03060134 (2) CITY OF CUPERTINo '
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION sw
ItUILDINGADDRESS: COSMOS ROOFING PERMITNO03060134
22 5;TFLNMHAI 1A
OWNER'S NAME: 1901 OLD MIDDLEFIELD .WY PERMIT ISSUE DATE
ONE: SANITARY N0. CONTROL N0.
(415) 493-6373
ARCIIO'ECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MCC"
o 0 0 0
±ore LICENSED CONTRACTOR'S DECLARATION
I hermy.farm Nat 1 i m liwnsed under provision.of Chapter 9(commcneing Job Description
with Section 7M))of Division 7 of the Businessand Proportions Cook,and my lice Mc is ��rdaa A ll �)
�„ infullfnrteantleffec 9J REROOF�TAR & GRAVEL aRR�$ Y� Vw rem
5�2 License �. Lic.N
a t- Date Contractor
eqq ARCHITECCSDECLARATION JUL 1 0 2003
y d I understand my plans shall be used as public records
5y
s Licensed Professional
OWNER-BUILDER DECLARATION BUILDING
1 OI 1 grow .(firm on I em exempt from the Contractors License law for
the
00 followinguirmsa (Section 703 Business and ve demolish.
Code:Any city fir county
5 S which its ssu issuance,permit us cnnswct,alo,c imprrSu h Permits nr repair any ttructuo -
_Ij, tht hen iseprsuant to the the applicant for Contmtur'suielm s Law(ed uao,mem
ss< thnheislicegxdpurstion70heofDiviomnfthe eBusi essancenselaonsCudmr9 Sq. Ft. Floor Area Valuation
F� that he is exemng pthherefrom and ith Division r the
theeged Business pt Profeon.Any
vi laaxk)tar
that he Is exempt therefrom end the basis for the alleged exemption.Any vinLtlon of 37541021 . 00
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty Of APN Number Occupancy Type
nut more than five hundred della.(SYXf.
❑1,as owner of the property,or my employees with wages as their sole compensation,
will do the workand thin structure is not intended or.femd Waste(Sec.706/,Business — Required Ins ections
and Professions Cade:The Contractor's Liceve law does not apply to an owner of 307 — INSULATION p
property who builds or improv thereon,and who doessuch work himself or thmugh his
own employees,prodded dial uch improvements tem not intended oroRered fersam.If. 601 — ROOF TEAR OFF
howewn the building or improvement is sold within one year of compo,tion,the owner,
builder will have she burden of moving loss he did not Wild or improve for purpose of 602 - ROOF PLYWOOD NAIL
sale')' 603 - ROOF BATTENS
01.a owner of due property,am exclusively contracting with licensed Contractions 10 604 — ROOF IN—PROGRESS
construct the pmject(sec.7064.Bustnert s Li
and Professions Code:)The Contractor
cense law does not apply to an owner of property who builds or improves themon,and,
who contracts fur such prujeca with a contracter(s)licensed pursuant to the Contractor's
License Lin-
0 1 am exempt under Sec. .B&P C for this reason
Owner Data
WORKERS COMPENSATION DECLARATION
1 hereby aRsm under penalty of perjury one of the fallowing dere asationa
I haw and will maintain a Cordillera of Consent o self-inerts for Worixes Comprr•
retie.,ss provided for by Section 7700 of the labor Code.for the performance of the
.,it for which this permit is issued.
I have and will maintain Worker's Compensation Insurance,as required by Section
711(1 of the Labor Code,for the performance of the work for which his permit is Issued.
My Worker's in of or nce artier and Policy number arc:
Caries s"`4 Policy N..a /1-03—//
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This sectio used not to completed if the permit is for one hundred dollars(SIM)
or to.,.)
1 unify that in to.performance of the work for which lou permit is issued.l shell nm
employ any Person in any manner an a m become subject o the Workers Compeassion
Laws of Celifomia.Date
Applicant
NOTICE TO APPLICANT:IL after making this Ccnif¢ne of Exemption,you should
become subject to the Workeh Comp:nation provisions of we labor Code,you must
.Jz ronhwith comply withauch pumW...or Nis pemut.h.11 he decmcd invoked.
'ZOECONSTRUCTION LENDING AGENCY
I hominy aRnm that there is auswctinn lending agency for the Performance or
> the work for which this permit is issued(Sec.3M.Ci,C.)
