05090232 CITY OF CUPERTINO BUILDING DIVISION PERMIT c A'�CTORANFORNATJ
BUILDING ADDRESS: COSMOS ROOFING rERMITNO.05090232
11866 WOODHILL CT
OWNER'S NAME: PERMIT ISSUE DAM
DONG-RU SHIEH 1901 OLD MIDDLEFIELD Wy ()9/30/200S
NE: SANITARY NO. CONTROL NO.
(650) 969-7663
-------ITECTIENCINEEIL BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Sop LICENSED CONTRACTOR'S DECLARATION
�dc . I thereby taf(hat that I am Ud?U&I provisions (commencing
Comm Job Description
dthyll. 'I.
in full fares and LrcRr,;I --T/OC SHAKES, ADD COMP. SHINGLES
jjZ License Class nF!� y
io • REROOF
Dam—
im Section 70M)ofl)Wlikat 3 Of
ARCHM
R 0
a 'C
31- a,Business DECLARATION
I onderacmd my plans"I W Used sm Public ructudsrg /4-
Xw� Li-cmd Professional )e)
Bt.0 OWNER-BUILDER DECLARATION
x I hereby affirm Net I am attempt from the Contractors License Law for the
i:a following moron.(Section 7031.5,Business and Professions Code:My city or county OCr $10785
which requires a Permit to construct.amr,arpreve, knoolibb.or mlWr my structure
prior In its issue=,also requires don applicant forsuch permit to rile a signed summent
man W I.licensed pammost su the ponvigmu of the Contrector's ULcnm Law(Chapter 9 Sq.Ft. Floor AreaValuation
rE (commencing with Section YOM)of Division 3 of the Busimm and Profemkors Code)or
fi
Chat M is exempt therefromtherefromand ft basis for doe alleged exemption.Any violmitm of fla (ii
Section 7031.5 by A"applicant,far a pennit subjew,me applicant to a Civil penalty Of -5)kPR IRNWer U U
not more man fivehundred dollars($500), Oc�cffppcy Typ
e
0 l,mower ofthe propeny.mmyemploycawith wgnuNoir sok cmpennOon,
will ce,the work.and the,structure 4 notirmodum.ifenci forsake(San.7044.Business
and Professions Cade:The orouractor's Liam Ina dao not apply W an owner of Required Inspections
property who build,or improve thereon,and who does such work hissualfor through his
Own employees,provided that such improvements am not intended oraflered far stie.If.
however.me Wilding or Improvement Is sold within am you of completion,the Owner.
builder will have the burden,of proving that he did not build or Improve for purpose of
ask.).
[]1.as Owner Or the property am exclusively contracting with licensed conaammn an
construct Use project(See 7044,Business and Professional Code:)The Contunctor's U.
came,Law docs not apply at in Career ofpmpeny who builds or improves,Norton,and
who corrusects for such prejecut with a caturictor(s)licensed pursuant in,the Carmine,
Lik"em Law.
[-)I am exempt morke Sao _.B&P C for this moon
Do. Data—
AlAkWORKERS COMPENSATION DECLARATION
I Wha"by me no*,parody of perjury Cm of the following deflarationa:
R to
I M matiresm.ctomr.O.I.Orconstarit.self-ImUre rdewarkee.c.p...
sithm.as provided for by Sao.3700 of ma LaWar Code.far live performance of Use
work for which this Permit is Issued.
41 haw and will maintain Worlam's Compensation Imuran,as rexturinad by Section
00 of the Labor Code,for the aurformamm of the work for which this permit is issued.
My Wmilme !:a" done I carrier and Poll,number am:r ;r Policy No.:311—a
CERTIFICATE OF ExEmFnON FROM WORKERS'
COMPENSATION INSURANCE
(This suctim need not becompictod If the Permit Is form=hundred dollars(SIM)
or lm)
I Certify that in the Performance of the work for which this PC=],is issued.I mall not
employ any iscroar,in any mannerm as M bccamc subject to the Workers'Compentuallon
Law,of California.Dam
Applicant
NOTICE TO APPLICANT:If.After making this certificate or EXCUOUPLi011,YOU Should
become subject in ft Worloor's Compensation provisions of ft Labe,Code.you a=
Z formwoola comply with men provisions Cr this permit shall W domed revoked,
z 0
CONSTRUCTION LENDING AGENCY
I hereby afflion Net them is a construction lending agency lot me rerformance of
the work far which this permit 1b;issued(Sec.3097.Ch,C.)
alender's Name-D z Lember'sAddinessai
U0 I certify that I have head this application and scate that the above information is
y with all city and county ordinances and sum laws resting ho
0 Wilding construction.and hereby authorise representatives;of this city to cmcor arm the
Wv.-M.nu...4 Property for inspection purposes.
(We)agree in save.indemnify and keep harmless the City of Cupertino against
coral I"'C'm"Oup"
Ilabilides,judgments,cow and experam.which May in My My ACCTUC against said City
"'a"0" perm
am a'"m
n C=CA 'N Of ID Issued U in
C "NDEMSU' OMPLjY WITH ON-POINT I dby:3 Date
UL S.� ea
C UL _(7
�R Re-roofs
Elliman.ofApplicaus,10MUrecter DOW
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant of to=Wilding occupant some ar handle hansidous material
as&Rncd by the Capetian Municipal Code.Chapter 9.12,and the Health and Safety
Care,Sued.255324)? All roofs shall be inspected prior to any roofing material being installed.
Oyu ERm'—
Will the applicant or future Wilding Occupant use equiparnecart or deices which If a Toof is installed without first obtaining an inspection,I agree to remove
v
it bounteous air contanolmoms U dcflwd by the Bay Area Air Quality Management all new materials for inspection.
C]Yes
I hew meal the newerdous romati.]z requirements muterChmpter 6.95 of the Calif.r.
Jae I he lenam.met it 13 My responsibility 0 notify that OCCUPLUL Of on
.is Has]"SalclyCode,Socumas 25505,25533 and 25534.1 madenuout ondirom Wilding
dra _;�>Psa
"Olck, h bc
oa�
raquire.c.,I of Signature of Applicant Date
0 S All roof coverings to be Class"B" or better
Owner &nh.ri,..d.,n1d Dam
09/28/2005 15:52 7075287663 PERMIT SERVICES INC PAGE 09
Sep 28 05 09:41a Cosmos Roofing (6501969-9905 p. 2
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GENERAL C>dNfRACPpR ) FAX d
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Pkaw cheek a e Date
the foo—Owing kmMEWL
SUMONTRACTOR SUSlN899 NNAME InBVSJNESS LICENSE#
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L1149M/ Wood
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Community Development Department
apa3;b�
Building Division
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
U PEkT'I A 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: 00 x5; e
Job Site Address:
i
Roofing Company Name:
Applicant's Signature: Date: OS
Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF
CUPERTINO PERMIT APPLICATION FORM
NN' APN# > 6/ / Date:
6
Building Address:
Owner's Name: [' p Phone#:
Contractor: Phone #: License #:
t/i 50 96 F Z b 3 2 9- N LI I
Contact: Phone#: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof L3 Built-Up roof
O Asphalt Shingles -9/ 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.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ❑
Job Description: 7—/, c '�� . CL—,a--d Sd t
Residential.. _Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Det. if
there are anrestrictions: LI
Cost ofprojecs y .p Type of Construction: Occupancy group:
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