03090006 (2) CITY OF CUPEWUNO -'
BUILDING DIVISION PERMIT ,CONTRACTdR,INFORMATI0,N:
rk>,.,. _P= ,rte . a
BUI LDING ADDRESS: COSMOS ROOFING PERM1TN003090006
WNER'S NAME: 1901 OLD MIDDLEFIELD .WY PERMIT ISSUE DATE
r NE: SANITARY NO.
(415) 493-6373 CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECIi
loo LICENSED CONTRACTOR'S DECLARATION
wp 1 hereby affirm that 1 am licensed under provisions M Chapter 9(commencing Job Descri tion
FzW with Scedon?Mol'Di"sion3ofNCBusinessa PrufcscionsCodc myliccnsi �lN�1L.E®
in full farce and eff
;�� a« a � —ROOF
- p Dam
ARCHITECT9 DECLARATION SEP 2 3 ZOOS
I w U 1 understand my plans shall W used as public records
a.
:�� Licensed Professional BUILDING g OWNER-BUILDER�ECLARATION BUILDING
a f 1 hcrchy affirm that I am exempt from the Contractor's License Law for the ✓✓{V/
00 fallowing reason.(Section 7031.5,Business and Professions Code:Any city at county .
<$ which rcyuiress a permit to construct,alter.improve,demobh,or repair any stactum
poor to its issuance.also requires the applicant forsuch permit to file asigned..Satemenl
cre< thathc¢licensedpursuanlmlheProvisionsOfthcContmcmrsLicenschw(Chapter9 Sq. Ft. Floor Area Valuation
RI—Q (mm mencing with Section 7000)of Division 3 of the Busimea and Profcssinru Code)or
Out he Is exempt Ocrefrom and Ne basis far the alleged exemption.Any violation of 32630182 . QQ
ane ccas
Section 7031.5 by any applicant be,a permit subjects On applicant to.civil pemlly of AIN Number
not OType _
more than fiw hundred dollars(SSW). P Y YP _
1,as owner of the progeny,or my employees with wages as their sole compensation,
will do the work,and the structure is not intended or onered forsale(Sec.7064,Business
and Pmressinns Cade:The Contactors Liaas<Law doas not apply m an owner or — Required Inspections
propertywhebuilds.rimprowsthereon,andwhodoese�chworkhimselforthroughhis 307 — INSULATION
own employxv.provided the such improvements are not intended oroffefed for sale.If. 6O1 — ROOF TEAR OFF
however,the building or improvement is sold within one yew of completion.Oe owner-
buildef will new Or burden of proving that he did nm Wild or improve fur purpose of 602 — ROOF PLYWOOD NAIL
sale.).
1,as owner of the property,am exclusively contracting with licensed emoricaaa to 603 — ROOF BATTENS
convect the project(Sec.7064,Business and Promsslom Code:)Tom Contrecons Li. 604 — ROOF IN—PROGRESS
cense Law does not apply to an owner of property who Wilds or improis Wcreon,and.
who contracts for such projects with a contras of(s)licensed pursuant to Or Contractors
Lice nae Law.
❑ l am exempt under Sec. ,B&P C for this reason
wner Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following occlusions:
1 haw and will madown.Cert elan of Conunuo self-insure for Worker'sCompcn-
smion.as provided for by Section 37W of the Lmm Code,for the Performed.of the
work for which this Permit is issued.
1 have and will maintain Worker's Compensation Inmance,as required by Section
3700 of the Labor Carlo,for Ne performance of the weak far which this permit is issued.
My Worker's Compensation Insurance carrier and Policy number art:
Carver. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not no completed!if the permit is for one hundred dollars I$1(1(11
at kers.)
I certify that in the performance of Ne work for which this Permit is issued,I shall not
employ any person in any manner m as In Wcomc subject to the Workerd Compeaddion
Laws or California.Date
Applicant
NOTICE TO APPLICANT.If,after making this Certificate of Exemption,you should
become subject to the Workers Compensation provisions of the Labor Codc,you must
z forthwith comply with such provisions or this permit shall lrt decmcd invoked.
Z O CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a consWction lending agency for the performance of
Aa 7 the work for which this permit is issued(Sec.3097,Civ.C.)
25 o Under'Name
3. Lender's Address
Dz
J O 1 sonify Oat 1 have read this application and sum that the above information is
y cancel.I agree to comply with all city and county ordinances and stets laws relating to
Z)U building convection,and hereby authorise representatives of this city to enter upon On
W alwvrme dproperty fan inspection purposes.
gy (We)agree to save,indemnify and keep harmless th
rmlee City of Cupertino against
lip
liabilities, dgmcn¢,costs and capcnses which may in any way¢serve against said City
;J z in conuquertce of ting of lis
^� APPLICANT U RSn A LL CO Y WI ALL tJO POINT Issued by: ADate
SOURCE 4/
Re-roofs
9gnuure ofAppl¢anUConvumr Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will On sodium,or future Wilding Occupant store or handle hawdous material
az defined by the Cupmina Municipal Codc.Chapter 9.13,and the Health and Safety
de.5cctien 25553(¢)? All roofs shall be inspected prior to any roofing material being installed.
Yq
(
Will
the applies.,or future building Occupant me equipment or dchen which If a roof is installed without first obtaining an inspection,I agree to remove
it haewdnus air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection.
vier? ^��
❑Yes Is mat
1 have mad the hmzNrmsmaterials rtyuiremcnts under Chapter 6.95 of the Califon
Dia HcalO&Sof Codc,Sccliun 35 15533 an 534.1 undcrsevN Oazif the Wilding Z
Cites Dol cu r halo. m t' is my res iM1ilityln notify Oe rveupwt of Oe
q m Signature of Applicant Date
Owner ser au,hanscd agcm 9 DO All roof coverings to be Class "B" or better
Community Development Department
Building Division
:dr City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
U P E IST I N 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.
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: 0(U
Job Site Address: X08"52
Roofing Company Name. oy --zs
Applicant's Signature: Date.� 3
Greg teal
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
"ROOF
CUPEkTINO PERMIT APPLICATION FORM
to3p 9X0o
APN # 3,;, Y Date: _PI 3
Building Address:
d.e 'L,
ner's Name:C_ Phone#:
Z70 s. _ �o � 7_36 -5700
ontr c r: Phone#: License It:
650 96r-760
Contact: � Phone#: � — Cupertino Business fr
Type of Roof Covering: O
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.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Jo esc ' do
7/0
Residential Commercial ❑
F' Zone: Yes ❑ o ❑ Confirmed with Planning Det. if
there are anrestrictions: LJ
Cost of Project: Type of Construct' Occupancy group:
/S S/o 6b
ft,,cable
Fee ID Fee Description Fee Group
ERMFEE Bld Permit Fees BUILDING
NERGYEner BUILDING
EISMICRE Seismic Fee Res BUILDING
EISMICOM Seismic Commercial BUILDING
LANCHK Plan Check Fee BUILDING
SLIC Business License BUILDING