06010098CITY OF CUPERTINO,
BUILDING DIVISION PERMIT
,C0NTI2ACT0RIN1i0RMA'CI0N
BUILDINGADDRESS:
0 T N AVE
COSMOS ROOFING
PERMMN0-06010098
-10420
OWNER'S NAME:
PERMIT ISSUE DATE
THOMAS JENNINGS
1901 OLD MIDDLEFIELD WY
01/18/2006
NE:
SANITARY NO. CONTROL N0.
(650)969-7663
ARCHITECUENGINEER:
BUILDING PERMIT INFO
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LICENSEDCONTRACTOR'S DECLARATION
IwmbyafftrmNalIamfdORdunderprovisionsorChode Y(commencing
Job Descriptio
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tender,
withSectionComn]d1( Division 3oflhcBmincWand Pmfrssinav Codc, and myliccnm is
three once 7�5
REROOF--T/O BUR ADD BUR
License
Liccnsc I
�a
C.Mo
Dao: Contmemr
Ass Hall CIB DECLARATION
I undcntanJ my plans shall w useJ ss public records
Licensed Professional
OWNER-BUILDER DECLARATION
f
I hereby affirm that I am exempt from de Contractor's License Law for the
t o
following mason. (Section 7031.5. Buaincas and Pro cssiorr Code: Any city or county
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which 21t.n. a Permit m Consumer. eller. Improve. dcroutud1. or repair any structure
` l3 �! ;y $6340
:y
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prior to is issuance. also requires the applicant Tor such Permit o rale a signed statement
Chat he is licensed pursuant to the previsions of the ContmcmreLicense Law (Chapter 9
Sq. Ft. Floor Area � 'Valui[ion�
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(commencing with section moo) of Division 3 of the Basin and Prorcesions Code)or
.
that M is exempt Osrtfram and she bass for es alleged exemption. My violation of
�L�•'
Section 7031.5 by airy applicant for a permit subjects the applicant a civil penalty of
r
Occupancy Type
not more than fres hundred dollen (E500).
I, as owner of the prapcny, or my employees with wages as their sole compensation.
will do the work, and thn structure is not intended or offered for sale (Sm. 7011, Business
and Prefessums Code: The Comment's Lt.. Law does nor apply to an owner of
Required Inspections
property who builds or improves daemon. and who doeeeuch work himadf orlhrough his
awn employers, provided that uch improvements art not hummed proffered for sale. If,
however, Ne building or improvement is sold within one year of completion, Ne owner.
wilder will haw she widen of proving wt the did net wild or improve for Purpose of
.ICI
❑ 1, as Owner of Ne property, am exchuively contracting with licensed contractors to
convect the pmjen (Sec. 7014, Business and Professiams Code:) M Commuter's V
Cense law dors not apply to an owner of property who builds at improves th ccom, and.
-
who contracts for such projects with a eonvaclor(s) licensed ParasoOo the Convenors
License Law.
❑ I am exempt under Sec. ,B&PCforlhismarm
nee Das
WORKER'S COMPENSATION DECLARATION
1 hereby aRirrn under Penalty of perjury One of the following declarations:
I bas and will maintain a C.rdfi mef C . . . I mself-insurefor WOrhYSCompcn-
,ien, as provided for by Section 370 of the, Laver Code, for Ne performance of the,
work for which this permit is issued.
1 have and will maintain Worker's Compensation Insurance, as required by Section
7w of the labor Code, for Ne performance of Ne work fa which this Permit is issued.
My Workicb, Co nation Cartier and Policy ice:
n1l�naunntt
ynnumber
Cart+4 "R-- Policy NJra 7 �dS I
CERTIFICATE OF EXEMPTION MOM WORKERS'
COMPENSATION INSURANCE
('Nis section need not hecomplcted if the permit is for one hundred dollars (SIM)
or less.)
