06040101 CITY OF CUPERTINO -
BUILDING DIVISION PERMIT CONTRACT( RI�FkORMATION,
BUILDING ADDRESS: COSMOS ROOFING PERMIT NO.O 6 OSI O 101
22363 ST ANDREWS AV
OWNER'S NAME: PERMIT LSUE DATE
ROBERTS PAUL V AND INGE 1901 OLD MIDDLEFIE Y 2006
NE: SANITARY NO. CONTROL NO.
(650) 969-7663
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMS MECH
;Op LICENSED CONTRACTOR'S DECLARATION - lob Description
mF 1 bereby affirm Nal l am licensed under provisions of Chapter 9(commencing P
�he with section 7WU)of Division 3 or NC Business and Prufcssiom Cade.and my license is
±;N 'a fullrarteande ifs"It'll TEAR OFF COMPOSITION SHINGLES ON PITCHED ROOF A
L1em CC'y' Le'w
R 30 YEAR COMP SHINGLES . TEAR OFF FLOOR TILE & BV
-F p Dau�O/ Caaramar
ARCHECTSDECLARAT N ON PATIO ROOF; ADD METACRYLIC ROOM MEMBRANE CLA
m< 1 undersand my plans shall be used u public raor& z
7aU
eon Licensed Pmfcssil
ana
OWNER-BUILDER DECLARATION
iP 1 herthy infirm Dot exempt am cmpt from the ContractorLicense cense Law for the
O O following mason.(Section 71171.3,Business and Pmfcuions Calc:Any city or county
which requires a .it m cowrxt,ahm,suspense.demolish,ter repair any structure
_zY prior to its hems...at.requima da applicant for such permit to flea signed statement
< than he is licensed pumsant to the provisions of the Character's License law(Chapter 9 Sq.Ft. Floor Area
M&
'FC (commencing with Section 7000)of Division 7 of the Business and Professions Centel or 95
e u tMm
9 BOB hexempt Gom and the basis for Nny e alldgcd exemption.Aviolation of FINA
Section 7031.3 by any applicant for a Permit subjects the applicant in anvil penalty of APN Number - Oce pa ype
out more than five hundred dollar(SSW).
❑1,u owrrer of Bnu proprxy,m my rmplayw with urges u the'v ale compensation, MAY
` !
and do thework.and, The Cmlarmes Lt Boron,doers Out
applyB.Of Re wired 0 -Ons
and property
who bis Cade:The cant anvis ercem License law dna rot apply ism owner of LI B
mean who Wipmvt&dp set
imawoomia dmnsahende himselfar Ferrate his
own employees,p Wilding
or improvement Out such Is semmu art not intended mputi n.Lunate s,
builder.Nebuilding Orenofpksoldwithinoro year of mmpkuon the use of
builder will nave the burden of paving Nat W did not build as improve for purpose of
tile.).
❑1,as Owner of the property,am exclusively contracting with licensed contractors In
construct the project(Sec.70ad,Business and Professions Cade:)The Conmacmrs U.
cense taw docs oat apply man owner of pmpeny who Wilda or improve decomm.and
who contracts for such projects with a contractors)licensed pursuant in tW Contractors '
License Law.
71 I am exempt undm Sec. .B S P C fm Nis mason
Owner Date
WORKERS COMPENSATION DECLARATION
40 1 Wmby alllrm under penalty of perjury ane of the following declarations:
❑1 nave and will maintain aCutifiate o(Conscm roself-imam(err Wafters Campm-
sadon,as provided for by Section 77X0 of the Labor Code.for Bre Performance of the
work for which this permit is issued.
)I have and will maintain Workers Compensation Imumu
rce, required by Section
37W of the Lanni Cede,fm me performance of the work for which this permit Is issued. '
My Workers CmnpemaIluan from nee artier and Policy number arc:
Cartier. 5 T s^
CERTII'ICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Rhin scCtim wood no loccompkied Vince permit islmonc hundred dollars(SIM) v
or Ices.)
I unify Butt in the Performance of the work for which this permit is issued.I As[]not
employ any person in any manner an as in become subject to me Workeri Compensedon
Laws of Caliromia.Dau
Applicant
NOTICE TO APPLICANT:If,ilia malting this Ceniftcate of Exemption,you should
biome subject in tW Workers Compcnadaa provisions of the labor Code,you mea
.JO forthwith comply with men Provisions or Nu permit shall W deemed rtmked.
Z` CONSTRUCTION LENDING AGENCY
[•+ I her which
Rum that mdse ii a nd(See.30 lending agency for the perfurmantt of
C> Le ten for wnkn cola Pm,nh is issued(sac.3097.civ,c)
aLanders Name
z Lender:Address
U C) I emtify that I have rtad this application and nae mat me abuse infmmatiun is
gU F Correa 1 agree Be comply with all dry and comity onlinences and sure laws relating to
�U building Construction,and hereby mdKm?C reprmenusives ofthis City to enter upon the
Y'G abovc-mcnuoncd propcny far ie penes puryoms
(We)agree to sass:,indemnify and Fecp lis U the City Of Cupertino against
wLI)Z fiabilincorossme eofth,case and expenses a wnich may in my way accrue against said City
U sZ AePLICAN ce of thegrantingof mu permit.
^� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE_UL¢T1 s n 4/19�a L
Re-roofs
Signature of ApplicambV trans Dau
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Be applicant or future Wilding occupactnhm or handle baeallow manurial
as cef and by Bre Cupertino Municipal Code.Chapter 9.11,and the Health and Safety
Code,Section 13331(:)?
❑Ye te - All roofs shall be inspected nor to an roofingmaterial beingInstalled.
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
omit hazardous air commonness is defend by the Bay Area Air Quality Management all new materials for inspection.
13 yes tx�/
Ihave&SaBs Codc.he Sedans 25505.smquimmcnuundernewhan dor dime Glding t,
not HaINASakiy Ce de Satiate 25505.25533 and Z533a.IrChund.95fte Cain, \`+\✓1J>/- 1`9
Boa not cutly hose a whimL mftat it is my responsibility to notify the oempent of
mein nenw ' met M* maandedracertifakalq�epoincyG Signature ofApplieant Date
T 6
Owner Or mthhrrre gent Danu All roof coverings to be Class "B"Or better
Community Development Department
Building Division
_ City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
U P E RT I 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$176.18. The re-inspection fee must
be paid before another inspection can be scheduled.
IMPORTANT:
1. Flat roofs must have a minimum of 1/4" per foot slope and demonstrate
that there is no ponding.
2. An I.C.B.O. report is required to be on the job site at the time on inspection.
I understand and will comply with the above stated policy on re-roofing.
Homeowner's Name: �Cc � 4
Job Site Address: -33 Q �.c L7in Gl/Luc c.�
Roofing Company Name: C"c� s
Applicant's Signature: (;dnf Date: ! C) (,
• Greg Casteel
Building Official
Revised 11/2/04
Pnnted on Recycled Paper
Apr 19 06 07s34a Cosmos Rocfing 16501969-9905 p.2
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Building De arbnent
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X I am not using any svbconkaetW$,
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Please checkapplicablesebcontz act0:e and gMEIgLe floe fan&wlm kdorruwn
SUBCONTRACTOR BUSINESS NAME BUMMS LICENSE N
CAbittetr&Millwork
Cep
F1echiml
Fencing
• Lb oleum/Wood
claw/
boulas[on
i
vy
Oesla�mel Sheet Meati]
rain - Wallpaper
Paying-
Sepik
' Tank
Sheet Metal
Shat Ruck
Tile
Date
•
60 3�J'Jd ONI S201Ad35 IIW2Gd E99L8Z9L0L T" OI 500Lj81/7'0 ,
CITY OF CUPERTINO
eem 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 35604013 . 00
DATE ISSUED. . . . . . . : 04/19/2006
RECEIPT # . . . . . . . . . : 34045
REFERENCE ID # . . . : 06040101
SITE ADDRESS . . . . . : 22363 ST ANDREWS AV
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : ROBERTS PAUL V AND INGE
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-3968
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
*FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BPERMFEE VALUATION 14 , 000 . 00 212 . 76 0 . 00 212 . 76 0 . 00
BSEISMICRE VALUATION 14 , 000 . 00 1 . 40 0 . 00 1 . 40 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 214 . 16 0 . 00 214 . 16 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------ ------
OTHER 214 . 16 VISA
TOTAL RECEIPT 214 . 16
•
- ,� CITY OF CUPERTINO
REROOF U 4b 1 b 1
CUPERTINO PERMIT APPLICATION FORM
Ah
APN # h' t �l2 Date: '11191, 6
Building Address: V"J
ZZ 3 (� 3 giX ' Q �-�--
Owner's Name
:/J Phone#:
,JOct.u-P 4�" 2 5 z -D 3 E/0
Contractor: n Phone#: License#-
C�. � �r,-� 65v ?6 4 -7G63 7,?S y�f
Contact: Phone#: Cupertino Business License#:
650 ./pd --2 cl'/5
Type of Roof Covering:
Existing: Proposed:
Built-Up Roof ❑ Built-Up roof
Asphalt Shingles 36 Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles n
❑ Other(Specify) )13 Other(Specify) AtLo Il,4
Number of existing coverings ❑ Provide I.C.B.O.Report# 7 eS
To be Removed ❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will C m ly With Cu ertino's Tear Off Policy:
Job Description: 7- 0 y •• -tc va- &oW asp yn �y
7/0 ILV, tL� t is.U. 2 rn 1'ci c a - rLdCp Yhu 4 —
Residential X' Commercial ❑ °moo'A, "
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Pro ec� 9
Type of Construction: Occupancy group:
Qty. if
Applicable Fee ID Fee Description Fee Group .
I 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
•