03120016 (2) CITY,OFCUPFRI'INO "'"'n' " t : >`' ='
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION ^`
Jfi rf'x'a$.°". `" SRS w.•c- k \ :r� '/5� 4,Q 3i3 ^'k.
BUILDING A DURESS: COSMOS ROOFING PERMIT NOO 3120016
48 HYDE AV
'ER'S NAME: PERMIT LSSUE DATE
QNA YUNG 1901 OLD MIDDLEFIEL 12/03/2003
ONE: SANITARY NO. CONTROL NO.
(415) 493-6373
ARCtI1TECT/ENGINEER: BUILDING PERMIT INTO
BLDG ELECT PLUMB Mn
100 LICENSED CONTRACTOR'S DECLARATION Job Description
I herchy affirm that I am licensed under provisions of Chapter 9(commencing p
£ito with Simon.7000).f Division 3 of me Business and Profession Code.and license is
in Leer eeand of 39 RE-ROOF TEAR OFF B.U. R.
oo�n GI Co." B.u.R. FI
ARCHITECTS A' N�4,L��
f w a I understand my plans.hall he used as public records
oLicensed Professional FEB 1 6 2004
g OWNER-BUILDER DECLARATION
<$ 1 herchy affirm that I am exempt from the Contmemr's License Law far the
O 0 following mason.(Section 7031.5,Business and Professions Cmle:Any city or county BUILDING<m� which rcPermit quims a peit to construct,alter,improve,demolish,or repair any strucmne say
?iy prior m its issuance.am requires the applicant for such Permit to fit ea.igmad smtamenl
a that he islimaxedpurmanttothe pmvisionsnfthe Contractor's[,loan=Law(Chapter 9 Sq. Ft. Floor Area Valual$)I)100
EFC (commencing with Section 70007 of Division 3 Of the B usincv and Professions Code)or
Q $
that he is exempt memGom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects me applicant to a civil penalty of APN Number Occupancy Type
not more Nan five hundred dollars(S500).
Dl,as owner of the pmpeny.or my employees with wages as theirtalc mmpereaddin, 37539001 . 00
will do the work,and the larmacm is not intended or offered for sale(Sec.7041,Business
and Professions Cock:The Contractor's License Law docs act apply to.n owner or Required Inspections
progeny who builds m imprmvas mereon,and who doessucM1 work himself or mrougA his
n employees,provided thatsuch improvements are nut intended oroffered formic,If.
however.Ne building ar improvement is told within ane year of completion,the owner.
builder will have me burden or proving mat he did not hot ld or improve for propose of
sale.).
D 1,as owner or the progeny,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Code:)The Contractar s U.
cavae Law docs not apply to an owner f property who builds or improves themon,and
who contracts for Such projects with a eon aemr(s)licensed pursuant to the Comnctoes
Lima.Law.
❑1 am nampt unties Sec. .B A,P C far Nis reread
Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury arc of the following declarations:
I have and will maintain a Car ificam of Cantata to self-insure for Worker's Compere
sxtion,v pmvidcd for by Section 3700 of Ne labor Cade.for the pcdormanca of the
work for which Nis permit is iasucd.
an and will maintain Worker's Compensation Insurance,as required by section
't I Ne Labor Cafe,for Ne performance of Ne work for which this permit is issued.
My Worker's Compensation Insurance caner and Policy number are:
Camey. 5 - -1 a--J- Policy No.:'g 11 -0
CERTIFICATEOF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
This section need not he eomiramd irtha permit is for one hundred dollars($100)
lem.)
1 certify Nat in the parrnrmance or the work for which this permit is lotted,l shall not
employ any person in any manner an a to become subjecu.the Woraesi Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:IL after making this Cenificam of Exemption,you should
became subject to the Worker's Compensation provisions of Nc labor Cade.you must
O fonbwith comply with such pinvisi.m.1 this permit shall he domed ro
oked.
