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12030124 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7868 CREEKLINE DR CONT'RACT'OR:COSMOS ROOFING PERMIT NO: 12030124 OWNER'S NAME: OYANG YEN-JEN AND MIIN-I1UEY 999 CONINIF,RCIAL 91'511' 105 DATE ISStJFI):03232012 ,,,,,0/FF,,,WNER'SPHONE: 4088780878 PALOALTO.CA 94303 PIIONENO:(650)969-7663 pl LICENSED CONI'RACI OR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB C: /License Class CM Lie.4 / S L4 I . r r r //�� ?`x.� 3/ 3/ ►,� RI F.CII RESIDENTIAL COMMERCIAL Contractor w7th'��i f-e�-'r(��j Date 2' I hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION: R6ROOF TEAR OFF SHAKE NO RESHEET INSTALL 30q (commencing with Section 7000)of Division 3 of the Business A Professions FELT,LIFI3TIME COMP 32.SSQ CLASS A Code and that my license is fn fall force and effect. hereby affirm under penalty of perjury one of the fallowing two declarations: I have and will maintain a cenificale of consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the labor Code,for the performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance,as provided for by Sq.Ft Floor Area: Valuation:$14590 Section 3700 of the Labor Code,for the performance of die work for which this permit is issued. APNNumber:36217028.00 Occupancy Type: .UTI-IG\N'1'GFR'1'I FIC.\'PION I certify that I have read this application and state that the aboveinformatidli is correct. I agree to comply with all city and county ordinances and state laws relating to building construction,and hereby authorize representatives of this city to enter PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accme against said City in consequence oftheIgo DAYS FROM LAST CALLED INSPECTION. granting of this permit. Additionally,the applicait understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section _ 9.18. Issued by: �'�f//V f/jG/Z Dale: 3-R3' /a— Signature Date Z IZ ❑ 'NI_R-IIIJILIWR DECLARATION RE-ROOF'S: All roofs shall be inspected prior to any roofing material beug installed.If a roof is hereby affirm that I am exempt from the Contractor's License Lau for one of installed without first obtaining an inspection,I agree to remove all new materials for the following two reasons: inspection. I,as owner of the property,or my employees with wanes as their sole compensation, will do the work,and the structure is not intended or offered for sale(Sec.7044, Signature of Applicant: Date: Business S Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business g Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR IIrT`I'ER hereby affirm tinder penalty of perjury one of the fallowing three declarations: IIA%ARDOIIS NIATERIALS DISCLOSURE I have and will maintain a Cenifcatc of Consent to self insure for Worker's I have read the hazardous materials requirements under Chapter(95 of the Compensation,as provided for by Section 3700 of the labor Code.for tine California Health S Safety Code.Sections 25505,25533.and 25534. 1 will maintain performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the health I have and will maintain W'orker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air contaminants as defined by the Ba) Area Air Quality Management District I will permit is issued. maintain compliance with the Cupertino Municipal Cade.Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued,I shall Health S Safeh'Code,Sections 25505.25533,and 25534. not employ any person in any manner so as to become subject to the Worker's Compensationlawsof Califomia. If,after making this certificate ofexemption,IOwnernraut agent• -3 /72- become subject to the Worker's Compensation provisions of the Labor Code,I must Date: / forthwith comply with such provisions or this permit shall be deemed revoked. CONSTR11C11ON LENDING AGENCY APPLICAti I'CERTIFICATION I hereby affirm that there is a consmuaion lending agency for the performance of work's I certify that I.have read this application mid state that the above information is for which this permit is issued(Sec.3097,Civ C.) correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name to building construction,mid hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address indemnify and keep harmless the City 01 Cupertino against liabilities,judgntents, costs,mid expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply .\RCIII'I'F:CI"S DECLARATION with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records. 9.18. Licensed Professional Signature Date CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36217028 . 00 DATE ISSUED. . . . . . . : 03/.23/2012 RECEIPT #. . . . . . . . . : 9S000016350 REFERENCE ID # . . . : 12030124 SITE ADDRESS . . . . . : 7868 CREEKLINE DR SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER OYANG YEN-JEN AND MIIN-HUEY ADDRESS . . . . . . . . . . : P 0 BOX 2473 CITY/STATE/ZIP . . . : SARATOGA, CA 95070 RECEIVED FROM . . . . : PERMIT SERVICES INC CONTRACTOR . . . . . . . : COSMOS, RICHARD LIC # 18844 COMPANY . . . . . . . . . . : COSMOS ROOFING ADDRESS . . . . . . . . . . : 999 COMMERCIAL ST STE 105 CITY/STATE/ZIP . . . : PALO ALTO, CA 94303 TELEPHONE . . . . . . . . : (650) 969-7663 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 14 , 590 . 00 1.. 00 0 . 00 1 . 00 0. 00 1BSEISMICR VALUATION 14 , 590 . 00 1.46 0.. 00 1 .46 0. 00 1REROOFRES SQ FEET 32 .50 455 . 00 0. 00 455 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTALPERMIT457.46 0 . 00 457 .46 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- ------------------- CHECK 457 .46 #43300 TOTAL RECEIPT 457.46 VOICE ID DESCRIPTION VOICE ID ,DESCRIPTION -------- ---------------------------- -------- ---------------------------- 309 EXTERIOR LATH 311 SCRATCH COAT 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 604 ROOF IN-PROGRESS 605 FINAL REROOF CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION 172 ADDRESS: 7868 creekline DATE: REVIEWED BY: APN: BP#: 'VALUATION: $14,590 *PERMITTYPE: Minor Building Permit PLAN CIIECKTYPE; Re-roof PRIMARY SFD or Duplex t PENTAMATION 1SFDWLROOF USE: PERMIT TYPE: WORT: re-roof tear-off shake no resheet install 30#felt lifetime c6mp 32.5s SCOPE FEEID ROOFAREA s.f. 1REROOFFRES 3,250 Aferh. Plan Check Plumb. flan Check Clea Plan Chccti- Meeh. Penuit Lire: Manch. Pererir Fee: E/er. Permit Fre: Other Aldch.hap. Otho.Pltmh 1' Other lolec:. lncp. ET A�evh.Insp. Fre: P/uudt. lnsp,Fee: Flee. lap. Fee: NOTE: This eviinmte does not include jeee clue to other Departments(i.e. Planning, Public Works, Fire,Sanilarr Sewer District,School District,etc.). These ees are haled on the prelininan information available and are onh,an estimate. Concoct the Delafor addn'/info. FEE ITEMS (Fee Recolurion 11-053 Eff 7/1/11) FEE QTY/FEE MISC ITEMS Plan Chevk Fce: Suppl. 11C.Fee PGanh.irl r'lech.illec PennitFee: $462.00 Suppl. InsP Fee Pl r r rn b.:•it de ch.:'ls"Ja<: PGrmh_G1•lec/r.:�'lec Permit Fee: Coestrncliun Tac: .1 dministrati v:•1•-ee: Work Without Permit? O Yes (D No $0.00 Advanced Planing Fees: Travel Documentation Fees: � Strone Motion Fec: IBSEIS,NICR $1.46 Select an Administrative Ityi)_ Lf 131cim Stds Commission Fee: IDCBSC $1.00 q I 1 SUBTOTALS: 1 $464.461 $0.001 TOTAL FEE: $464.46 Revised: 1/19/2012 ( -Z v REROOF PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUPERTINO (408)777-3228•FAX(408)777-3333•buildinaIiDcuoertino.ora /� I PROJECT ADDRESS �/ I� I APN- :3 ( -7 _ / ) �V OWNER NAME ) / / �AJ/_ PHOD / C�^D� E-MAIL l/ CC��Q STREET D ES (_ �S CITY,STATE,ZIP FAX 1IAJE z. w?L, _7/AJo c,i .9501 CONTACT NAME WANDA ® COSMOS ROOFING PHONE 650-969-7663 EMAIL STREET ADDRESS 999 COMMERCIAL STREET 4105 CITY,STATE.ZIP PALO ALTO, Cas 94303 FAX 650-485-2314 ❑0W, ❑ OWNER-BUILDER ❑ OWNERAGENT E) CONTRACTOR ❑(7ONIRACTORAGENr ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME LICENSENUMBER LICENSE TYPE BUS.LIC.> RICH COSMOS 785441 C39 COMPANY NAME COSMOS ROOFING E-MAIL FAX 650-485-2314 STREET ADDRESS 999 COMMERCIAL STREET 4105 CITY,STATE,ZIP PALO ALTO, CA 94303 PHONE 650-969-7663 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC.. COMPANY NAME E-MAIL FAX STREET ADDRESS CITY.STATE ZIP PHONE USE OF ❑ SFD or Duplex ❑ Multi-Family ROOF AREAL: �, VALUATION: STRUCTURE: ® Commercial Z�C./ `7F EXISTING ROOF TYPE: 11 BUILT-UP ROOF ❑ASPHALT SHINGLES XWOODSHAKES ❑WOODSHINGLES ❑OTHERLSPECIFY) REMOVE'REPLACE 10YES ]END. PLYWOOD ❑ M" ❑ PLYWD ❑ OSB PITCH: ROOF ❑ NO nLAYERS THICKNESS' ❑ Sre" TVPE: ❑ CDY �'12 CIA PROPOSED ROOF TYPE 1:1 BUILT-U?ROOF ASPHALT sHINGLES ❑WOODSHAKES ❑WOODSHINGLPS ❑OTHER ICC-RS REPORT DESCRIPTION OF WORK: '5 irKr .JO 1514LY 7. wn Zg-/ 3CD By my signature below.I certify to each of the following: 1 am the property owner or authorized agent to act on the property,owner's behal F. 1 have read this application and the information I have provided is correct. I have read the Description of Work and,crify it is accurate. 1 agree to comply with all applicable local ordinances and state laws relating to building construction. I authorize represemat w f Cupertino to enter the above-identified property forinspection purposes. Signature of Applicant/Agent: Date: 3 1 Z- SUPPLEMENTAL RJMATHINREQUIRED t OFFICE:USF.Ou.v _If building is associated wi t a Home Owner's Association,provide letter �sA,�,�.// PLAN CHECK TYPE ROI TING SLIP of approval from HOA. 1LX OYER.TIIr:coDBT Ell ❑ BIIILDING PLAN REVIEW Provide Planning approval to verify if there any restrictions. !❑ - EXPREtiti ❑ PL\N'N'IN'CPnANRr.vIFw _ Provide copy of Manufacturer's Installation Specifications. SIANDARD ❑ FIRE DEPT Provide signed copy of Cupertino s Tear-Off Policy. ❑ OTHER: I, -. _.. ._ . _ , Reroofil pp_201 I.doc revised 03116111