06070021 (2) CITY OF CUPERTINO "
Bm�DINc DIVISION PERMIT CONTRAC�TE1BIliORMATIE)N '
BUILDING ADDRESS: COSMOS ROOFING, PERMIT 0006070021
809 STENDHAL LA
OWNER'S NAME: FERMPf LS5UEDATE
HOLDENGRABER CAROL F 1901 OLD MIDDLEFIELD WY 07/06/2006
NE:
SANrrARY NO. CONTROL NO.
(650) 969-7663
ARCHf1ECDENGINEER: BURRING PERMIT INFO
BLDG ELECr PLUMB MEC"
aaoa LICENSED CONrRACTOWS DECLARATION Job Description
U C 1 herby affirm Nal 1 am licensed under provisions of Chapter 9(commencing
5Zry with Session 70118)of Division 3 of thea mass and Frofessium Code.and my licensee
infall(..aandPl 7 $5viot/ TEAR OFF FOAM AND TAR & GRAVEL, ADD TAR & GRAVE
aq3 Licenx L'm.N
;moo Dax Sa'v` pr omranor�C4 PLY ROOF SYSTEM
"t ARCCI'S Dry. 1
f s a
1.7d rsmnJ my"a ygbBe
Jan
G Licensed Prof eestons]
S OWNER-BUILDER DECLARATION
Z I hereby 41Erm Nat I am exempt from the Contractors Uecnx Law for Use
0 o fallowing mason.(Section 7131.5.Business and Prefessiom Code:Any city of roomy
5 m which mquirex a permit to cnnewct,elle"impfovc,demolish,or repoir any someone
-iy prior to its issuance.also acquires the applicant for such permit to rile a signed suxment
s G Nat he is licensed purmam to Inc provisions of du Contncmr's U¢ux law(Chapar 9 Sq.Ft. Floor Area Va13at B 2 B(]
i~$ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
that he is exempt therefrom and Ne buss for the alleged exemption Any vuladon of
Section 7031.5 by cry applicant far a permit subjects Ne applicant to a avil penalty ofN,{�`T}lII1I er Occupancy Type
not more Nan five hundred dollars(5500). 3 /J 4 L U 4 J . 00
I,uowncr of du propmsY•ocmY moPlayeu with vagexu Nc'v xlecmmpcvation,
will dothe work,and Neswaormacearintended Livens"raw does
forsake apply.7an.wner of Required In ections
and Profe work Code:The ContfxmrY License Law does not apply ban owner of q P
property who builds m i mproves theshon,and who docs such work himself m Nmugh his
own employees,provided Nat such improvements art not intended afoRefed forcafe.It.
however,the building or improvement is sold within ane year ad'Mmpleuon.the owner-
builev wise have the burden of proving Nat he did Out brJW or improse fm puryux of
ole.).
❑1.as owner of the property.am euluivsly cdnuacdog with licensed Contractors b /
cotutmst Ne pmjec(Sec.7044,Business and Profestiou Code:)The Contmetors U.
chose law cora not apply an owner of propcny who builds or improves thereon,and.
who contracts for such projects with a eontmcbKsu
s)licensed puram b the ConvxmrS
Lice.am Law.
0
slam exempt under Sam .B kPCfar this moon
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby affm under penalty of perjury arc of the following dedication:
I
ham and will maintain a Cerufiaae of Ccom.,an self-innm far .Wa lkere Campmo
cation,as provided for by Section 3700 of the Labor Code,for On performance of the -
work for which Nis pconit is iscucd.
1 have and will maintain Workers Compensation Insunn¢,u required by Section _
3 00 of Ne labor Codc,far the performance of the work for which this permit is iuucQ
My WarYsrs Com"'ron htsurance carrier and Policy number ase:
Cartier. D - 't gC Polity No.:S�f'U6—y12S
CERnFICATE OF EXEM MON FROM WORKERS'
COMPENSATION INSURANCE
(Thu M.occtl not bccanpleted if de permit is fmonc hundred collars(SIM)
or esL)
1 cerufy Nat in the performance of dm work for which this permit Is issued.l shall not
csnpby any person in any manncrx as to become subject to the Workers'Compmendon
Laws of Califomm.Data
Applicant
NOTICE TO APPLICANT:If,after making Nu Cat ificam of Exemption•you should
became subject in the Workers Compensation provisions of the Lzhm Codc,you most
.J O foMwiO comply wit such previsions or this permit shall be deemed revoker.
Z` CONYMUCr10N LENDING AGENCY
1 hereby anion Nat Nem is a construction lending agency for Oc performance of
aNe walk fur which Nis permit is earned(Sec.3 •Civ.C.)
t51 0` Uneers Name
az Under's Address
U 0 1 earufy,Nat I love mad this application arta sum Nat the show information u
L[. comm.1 agree to comply with all city and county ordinances and sure laws relating to
0(,� building construction,amt hereby authodm Opotsentmivcs of Nis city to enter upon the
aabitue,juoncd prapc costs
Ire a penes purposes.