Z o CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for Performance of
il4 > the work(ar which this permit is issued(Sec.3097,Cil G)
!Ll O Lender's Name
=,z Lender's Address
U O 1 certify Net I ban read this application end rata ren the above information is
f-' connect.l agree to Comply with all city and county ordinances and Stam laws adating to
0 U building construction,and hereby atimmim representatives of Nis city to enter upon the
C. ahovcmaa)ancd gme,to ave for Inspection an keephs.
(Wcj agmen to vvc,indemnify and kith harmless the City ore against
against
UZ
liabilities. S oft naesmit. mryinany way accmeaPinxt soldCity
Uz inconsequcncc afinegmmoN Soft permit.
�-'
APPLICA NDERST N D WIL OMPIaI'WITH ALL
/NON-POINT Issued by: Date
Signs ULA V-3/0
7 Re-roofs
Signs of Applicm HAZARDOUS
Dam
HAZARDOUS MATg occr50oomm URE Type of Roof
Will dtaapplicant or future buildinge.Chaptstore.,handle Health and Safety defined by
the Cupertino Municipal Code.Chalone 9.11,and the Health and Safety
.Section 15531(a)7nom_ All roofs shall be inspected prior to any roofing material being installed.
Dy.
Will the applicant or future building occupant um equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it hazardous air contaminants u defined by the Bay Area Air Quality Management all new materials for inspection.
District]
❑Yes
Iban&Safet Cede.Se n.materials 533sume as 5534.1under Chapter
rstand 95.fine Caldror.
n
.is not cur Safety Cale,Sen.. t is my 3 and25534.1 to mm y the OcDM building
Of me
dors not currently have a mnens BOBNat it is my reaponsiM1ility m nodlj'the cecupant of me
rayuiramam hmhmvv me rtuissa .nanfie,mar�o ar Signature of Applicant Date
All roof coverings to be Class"B" or better
Ow`7%ft,--r1A7rnVcat 7 Dam
CITY OF CUPERTINO
1 of 1 PERMIT RECEIPT OPERATOR: suem
COPY # 4
Sec: Twp: Rng: Sub: Elk: Lot:
APN . . . . . . . . : 37539001.00
DATE ISSUED. . . . . . . : 12/03/2003
RECEIPT #. . . . . . . . . : 23950
REFERENCE ID # . . . : 03120016
SITE ADDRESS . . . . . : 948 HYDE AV
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : ANNA YUNG
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4663
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 . . . . . . . . : (415) 493-6373
E ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
_____ _____________ __________ __________ __________ __________ __________
BPERMFEE VALUATION 8, 000.00 137.00 0.00 137.00 0.00
BSEISMICRE VALUATION 8, 000.00 0.80 0.00 0.80 0.00
__________ __________ __________ ----------
TOTAL PERMIT 137.80 0.00 137.80 0.00
METHOD OF PAYMENT AMOUNT NUMBER
_________________ ------------ ----__-___________
OTHER 137.80 VISA
TOTAL RECEIPT 137.80
CITY OF CUPERTINO
sc
45% REROOF a,3IC2001UPERTINO PERMIT APPLICATION FORM
I
APN# �j Date:
Building Address:
Owner's Name: O {� Phone#:
1-57 - 5y33
Contractor: P e#: License#:
4.50 ��5 76�� 7
Contact: P Phone#: fil— Cupertino1B i ssfLicense#:
15
Type of Roof Covering: �,
Existing: Proposed:M
Built-Up Roof 7' Built-Up roof
13Asphalt 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: ❑
Job Description:
Zl. Q-C�D
/j • u l�
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed EPPIanning Dept.Eif ]
there are anns: LJ
Cost of Project: Type of Co io Occupancy group:
�/OQ • W
Qty. i
A licab Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
BENERGY Energy BUILDING
1.... ._ BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
Community Development Department
Building Division
i
Il City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408) 777-3333
CUPEkTINO
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: 12�'I/i�LIQ (fit S—
job Site Address: 9y_
Roofing Company Name:
A p �-'cant's Signature: Date: y 03
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper