06080249 (2) CITY OF CUPERTINOM",
`
BUILDING DIVISION PERMIT ;kCOk1�TRACTn.RwINFURM.ATIQ
BUILDING ADDRESS: COSMOS ROOFING PERMIT ND.O 6080249
10665 MORENGO D
OWNER'S NAME: PFRMR'LSUBDATE
RICHARD BEERMAN 1901 OLD MID
E: SANITARY NO. CONTROL NO.
(650) 969-7663
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
D O O O
I,00C LICENSED CONTRACOWSDECLARATION Job Description
i V ys I hereby efflrm that i we licensed make proviAma of Chapter 9(cmnm useing
util with Smhwn]UMs)of Division]af the Budnevand Profusions Cde.and mylkenseu
j infull fo=and r 7 yLl REROOF TAR AND GRAVEL CLASS A
�>az License CI
Cony
F� Dale Conmacbr
££
1 undr
ARCHITECTS DECLARATION
�C� cwnJ my Puns shall W used as Public mcnrJs
iyU
G
LicenscJ Pmfcuional
'y3 OWNER-BUILDER DECLARATION
I i I hereby affirm that I am exempt from the Cantalcloral License Law for the
:O o following mason.(Section 703 1.5.Business and Prafessinns Cade:Any city or county
19 a which mquima a permit to construct,alter.improve.demolish,m mpalr any coccus, $5292
prior in ha issuance,9190 requires Ne applicant for each Permit rile asignd statement
i G That heulicensedpursuanttotheprevisionsoftheConoador'sLicamcLaw(Chapter9 Sq.Ft.Floor Area Valuation
i $ (commend.{with Section 7000)of Division 3 of the Business and Professions Code)or
that he is exempt therefrom and the basis for the WeSed exemption.My violation of
Section 7031.5 by my applicant fm a permit Ubjmu the applicant ha a civil Penalty of ( Occupancy Type
not mom data Bea hundred dollsn(5500).
0 1.u owner of the property,or my employees with saga as their sole mmpensoou,
will da the work•and to auucom as=I Intended or offered for wall(Sea 7044,Beef., Required Inspections
and Professional Code: o sem The Carmichael License Law does, apply an owner of q P
pmpeny who builds m impresses dicamen,and who does such work himself or trough his
own employes,provided that such lmpmsemenu am not Intended oroffmcd forsake If. �f
hmaeum,the Wilding or Improvement is old within mm year of completion,the ownta-
builder will Nva IW burden of proving that he did Out Wild or improve for purpose of
sale.). `L1
❑I.as owmr of she property,w aelusively...gong with Insured cenohehars m
Imem La the project(Sec.o an Businessfand Property
ol Code:)TW.dureara LI-
w hoe(sew dos vest apply j.an owns of I.opanY who holds din m bnprova therven,and
who.Lacu fm such gojecu with amnmaetar(s)licensed Pmsuanl m the Convacmts
License Taw. T j
❑lam aaempt under See .B&PC fm Nis moan ,
Owner Data
WORKERS COMPENSATION DECLARATION v
I hemby aflUm under penalty of perjury am of the fallowing dmlaroans: b
0 I ham and will malnuin a CartiOate of Consent ha helf•Inalurt fm Workers Campem /
soon,u pmvidd fm by Station 5700 of the Labor Code.for the perform me of the �o
work for which this permit is Issued.
0 1 have and will maintain Workces Compensation Insurance,as required by Section
37W of the Lamar Cade,for Ne performance of the work for which this permit is limed.
My Workers Compensation Insurance carrier and Policy number are:
Curter. a4{911. F.h A Policy No:S7/-000)1115�—
CERT1 TIF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE -
(ibissectim heed not W completed If the permit is(mane hundred dollars($1010
or la:)
I cenify that in the performance of the work for which this permit is issued.I shall not
employ anyperson in any manherse a to became object m the Womost Compensation
Lawsof Caffomia.Data
Appllont
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject in the Warke s Compensation parmuns of the Laden Code,you am
,J 0forthwithPer
forthwith comply with such provisions or this mit Mall be deemed revoked.
„zhCONSTRUCTION LENDING AGENCY
t~ 1hemby.M.then f.iso mnnn¢tinn lending agency for the performance of
tx> the work for which this permit m issued(See.3097,Civ.C.)
(y Q Lcnddal Name
G Lenders Address
U 0 1 certify that 1 have read this application and sate that the and.lot ormaJun Is
gy H
correct.I agrce to comply with all city and county ordinances and suss law relating re
V building construction,and hereby authorise mpmommiva of this city to enter upon the
W shove-mcooncd pmpcny for inspection purposes.
