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11060031 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 850 STENDHAL LN CONTRACTOR:COSMOS ROOFING PERMIT NO: 11060031 OWNER'S NAME: MIKE SEGAL 1901 OLD MIDDLEFIELD WAY STE 22 DATE ISSUED:06/03/2011 OWNER'S PHONE: 4083799039 MOUNTAIN VIEW,CA 94043 PHONE NO:(650)969-7663 LICENSED CONTRACTOR'S DECLARATIONr— BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class C1>7 Lic.# -74? 5 9 4' MECH RESIDENTIAL COMMERCIAL Contractor Date 613 11) I hereby affirn ncensed under the provisions of Chapter 9 JOB DESCRIPTION:RE-ROOF TEAR OFF TAR&GRAVEL&INSTALL NEW (commenc' ection 7000)of Division 3 of the Business&Professions 4PLY Code an at my license is in full force and effect. TAR&GRAVEL;EXISTING SHEATHING STAYS I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate 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 Section 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Floor Area: Valuation:$10500 permit is issued. APPLICANT CERTIFICATION APN Number:37541018.00 Occupancy Type: I certify that I have read this application and state that the above information 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 upon the above mentioned property for inspection purposes. (We)agree to save PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. 46 /" Issued byF Date: G Signature Date — C OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for I,as owner of the property,or my employees with wages as their sole compensation, inspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) Signature of Applicant: Date: I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: HAZARDOUS MATERIALS DISCLOSURE I have and will maintain a Certificate of Consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(x)should I store or handle hazardous material. Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534. Compensation laws of California. If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,I must Owner or authorized.9gen forthwith comply with such provisions or this permit shall be deemed revoked. Date: �ONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I certify that I have read this application and state that the above information iscreby affirm that there is a construction lending agency for the performance of work's correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address co,zt- and expenses which may accrue against said City in consequence of the I g of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION w.. .A non-point source regulations per the Cupertino Municipal Code,Section 9.18. 1 understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 37541018. 00 DATE ISSUED. . . . . . . : 06/03/2011 RECEIPT #. . . . . . . . . BS000013654 REFERENCE ID # . . . : 11060031 SITE ADDRESS . . . . . : 850 STENDHAL LN SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . . MIKE SEGAL ADDRESS . . . . . . . . . . : 850 STENDHAL LN CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : JEFF RAINEY CONTRACTOR . . . . . . . : COSMOS, RICHARD LIC # 18844 COMPANY . . . . . . . . . . : COSMOS ROOFING ADDRESS . . . . . . . . . . : 1901 OLD MIDDLEFIELD WAY STE 2 CITY/STATE/ZIP . . . : MOUNTAIN VIEW, CA 94043 TELEPHONE . . . . . . . . : (650) 969-7663 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 10, 500 .00 1. 00 0 . 00 1 .00 0. 00 1BSEISMICR VALUATION 10, 500 .00 1. 05 0 . 00 1 . 05 0. 00 1REROOFRES SQ FEET 25 . 00 325 . 00 0 . 00 325 .00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 327. 05 0. 00 327 .05 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 327. 05 MC --------------- TOTAL RECEIPT 327. 05 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 CUADDRESS: 850 STENDHAL DATE.. REVIEWED BY: : BP#: *VALUATION: 1$10,500 *PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof PRIMARY SFD or Du lex PENTAMATION 1 SFDWLROOF USE: P PERMIT TYPE: WORK RE-ROOF TEAR OFF TAR & GRAVEL INSTALL NEW 4PLY TAR & GRAVEL 25SQFT SCOPE FEE ID ROOF AREA s.f. 1REROOFFRES 2,500 T7 I T Li NOTE. Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addn 7 info. FEE ITEMS (Fee Resolution 09-05I Eff. 7,1//OL FEE QTY/FEE MISC ITEMS Permit Fee: $325.00 Work Without Permit? 0 Yes No $0.00 i Strong Motion Fee: IBSEISMICR $1.05 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $327.05 $0.00 TOTAL FEE: $327.05 Revised: 04/29/2011 REROOF TEAR-OFF POLICY COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION ALBERT SALVADOR, P.E.,C.B.O.,BUILDING OFFICIAL CUPERTINO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408)777-3228• FAX(408)777-3333•building(a.cugertino.ora PROJECT ADDRESS 51 / APN# _50 OWNER NAME /{/I , ICC_ Iv PHONED 2 n 6. 7 E-MAIL STREET ADDRESS 5 O 57L n1_P14f} ' ` CITY, STAwIP `R^1 1 -7(Nv �� lI/ 1 FAX CONTRACTOR NAME (� LICENS�E7NUMBER LICENSE T P x BUS.LIC.# l / � e COMPANY NAME E-MAIL FAX STREET ADDRESS O a J 1 f CITY,STATE, E,ZIP 9 `f ONE - 7Jr cA I UNDERSTAND AND AGREE TO THE FOLLOWING: I. The re-roof project shall comply with all applicable provisions of the 2007 California Building Code. 2. You must schedule all needed inspections a minimum of one day before the requested inspection date. Please schedule inspections online or call (408)777-3228 between 7:30-3:30 (Mon-Fri). 3. Tear-off roof inspection is required. Please call for tear-off inspection after the roof is torn off and all the nails/fasteners have been removed. Any and all dry-rotted wood shall be replaced prior to this inspection. A building inspector will be available within one hour. There are special hours for this service: 7:30 — 10:30am and 1:00—3:30pm(Mon—Thurs); 7:30 — 10:30am and 1:00—2:30pm (Friday). 4. If plywood is installed, a plywood nailing inspection is required. 5. In-Progress roof inspection is required. Call for an in-progress roof inspection to verify building is weather tight after installation of approximately 25% of the roofing material. 6. New roof coverings shall not be applied without first obtaining all inspections and written approvals from the building inspector. Any roofing which is applied without first obtaining an approved inspection will require the removal of all new material down to the sheathing so a proper inspection can be performed. 7. A final inspection and approval shall be obtained from the building inspector when the re-roofing is complete. To receive a final sign-off, the following items will be verified: a. Flat roofs shall have a minimum of'/4"per foot of slope and must demonstrate there is no ponding. b. Listings from approved testing agencies for all pre-manufactured products used shall be available on-site to review at the time of the inspection. c. Proper spark arrestor installation. 8. NOTE: If you call for a tear-off or plywood nailing inspection and the work is not complete, you will be charged a re-inspection fee of$126.00. The re-inspection fee shall be paid before another inspection can be scheduled. By my signing below, I certify each of the following is true: I am the property owner or authorized agent to act on the property owner's behalf. I unde d agree to comply with the re-roof policy stated above. Signature of Applicant/Agent: Date: RerooJPolicy_2010.doc revised 05/17/10 Jun 02 11 11 : 02a Cosmos Roofing (650) 969-9905 p. 2 18304 Tara Ar�w CwacdwCA M14 Tdgftw Non"?-N= Fit(4M 777 3333 CUP NO Buildinz De arhnent 1O3 ADDRa- rMMUTO UWNWS NAIuR's: Yv\i E Sc_ PHOM# zlpg 3� GENMAL QQ TUCTOR: Cne, FAX# lq 90s' r M not Uft any 1P 2, p 1 Date Pgeaee check ca Mfl coats the it�f�o on: SMCONTRAC'TOR I BUSDIM NAME BUSMESS LICENSE# Cabbaft&hM hvork Cement ' ELecb!kW T�ocevadon FI Urwlem wood GUM huniation r. Ma o nrai Sit Metal Nving P! Se Tank S��et Metal Sheet Rock �. Date 2011-06-02 10:52 650 969 9905 Paqe 212 l I C5 IMREROOF PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUPERTlNO (408)777-3228•FAX(408)777-3333•building(okupertino.or4 PROJECT ADDRESS q5 l.` A ] ^ 1 APN# �L l q, v l OWNER NAME 1_ /' LPHONE4 0 C 03-7 of-MAIL STREET ADDRESS �r� C 7r _t / I CITC STATE,tZV-7I�M C a -5 o`�J FAX CONTACT NAME I ' PPHONE5/D i'1 2'7 _U E-MAIL :) t� ..hi.JL STREET ADDRESSI 0 ` /,�6�VVI�1-�� p CITY,STATE,CZ�Ii��� /c{ FAX ❑OWNER ❑ OWNER-BUILDER L❑ OWNER AGENT ❑ CONTRACTOR 11 CONTRACTOR AGENT ❑1 ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME Z l LH /, ��� LICENSE NUMBER i LICENSI;TYPE BUS.LIC.# cl COMPANY NAME `YIV `C•/� 1 \ / E-MAIL _I FAX 7 n 67 STREET ADDRESS ►/ (J CITY,STATE,ZIP P ONE i o CL-p ,�taD CF-IIID Y ,M►_ victj . CA .�`��'`�3 iso E9 7E� 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 AREA: VALUATION: r7 STRUCTURE: ❑ Commercial Z.S cz) � f O �V v EXISTING ROOF TYPE: MBUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY) REMOVE/REPLACE ES IF NO, PLYWOOD ❑ h" ❑ PLYWD ❑ OSB PITCH: { ROOF ❑ NO #LAYERS: THICKNESS: ❑ 5/8" TYPE: ❑ CDX 'I Z CLASS: `� PROPOSED ROOF TYPE: BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT# DESCRIPTION OF WORK: —� 1 rZ U� 1Z 'r G i> i G ( � 5 14--t By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. 1 have read this application and the information 1 have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building c!rVAcoon. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant>Agent: Date: 6 f -3 SUPPLEMENTAL INFORM N REQUIRED OFFICE USE ONLY _If building is associated with a Home Owner's Association,provide letter PLAIN CHECK TYPE ROUTLNG SLIP �, of approval from HOA. R-THE-COUNTER BUILDING PLAN REVIEW Provide Planning approval to verify if there any restrictions. ❑ EXPRESS ❑ PLANNING PLAN REVIEW Provide copy of Manufacturer's Installation Specifications. ❑ STANDARD ❑ FIRE DEPT Provide signed copy of Cupertino's Tear-Off Policy. ❑-OTHER, ReroofApp_2011.doc revised 03116111