictions: LJ
Cost of Project: ;? Type of Construction: Occupancy group:
18, 300
Qty. if Fee Grou
A licable Fee lD Fee Description
BPERMFEE Bld Permit Fees BUILDING
BENERGY Enerev BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING