06080250 (2) CITY OF CUPERTINO
BUII:DING DIV
ONTRA, ATI
[SION PERMIT
BUILDING ADDRESS: COSMOS ROOFING PERMIT ND.06080250
10665 MORENGO DR
OWNER'S NAME: PERMR ISSUE DAM
RICHARD BEERMAN 1901 OLD MIDDLEFIELD WY nP /';n/9006
SANITARY NO. CONTROL NO,
(650) 969-7663
ARCHITECT(ENGINEER: BUILDING PERMIT.INFO
BLDG ELECT PLUMB MFICH
=3
is c LICENSED CONTRACTOR'S DECLARATION
Mu I hereby alliin not,I Am ficemand.ndc,parvismans.tCholucti? Job Description
whs0foaande. GARAGE REROOF TAR AND GRAVEL CLASS A
7Q m
z ii I
Ce.0 a LIC.
—
Daw CO.,Matus, Lt
;�_Sgr
ARCHITECTS DELLA ON
fl I modconand my plam.M.11 oc used as public record,
1 6
Licensed Pmficsdonal OWNER-BUILDER DECLARATION
I hereby AM.that I am ascroph from the ConaracCer's Loeme IAw for do,
;0C following Manor.(Section 703 1.5,Business And professions Could:Any city or county
1 which requinds a permit to consurect,alter,improv,demolish,or Mmur my structure $1098
ley priors,its forsuch permit
file as
Law(ChApstog _Sq Ft.Floor Area Valuation
uuunem
(commencing with Section 7000)ofDiveflon3afthee Businasnumal PneficationsCoulux)ur
that As is exempt therefrom and the hub for she 11agod exemption.Ary vtoWon at
Section 7031.5 by any Applicant Im a permit subjects ft Applicant M A Civil PAmA1Y Of UR 996er 0 U Occupancy Type
not mom than nw hundred dollar,(1500).
0 I'Movourrofthe property,army employees with wags emir sole cormacemandon.
will do theworix.And Ne heammutntiant or.fRoul fortune(Sec.7044.Busanass
and Ponfeasions Cocke The Commmemor's License Law Chad set Apply wan omoses,of Required Inspections
formerly who build,wimpravcs Ihercen.and who doessuch warichimuselforlhamth his
.employ=,provided Nonsuch improvements AmMaintanded..fr..d forsala.If,
however.the building ar improvement is said withA.year ofccompl.d.,the owner- -_/�p
builder will have the Waseca of proving Nu he did set build A,improve far purpose of
sain).
[11,As Owner of he property,am exclusively contracting with licensed COMMCICaS to
aeummuct the Project(Sec.7044.Busincss,And Professions Code:)The CooMewes U-
c.Law does not apply to an.of property who wild,.bAPMvM theman.Md.
who contracts for such projects with a mattracums)licensed pursuant or the Coffiaselon's Tp
Lie'=LA-
0 1 AM asmom maim Sm, _,B A,P C for Mis mswn
Owner Dam—
WORKER'S COMPENSATION DECLARATION
I trumby affirm under penalty o(perjury,Arm of the following declarations.
I have and will maintain a CattifinnOw of Consent to self-insum for Workees Comfort.
Who.,a provided far by Section 3700 of the Labor Code for the part..e"e of the
worts far which gas permit is Wood.
0 1 have and will maintain Wmkces Compensation lamuntrucc.As m4unmd by Section
3700.17the lab"Chad,far the parfameMentn'She want to,which this Knoil is human.
My Worimes C.. emuldon brov.rani"A,And Poll,number Am.
Cartier. !j19A Policy NO.9 7 l—M6Al S-0 5
WMATAEF EXEMPTION PROM wuRKERS
COMPENSATION INSURANCE
This section neant an,be Coat it we permit ins forane hundred clailars;(SIM)
m leu.)
