05100060 CITY OF CUPERTINO *
7r' e 3�
."UILDI)G DIVISION PERMIT ICON T10 IN URMATTUI�,
BU ILDING ADDRESS: COSMOS ROOFING PERMIT NO,05100060
OW NER'S NAME: PERMIT ISSUE DATE
DONALD FINLEY
ONE: SANITARY N0. CONTROL NO.
650) 969-7663
ARCHITELTENGINEER: - BUILDING PERMIT INFO
BO EO PLO O
30j LICENSED CONTRACTOR'S DECLARATION JbDescriP tion
(uj I hereby affirm that m li
al I aconacd usurer previsions of Chaptero
9(commencing
with swam 70110)of Division 3 of dw Business ane Prdiesdons Code.and my Ikense Is
mmurawearwe �c g -7 8 y4 REROOF-T/O TAR & GRAVEL, ADD TAR &
j License Cl
�, Dave j�Conunm, GRAVEL (4 PLY + 6)
ARCHITECT'S DELLA TI J
y!T5r 1 understand my ptaw"I tW used u public records
z,l
j0� Licensed encs oodfami onol
OWNER-BUILDER DECLARATION LE®
0 Y I hereby aRrm that I am BUILD form me RATION License law for me
.n p p fallowing rcuon. ormal i 11131.5.sum B.idwr. and Pro.essumst&Mots Coden..1 My city m county
.,_Z 1 which require n permit re ermRroce alcan improve,demolish,lir¢pair any suunure
..–i� pdm wslcensed purearcquirca"Vista"orfor suehpermi'm0cone,Law(Chapter
-
F�o throw is sed pursuant an the of Divionsn of Contractor's amsesdans Code)
apwr9 Sq.Ft. Floor Area OV .� VaIuB�IQIg450
s S armM"ncixewiNSecdon TOnd WDiasis for
thew Budnwaeton.Anynvi Ca on of 2005
'�5.� Nal he ts exempt therefrom and the buLL for to alleged conception.Any violatron of
Section 7031.5 by tory applicant far a permit subjects the applicant m a civil penalty or APN Number Occupancy
.atmare than him hundred dollan(5500). 37540033 . 00 �YPe
❑I,u owner oruie pmpwy,m my employes with wage u tmtr mm tompmudon.
will do Nework,ml the structure iseminwMedoraffered forsom(Sm.70".Business Required Ins e (i V
and Professions Codc:The Cowmensta
me,Lice Low danot apply m an owner of C q Pc on
Instant who builds or improves thereon,a nd who does ouch work himself or through his
Own employees,provided that such Improvements sm notimended conRered for sole.If. a
however.the building or improvement is mid within arc year of completion,me owner.
builder will b.ve are burden of proving that be did not build or improve for purpose of -
ule).
❑L as owner of the property.am exclusively condoning with licensed contractors on
answct me project(Sec.7044,Bines and Forearms Code:)The Conuacmr's LI-
came law dean not apply to on owner of poopertywho builds or imprevm thereon,and,
who contracts for such projects with a conuacmKs)licensed pursuant m W Contractor'.
License law.
❑I am exempt under Sec. ,B k P C fm this rcuon
Owner Dau
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty at perjury one of the following declarations:
I have and will maintain a Cardleaw or Canroal or elf-mmea for WmkeraCatalan.
1�3700
0on,u provided for by Section 3700 or eve labor Code,for me performance of the
work for which this Permit is!wood.
born and will maintain Wormer Compensation Insurance,u required by Section
of me labor Cade,fm the performance of the work for which this Permit Is issued.
yWorker'.Cam tan 1 rsntt carter end Policy number ave:
rrier. `7 a p� Policy No.:��7 l–05—112-5
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(ntssectiat most not becamplemd if the permit lsfmarm hundred dollars($100)
lir less)
1 certify that in the Performance of the work for which this rcreall is Wood.I shall not
employ any person In my mannerm as to become subject to the Workcra'Compcnuton
Laws of California.Dow
Applicant
NOTICE TO APPLICANT:IL after making this Collimate of Exemption,you should
Income subjw m are Worker.Compensation previsions of the labor Code.you muse
.J O foMw•ith cemply with such provisions ar this permit mall be domed rcveked.
,z.m� CONSTRUCTION LENDING AGENCY
[–m 1 hereby afros that mem is amntruction lending agency for one perarmuwe of
G'> ten work for which this permit Is Issued(San.3097.Civ.C.)
0 Lender.Name
z Landers Address
r Q I entry that 1 have real Ws application aad mw mat the above:inmornot an h
D.F coram 1 agree in comply with all city and county eminences and sum tsws relating to
0 building construction.and hereby authadre representative of this city in enter upon des
W above-mentioued pmPony ren IMP4nion Purposes.
Liv, pg. (We)agree m save,indemnify,and kap humus me City of Cupertino against
ry r/y liabilities,judgments,mow and expenses which may In my way am=against tab City
t.>7 In consequence of the grandin5 of this permit.
r7 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NPN-POINT Issued by: Date
SOURCE REG'75 /
Signature ofApplcanVContolicaor Data
f nil
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or for=Wilding Occupant nom rehandle haesmou mawdd
u defined by Iles Cupertino Municipal Cade.Chapter 9.13,and the Health and Safety
Inia
ada,Sectian 33533(x)? M41r All roofs shall be inspected prior to any roofing material being installed.
❑Yu
Will ere applicmt or future budding occupant use equipment at devices which If a roof is installed without first obtaining an inspection,I agree to remove
old hazardous air contaminants u denncd by the Bay Area Air Quality Management all new materials for inspection.
iwict7
❑Yes gNn—
Ihave mW the hmamousmawrimsrequinemenu under Chapmr6.95oftheCalifor-
HcalmdrS41etyCode.Sections 35505,35533 and35534.i unicrsland thuifthe Wilding
oes not currently hex a cannot,that It is my responsibility m noulfy the a:cup lit of the
quirear ,Whic xmnp rmmumaoraccrtnewofoo Signature of Applicant Date
1� ) °5All roof coverings to be Class "B"or better
LO-ac,.1 msharq ge D.C.
10/11/2005 10:00 7075287663 PERMIT SERVICES INC PAGE 04
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CITY OF CUPERTINO
REROOF
CUPERTINO PERMIT APPLICATION FORM
APN# 3 7� � o 62 Date: L
Building Address: � 5 2r
Owner's Name: Do.,- Phone#:
X52 - 2 � g/
Contractor:n Phone #: License#:
(%�'j'i��-' 9 650 96 9 7G 6
3
Contact: Phone#: Cupertino Business Lic nse#:
Type of Roof Covering:
Existing: Proposed:
Built-Up Roof �ir Built-Up roof
❑ Asphalt Shingles - ❑ Asphalt Shingles
❑ 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 o Provide Mfgr.Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description: o Y- � a�G� �
G
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are anrestrictions: LJ
Cost of Project: V Type of Construction: Occupancy group:
/R , 4/5o
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
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
CI OF Telephone: (408)777-3228
U PE TI N O 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 reroofing
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: /
Job Site Address: lS P' GU�
Roofing Company Name: �l c
Applicant's Signature: . ° Date:
Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper