03030160 (2) CITYOFCUPERTINO * ,r' s ••'• - ' JiarKm, ::
amLmnc orvlsloN PERMIT C,0W, luCT', ANF�ORMA4TION
c BUILDING ADDRESS: PERMIT NO.
COSMOS ROOFING
OWNE PERMIT iss
1901 OLD MIDDLEFIELD -WY
N—ihh. tfN SANITARY OL NO.
(415) 493-63.73
RCHITECTIENGiNEER: BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
O O O
goZ, LICENSEDCONnRS DECORATION Job Description
I hereby affirm that 1 em licensed
underunder provisions of Chapter 9(commencing p
m�1� with Section]IX0)of Division 3of the Business and Profeasinns Credo,and my license is
l lTome tl
f
I uonc ye
�3I f� LIc.M� REROOF
0 � Dam Contrmmr
ARCHITECTS DE LLA oN T/O B.U.R. W/GRAVEL, ADD B .FRy AWo/L
I understand my plana shall be�stee
e d u public cords
M111"hod p'n" "nO
OWNER-BUILDER DECLARATION APR 2 2 2003
i� 1 hereby affirm that 1 am exempt from the Concourses License law for the
O O following reason.(Section 7031.3,Business and Professions Code:Any city or county
5$ which wo tires a permit m construct,alcor,improw,demolish,m repair any structure
is prior o its issuance.arm requires theepplicant for such permit to file A signed statement
z< that he is licensed pursuant to the previsions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area ftmllon
$ (commencing with Section 7000)of Division 7 of the Business and Professions Code)or
a Nat he is exempt therefrom and the basis for Ilw alleged exemption.Any violation of
Section 7031.5 by Any applicant for A permit subjects the applicant m a civil pcntlty of ApN Number est ane I3 e
not more Nen fin hundred dollars($500). P Y [ P
1,As owner of the property,or my employees with wages As Neo rule compensation, C4 '
will do lie were,and the Structure Is not intended or offered for Asia 7DN.Buuneu
and Forretalov Code:The Convno's Licerue Low circa not Apply m an owner of - Required Inspections
property who builds orimpmves Narcan,and whodueuuchwmk himselforthrough his 305 - FRAME
ownemployees.provided Nm such improvements arsnot Intendedoroffered forty It.
however.the building or improvement tsmid within oneyearofcompletion,tia owner- 307 . — INSULATION
builder will have the burden of proving Nn he did not build or impress for purpose of
.1.). 601. - ROOF TEAR OFF
❑1,as owner of the property.am exclusively contracting with licensed contractors to 602 ROOF PLYWOOD NAIL
woutroet the pmjeet(Sec.71344,Business and Profesdov Code:)M Contractor's U.
come Law does not apply In an owner of progeny who builds or improve Neuron.And, 603 — ROOF BATTENS'
who contracts for such projects with A conusambs)licensed pursuant m thw Contrsnoes 604 - ROOF IN-PROGRESS
License La-
0 .
aw.❑l.O.ImplunderSx .BBPCfmlhls.n "
Owner Data
WORKER'S COMPENSATIONDECURATION
I hereby affirm under penalty of perjuryone of the,following declarations -
haw and will maintain•CenlBcem of Covent m wlf-Insure for Worker's ComPen-
on,u pmvided for by Section 3700 of thre labor Code,for the performance of the
weak for which this permit Is loved.
1 have end will mainuin Worker's Compensation Inmro nce,u requited by Section '
110 of the labor Code,for the performance of the wolt for which this perm,is issued,
My Werke omlpvafton 19Bya�cgnie end Pol511-0241Z,_5
ty number.:2�/
Center: �.�il! a /O` Policy
JLe'+ I C ]mss
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not becompleted if Ne Permit is intone hundreddnllars($100)
or less.)
I anify Nal In the performance of the work for which this Permit is loved.I shall non - -
employ any Noun In my mmncr an As to lsrome subject to th,Workers'Compensation
Laws of California.Date
Applicant '
NOTICE TO APPLICANT:If,&Ret making N4 Cmdricate of Exemption.you should
become subject in the Worker's Compenodon provisions of the Labor Coda you must
0 forthwith comply with such provislons or this Permit shall be domed revoked.
CONSTRUCTION LENDING AGENCY -
r I hereby anirm NAc them is a construction lending egency for the performance of -
7L> the work for which this permit is issued(Sec.3097.Civ.C.) "
Q Lender's Name
7 z Lender'sAdd.
-
J Q 1 anify that 1 haw read thea application and sum that the show information is
y F
comet.I gra m comply with all cloy and county ordinance,and sou law relNng m
O V building construction,and hereby authorize mpm¢nutiws of this city minter upon the
a shove-mentioned progeny for inspection whicvea
(We)agree m on,indemnify and keep harmless the City of Cupertino agaiut
L)r/1 liain
entooof
granting
uind or this
may in any way cave against said City
;�r•,,7. A PLICANT of UNDERSTANDS
Ing of lith Permit
APPLICANT UNDERSTANDS AND WILL C SPLY WITH AL NON-P Issued by: - Date
SOURCE REGULATION ,w
Re-roofs
Signstum of ApphesnUConuant qua:
HAZARDIS MATERIALS DISCLOSURE Type of Roof
Will fix Applicant or future building occupanutore what c harudous mamdtl
As dented by the Cupertino Municipal Code.Chapter 9.13,and the Hu1N and Safety
Code.Section 15532007 All roofs shall be inspected prior to an roofing material beim
❑yes q�Nyi p p y g g installed.
If a roof is installed without first obtainingan inspection,I agree to remove
WIII the applicant Or fwure building rccupam use equipment or devices which - P g
D hovardous air contaminants As defined by the Bay Ara Air over icy Management all new materials for inspection. '
1
❑Yes Qlat
Lhawrenithehusrmuns 2 materials 5334,1under Chapter
rad6.95 tow it Um Cable,. /
ria Health&Safety Cade,Sations15505.25577 and 2553x.1 undcrrtmd Nu irk building bZI`A
docs not currently haw A court,that it Is my responsibility m ratify the as pant the '
requimmcn tutbemel iormioummofaccniicateof au ter. Signature o Applicant - Date `
Owner or ret rivaa agent DgR All roof coverings to be Class"B" or better
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
+I,}tybne ,
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
CUPERTiNO
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
e-roofingis 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:
Job Site Address: l
Roofing Company Name: ( Q
AplicanYs Signature: g Date:
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
I
CITY OF CUPERTINO
G REROOFIT F
CUPERTINO PERMIT APPLICATION FORM
APN# Date:
Building Address: -
Owner's Name: o� Phone#:
Contractor: Phone#: License#: ,
650 969 -7`63 yz//
Contact: Phone#: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
Built-Up Roof _'QO BuiIL-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes O Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings 1 ❑ Provide I.C.B.O.Report#
XTo be Removed ❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description: 71,o U-,e. w
as dcP d .V. /e. w
Residential/)f' Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are an restrictions: LJ
Cost of Project: Type of Construction: Occupancy group:
�OOd• C'a
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
# ut� 79
r � 7,