I Certify that in the performance of to wark for which this pearrall is Wood.I shall no,
employ any person In any Ammer so a W became subject W ft Workers'COMIXASWOn
Laws of CalifmAI&Dam
Applicant
NOTICE TO APPLICANT.If,after malting this Certificate of Exemption,you should
become subject in the Worker',Compensation provisions of the LAW Code.you rush
z forthovkh comply with such Provision,"this permit" on I daemon mulled.
z 0 CONSTRUCTION LENDING AGENCY
(ti14 1 hereby affirm Last them is a comerareflon lending agency for the KrImmumen of
CL> the sonic for which Nis Permit Is isouni(Sm.3097.Civ.Q
Undoes Name
z Lander'sAddress
U0 I Certify that I have mad door Application and sum that the above im.M.is
correct.I agree to comply with all city and county onfinima),and sum Is"relating M
building conothactiOur and hereby atahorim mpmAxotatives O(dox Cay to Cnmr upon the
r Fal b.vn-racrui...d property far inxKCu,m porPrumA
(We)Agree to save,indemnify And acc,hanciers an,City.(Catcati..agral
rFy 0,, listoini.jAdgm)na,costs Add esp.which May I.My way actrox.gaiMt said City
O in conseof me torming of permit.
APPLICANTquence UNDERSTANDS AthisND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOD RE NS.
ZCE' !qe-z Re-roofs
Slpatom orkExmUCmMmaor
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applies Or to=building actvinuol a.or Media haalood mamrill
As defined by the Cupen,.no 147pat Code.chapter 9.12,and the Ncifint and Safety
Code,Section 25532(a)7 No All roofs shall be inspected prior to any roofing material being installed.
CY.41 If a roof is installed without first obtaining an inspection,I agree to remove%If the applicant or future building Occupant use equipment or dcvices which
emit hvxd.u,.1,c.nuarm. ts unit d by the Bay Area Air Quality Management all new materials for inspection.
District?
0y. '7N. an
Ithave man the hersorda.,Material.rermanummatutdc,Cupwr6.95 ordho C.1if.r.
as Fical"SafeyCode.Sections 25505,25533 and 25534.1 undcauthend theAfthe Wilding
does an'.."A"Ll,have A musum.than I,a my responsibility to nouly the oavpant of me,
zzh h be Met priorut issuance or,cemrjcgw or Opcumancy. Ignatare Applicant Date
W ty-4 0-06 All roof coverings to be Class "B" or better
nenmMiTimimal.gern Dam
CITY OF CUPERTINO
�m 2 of 2 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . I . . . 1 : 37534014 . 00
DATE ISSUED. . . . . . . : 08/30/2006
RECEIPT # . . . . . . . . . : 35836
REFERENCE ID # • : 06080250
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 2 , 000 . 00 83 . 16 0 . 00 83 . 16 0 . 00
BSEISMICRE VALUATION 1, 098 . 00 0 . 50 0 . 00 0 . 50 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 83 . 66 0 . 00 83 . 66 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
CASH 210 . 62
TOTAL RECEIPT 210 . 62
•
CommmiW
10300 Tale AvmW
Cul a CA 93014
Tebpbm(408)777-3228
CUPEI�TINO Fu(408)977.3733 -
•
BuildingDe artment
JOB ADDRESS: PERMITI
1 x(0405 DR'--w6D 'D►2 6o e-02 S`d
OWNWSNAME PHONE#• 8- S2,1 -2
GENERALCONTRACfOR: C.pSV-^C>S FAX# q7b q 1.9 05
X I am not using'any subcontractors; 8 3D D6
S Date
Please obecic sipplicable subcontractors and complete the following information
S„ CONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets&Millwork
Cement Finishing
SeelrJcal
F=Vation
Fendng
F1'
Unoleum/ Wood
Glass/ Glaring
• Heating
Inotdation
Landscaping
Lethin .
Masonq
Oawmental Sheet Metal
P / Wallpaper
Paying
Plaslming
Pl
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
x - 8 0�
Owner/Con tore Date
11
CITY OF CUPERTINO " 25
"(N• REROOF
-
CITY
• CUPEILTINO PERMIT APPLICATION FORM
APN 4315_
�. 0 4 Dat
Building Address: V
Owner's Name: Phone#:
qiZACArd M
Contractor: License#:
ZEI.(141
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 ❑ Wood Shingles
V Other(Specify) rai y + L{ Other(Specify) &f, g GRave(
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 De cription:
t Q f v C t eiv
Residential Commercial ❑
Fire Zone: Yes ❑ No Confirmed with Planning Dot. if
there are any restrictions: LJ
Cost of Project: Type ofConstruction: Occupancy group:
1099
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.
Homeowner's Name: l c k w-sl I]-e r m ul
Job Site Address: 10095 imo(aftGo 'D r`
Roofing Company Name: nr�F /I a
Applicant's Signature: Date:
Greg Casteel •
Building Official
Revised 11/2/04