W 0 Lsndcr's Name
Z) z (.ender's Address
U C) 1 certify that I hive reed this application and sura Nat the above information is
Uy P correct.I agree to comply with all city and county ordinances and shoo,laws mating to
0U building construction,and hereby authorim repicammiim of this city to enter train the
,r W
show-mentioned(WeIigim wrcnyforinspection keCipta.
(Wc)egme to saw,indemnify and keep hay in an the City or Cummins egoist
U Z Iiabilitia,juCCaf u,emuand cxpcmcsmit. may to any way accrue agaimlreid City
U ,'� A consequence of the grating of this permit.
^' APPLICANT UNDERSTANDS AND WILL COMPttY.WITH ALL N -POINT Issued by: Date
SOURCE REGULATIONS. � _
G D7J
X7
Signature of ApplinDale 03 Re-roofs f
HAZARDOUS
US MA RIALS DISCLOSURE Type of Roof
WIIby ft Cuproliant or forum building de,Chapter
rtes or hanand the
Hedduus and Safety '
u defined by d¢Cupertino Municipal Code,Chapter 9.11,and the Health and Safety
Code,Section 15531(a)? [3n All roofs shall be inspected prior to any roofing material being installed.
0 Ya
Will the applicant or future building occupant use equipment at devices which If a roof is installed without first obtaining an inspection,I agree to remove
It he...dns.air contaminarmss dcancd by the Bay Am.Air Quality MmagCurrent all new materials for inspection.
airier?
❑Yes A-br
I haw read the haaasdouc materiab.quiamens under Chapter 6.95 arose Califon a
nia Within&Saf:ty Code,Sections 25505,25577 and 25534.1 understand that it he building
dos nm curmndy low a tenant.tNt it is my responsibility w to of cc occupant of dm )
myvismcns wh' a et pdortoiss ce oh Certificate of Occup Signature of Applica Date
(o p3
Owner tar suthori'rcd esc Dac All roof coverings to be Class °$° or better
Community Development Department
Building Division
ffl_;I;N
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
fUPEkTINO
Fax: (408)777-3333
Building Department
Subject: Re-roofing policy for the City of Cupertino
1. Prior to permit issuance,you must agree to comply with 1997 UBC Standards
and manufacturers specifications on re-roofing.
2. New roof coverings shall not be applied without first obtaining all inspection
and written approval from the building inspector. A final inspection and
approval shall be obtained from the building inspector when the re-roofing
is completed.
3. All roofs shall be inspected prior to any roofing installation.
4. To receive a final sign off from the City, the following steps are
required:
1) Pre-inspection and/or tear off approval.
2) In-progress inspection approval.
• 3) Final inspection approval.
a) '.Spark arrester installation.
5. If plywood is installed, a plywood nail inspection is required.
6. Any roofing which is applied without first obtaining an inspection,
will require the removal of all new material down to the sheathing,
so a proper City inspection can be performed.
IMPORTANT:
1. Flat roofs must have a minimum of 1/4" per foot slope and demonstrate
that there is no ponding.
2. An I.C.B.O. report is required to be on the job site at the time on inspection.
I understand and will comply with the above stated policy on re-roofing.
Homeowner's Name:
Job Site Address: e�
Roofing Company Nama6,4
A p'ican' l'7103
sSignature: Date: �
eel
• Greg t .
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
DREROOF
• CUPERTINO PERMIT APPLICATION FORM
APN# •3 -7 p -2—f Date: `11 7/0-3
Building Address
��a ��-e--
Owner's N n, Phone#c
ContraP ne#: License#
�so 9697( '.5 �/ u
Contact: '-(' Ph on #: Cupertino$u�inLi�ense#:
IOCL c cQ �So� 9 G q- G 63 / d' 7
Type of Roof Covering:
Existing: Proposed:
Built-Up Roof Built-Up roof
❑ Asphalt Shingles O Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings J ❑ Provide I.C.B.O.Report#
To be Removed ❑ Provide Mfgr.Installation Specs.
• I Have Read, Underst nd a d Will Comply With Cu ertino's Te Off Policy:
Job Description: T p 4,z— ol-,i1 �—
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Project: Type of Construction: Occupancy group:
Aty. if
/Applicable Fee ID Fee Description Fee Group
1 BPERMFEE Bldg Permit Fees BUILDING
BENERGY Energy BUILDING
P BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
Z12, 2, 14