05110010 (2) ,CITY OF CUPERTINO >u�x ,l � ' Y°r%�'�'' °'`'` }` - '•' `e
BUILDING DIVISION PERMIT ,, NT ,�,Ta' '.T, �' -
BUILDINGADDRESS: COSMOS ROOFING "c"m1 ND'05110010
-22741 MEnTNA IN
OWNER'S NAME: PERMIT ISSUE DAIS
DIANE THOMAS 1901 OLD
NE: SANITARY NO. CONTROL NO.
(650) 969-7663
ARCHr1ECTIENGINEER: BUILDING PERMIT INFO
'BLDG ELECT PLUMB MECH
0 0 0
LICENSED CONTRACTOR'S DECLARATION Job Description
t I hereby by slams tem 1 w ta licensed under pmvsfiaof Ceapm 9(commencing
with Section Tow,arDividon S Older BusisemW Professions Cade,and my liar le
+� ifull raa.ndQe<(f{t:i�jr�wjj REROOF--T O WOOD SHAKER, ADD COMP
Licence Clma�Lle.N?R-5q' /
Dan: Conu>mar
p ARCHITECTS DECLAR TIO
f I understand my plans Nall k used an public meord,
va
Licensed Pm(essianal
OWNER-BUILDER DECLARATION
S 1 hereby.aim that 1 1. eumpt from Ne CUime,Co Licence Law for me
0 o following moon.(Sudan 703 construct,
Busies and wn.de oli Cole:Any city or county $15660
9 which its Wa a demit re ctmruct alter.nnprow,demolkh,er e poly any aceneert
Zr
that
he I.lu+wrc0.almet to the the applicant for such Cmeracmttm rig Law(mmcment y
€< (commis licensed mmUon to the of Division
3NC Conummrand Proflaw(Chapm9 Sq.Ft.Floor Area Valuation
s (commendnSwiNSecdon70adthe baision3 them Bmissondon.MyoviCode)onof
—
that k m nwnpt therefrom and Ute bum fa the alleged...—ptidt MY violation of
Semon 7031.!by airy appliant(er a pewit mbjuu Ne tpplkant m a dNl penalty of - cupancy Type
cot mom than Bw hundred dollars 15300). 0
0 1,an owam of No property,army employs with"gas u dteirmk comp umation, AN
will do tkwak.an4 thearoctme m cot intended erOffered fared.(Sm.7044.Business
and Profesdarm Code:The Conlractora License Law ds Out apply W an owxr,of U d Chong
property who buildsorimpms Unseen,andwhodoessuch work himselforthrough his �pw�
awnemploys,Provided that such Improvements w not intended oroRered fords U. 1,7T/vC\
however,the building or improvement is mid within cam year of ma pkeon.Ne oww- L
builder will bane Ute burden of proving that k did not build Or Improve for purpose of
❑1,u mrsr or Ute Property,w exclusively contracting with Beenud contractors W
carrousel the project(See 7044,Buena and Profte sir Cod.)The CoourWs U,
cease law ds not apply to an owner of propenYwhu builds or improves shaman.and,
who contracts for such projects with a contractor(s)licensed pursued m the Commemes
License law.
0 l am umnpt under See .B h P C for this renov
Owner Data
WORKER'S COMPENSATION DECLARATION
1 thereby affirm under penalty of PadmY tiro often following dedarmiov:
I have mW wRI mainWnaCeNrmam a(Cansent s self-luume far Worker'sCompen-
sedan,u provided for by=on 7700 of the Labor Code.for W performance of the
svmh far which Its permit is imud.
I have and will maintain Worker's Compemadon luunnce,u required by Sedan
of the labor Cous,far Ne perfarmwme of Out work for which this permit in Wood.
