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10100202 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10816 W ESTATES DR CONTRACTOR:COSMOS ROOFING PERMIT NO: 10100202 OWNER'S NAME: JOHN LUM 1901 OLD MIDDLEFIELD WAY STE 22 DATE ISSUED: 10/28/2010 7NER'S PHONE: 4089624291 MOUNTAIN VIEW,CA 94043 PHONE NO:(650)969-7663 41 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL License Class C 3� Lic.#_ 7g 5 4`� RE-ROOF 23 SQUARES TEAR OFF EXISTING WOOD � II SHAKE Contractor )�a Date RESHEET W/OSB INSTALL 30 ILB FELT COMP SHINGLE I hereby affirm that I am licensed and a provisions of Chapter 9 CLASS A (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. 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. Sq.Ft Floor Area: Valuation:$11655 1 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 whic his APN Number:36922028.00 Occupancy Type: permit is issued. / APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgment:, costs,and expenses which may accrue against said City in consequence of the Issued by. Date: granting of this permit. Additionally,the applicant understands and will comply with all non-poin rce regulations per the Cupertino Municipal Code,Sectior 9.18. RE-ROOFS: Signature Date fin l� All roofs shall be inspected prior to any roofing material being installed.If a roof is _ installed without first obtaining an inspection,I agree to remove all new materials for inspection. WNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I,as owner of the property,or my employees with wages as their sole compensz tion, will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractor to HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. 1 will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Section 2550ILENDEING 25534. Section 3700 of the Labor Code,for the performance of the work for which thi: Date: Owner or authorized agent: permit is issued. I certify that in the performance of the work for which this permit is issued,I sl all not employ any person in any manner so as to become subject to the Worker's C CTION GENCY 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 I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address 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 re ating to building construction,and hereby authorize representatives of this city to en er upon the above mentioned property for inspection purposes.(We)agree to save, ARCHITECT'S DECLARATION i• lemnify and keep harmless the City of Cupertino against liabilities,judgments, ,,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. b.,nting of this permit.Additionally,the applicant understands and will compl� with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date CITY OF CUPERTINO FEE ESTIMATOR— BUILDING DIVISION ADDRESS: DATE: REVIEWED BY: APN: BP#: *VALUATION: $11,655 91;PERMITT'YPE: Minor Building Permit PLAN CHECK TYPE: Re-roof PRIMARY 17 r PENTAMATION 1 SFDWLROOF USE: SFD or Duplex �.�� r r, ,y PERMIT TYPE: WORK SCOPE FEE ID RC OF AREA s.f. 1REROOFFRES 2,300 Li Im"' 1°c k" NOTE: Theseees are based on the preliminaryin ormati gn available and are onlyan estimate. Contact the De t or addn'1 info. FEE ITEMS (Fee Resolution 04-051 Ejf. T'1/10j FEE QTY/FEE MISC ITEMS 1'1(oi Check r:ec. szappL PC/'ec F771 'A Permit Fee: $299.00 s aloe[ A to Unit 1'faaatr �...t1c� l..�Ie'l�:c Pelami", I"A" -O?I_�if'tIC'IioPl �l ci:�" Work Without Permit? 0 Yes No $0.00 //canna g T CC'N: TV,wcl Ooccrr n("afratiol; Strong Motion Fee: IBSEISMICR $1.17 Select an Administrative Item Bldj4 Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: D$301.17 $0.00 TOTAL FEE: $301.17 Revised: 10/17/2010 CITY OF CUPERTINO 3 ITEMS OF 10 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Elk: Lot: APN 36922028 . 00 DATE ISSUED. . . . . . . : 10/28/2010 RECEIPT #. . . . . . . . . ES000011863 REFERENCE ID # 10100202 SITE ADDRESS 1.0816 W ESTATES DR SUBDIVISION . . . . . . . CITY C:UPERTINO IMPACT AREA . . . . . . OWNER JOHN LUM ADDRESS :_0816 E ESTATES DR CITY/STATE/ZIP CUPERTINO, CA 95014-4538 RECEIVED FROM .JEFF RAINEY CONTRACTOR . . . . . . . : I-OSMOS, RICHARD LIC # 18844 COMPANY �OSMOS ROOFING ADDRESS L901 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 11, 655 .00 1 . 00 0 .00 1 . 00 0 . 00 1BSEISMICR VALUATION 11, 655 .00 1 .17 0 .00 1 . 17 0 . 00 1REROOFRES SQ FEET 23 .00 299 . 00 0 . 00 299 . 00 0 . 00 ---------- ---------- ---------- ------ TOTAL PERMIT 301 . 17 0 . 00 301. 17 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- -------------- - ------------------- CREDIT CARD 690 . C4 visa -------------- - TOTAL RECEIPT 690 . 