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03050034 (2)CITY OF CUPERTINOT"•!r�J}`�*('' TOR' j��iI R��{/�`' BUILDING DIVISION PERMIT 3�0NTR2 "^.0� g'^�0 - BUILDINGADDRESS: COSMOS ROOFING PERMIT "03050034 OWNER'S NAME: 1901 OLD MIDDLEFIELD .WY " iffn8/2003 !I JOHN P AND "E: (415)493-6373 SANITARY NO. CONTROL NO. ARCHITECTRINGINEER; - BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 LICENSED CONTRACTOR'S DECLARATION lob Description I thereby of irm that I Am licensed under p evisiom of Chapter 9 (commcncing p with Section 70(10) f Division 3 of the Business end Professiom CCdC,md my license is C... Uwmo Cl inti utter Llc.x �e A �m�. REROOF FI7VI' LE13 Date Contractor ARCHITECT'S DECLARATI N I undeatend my plant shell no used As public mentos /lh1 O Y 2 O 2003 MAY .1 ns Liceed Professional OWNER -BUILDER DECLARATION I hereby am. that 1 em excerpt fere the Commode. License Le. far,he BUILDING follnwrumen. oon. (Scedun 710 L3, Business and Projectors, Calc: Any city or county which requires a rural, to convect. sitar, improve, demolish or ¢pale my sanctum poor to its issuance, also mquint the applicant formch permit to Ile a signed su dement Sq. Ft. Floor Area that he is licensed punumt to t pmvisiovof the Contractor's U.. U.(Chapef9 $510IMtion (commencing with Section 7000) of Division 3 of du Business and Profusions Cade) or thou, he is exempt tilere(rom and the bmis fm the alleged exemption. Any violation of 3 WN2116- berO 0 Occupancy Type Section 7031.3 by any applicant far a permit subjects the Applicant 10 A civil penalty of not mom than Eve hundred dollars (SSW). ❑ I, as owner of the properly, or my employees with wages As their a ole compensation, —gg L dIns ections p will do the work,and tltestrcwm h totinundedproffered forrele(Sec. 7044, Business and Profuasiom Code: The Ommcme, License Law does no, apply re An owner of property who builds m improve, thereon, aha who doe ouch work him sel f or through his 3 0 7 - INSULAT awn employees, provided that such improvements menot Intended maBeredmrsathIf, 601 - ROOF TEAR OFF however. the building or Improvement is mid within one year of eempledon. the owner, buildm will have the Wnden of proving that he did not build or improv for pryose of 602 — ROOF PLYWOOD NAIL tale')' 603 - ROOF BATTENS ❑I. as Owner m the prnpeny, am exclusively contracting with licensed eontractmAm 604 - ROOF IN -PROGRESS eomwet the project (Sec. 7064. Business and Professions Code:) Me Contraemrs Li c me Law does not apply to an donor of propenY who builds or Impress Merton, red, who contracts for such projeem with a contmeor(s) licensed pursuant m the Contractor, License Law. ❑ 1 am exempt under Sec . B A P C for this mason Owner Data WORKER'S COMPENSADON DECLARATION I hereby affrm under penalty of perjury one of the following decimations: I banned will maintains Cenif¢omaf COnsenl to relGinsure for Workers Compere sadon, As provided for by Secuan 37W of the Isbor Cade, for the preforance of the work for which this permit is issued. have and will maintain Workers Compensation Insurers, As required by Section W of the labor Code, for the pCdormanee of the work for which this permit is issued. - y Workers Compe tion Insurance grim And Polity number Am - I_O Z� I vzL& CA rtier. ��� Policy No:S7 CE IFICATEOFEKEMP71CN FROM WORKERS COMPENSATION INSURANCE ('Dau seNm need me 4 completed If the permit is Intent, hundred Collmi nll W) or eat) I certify her in the perfortmoce of the work for which this pemtit is issued, I shall nm employ any person in my manner an As On become object to the Workers' Compensation Lew, of Calif uai, Dau Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption. you should became subject to the Worker's Compensation provisions of tits Inbar Code, you must forthwith comply with such provisions or this Purnell hall be deemed revoked, CONSTRUCTION LENDING AGENCY 1 hereby aRrre that dart 1, e eonnretlon lending Agency for the Performance of the ..,it for which this permit is issued (Sec 3097, Civ. C.) Lend cr'a NAmc lenders Address I certify War 1 haw mrd dust Application and sure thn the above infommNun ist cortcct.I Agree mcomply with All city and county ordinances and sale laws relating to Wilding Construction, no hereby mthorir miumenuuvv of this city to unser ulmn the move -mentioned prPcny for inspersion purposes (Wt,) agree to ate, indemnify and keep harmless the City of Cupcnino against liabilities, Judgments, cru and expenses which may in my way amu, Agafmt mid City in consequence of the grmung of this pcmail. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NOP INT Issued by: Date SOURCE REGULATIONS. C U 4C3 Re -roofs Signalurc o(ApplicondConusemr role HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant mfuture building acuhaptamtare handle As defined by late Cupertino Municipal CtMe, Chapter 9.13, end the Health and Safety Heal, and ' do. Scedon as32h)? All roofs shall be inspected prior to any roofing material being installed. ❑ Yes If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future building Occupant ase equipment or devices which not hammus air contaminants As deftncd M1 .the Bay Arta Air Quality Management all new materials for inspection. istrict? Dyes 100wcc, IhawreWahe haraNamsmmcriau mquiremcnuunhrChePur 6.93 ofum Wilding .a.,ntlyostiiimyrespotoCoulWildingses oat cavrtnaly haw • Itnanl,lMt it u my respomihili,y b nosily tM mu ret ofquirements whi hams he mea poor n; issuance alaCcruft'wcfOce y Signature of Ap cant Date ""'-5All roof coverings tQ be Class "B" or better or aath5rixcd AgC ate CITY OF ICUPEkT]NO Community Development Department Building Division City of Cupertino 10300 Torre Avenue Building Department Subject: Re -roofing policy for the City of Cupertino Telephone: (408) 777-3228 Fax: (408) 777-3333 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: o —fv�✓ Job Site Address: M Ll' Roofing! IF -- Applicant's Signature: Greg teel Building Official Revised 1/30/03 Printed an Recycled Paper Date: Dater o3 E t CITY OF CUPERTINO CITY OF CUPERTINO REROOF PERMIT APPLICATION FORM 0305 � APN # q 0 Date: �/ a3 Building Address/O/ l cue Owner's Nam p BSEISMICRE Phone #: p 30 7— d/ 2 - Contractor:,,,? Contractor: Phone #: License #: BUILDING BPLANCHK Plan Check Fee Contact: Phone #: Cupertino Business License #: BUILDING / Type of Roof Covering: Existing: Proposed: Built -Up Roof � Built -Up roof ❑ Asphalt 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 ith Cu ertino's Tear Off Policy: Job Description: T�p , (� , yi Residential] Commercial ❑ Fire Zone: Yes ❑ N Confirmed with Planning Det. if there are an r tcttons: LJ Cost of Project: Type of Cons ct X( Occupancy ro Qty. if ADDI icable FPP m T P r)... •f n�f /1ff BPERMFEE BI d Permit Fees BUILDING BENERGY Energy BUILDING BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING 2let 1� #- 117.