F y (We)agree to save,indemnify and keep harmless the COY of Cupertino against
incoisequer cOfn ccomane expenses which may in any way aamc against said City
Uz Aemtcequcrrce of the gnnting"(this peoniL
^ APPLICANT EAS7A S 1 WILL C, IPLY WITH ALL Issued by: Dale �
SOURCER LATI ?/6
`/10 6
Re-roofs
Signmecol'ApplicarwConvactor Data
HAZARDOUS MATERIALS DISCLOSURE Type Of Roof
Will thea Cupert afuture builtlinge.Chapter
vertm handle hvardaumaterial
u
definedSac by 0e 32(a)l na Municipal Code.CTapmr 9.13,and Nc HcaIN and Safety
Cone.prG zss3x(a)7 No All roofs shall be inspected prior to any roofing material being installed.
41 Will the applicant of future building occupant use equipment or Devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hsaaa-as air croumirunts as refined by On Bay Area Air Quality Management all new materials for inspection.
Disvic7 �/ k��
❑Yes -0No
I h&Salol Code,SaMo mamriaHm and!nu34.l u dermo 6.95 of du Wilding
rias non &Safety Code,Scctiou 25505.25533 am125534.1 unJcrsund thetiftM Wilding
Docs not cum" w a unanL Nat it' y rexpami 'IitY b notify do aceuDenr of Ju C
regairemenuw mosLhc eanrear mulicaeoroiea eY. Signature of Applicant Date
r authamce sem All roof coverings to be Class "B" or better
owner oDam. .
Jul 06 06 08: 41a Cosmos Roofing 16501969-9905 p. l
CommuaiW Development
10300 Tare Aveeue
Cupadw CA 93014
• Talapbooe(408)777.3228
CUPE_ N0 Fni(408)777.7777
'Q\�
Building Department
JOa ADDRESS: PERNM#
�] STE^,t),i,�NAI . Lor o& 017ODZ /
OWNIIt'S NAME S�,4�( 6A- PHONE#
GENEILAL CONTRACTOR o 5 FAX#
X I am not using any aubcontractorso 6 D 6
�- Date
Please check applizable subcontractors and complete the Poll information
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE#
Cabinets&Millwork
Cement Fin A&g
Electrkal
Excavation
Fencirm
I.irwletum/wood
Glass/ Glazing
• Heating
IraWation
landscaping
Udhing
M"OMY
Ornamental Sheet Metal
Pain /nEpaper
Pa '
Plastering
Plumb
Roofing
Septic Tank
Sheet Metal
Sheet Rock -
Tlle �
i
f�
7 l /
�� _
X Owner/Con lure Date 6
•
CITY OF CUPERTINO
wm 2 of 2 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 37542043 . 00
DATE ISSUED. . . . . . . : 07/06/2006
RECEIPT # . . . . . . . . . : 35124 ,
REFERENCE ID # . . . : 06070021
SITE ADDRESS . . . . . : 809 STENDHAL LA
SUBDIVISION . . . . . . :
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . :
OWNER . . . . . . . . . . . . : HOLDENGRABER CAROL F
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : BONNIE JENKINS
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 9, 000 . 00 158 . 76 0 . 00 158 . 76 0 . 00
BSEISMICRE VALUATION 9, 000 . 00 0 . 90 0 . 00 0 . 90 0 . 00
---------- -- ---- ---- -- -------- ----------
TOTAL PERMIT 159 . 66 0 . 00 159 . 66 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
--------------- -- ------------ ---------------- --
OTHER 1496 . 48 VISA
TOTAL RECEIPT 1496 .48
•
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
Homeowner's Name: (_G� /
job Site Address: ¢—
T
Roofing Company Name: --Z _
Applicant's Signature: Date: :��cl (�
• Greg Casteel
Building Official
Revised 11/2/04
nn
CITY OF CUPERTINO ��M9-\
REROOF
• CUPEkTINO PERMIT APPLICATION FORM
APN# �S-15 ^4n J D1 ' Date: L 0 L
Building Address: 8O 04
L C 1"� �
Owner's Nan(9 Phone#: S
—6,
/ -
Contractor: License#: tf5 y 4 /
Contact: Cupertino Business License #:
Type of Roof Covering:
Existing: Proposed:
Y-N Built-Up Roof y 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 With Cu ertino's Tear Off Policy: ❑
Job Description: T/O ;7a=4.,, *-74 Twc o-t . Lf j y B�p
0 "I GJl
Residential Commercial ❑
Fire Zone: Yes ❑ No [y Confirmed with Planning Dept. if
there are any restrictions: U
Cost of Project: Typeo ns ction: Occupancy gro
2 O
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