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03070077 (2) CITY OF CUPERTINO BUILDING DIVISION PERMIT 4CONTRACT•.OR INFORMATION " aU (415) 493-6373 ILDINCADDRESS: COSMOS ROOFING """'*03070077"""'*03070077OWNER'S NAME: 1901 OLD MIDDLEFIELD .WY PERMIT ISSUE DATE ONE; SANITARY N0. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH up LICENSED CONTRACTOR'S DECLARATION L� LL1� v....l'� w FOF I hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Des ript10n r Fit3 with Scoti..7MM))of Division 3ofthe Uusinasatd Professiom Codc.and my hot.is ,pH in mu tome and cf t '�. 8'S �'� REROOF JUL gl 2003 ? License CLle.N Dam Cunt cod' £4 ARCHITECTS aDECLARATION rpt/+ �W I understand my Pl ..us,hall W usedpublicmeool. BUILDING pa 5� Licensed Pmfesximil GNER-BUILDER DECLARATION f 1 hereby strips Nm 1 em exempt from the Contractor's License Law or the _p O following reason.(section 7(01.5,Business and Professions Code:Any city or county which m4onct a Perrot to construct,alter,improve,demolish,or repair any atrnemm pnmm its issuance,also requires she applicant for such Pcrmitto file a signed statement mm< that hcislicensed pursuant tothe ptivisions(if the ContractorsLimsto aw(Chapter 9 Sq. Ft. Floor Area Valuation rl-$ (commencing with Section 701(1())of Division of the Business and Profcssinns Code)or - [t that he Is exempt therefrom and the basis for the alleged exemption.Any violist of 34214111 . 00 Section 3051.5 by airy appliesnt fon permit subjects the applicant to a civil Penalty of APN Number Occupancy Type not mom don fns hundred dollars($500). ❑ I,u owner of the property,or my employees with wages u their sole compensation. will do the work,and to income is not intended or offered for sale(Sec. Business 305 FRUME — and Professions Code:no Com uchn's License Law door not apply in an owner of Required Inspections property who builds or imprnws Hereon.and who does such work himwlfcr through his 307 - INSULATION own employees,provided that such improvements arc not intended or orfered(or sust.If. 601 ' — ROOF TEAR OFF however,to lmilding of improvement is within one you of compound,the ownco- builder will have the burden of proving that he did not build or Improve for purpose of 602 - ROOF PLYWOOD NAIL sale')' 603 - ROOF BATTENS ❑1,as owner of the propcny,am exclusively contracting with licensed contractors to coauucnhe project(Sec.7G&L Business and Praressions Codc:)The Commcmrs Li. 604 — ROOF IN-PROGRESS exist,Law docs not apply to an owner of progeny who builds or improves themon,and who contacts for such p ejects with a contracon(s)licensed pursuant m the Co Ionto'. - License Law. ❑I am exempt under Sae. ,B&P C for this moon Owner Data WORKER'S COMPENSATION DECLARATION I hereby aRrm under Penalty of injury one.(,he following declarations: I It.-and will maim.in a CeniMam u of Consent wlf-inam for Worker.compete mien,a provided for by Section 37W of the labor Code,for the performma or the w ret for which this Permit is issued. I have and will maintain Worker's Compensation Insurance,as required by section W of the Labor Code,for the performance of the work for which this permit is issued. y Work-AC.0gfensuni Insunntt nrticr and Policy �naumberno: Cartier.-NZ �s•'—r Policy Na /1 CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Thisseetion need not hecomplowd if the permit is fnrond hundred dollars($100) or Ices.) I comfy that in the performance of the work for which this Permit is issued,I shall not employ any Person in any manner at or m become subject to the Worlecri Compensation Laws of California.Date Applicant NOTICE TO APPLICANT.If.afwr making this Ccnifrcaw of Exemption.you should become Subject m the Worker's Compensation provisions of the Labor Code,you must .J z forthwith comply with such provisions or this Permit hall M doomed revoked. Z 0CONSTRUCTI ON LENDING AGENCY — I thirchyshame air,.Nat dwreiu eoatnwtinn lending agdmy or Use Pcrfurmantt of (✓ — CL> the work for which this permit is issued(Sec.3( ?.Civ.C.) de W Q Lsnr' Name . D z Lenders Address U Q 1 certify that 1 have mad this application and auto that dm above information is Fcorrect.I agree to comply with all city and county ordinances and state laws misting w 0U building construction,and herebyauthorise mpraenutims of this city to enter upon the G ahovo-mentioned proarty,for Inspection purposes. (We)acme to ave,indemnify and keep outsold.the City or Cupertino against ti N liabilities,judgment,eosu and expenses which may In any way accrue againnsaid City / - U Z in consequence of the gaming of this Permit. APPLICANT UNDERSTAND�J.NB-11(ILL COM��IIL..Y WITH ALL NONPOINT Issued by: Date SOURCE REGULATIONLtQ I .M/l o r6� •(J�� ( / Re-roofs Signature of APplicanVConmcmr1110 Got HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future Wilding occupant store or handle h unamous material a defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety Code,Scctirn 25532(a)? All roofs shall be inspected prior to an roofing material beim Installed. ❑Yea p p ' y s g ' Will the applicant or future building tecupant use equipment or devicor which If a roof is installed without first obtaining an inspection,I agree to remove It ho'mrdnm air contmninano as defined by the Bay Area Air Quality Management all new materials for inspection. «� ❑Yet ❑ I have reW the haardWs materials m loremenu under Cooper 6.95 or the Calif.,. nia Health&Safety Code.Sections 25515.35533 and 25534.1 undersand that ifthe building _71)v dens not currently haw a moans Nat it is my msponsihil ity to nndfy the accuPat of the myuire" whi���'�°}tett prior wisstyyq�s ofa Certificate:of Occas dr. Signature of Ap Kant Date O - —L- �O�L 7ll�V�S Owner onwhorimda t to All roof coverings to be Class"B"or better Community Development Department Building Division � City of Cupertino 10300 Torre Avenue Telephone: (408)777-3228 CITY OF Fax: (408) 777-3333 fUPE' kJ1N0 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: �R/Ln/u %� C.,04 a(s��y� - Job Site Address: Roofing Company Name: e,,V t.v o �*_ A plicanYs Signature: " 10 O3 eel Date: 2 \�ll4tilh10LY� I� Greg t Building Official Revised 1/30/03 Printed an Recycled Paper 1 CITY OF CUPERTINO d 3 0 7 n a 77 REROOF CUPERTINO PERMIT APPLICATION FORM APN# n I Date: _00103 LafD Building Address, O Owner's e* Lin Phone# �S593 Contractor:12 Phone#: License#: 6.52 94IF= 64-3 7IsVs�/ Contact: Phone#• Cupertino Business License#: Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles )(- Asphalt Shingles `K Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other(Specify) ❑ Other(Specify) Nkmber 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:Ta S,14,& � 74 Vss, 3e-f�. Qow Residential Commercial ❑ Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if there are any restrictions: LJ Cost of Project: Type of Construction: Occupancy group: 131 )2-3 • n if h ble 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 lro , �0