02100072 (2) CITY OF CUPERTINO1 �w � :
BUILDING DIVISION PERMIT , CONTRACTOR"�INFORMATION:s<'
BUB WA5DRBHADYGROVE DR COSMOS ROOFING PIRMrrN®2100072
owlRA&MMADERRAJU 1901 OLD MIDDLEFIELD WY APPLICATTIOf FY9*Y2002
I]ON[: 41S 493-6373 SANITARY NO, CONI'ROLNO.
ARCH['I'ECrIENGINEER: BUILDING PERMIT INFO
BLDG CLECs PLUMB MECH
WOO LICIiNSIiD CONTRACTOR'S DECLARATION
r w m licensed F I hereby affirm mbar I am ander provisions of Chapter 9loommrneing Job Description
<i withSec,inm7(XXBrfDivision3ut,beBusinessandPrdcexioosCode.andmylicenseis REROOF ��,����®
'n On w4se delle' SSS YS//
License Clas 1 Cul ozFa D:ucf-R Contracror �— NOV O 202
F= w ARCHMiLTSDECLARA'IION
Ec< I molt,mand my plan,, be used as P.hill records
E:0 au
y3 Licensed Prnfessintal '�1,
K <T OatIameUILDCRDECLARATION BUILDING $8170
1 hemM1y a0irm that 1 R-GUILD from,M RATIONra License Low lot the
i S C O fallowing reason,(Section 9(131.5.13tiamoss and Professions Cut Any city of county
a.%m which requires a Permit h,construct,alms,improve.demolish,or repair any structure
w"^
photo its issuance.also requires the applicant forsuch permiun fileasigncdnalocn,
t=S�< that he is licensed pursuant write provisions oacrvk
f the Contrlicense law(Chapmr 9 2R5l4Cf�UAIQ0 Valuation
�O fmmmcncing wfh Suction 7yAnot Uivix nn 3 ofthc Business and Professions Code)nr
a 3 Nat W is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7191.5 by any applicant for a Permit subjects the applicant lo a civil Penalty of PNN Occupancy Type
nor more than five hundred dollars($500). 307 — INSULATION
❑L as owner of the property,or my employees with wages as their able compensation, 691
will do Ne work,and Ne swgwre is not intended Or offered for sale(See.7(1aa.Business 1"H' R
and Professions Code:The Contractors License Law does not apply to an owner of 6 0 2 — ROOF P 0 n dy�CC�1Ens
progeny who builds or improves,hereon.and who does such work himself or through his
employees,provided that such improvements are nnumended or offered for sale.if, 603 — ROOF BATTENS
nabever.the building or improvement is sold within one year of completion.the owner. 604 — ROOF IN—PROGRESS
builder will have the burden of proving Na,he did not Wild or improve for purpose of
sale).
1,as owner of the pmpeny,am exclusively contracting with licensed contractors to
conslmct the project(Sec.7144.Business and PrOlesxions Code.)The Contractor's Li.
cease law docs not apply to an comor of property who Wilds or improves thereon,and
who contracts for such procto with a cOnommf(s)licensed pursuaauu the Conmautor'a
License 1.w.
❑I am eacmpt anile,Sea ,B&PC for this ..an
OwnerDat
WORKER'S COM PC NS ATION DECLARATION
1 hereby infirm under penalty of Perjury one if the following declarations:
1 have and will maintain a Certificate of Consent to self-insum for Workers Comilla
action,m provided for by Section 370O of the Lehr Code,for the Performance Of Be
work ser which this Permit is issued.
I have and will maintain Worker's Compensation Insurance,as required by Section
710 of the labor Cade,for dm performance of the work for which this Permit is issued.
My Workers Cr Pcomiun Insurance carrier and Policy number are
I
:
Carticc Policy No.5
CERTIFICATE FEXEMFUUN PROM WORKERS'
COMPENSATION INSURANCE
(This section need no,W completed it the permit is for one hundred dollars 410)
less.)
1 ecnlfy that in the Performance Of the work for which this Pamir is issued.1 shall not
employ any Person in any manner so M in become subjcauo the WorkersCompensation
Laws n(California.Dam
Applicant
NOTICE TO APPLICANT:IL atter making this Ccni foam of Exemption,you should
Meme subject to the Worker's Compensation Provisions of the Labor Code,you mux,
C) Z forthwith comply with such provisions or this Permit shall be deemed invoked.
z O CONSTRUCTION LEN DING AGENCY
I hereby affirm that more is a coadmction lending agency int the Performance rt
psa7 the work for which this Permit is issued(See.3147,Civ.C.)
CLenderNations Nation
z Lenders Address
U 0 I lenity that 1 have rtad this application and some to., move intnrma,ion Is `—
P conecL 1 agree to imply with all city and county ordinances and state laws relating m
OU building construction,and hereby outharie mprcun,atives of this city to enter upon the
r sea aWm-(We)ace In cove Ins inspection an keep purposes. 7 /
f' G (We)ag Fragments.m ave,indemnifyandkith harmless wCityof aganst against / ll//
h inetnsequencelthegranting expenses thisPowbich may in any way accrvc against mid City t /�
U z A APPLICANT
NDER granting this permit. ll
^� APPLICANT UNDERSTANDS ILL COMPLY WITH AL1.NON POINT Issued by: DatC
SOURCE REGULATIONS.
/!� 9 4— Re-roofs
Signature m Applia'a ou Cuntracmr Date
HAZARDOUS MArERIALS DISCLOSURE Type of Roof
Will the applicant or future building Occupant store or handle hamadous material
as del by the Cupcnino Municipal Code.Chapter 9.12,and the I leshlb and Safety
Code,seedon z5532wr' All roofs shall be inspected prior to any roofing material being installed.
❑Yea
IpAv-
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
mi,b...noms air cnmaminenu as defined by the Bay Arm Air Quality Management all new materials for inspection.
District!
p yes 0 N
Ihaw n&Salo thebmardons.25505hre533 and 5531.ts ler Chneread al OHhe holding
doesnalth&Salcty Calc,Secants anti my ocsnd2553l.1 indo ly hha,ifthe Wilding L� ��YI�A—•. 7
Jmcs no,currently have a moan,.Nm it is my rcsp,mihili,y m notify,M,a'cu and of the 7�
requirementsw'a st Wmm prior 'smame of a Cenifcate of O:l. . y. Signature of Applic6nt Dale
owner raamoax gen t Da,D2- All roof coverings to be Class "B" or better
Building Division
10300 Torre Avenue
4 Cupertino,CA 95014-3255
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
CUPpEkII*'O
Building Department
Subject: Reroofing policy for the City of Cupertino.
1. Prior to permit issuance,you must agree to comply with 1997 UBC Standards
and manufactures specifications on reroofing.
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 reroofing 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) Preinspection 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 that the
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 of inspection
We understand the above policy on reroofingandwill comply withthispolicy.
Homeowners Name: �D� �S �fr7a ctGy cn�n•� Q/�l ,
Address: 'ea-'o 0.
Reroofing Company Name: r�—! 7�n✓ G
Applicants Signature: Date: D z
'Joe Antonucci
(Chief Building Official)
6/25/01