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07030091 --------777-77777777777777777777777777777777777 CITY OF CUPERTINO BUILDING DPVISION PERMIT �� GT® .ZN.- tMW-. .N; PERMIT NO. BUILDING ADDRESS: 11622 SEVEN SPRINGS DR COSMO: ROOFING 07030091 PERMIT ISSUE DATE OWNER'S NAME: KEATING THERESE M AND EDWARD 1901 CILD MID SANITARY NO. CONTROL NO. )NiFc (650) S69-7663 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB b1ECH i p p LICENSED CONTRACTOR'S DECLARATION Job Description Lu 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing Z with Section 7000)of Division 3 of the Business and Pr ions Code,and my license is REROOF'-T/O (E) SHAKES, INSTALL NEW 3 0 LB FELT, 5 0 "(m- in full force and effect i> ;4Z Li CI s CJ Lie.x y YR COMP SHINGLES-28 SQUARES p Dale "� Contractor F ARCHITECTS DECLARATION 7 e�C< 1 understand my plans shall be used as public records )aU u.i; Licensed Professional :O< OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the c O following reason.(Section 7031.5,Business and Professions Code:Any city or county u which requires a permit to convect,alter,improve,demolish,or repair any structure prior to its issuance,also requires the applicant for such permit to file a signed statement Ft.Floor AValuation < that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq Area $8560 t- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or i R� that he is exempt therefrom and the basis for the alleged exemption.Any violation of Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3665401 4 APON Number not more than five hundred dollars(5500). ❑1,as owner of the property,or my employees with wages as their sole compensation, will do the work,and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections and Professions Code:The Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements are not intended or offered for sale.If, however,the building or improvement is sold within one 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 property.am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li- cense Law docs not apply to an owner of property who builds or improves thereon,and. who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law. - ❑1 am exempt under Sec. - ..B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declaradonsz - t]1 have and will maintain a Certificate of Consent to self-insure for Worker's Compen- sation,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 Workers Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is�� issued. My Worker's Compensation Insurance carrier and Policy number are: / O Cartier. --T4S A�� Policy No.� `7/-U00 ` 2 CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars($100) or less.) I certify that in the performance of the work for which this permit is issued,1 shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:if,after making this Certificate or Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must Oforthwith comply with such provisions or this permit shall be deemed revoked. Z "- CONSTRUCTION LENDING AGENCY E~-o��• 1 hereby affirm that there is a convection lending agency for the performance of - (:(,> the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lender's Name az Lender's Address U C1 certify that 1 have read this application and state that the above information is cortect.I agree to comply with all city and county ordinances and state laws relating to U building construction,and hereby authorize representatives of this city to enter upon the W above-mentioned property for inspection purposes. Gl. (We)agree to save,indemnify and keep harmless the City of Cupertino against liabilities,judgments,costs and expenses which may in any way accrue against said City U Z in consequence of the granting of this permit. Date L APPLICANT UND STANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SOUR E UL NS. `, Re-roofs l Signature ofApplicam/Con Da1c Type(If Roof HAZARDOUS MATERIALS DISCLOSURE yP Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Code,Section 25532(a)? All ro)fs shall be inspected prior to any roofing material being installed. ❑Yes If a roof is installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yes I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that ifft building docs rrcnd have tenant that it is my responsibility to notify the occupant of the re�whi be met prior to issuance of a Certificate of Occupancy. Signal ure Of Applicant Date 3`"`')� All roof coverings to be Class"B"or better Owner or authcrtuc gem U k Date CITY Ol? CUPERTINO 2 ITEMS OF 6 PERM:-LT RECEIPT OPERATOR: suew COPY # 1 Sec: Twp: Rng: Sub: BLk: Lot: APN 33654014 .00 DATE ISSUED. . . . . . . : 0.3/13/2007 RECEIPT #. . . . . . . . . B3000000677 REFERENCE ID # 07030091 SITE ADDRESS 1L622 SEVEN SPRINGS DR SUBDIVISION . . . . . . . CITY C JPERTINO IMPACT AREA . . . . . . OWNER K3ATING THERESE M AND EDWARD K ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : SJNNYVALE CA, 94087-1216 RECEIVED FROM RECEIPT INTERFACE CONTRACTOR C3SMOS, RICHARD LIC # 18844 COMPANY CDSMOS ROOFING ADDRESS 1901 OLD MIDDLEFIELD WY CITY/STATE/ZIP . . . : MDUNTAIN VIEW, CA 94043 TELEPHONE (650) 969-7663 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---- BPERMFEE VALUATION 8,560 .00 158.76 0.00 158 .76 0.00 BSEISMICRE VALUATION 8, 560.00 0. 90 0 .00 0 .90 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 159.66 0.00 159.66 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 772 .40 MASTERCARD --------------- TOTAL RECEIPT 772 .40 CITY OF CUPERTINO ..!I RI,ROOF Ciro Of CUPEkTINO PERMIT APPLICATION FORM APN# Date: Building Address: 116Z2 S a ,) Owner's Name: Phone#: Contractor: /)�o�``� �, License#:�,� yy/ Contact: / / Cupertino Business Lice : Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles ) , Asphalt Shingles 3_0 1 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 Cupertino's Tear Off Policy: Job Description: s, �,-? s�s Y.-c,s T� ��.�//,,,�r,�,� 3i��ti,�'� l>L :�(�" i �- G;,w., �► �G, , �; -c Q s Residential � Commercial ❑ S f s. Fire Zone: Yes ❑ No Confirmed with Planning Dept. if there are any restrictions: LJ Cost of Project: Type of ConsA[uc on: Occupancy rou 60 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 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 aE,ree to comply with 1997 UBC Standards and manufacturers specifications on:-e-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 nz.il inspection is required. 6-' Any roofing which is applied withou t 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 f,?e of$176.18. The re-inspection fee must be paid before another inspection can be scheduled. IMPORTANT: 1. Flat roofs must have a minimum of 1/4" per foot slope and demonstrate that there is no ponding. 2. An I.C.B.O. report is required to be cn the job site at the time on inspection. I understand and will comply with the above stated policy on re-roofing. Homeowner's Name: �ed He,41 .4J job Site Address: /1& 3� � t✓� � � ` �� ' Roofing Company Name: Applicant's Signature: '1`�%"�G� � / Date: 3 Greg Casteel Building Official Rei•ised 11/2/04 03/13/2007 07:04 7075287663 PERMIT SERVICES INC PAGE 06 Mar- I3 0? 07: 018 Cosmos Roofing C6501965-9905 p. 3 A�n Aopdat COCOWCA M14 Daae(4M 777-32WCU lNO Fa(am)777a33a - BuAding De axisnter�t Job wDUR�ss: Pte'� �Xrlt�►c' R FAX t aim na Uft any$abc�tsac vabe SUB P]ea�e jesnbcoa�raceoee a� the� �n . Cabdnft do M31 WM* Cwt P3:rishim E1ech�lcal 1�,.vatian t,MA�/Woad �1 Haft kwwa6m f�daca Mason Otte Sheet Mata1 ' Paatt�J Waal Pa ' Pl _ Tw* Sl>met Metal Sheet Rode T c!/!! Date