I coni(,, Na in the performance of the work for which this Permit s issued. I shall not
employ any person in any mannerso as to become subject o the Workers' Compensation
Laws of California. Date
Applicant
NOTICE TO APPLICANT: If, after making this Cenifcate of Exemption, you should
become subject to Ne Workers Compensation previsions of the Lahr Code, you most
feM
O
with Comply with such Or this Permit shall bre
provisions e decreed revoked.
CONSTRUCTION LENDING AGENCY
?I
hereby affirm that Vert is a communion lending agency Car NC Performance of
thc work for which this permit is issued (Sec. 3097. Civ. C.)
Under's Name
Lender's Address
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1 esnify Nu I haw read this application and sum Nat the above information is
^
cored, l agree 10 comply with all city and county ordinances and state laws relating to
Jbuilding
convection, and hereby authorim represcetatives of this city to enter upon Ne
shove-memipnce Property fend
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1
(We) agree t0 save, indemnify and keep harmless the City of Cupersom spin"
n
m.
laws may in any way accrue gainsl said City
egjnce
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inof theCosueng of this
of Nis permit.
APPLI ANT of UNDERSTANDS
APPLICANT UNDERSTANDS ANO WILL COMPLY WITH ALL NON-POINT
SOU GULA BN.
Issued by: Date �
J le 6
/
Re-roofs
Sgnawrc of Apphc onruIn Dam
AZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will theapplicam or future wilding acupant start M h.rtdlc haesrd0ue masrial
r
u defined by the Cupertino Municipal Code. Chapter 9.12, and the Hearse and Safety
odo. 5c uon 25533(.)?
❑Yes pm.—
All roofs shall be inspected prior to any roofing material being installed.
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
it hacardous air contaminants as defined by the Bay Arca Air Quality Management
istricl?
all new materials for Inspection.
C] yes
Ihrve read the hvardnusmasdals requirements under Chapter 6.95 of Nc Califoo-
ria Health &S afctyCodc, Seeuuu 253115.35533 and 25534.1 undersand that if Ne wilding
dors net currently haw a tenant. Net it is my respolrsibility to ft
noufy ce upon, n the
rtquirtments which mu en IPoor to iss ce or ccriraeam pr fxfp p.
Signature of Applicant Date
roof coverings to be Class "B" or better ,
Owner or auloon7.ed ag I MCC
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•
01/17/2006 07:42 7075237663 PERMIT SERVICES INC PAGE 02
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SUBCONI'RACiOR BUSINESS NAME BUSDMS LICENSE
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Date
Community Development Department
Building Division
Cf"I 7 t City of Cupertino
10300 Torre Avenue
pCI[TY OF � Telephone: (408) 777-3228
CUP S ��' I V 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 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:
Job Site Address: /D Q_ `.
Roofing Company Name:r/
Applicant's Signature: �. Date: IM' 6
Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
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•
CCI-
cm OF
CUPERTINO
CITY OF CUPERTINO
REROOF
PERMIT APPLICATION FORM
APN # r�'I S — I
Lq ^ U 2 Z
Date: l� /y/0
[!![
Building Address: /O / `Zv
7Phon
Energy
Owner's Name:
�n v.
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#:
3 — L
BUILDING
_,e_
Seismic Commercial
Contr r:
Phone #:
License #:
Lodi
� Sv q 6 -766 0
-1 0,>_S V -y
Contact:
Phone #:
Cupertino Business License #:
5 a_�
i 7
Type of Roof Covering:
Existing:
Proposed:
Built -Up Roof
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
❑ Provide Mfgr. Installation Specs.
1 Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description:/d ` rs.
l
� vle . a m__
�lC.. g. U.2
Residential
Commercial ❑
Fire Zone: Yes ❑ No ❑
Confirmed with Planning Dept. if
there are any restrictions:
Cost of Projecj:
Type of Construction: Occupancy group:
Qty. if
Applicable
Fee ID
Fee Descrintion
Fee Groun
/ 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
3 z.
# / 37- s4