My WorkeYafta7115 Nim uwic and Policy number tae:
Carder. �7'' M x Policy No.4 71—0 S w// LS
CERTIFIG7E OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This Mellon sed oat k emnpkmd If use permit is furone hundred dogma($100)
or leve)
I certify that in the performance of the work for which this permit is Wood.I shall am
employ any permn in any mannoran m in become subject in Uewarkem'Compenmdon
Laws of Califomia.Dam
Applicant
NOTICE TO APPLICANT:If,after making this Cerin^,^of Esemption.you dmuW
become subject in Ne WarkeYa Cnmpensaunn provisions or the Kiser code you a=
.J O forthwith comply with such provision or this permll Nall the deemed revoked.
zy CONSTRUCTION LENDING AGENCY
(.n Ikrehy am.that Nes is a eonmttetinn lending agency for the lterlo^na^ce of
ai > the wort for which this permit Is(stud(Sec.3097.Civ.Cd
a . I..-Oes Nsmc
.7. z Lender+Address
U0 mI aNthat m I have read this application Nm
ion and the above in(omadun is
U.U coet I agree m Ordinances with all city and county Ordinaand state laws relent m
O building construction,and hereby worodse mprucrOL"M of Nk cicy to enwupnn One
W ahwe-mentiamd property fm inspection purposes
(We)agree m save,indemnify and keep hamleh the CnY Of Capenino agent
cA IiabiliUu,judgmenu,cuts and expenses which may In my way mese against said City
U z in COmmiave of the totaling of this Permit.
., APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REG S.
:1 /%(/09 Re-roofs
Sigmund a( pplican u Dim
AZARDOUS MATERIALS DISCLOSURE Type of Roof
W(11 Ilan applicant or future building aapant mom or handle ha>nduus material
an dented by the Cupertino Municipal Code.Chapter 9.11,and the Haws and Safety
ode.Sedan25532(a)? All roofs shall be inspected prior to any roofing material being installed.
[:]Y. feia�`
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mit hazard.us dr contaminants u dented by the Bay Ams Air Quality Management all new materials for inspection.
District?
DYns QsYY�
I haw mad Ute hazardous materials mquimmew under Chapter 6.95 of ft Cali(or•a tenI•y 1
nix Health&Ssfmy Cade,Secds25505,25533 end ISS34.I undermand Nnlfdte building /� t 1Qs
Js seat monody how ant dant It is my responsibility m notify the of Ne
rtyutrtmenuwh dpoor miu ar.cerdnama„ Signature of Applicant Date
ei
Owns armNanxdagDow All roof coverings to be Class"B"or better
11/01/2005 09:35 7075297663 PERMIT SERVICES INC PAGE 03
Nov at CS 09:50e Cosmos Roofing (650] 969-9905 p. 4j
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C� 1N0 FU(40t)777.3737
Building De arbncnt
JOB ADD11Ti6S:
2•Z l E.�I.NA LAq� �RhtIT DSllaol0
OnTW NAA IAL)& Tli B 4e 4U6-f L4$
DS F IJ AXN
X I am not using any subconitRctm
s Date
Piee.edwk appamwesa O0
SUBCONTRACTORBUSWL86 NAME BUsvft UCEN6B 8
Gabh�&MRwark
canwrt pin
ffiecMai
JB�awvatton
fl
unoteam/wove
1-]ea
• hunlation
dsstamosuat Sbeermeal
w
Septk
TU&
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Shan Rock
OWMI tun / / Date
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
OCITY OF Fax: (408)777-3333
UPEkTINO
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 sta ed policy on re-roofing.
Homeowner's Name:
Job Site Address: 7 7
Roofing Company Name:
Applicant's Signature: Date: ! D S
• Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
� CITY OF CUPERTINO
GUS- REROOF
2 CUPEkTINO PERMIT APPLICATION FORM
APN# 02 30 0 -S, Date: /l//� � O--s
Building Address:
227 sir �'►n ecP.w; La,,.= _ — pyo �-N
Owner's N e: Phone#: Y 4C _ 6'2-44 $
Contractpq e# License#:
� IdA, CSS G 9-76 63 785`! V I
Contact: ,/� Phone : Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles >C 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.'
escriptio �a, ,Q �c2 s- 4 �/� 50 7+ Q�14
Residential Commercial ❑
Fire Zone: Yes ❑ No @- Confirmed with Planning Det. if
there are any restrictions: LJ
Cost of Project: Type of Construction: Occupancy group:
/,57 6Go . w
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
BENERGY Ener BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
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