04070079 (2) 1 CITY OF CUPERTINO
I 77177777777777-
BUILDING
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BUILDING DIVISION ieTQ`R TN" O � AT -
PERVCONT
"
i BUILDING ADDRESS: COSMOS ROOFING PERMITND04070079
OWNER'S NAME: PERMITISSUEDATE
RICHARD SCHUSTE
IF
NE: - SANITARY NO. CONTROL NO.
(415) 493-6373
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
u0Z, LICENSED CONTRACTOR'S DECLARATION IbDtion
u I hereby affirm that 1 am limused under provisions O05CO of Chapter 9(commencing P
ii with Stttion]IXIU)pf Diviaion7of NC eusinessand Profrssiuna COk.and mylicenacis FW
0 intuit force and ef(zt.� y4I �,(T,IyrJ GRAVEL
�Z License��'1 3 IT -Lt..p r/L B/p��'a,+_'r`-
z^p Date O Canlractor
ARCHI CT`SDECL'RA
I understand my plans s usgU as I' c s D
W, r LI
W W
C 3 Licensed Professional ON AUG A
th NE.exemptfood
Re
007
TI hereby affirm Net I am exempt Item Ne Cnntmcmr's License Lew for the
T.O O following mason annit t 7031.5.Business and Improve.
de tins Code:Any city ter count
�lei which required a permit so ennswct.alter,improve,Jemnlish,or repair any svuau _ _
FZ6 prior W its issuaom:also requires the applicant fcrsuch permit m 1. esigncU summc
s Nalhei¢IiccnuJ pursuant to Nc Provisions oftbe Convumrs License law(Chepmr ea Valuation
�Fm (commencing with Section 7")ofDivision 3 of Ne Businessund Professions Code)or
y But M Is exempt Nerefmm and the basis for Bre alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3 �er0 0 Occupancy Type
not mom Nan five hundred dollars(5500).
❑I,.owner of the property,or my employees with wages m their in compe sahm,
will do Ne work end Neawcture is not intended proffered I...1.(Sew 7044,Business
and Professions Code:The Communes Licees License Law donot apply in an owner of Required Inspections
property who buildsor improves daemon,and who doessuch work himselforthrough his
own employees,provided Natsuch improvements are not intended aroffered forsals.If,
however,the building or improvement is sold within ons year of completion,the owner-
builder will have the burden of proving that he did not build or Improve for purpose of
sale.).
❑1,as Owner of the propeny,am exclusively contracting with licensed convectors to
construct the pmjcet(Sec.70Ys,Business and Professions Code:)The Convecma's Li"
cense Law does not apply to an owner of property who builds or improves thereon,and
who contracts for such project,with a canuamr(s)licensed pursuant m Ne Contractors
License Law. -
❑I am exempt under Sec. .B&P C for this mason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby afro under penalty of perjury one of she following declarations:
I have and will maintain a CertiOcau of Contin m self-insure for WmkeraCompcn-
sation,as provided for by Section 3700 of Ue Labor Code,for Ne performance of the
work for which this permit is issued.
have and will maintain Workers Compensation Insurance,m required by Scedo t
] of 0¢Labor Code,for the performance of the work for which this permit is issued.
My Workers COUINgnsmio�ns Insurance carrier and Policy amber am:
�
Canier:�g fV LLi Policy No:r7I `04-/1 -S
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Thusectitm need not Mcompleted If the permit isforoachunJ¢d dollen(SIM)
or less.)
I certify Nat in the performmce of Ne work for which this permit is issued,l shall not
employ any Person in any monodist,as to become subject an he Workers''Compensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If,after making this Cenificam of beapption,you should '
become subject m the Worker's Compensation provisions of the Lahor Code you must
.J O 10"W ith Comply with such pmvisions of Nis Permit hall be deemed revoked.
.zi rte~. CONSTRUCTION LENDING AGENCY
F-t Ihereby affirm that them is a Construction lending agency for Ne Performance of
6$ rte-, the work for which Nis permit is issued(Sec.3097,Civ.C.)
W Q Lender's Namc
IY Lender's Address _
U C 1 certify Net 1 have read this application and sum that OR above information is
W P correct.1 agree to comply with all city and county ordinances and state laws relating a
�Ubuilding construction,and hereby authadve represematives of this city to enter upon the
W shove-mentioned property for inspection Purposes.
'fJy4 Qw (We)agree to save.indemnify and keep harmless the City of Cupertino against
j.y(/f liabilities,jadgmenia,costs and a%pCMC3 WM1idh may in any WaydedNC against sold City
U z in Oona uence Ne grantin oh ' crmn. /
.. APPLICA ND�R A WILL MPLI•WITH ALL ON-POINT Issued by: a[
SOU C gq
- 1510 Re-roofs
Signamm o(ApplicanUConoscmr Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof t
Will the applicam or future building mcupam aid.or handle W.Ous material
as defined by Ne Cupertino Municipal Code.Chapter 9.12.and the Health and Safety
Code,Section 25532(.)? All roofs shall be inspected prior to an roofing material being❑Yes p4m- P P Y g ginstalled.
LWill the applicant or futum building accupont use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
t Immmous air contaminants as defined by Nc Bay Arca Air Quality Management all new materials for inspection.
District?
❑Yes ❑plums
Ihevc real the hamfdnusmamrials requirements under Chapter 6.95 of the Califao- '
aia Health&Sof Cade.Sectrons 255 .25533 and 534.I understood!Nmif Ne building
dMa not ca t hate a. t, 1¢my rG sihilily a notify the Occupant of dm
myui me m m pt, fa' a arOcdapanyy Signature ofApplica t Date
Damn,or amhorivcd agentDoc All roof coverings to be Class"B"or better
'r,' I
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
S' 1 CITY OF Telephone: (408)777-3228,
U P E kT I N O Fax: (408) 777-3331.
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 appliedwithout 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 rhe roofing.
Homeowner's Name: p 6c, .�
job Site Address:
Roofing Company Name:
A plicant's Signature: Date 2 I`�
Greg teel .
Building Official
Revised 1/30/03
Printed on Recycled Paper
Jul 13 04 1e: 43p Cosmos Roofing 16501969-9905 p. 3
• Community Development
10300 Torn Avenue
Cupertino CA 95014
Telephone(409)777-3228
CUpCkT1N0 Fa(408)777.3333
r`
Building artment
)OB ADDRESS: _. PERMITM
'1'7� STEoDAI-tt_ 1.t4" y 0 7 00
OWNER'S NAM&: IC14AR S us PHONE# Io5p_
GENERAL CONTRACTOR 5 izoo� FAX# (, -9/�- 79�4�0.5 �
I am not using any subcontractors:( /A" �71Yldd —�t1.!
Si a Date
Please Check applicable subcontractors and Co tete the foVowinLrinfortnatlom
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets&Millwork
Cement Finishing
Electrical
Excavation
Fendn
Flooring
Linoleum/ Wood
Glass/ Glazing
• Heating
lmulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Faintutg/ wall per
Pav
Plastering
Plumblrtg ----
Roofing
S tit Tank --
Sheet Metal
Sheet Rock
Tile p
Owneotontracw Signature
CITY OF CUPERTINO
REROOF . o ° 7 7
CUPERTFINO PERMIT APPLICATION FORM
APN# 3 ? S ,' Z, OP
Date: .7 / O q
Building Address:? 7 7 l �—/
ai4
Owneramen Phone#t
ate 9�G - 88�
Contractor: Phone#: License#:
650 9617-2663
Contact: t Phone#: Q � Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
Built-Up Roof X Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings I ❑ Provide I.C.B.O.Report#
)11, To be Removed ❑ Provide Mfgr.Installation Specs.
• I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description: 0 /7
Residential Commercial ❑ r
7
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are anrestrictions: LI
Cost of Project: o. Type of Construction: Occupancy group:
990 j
Qty. if
Applicable Fee ID Fee Description Fee Group
/ BPERMFEE Bldg Permit Fees BUILDING
BENERGY EneEgy BUILDING
/ BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
�s
6 6