04 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 Oct 26 10 01 : 42p Cosmos Roofing (650) 969-9905 p. 7 Carmo�i0►Ds+aiopise�t 10300 Tae Av w C*UdN CA 95014 Tdg6m M 777-3no g�(4M777-3333CUP NO Bulildia De artment JOB"DMS: rERWr# esT A rles --OK OWNERS NAME PHOM# '-7W5 GEMAL C3ONTRACrOft FAX# I am not using any f Date Please check a stibcm---- dote the fonowan3u� SUBCOlV'x'�LACrOR BUSII�IFSS NAME BUSIIVESS LICENSE#E Cabinets&MiDw+adc camentphdAmng. Aecaicat Evmvadon Fendng Linoleum/Wood c /Gazing Headng In+eaLidion I.atlmn6 On ammw!Sheet Metal Pai: g/W Slop&Tw& Sl�sat Motel Street Rodc T lc acv ..Date INPUT Resources Energy AQ M.Indoor Air Quality and Finishes 1.Use Low/No-VOC Paint 1 IAQ/Health pts y=yes 0 2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes 0 3.Use Low/No VOC Adhesives 3 IAQ/Health pts y=yes 0 4.Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes 0 5.Use Engineered Sheet Goods with no added Urea Formaldehyde 61AQ/Health pts y=yes 0 6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 0 7.Seal all Exposed Particleboard or MDF 4 IAQ/Health pts y=yes 0 8.Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes 0 9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y=yes 0 10.Install Whole House Vacuum System 3 IAQ/Health pts y=yes 0 . 1 1 1 N.Flooring 1.Select FSC Certified Wood Flooring 3 Resource pts y=yes 0 2.Use Rapidly Renewable Flooring Materials t Resource pts y=yes 0 3.Use Recycled Content Ceramic Tiles t Resource pts y=yes 0 4.Install Natural Linoleum in Place of Vinyl 5 IAQ/Health pts y=yes 0 5.Use Exposed Concrete as Finished Floor t Resource pts y=yes 0 6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes 0 i 1 1 I Total Points Available: 1401 130 57 Total Points Project Received: 0 151 0 i G:data/progs/gn enbuildingguidelines/remodelers/greenpointsfina12.12.04protected.xls REROOF TEAR—OFF POLICY COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE- CUPERTINo, CA 95014-3255 CUPERTIN+U (408)777-3228• FAX(408)777-3333 -buildinge-cugertino.ora PROJECT ADDRESS ( �} 5 t� 7 APN# OWNER NAME , L (!�_ 1 to PH�N L/ac?fl E-MAIL STREET ADDRESS (�V CITY, :.TATE,ZIP T FAX D S b I.�� S'TA'��� lZ Lc,,i'&I --7(,,j Ci4 . `� 5��� CONTRACTOR NAMEt LICENSE�NUM 3ER LICENSE TYPE BUS.LIC.# � !f-f I t C-3-/ COMPANY NAME E-MAI. FAX r . STREET ADDRESS CITY,�TATE,ZIP PHONE v �� rN►� �ncr r l��-� c� Y Z2 N.,-7. Jic �� . 9�c>cr3 "_51L C771E3 I UNDERSTAND AND ,kGREE TO THE FOLLOWING: 1. The re-roof project shall comply with all applicable provisions of the 2007 California Building Code. 2. You must schedule all needed inspections a mi:limum 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 witho-.it 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 dawn to the sheathing so a proper inspection can be performed. 7. A final inspection and approval shall be obtair ed 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 1/4"per foot of slope and must demonstrate there is no ponding. b. Listings from approved testing agencies f)r all pre-manufactured products used shall be available on-site to review at the time of the inspec,:ion. c. Proper spark arrestor installation. 8. NOTE: If you call for a tear-off or plywood Mailing 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. y my signing below, I certify each of the followint; is true: I am the property owner or authorized agent to act on the property owner's behalf understand and agree to comply with the re-roof policy stated above. Signature of Applicant/Agent: Date: ReroofPolicy_2010.doc revised 05/17/10 &{f`r' OF CITY OF CUPERTINO RI_�,ROOF CUP RTINO PERMIT APPLICATION /0C©U 20 Z APN # Date: Building Address: C fJ 16 �� • �5"7A-1�� � '�• Owner's Name: ,j f-�, ,,� v�� Phone #: HOA: Yes ElNo El if yes, provide 1 etter from HOA Contractor: Phone #: 650-793-5012 COSMOS ROOFING 1901 OLD MIDDLEFIELD WY #22, MENLO PARK, CA 94043 Fax #: 650-969-9905 Cupertino Business License #: Contractor License #: 785441 Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles ❑ Asphalt Shingles ;V, Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other(Specify) X Other (Specify) Cce,tm r S r•.;�; �c �� �Z Number of existing coverings _ ❑ Provide I.C.C.E.S. Report# ❑ To be Removed ❑ Provide Mfgr. Installation Specs. Job Description: C3z-15.7 i,-J-- j C m S N�� I�-� S�e Z'7 LJ5 /A�'TAI c- 3o 00 ii G �. H► l� C.ilss �'� Z 3 s� i;22s. Y Residential Ffl Commercial ❑ Green Building: Please complete relevant portion of the Confirmed with Planning Dept. if Green Building Checklist & attach it to the application or if there are any restrictions: ❑ -applicable, include in plan set & the sheet index. Valuation: ' G L 5 � I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy: Signature Revised 02/05/09