06090205 CITY OF CUPERTINO asz�°-','*a�" '`' '' '
BUILDING DIVISION PERMIT ,SCcONTRA.CT�f1RNk'QRMATIzON �{,
BUILDING ADDRESS: COSMOS ROOFING PERMIT NO.06090205
22045 WALLACE DR
OWNER'S NAME: PERMIT ISSUE DATE
Allk COCKERILL KAREN R 1901 OLD MIDD
7INE
: SANITARY NO. CONTROL NO(650) 969-7663
1ECf/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
pQ LICENSED CONTRACTOR'S DECLARATION Job Descrl tion
i U Fj 1 hereby affirm dust w li
t 1 censed uMcr provisions of Chapter 9(mmmcncirg p
qwIts,Section 70M).(Division 3 of the Business and Proressm.Code,and my license is
i in tc^Ise.meanderr 3 Lk.g Z 8S /FBF REROOF- TEAR OFF SHAKES, RESHEET OSB. ADD 40 YR
�f•o Dam ' Conuaewr COMP SHINGLES . CLASS A. 21 SQUARES
rJ` ARCH CTS DECLARATI N
ne U 1 understand my plans sh c used as li a
a
a H Licensed Pnsftessional
3 0 NER-BUIIDER DECLARATION
f I berehy afrion that I am eumpt from Ne C.nmacim's License law for Ne
e O following mason.(Section 701.5,Business and Profemiom Cotk:Any city or county
3$ which rcqui.a permit m conmrud alter.Impmw,demolish.or repair my suumum
-z`i prior w its motors.Shot reipts.Ne applicant forwch permitm file.signed statement
as
the,he is licensed pursuant to the pmvisionecfthe C.nuacmr's licence Law(Clape,9 Sq.F[.Floor Area Valua[i¢N350
`
�9 (commencing with Seed.n 7000)of Division oftne Busixcsand Profevsiom Code)or
— that M is exempt therefrom and the buss for the alleged exemption.Any violation of
Section 7031.5 by my applicant fora permit subjects the applicant In.civil penalty of APN Number Occupancy Type
mon mute mart fin hundred dollars(5500), 32602037 . 00
❑I,at owner or she Property,or my employees with wages u Neu sale compemzdon,
will do Ne work.and themacture 6 not intended or offered for sale(Sm.1044,Business Required Inspections
and Professlom Code:The C.omemr' es s License Law donot apply m owner ner of q p
property wed build.orimpr.ws thereon,and wbod.usuch work himselfor through his
awn employces,provided Nat such improements am not intended.r.EerW forsa e.IL
however,thea tiding ru Improvement u sold within one year of completion,the owner.
Wilder wits nue she burIm p o ement i dui W did no Wild o improve for purposeMe own of
.It).
❑1,as owner of property.,B ones and contracting wide Ranted contractors i.
mown desproject(Sec.o..t Business and Profusions Cede:)The Conherem. ed /
cense Law docs rsuapply je an owner of property wed sed p or improv then.ked. O
who anmcu for such pojeos with a eonrraemrts)licensed pull¢¢as ted Contractor's /
1 .Law.
0 lam ucmpt undo Sec .B&PCfor Nis reason �/
Owner Date
WORKERS COMPENSATION DECLARATION �o
1 barely affirm under pemlty of perjury one of the following declarations:
1 nave and will maintain a Certificate of Come..self-imam(or Woker's Corpetr
sasion,u provided for by Section 3700 of site labor Code.for she Performara of the
wok for whim this permit u soused.
1 have and will maintain Worker's Compeuatior,I.ce,he required by Scedon
POD of the LsWr Code,for ted performame of rhe work for which this permit is issued.
MY Workcr's mpe—n3sation Insurance carrier and Polity number are: t
Cartier. Policy N..gQV t ZS- S
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Ohs section need not W completed if Ne permit is future hundred dollars(SIM)
or less)
1 Mmi(y Nat in dm performance of the work for which this permit Is issued,I shall not
employ any person in any manor an at in Weems subject m the Workers Compensation
Laws of California.Dau
Applicant
NOTICE TO APPLICANT:IL after making Nu CeniBca c of Exemption.you should
become subject to the Worker's Compensation provisions of Ne labor Code,you mut
.J O (oMwiN comply with such provisions en Nu permit shall be deemed my.ked. '
CONSTRUCTION LENDING AGENCY
Fay k for
roby which Mi Pe Verttssmn(See.3nlending agency forth perfumtarxe of
a Nr.work fur which this pcmtit u issued(Sec.]097,Civ.C.)
aQ Landers AddName `
a Z landcfa Adtlmu
U I certify that 1 have read this applieauan and sate that the above information u
Iy (~ comm.l agree to comply with all city and county ordinances and sate laws misting to
Q U Wilding conviction,and hereby authorive representatives or Nis city to enter upon the
rG stun.menuugmcmu.enyfor inspection Purposes.
(We)agree to save,indemnify and keep harmless the City of Cupcnino against
F'fA Iiabiliuu,ludgmcnb,couand expcnsm whim may in my way vecme agafmssaid City
U z in comegrmnce of N ranting of Nis pe
^ APPLICANT U STAND LL CO Y WITH ALL NO
Issued by: Date
SOURCE E $
Re-roofs
Signature of AppliesntrCentractor Dau
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or fuwm building occupant more orburklc hanNow matmod
u defined by dee Cupertino Municipal Code.Chapter 9.13,and site Health and Safety
mdc.Seon 25532(.)?J2(a)7
[Dy. 9r� 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
Gods. e
out usekdom air contaminants u defixd by the Bay Area Air Quality Management all new materials for inspection.
Distrim
❑Yu
l
1 havemad Ne .Sa -asmaterials5533mdcruundo Chrsomil atofNc Califon
uHcothBSntly CwaSeedms 25505.2 my and25574.110 modify
Me occups Wilding
dues not currently naw a tenant Nat it is my rtsp.mihiliq to n.ufy the ocupmt of the Q
mgwromenet uubomct .rI mora ertirwate.foc Signature of Applicant Date
owners e , e D All roof coverings to be Class"B"or better
CITY OF CUPERTINO
!m 1 of 3 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 32602037 . 00
DATE ISSUED. . . . . . . : 09/21/2006
RECEIPT 4 . . . . . . . . . : 36140
REFERENCE ID # . . . : 06090205
SITE ADDRESS . . . . . : 22045 WALLACE DR
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER COCKERILL KAREN R
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
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
EE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- --------- - ---------- ---------- ---------- - -------- -
BPERMFEE VALUATION 8, 000 . 00 147 . 96 0 . 00 147 . 96 0 . 00
BSEISMICRE VALUATION 8 , 000 . 00 0 . 80 0 . 00 0 . 80 0 . 00
---- ------ ---------- ---------- ---- ------
TOTAL PERMIT 148 . 76 0 . 00 148 . 76 0 . 00
Community Development Department
Building Division
r ",t City of Cupertino
• "<`.,. 10300 Torre Avenue
CITY OF Telephone: (408)777-3228
Fax: (408)777-3333
C U P E IST I N O
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: /tt-a, ,e.r`— ac, �, �
job Site Address: Z Z V -/ S
Roofing Company Name: eo
Applicant's Signature: lP� Date: M7,d L
• Greg Casteel
Building Official
Revised 11/2/04
M'IW2006 09:34 7075287663 FERNIT SERVICES INC FAGE 04
sOF iy Us t0;4ea Cosmos RooFtng (650) 969-9305
P. 4
COmm W }t
CUPMtJ=CA 97014
• CUAr M0 T010*w(4M 777-32,4 FM(4011)
Buildin De arhnent
OWNtrR'S
AR �r2lo OW
X T alp not using any sabcontract ors; _
�lcaae cl�ecic a licebk •-� �� �a7 ti
anbcontractors and tete the folio Date
SUBCONTItpCTOR BUsINBSS NAME B tmation
C�bumfa Qc MBwork -- USMESSLICEMS~
Excavation
Unuk= Wood
_ cis
Heating
• IiuulaHon •—�
z. Mae
P�etwl Sleet 1•'fegl .' -�....—•----I
septic Tank
sheet Mew
Tue A
Owner/con tare
Date
u
ar
CITY OF CUPERTINO REROOF
• CUPERTINO PERMIT APPLICATION FORM
APN# Ju L�O J Date:
Building, Address:
Owner' (� Phone
P , - X772- - o3iz
Contracto License#:
-7FIS4f4 /
Contact: % -„ "- 4 CupertinoBusiness i ense #:
�n
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles -pr— Asphalt Shingles
Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
Cl Other(Specify) ❑ Other(Specify)
Number of existing coverings / O Provide I.C.B.O. Report#
lI To be Removed ❑ Provide Mfgr. Installation Specs.
• I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description:.r/ G_,1 /d �� s 6
U • Q.,r& 4�U y't Ls
Residential O��Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Projec73SU 03 Type of Construction: Occupancy group:
a CC4�
Qty. if
Applicable Fee ID Fee Description Fee Group
/ BPEFJ FEE 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
Telephone: (408)777-3228 •
Fax: (408)777-3333
Building Department
Subject: Re-roofing policy for the City of Cupertino
A , . .
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:
Roofing Company Name:
Applicant's Signature: Date:
Greg Casteel
Building Official
Revised 11/2/04