(Wo)agree to avc,indemnify and kcep harmless the City of Cupertino against
t�h c`c,ll Iiabilitim,jdgmenu,cam and expevu which may in any my ahem against said city
in conseranfing of that rmit.
APP CANTO UNDEofthe RSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date �y0�
SOUR REGyyATIONS.
A.— Re-roofs
Signature of ppt.oConmhemr Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or fume,Wading oaupaMsmm orhandlc haadoa material
asdented by the Cupertino Monica 1 Code.Chapter 9.12,and the Health and Safety
❑m
Cade.smtiar 25s3z(.)7 All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or fuum building mcupant use efulpmem or devlou,which If a roof is installed without first obtaining an inspection,I agree to remove
emit Want=it,conumianu uJcrinad by the Bay Arta Air Quality Management all new materials for inspection.
Disoict7
OYa On
1 haus real the hxrarda s materiahrequitemenhs undc,Chapmr6.95 of the calirm.
ilia Health&Safety Code,Sections 8505.35533 eco 8534.1 understand thmifthe Wilding
Jou out currently have a un m.tea It is my responsibility to notify the aceupant of the
Oct; menu 'ch a tkmatpriortahmanceofacenilicamorampancy. Signature of Date
$-30 All roof coverings to be Class"B" or better
Owner or m gem Date'
commnooy nevdopto w
10300 Torte Aveoue
Cvpabno CA 93014
Telephoee(408)717-3228
Fm(408)777-3333
• CUPEkTINO
Building De p artment
JOB ADDRESS: pERM1T N
1 DIW05 D Go bP 6 0<� -IL"7
OWNER'S NAME: Wjtg^Kp PHONE N 8-
GENERALCONTRACTOR CoSor,as IPF104 JFAXN q 4,,9 JJ-o-S
X I am not USWimy aubcontca..; - 8.3D D6
S — Date
Please duck applicaMe subcontractors and complete the Wowing information
SVBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #F
Cabinets&Millwork
Cement Finishing
Heelrical
Excavation
Fencing
Fl
Linoleum/ Wood
Glass/ Gbong
• Heating
hwulatton
Landscaping
Lathan .
Meso
Ornamental Sheet Metal
PWnft/ Wallpaper
Paying
PlastariAg
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/con tore Date
CITY OF CUPERTINO
46m 1 of 2 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 37534014 . 00
DATE ISSUED. . . . . . . : 08/30/2006
RECEIPT # . . . . . . . . . : 35836
REFERENCE ID # . . . : 06080249
SITE ADDRESS . . . . . : 10665 MORENGO DR
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : RICHARD BEERMAN
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : OMAR ORTIZ
CONTRACTOR . . . . . . . : COSMOS, RICHARD LIC # 18844
COMPANY . . . . . . . . . . : COSMOS ROOFING
ADDRESS . . . . . . . . . . : 1901 OLD MIDDLEFIELD WY
CITY/STATE/ZIP . . . : MOUNTAIN VIEW, CA 94043
TELEPHONE . . . . . . . . : (650) 969-7663
*FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
-- - ------- ------------- ---------- ---------- ---------- ---------- ----------
BPERMFEE VALUATION 6, 000 . 00 126 . 36 0 . 00 126 . 36 0 . 00
BSEISMICRE VALUATION 6, 000 . 00 0 . 60 0 . 00 0 . 60 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 126 . 96 0 . 00 126 . 96 0 . 00
•
(�1Q0�02�
CITY OF CUPERTINO
� `• REROOF
• CUPERTINO PERMIT APPLICATION FORM
APN# 4—�' 1 Date:
Address: `7
10465
Owner' Name: Phone#:
e 6�0- q R-7
Contractor: License#:
7 !2Q
Contact: Cupertino Business License #:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ����( E3Wood Shingles
I Other(Specify)�'a eF Or Other(Specify) 144r r^ V
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:
i (4��
Residential Er ommercial ❑
Fire Zone: Yes ❑ No 64— Confirmed with Planning De t. if
there are any restrictions: LJ
Cost of Project: Type of Construction: C,� Occupancy grou :
�e_ Vel
Qty. if
Applicable 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
•
Community Development Department,
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228 •
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.
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 stated policy on re-roofing.:U
pr-Name: tr 4 yr n
Job Site Address: l Q f f_ o_5 Al D ry itis o01.
Roofing Company Name: rn%� mwc- Q®pj�p r�
Applicant's Signature: Date:
Greg Casteel •
Building Official
Revised 11/2/04