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04100141 CITY OFCUPERTINO - "' _ 7 ' BvlLoI Dtvlsl * ON PERMIT ,CONTRAGT,OR INFORM itx s e.zr a BUILDING nnDRess: COSMOS ROOFING PERMIT N0.4100141 0520 STOKES AV OWNER'S NAME: PERMITISSUEDATE MARTA CERVANTES 1901 OLD MIDDLEFIELD WY 10/20/2004 HONE: SANITARY NO. CONTROL NO. (415) 493-6373 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH X00 LICENSED CONTRACTOR'S DECLARATION lob Description 1 hereby affirm that 1 am licensed under provisions of chapter 9(commencing p z w with Scarce anda nfe�mD'I ionJof lh9,Busincss and�Prufcsypm C�o,Jc.end mYli�nsc is _ d L eneQlassdcff 9 /T/J �O, REROOF W/ COMP. SHINGLES j�? License s p Dairdr A A, shall h use DECLAR 10� �i I undersand my plans shall he used as Public records o G Licensed Pndcmional g OWNER-BUILDER DECLARATION a f 1 hereby alfirm that 1 mm exempt from the Contractor's License Law far the 04 following reason.(Section 703 IS Business and Professions Code:Any city nr county y$� which requires a Permit to construct,alter,improve,demolish,or repair any structure 112 2 0 prior m its issuance,also inquires the applicant for such permit m file a signal stm.ment �FZa that he is licensed pursuant to the pmvisinns at the Contractors License Law(Chapter 9 Sq.Ft. Floor Area Valuation TH- (cam ramming with Section 700(0)of Division 3 of the Business and Professions Code)or .. Nm he is exempt du refrom and the basis for the alleged exemption.Any violation of Section 7831.5 by any applicant for s permit subjects the applicant to a civil Penalty of not more man Eve hundred dollars($5W). b Occupancy Type ❑h as Manor of the pmperty,or my employees with wages as their sole compensation, will do the walk,and the structure:is not intended or offered for sale(Sec.7W,Business and Professions Code:The Contact...License Law does nal apply to ea owner of Required Inspections properly who builds or ed that suthereon,and who adoes m nor work himself er through his �� own employees,builds prolds or im the such improvements and who are not such woetlhr offered tarsale,if, however,me building or improvement is sold within one year of completion,me owner. builder will have Be burden of proving met be did not build or improve for Purpose of ED sale.) ❑1,as owner of the property,am exclusively contacting with licensed contactors to NOV Z2U�4 construct the project(Sec.7044,Business and Professions Code:)The Contractor'a Lt L cense Low docs not apply to an owner of property who builds or improves thereon,and, who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's BUILDING License Law. ❑I am exempt under Sec. .B&P C for this most Owner Data WORKER'S COMPENSATION DECLARATION 1 hereby affirm under Penalty of fa jury one of the following declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's Cabinet- sound,m provided for by Section 37M of are Labor Code,for the performance of the i!wo for which this permit is issued. I have and will maintain Worker's Compensation Insurance,as required by Section 3700 of the labor Code,for to performance of the work for which this permit is issued. My Worker's(C�ompe—ntsation Insuance artier and Policy number are: Cartier: .l T '^ Policy No.: J '21-04-11 CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This session need Mol h.completed if the Permit is tone hundred dollars(51(X)) or lcsaJ 1 ccriry that in the performance of the work for which this Permit is issued,I shall not employ any Person in any manner so he to become subject to the Workcri Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making this Cenilicate of Exemption,you should become subject to the Worker's Compensation previsions of the labor Code,you most .J z forthwith comply with such provisions or this Permit shall re deemed revoked. z O CONSTRUCTION LENDING AGENCY T hereby affirm that there is a construction lending agency for the Marriottof !Yi > thd work for which this permit is iseucd(Sec.3097.Civ.C.) W� A Leader's Nam. z Lcndcr's Address V Q 1 certify that l have read this application and state that the above information is W P cored.l agree to comply with all city and county ordinances and state laws boro ngh CU building construction.and hereby au@Drina representatives of this city to enter upon the 4 above-mentioned property far inspection purposes. (W.)agree to save,indemnify and keep harmless the City of Corollate against CJ z liabilities,judgments,costs and expenses which may in any way seems against said City n canscyucncc ohhc granting of this mit. ^ APPLICANT ERSTA 5 ILL C PLY WITH ALL NON-POINT Issued by: Date SOURCE R ,L�A,TIO� y Re-roofs _ Sigratureaf Applacroo/Cantmear Dam 1 HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will me applicant or future building occupant same m handle havarduus material m defncd by the Cuperina Municipal Code,Chapter 9.12,and the Health and Safety Cade,Section 25532(a)7 All roofs shall be inspected prior to any roofing material being installed. ❑Yes f1— Will the applicant or future building accursed war equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove emit ad.oh us all aaaminams as Jcfincd by the Bay Area Air Quality Management all new materials for inspection. Dinrla7 ❑Yea qya__ I have real the haaNnusmamrials rcyvircmenas under ChvPmr b.95 of the Califnr. U nia Health,4SafctyCMe,Sccduns25505,25533and25534.1undc.wdmatiflM building dosnalcurtemlyh aten t,matitism spoouln)ty "a" IY hicoormiamofthe rcyuircmcnks IbiicheJSLbemetP rRrs�-�'ear ,n„are�ra�caelle Signature ofApplica t Date � — � jO All roof coverings to be Class "B"or better Owner or au and agent Date Community Development 10300 Torre Avenue Cupertino CA 95014 f Telephone(408)777-3228 CITY OF Fax(408)777-3333 �UPERTINO Building Department JOB ADDRESS: PERMIT # /O.�Z-0 a--g— a q,! 00 /Y / OWNER'S NAME: PHONE # a , q-lo q3 GENERAL CONTRACTOR: FAX # I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass/ Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile n , Owner/Contractor Signature Date Community Development Department Building Division City of Cupertino 10300 Torre Avenue OCITY�F Telephone: (408)777-3228 UPERTINO 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.. :-lf 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. , 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: _ ar/a C -ei—� � Job Site Address: J0,15'.2-0 l laraZ.a C'l - Roofing Company Name: Applicants Signature: Date:%++ uy ��114S1ADLX) �• • _ , Greg teel Building Official Revisedl/30/03 Printed an Recycled Paper -, . .CITY OF CUPERTINO RIEROOF �CUPR TINO PERMIT APPLICATION FORM APN# Z / �8. 3 Date: 10/Zs /o Building Address: �d S 2.0 Q'� -- Owner's Name: ^ Phone#: 214-'l a 43 Contractor: ( Phone#: License#:69-1 L -1 $5 44 4 Contact: Phone#: Cupertino Business License#: /S yOc1 -i fs y 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# 0---Tobe Removed---- ❑ Provide Mfgr.Installation Specs. I Have Read,Understand and Will Comply With Cu ertino's Tear Off Policy: Job escri tion:_., . esidential -lev ' Commercial ❑ -Z. Fire Zone: Yes ❑ No ❑ Confirmed with Planning De t. if there are any restrictions: LJ Cost of Project: Type of Construction: Occupancy group: Qty. if A icable' Fee ID Fee Description Fee Group BPERMFEE Bldg Permit Fees BUILDING �--� BENERGY Energy BUILDING, i' BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING '