01100133 (2) CITY OF CUPERTINO
!•BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO,
10225 BEARDON DR COSMOS ROOFING 01100133
OWNER'S NAME: APPLICATION SUB DATE
SKORDILIS NICHOLAS AND KASS 1901 OLD MIDDLEFIELD WY 10/24/2001
PHONE: (415) 493-6373 SANITARY NO. CONTROL NO.
q O ARCHITECfIENGINEER: BUILDING PERMIT INFO
<i I� BLDG ELECT PLUMB MECH
LZ_I 1==1
Z ori I hereby afilrm that 1 am CENSED lienutl under previsions of Chapter 9 hemonencing Job Description
LARATION
)w 1- with Section 7000)of Division 3 of me Business and Professions Curba.and my license REROOF.
5x65 iammnforea,e�<-rT<o� S � .r1 / T/O TAR & GRAVEL,
I a 6 License CI ss Lic,p
i0 O Dam �O U Contractor_
3
0 v ARCHITECT'S DECLARATION ADD B .U.R. W/CAP SHEET.
g O d I understand my plans shall be used as public mcords
a p p Licensed Professional
`d
OWNER-BUILDER mtCLARATION
uai 1 mason,
,(Sero o that 1 1. exempt from the Contractor's is License Law for the
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following reason(Sad ]031 5 Business and improve.
de Professions Code:Any city stcounty
3, which requires Permit .wet ape mforsu demolish,or p yswdurt
3 m - pito t t one Is q tie applicant far such pertnu to file asigned statement. -
tha(h sd«n:edp rs t[t Chep si of the Co Business
L . 1 ms,Cade)
) p F pp ¢.{ ) t*
(eo th cSection66i an fD iaror hhe8usmes ridPaf iCode) ��I,p`^'Ii\.ij:.et) � i:r1�lJ 'tae IPl t.Aii I 99'f ll'aUOn
or S h<7 cxcmpt thdefrom and the bass for the alleged airman to Any violation
of Section]831:5 iv any applicant fora permit subjects the applicant m a civil Penalty
of not mart man ave hundred dollars(asom. 3 2
O Los owner of the property,or my employees with wages as their sale compensation, '
will do me work.and me swam,is not intended or"olTmed for sale(Sea:70UI.
Busiac'sx'antl Professions,Coda:The Commcui License Law des supply to an 305 - FRAME Required Inspections:' ` ••
Owner of property Who Wilds or'repro a thereon,and who does such work himself
m through his own employees,provided that such improvements are not intended or 307 — INSULATION
offeredfol sale If,ho thebuilding' or improvement is sold within one year of
m ROOF
- - - - --..
- - -
eompleimn menwnera,'merwalna,�emenmm�nrpro.ngtbarnedid ntwileor 601 — ROOF TEAR OFF " . - 't• i: �'
reprove bar purpose of sale) 602 - ROOF PLYWOOD NAIL
1 LNeptceny exclusivelycontractingwnhlicensed contractors to
- 603 —ROOF -BATTENS-
0
construct'he p mi
ct(S 44 : d .70 B ns Cod )Th C noor
se s /
LicenseLa e, i dpplyi o nofpWilds m
pro<aaenn 604 - ROOF IN-PROGRESS ' /O
and ho.contract fo corm
actions)with.a.conctods)lickmad pn
ursut.to the
`
Canna to6 License Low.
❑lam exempt undo Sm. r' ''' " ' "•.B&PCfor this reason
Ow c " 'Dai
WORKER'S COMPENSATION DECLARATION
1 hereby eOirm under cevlry of perjury one of the following declarations:
01 haWtind will'maintain'a Certificate of Conten to self-insure lot Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance m me work for which this permit is issued..
1have and will maintain Worker's Compcnkmloo'Insurance,as required by Section
.of the Labor Codc,,0 the performance of the work for h ch this permit
sed MyW esCo pc tool s'a e. dPopcy nu be rc' -
'7-+'•Q.. -+Pau cyNn , f i., "<. '4'�'. 4. <: il --1' V1r: - -
t CERTIFICATION OF EXEMPTION FROMWORKEBt - J4 .I Yf�r3.:
r COMPENSATION INSURANCE'
r (Th' sect on need
rot,4, completed,f the permit is for one hundred dollars t. 's,', ' •i�')e
($100)or less) '
.4 cenifY that in the pert iia f the k for which thil7pi' issued 1 •,. '• ...._. - - .- -
Co.Out plyany ce nany mrm rsoa to bcomeab3ct to the Wokers
Compcnsa[ion Laws of C bforn a.Dam
z IcNOTICE TO APPLICANT:If,after making this Cnin s of of Labor Crude.you should -. -
cdme subject y the surkcr's Comceo rti is provisions of a deemed revok you must "
� O fonM1with comply with such provisions or this permit shell be deemed revoked. o
z
� CONSTRUCTION LENDING AGENCY i' r�� "'
' ;'o -1 h ieby eRnn chat Ne s a constrvn on IeiM'ng agency for Ne per(oimance
of the dri f h ch N permit ssued(Se 309]Civ.C) ' -'
�10 ,,. I<nfy Netlha Jih pPl emu d tt thin th abo f ions '
[r corte2t 1,gra to comply th all ny end aunty ordinance and nate laws renins
C)_V to buJding conatrvction,and hcreby'auNoiize rcpresenmtives ofthis city to enterapon
:�:,ra] the above-memioncd property far mspeaion purposes.,, ,
E..G (Wc)egramsave,indemnify and keep M1arirJess the City6f Cupeni,io against
y liabilities,judgments,costs eiM expenses which may in any way,accrver against said
V nZ., Ciiy in consequence of N gra i n f Nis c -
MPEICANT UNDER. ND WILLw)MPLY.WITH ALL NO �POY '
SOURCE REGULAT Is - _'` y���„/ e � Issued by: -712 Date 1��
Signature ofApplcinUConox r% - Yate ' :, . Re-roofs
W
HAZAR US MATERIAL$DISCLOSURE f _, '
U Ne applmaht o f more dnld dg acopnt tree or hnpole hazardous mammal Type of Roof
as defined by the Cupemn Mu ' plCode Chapter912 and the Health and Safety - I
Code Section 23532(a
r•a' +Q I
DY S 111 YI s a z ♦<.pt ' i tit: !
. All roofs shall be.Inspected pnor,to any-roofing material being installed.
• , Will Nc applicant or future building Occupant use equipment or devices which If a roof is ifistalled:without first obtaining an inspections I agree t0 re1170Ve
emit Was rdd ma t.is defined by thee y Arco A Quality Management
District?a - all new materials for inspection. Applicant understands and will comply with
" allnon-point source regulations. .t
_
" 1 have read. h zardo mac rials netpumment,under Chapter 6 95 of the r
Calif m a Health&Safety Core;S mons 25505 25533 add 25534 1 understand that
ifflaebuilifingJ notcurrently h tenni that yresp responsibility notify the
oc upant of the q Iii W rs w1. 1.11"hich most met Poor to issua ce of a C nificam of
Occupancy .
/p�2y/o l Signature of Applica Date
Data „ All roof coverings to be Class "B"or better
_.. f OFFICE
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