10100049 CITY OF CUPERTIP O BUILDING PERMIT
BUILDING ADDRESS: 1119 MILKY WAY CONTRACTOR:COSMOS ROOFING PERMIT NO: 10100049
OWNER'S NAME: CUNNINGHAM DENNIS AND CONNIE L 1901 OLD MIDDLEFIELD WAY STE 22 DATE ISSUED: 10/06/2010
BIER'S PHONE: 4084461793 MOUNTAIN VIEW,CA 94043 PHONE NO:(650)969-7663
LICENSED CONTRACTOR'S DECLARATIONIr
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class G ' Lic.# S r—
� MECH RESIDENTIAL COMMERCIAL
Contractor.Cv`7t�A 1�f9L��(. Date
I hereby affirm that I am licensed and he provisions of Chapter 9 JOB DESCRIPTION: RE-ROOF TEAR OFF EXISTING WOODSHAKE.RESHEET
(commencing with Section 7000)of Division 3 of the Business&Professions W/OSB.INSTALL LIFETIME COMP SHINGLES.CLASS A 27SQ
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.
I have and will maintain Worker's Compensation Insurance,as provided for by Sq.Ft Floor Area: Valuation:$15755
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued.
APN Number:36219015.00 Occupancy Type:
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above info ation 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 accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION.
granting of this pemrit. Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section r
9.18. Issued Dater(/""
Signature Date
Lr OWNER-BUILDER DECLARATION RE-ROOFS:
All roofs shall be inspected prior to any roofing material being installed.If a roof is
I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for
the following two reasons: inspection.
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, Signature of Applicant: Date:
Business&Professions Code)
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 HAZARDOUS MATERIALS DISCLOSURE
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the
Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. I 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 Worker'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 Bay Area Air Quality Management District I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534.
not employ any person in any manner so as to become subject to the Worker's
Compensation laws of California. If,after making this certificate of exemption,I Own or autho ' ed agent:
become subject to the Worker's Compensation provisions of the Labor Code,I must ate: I V 25
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's
I certify that I have read this application and 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,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address
i- ' nnify and keep harmless the City of Cupertino against liabilities,judgments,
and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION
granting of this permit.Additionally,the applicant understands and will comply
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
FEE ESTIMATOR-- BUILDING DIVISION
ADDRESS: DATE: REVIEWED BY:
APN: BP#: *VALUATION: $15,755
*PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY �,� ;�_ PENTAMATION 1 SFDWLROOF
USE: SFD or Duplex �t , rPERMIT TYPE:
WORK
SCOPE
FEE ID ROOF AREA
s.f.
1REROOFFRES 2,700
17-1
1."'':1 1o'
NOTE. Thesefees are based on the preliWinayUy in ormation G vailable and are only an estimate. Contact the De t or addn 7 info.
FEE ITEMS (Fee Resolution 09-051 Elf 7/1"10) FEE QTY/FEE MISC ITEMS
Plan C17C'C n
h."Flet: Plarr
Permit Fee: $351.00
.Stippl. Irrp F(::v
Elxtrzlr.=:1cr'tr.;`I�1c'c: t,'rrir fc�c:
1�'/�rrfrfr.i; Ilclr.%T:`le r° Pcrr,inil Fcc:
,IcndSlicol Rcvicii
Work Without Permit? 0 Yes No $(1.00
7'l-avcL
Strong Motion Fee: IBSEISMICR $' .58 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1 .001
SUBTOTALS: $35:.58 $0.00 TOTAL FEE: $353.58
Revised: 9/29/2010
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT' RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Bl}:: Lot:
APN . . . . . . . . . 36219015 .00
DATE ISSUED. . . . . . . : 10,'06/2010
RECEIPT #. . . . . . . . . : BS0)00011660
REFERENCE ID # . . . : 10:_00049
SITE ADDRESS . . . . . : 11:_9 MILKY WAY
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : CU]7NINGHAM DENNIS AND CONNIE L
ADDRESS . . . . . . . . . . : 1119 MILKY WAY
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-5064
RECEIVED FROM . . . . : JE: F RAINEY
CONTRACTOR . . . . . . . : COSMOS, RICHARD LIC # 18844
COMPANY CO3MOS ROOFING
ADDRESS 19 )1 OLD MIDDLEFIELD WAY STE 2
CITY/STATE/ZIP . . . : MO'JNTAIN VIEW, CA 94043
TELEPHONE (630) 969-7663
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- - --------- ---------- ---------- ----------
1BCBSC VALUATION 15, 755. 00 1 . 00 0 . 00 1. 00 0 .00
1BSEISMICR VALUATION 15, 755 . 00 1 .60 0.00 1 .60 0 .00
1REROOFRES SQ FEET 27. 00 351 . 00 0 .00 351. 00 0 . 00
- --------- ---------- ---------- ----------
TOTAL PERMIT 353 . 60 0 . 00 353 . 60 0 .00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 353 .60 VISA
---------------
TOTAL RECEIPT 353 .60
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
INPUT Resources Energy IAOJHealth
M.Indoor Air Quality and Finishes
1.Use Low/No-VOC Paint 1 AQ/Health pts y=yes 0
2. Use Low VOC,Water-Based Wood Finishes 2 AQ/Health pts y=yes 0
3. Use Low/No VOC Adhesives 3 AQ/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 6 AQ/Health pts y=yes 0
6. Use Exterior Grade Plywood for Interior Uses 1 AQ/Health pts y=yes 0
7.Seal all Exposed Particleboard or MDF 4 AQ/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
■ I I I
N.Flooring
1.Select FSC Certified Wood Flooring 8 Fesource pts y=yes 0
2.Use Rapidly Renewable Flooring Materials 4 Fesource pts y=yes 0
3.Use Recycled Content Ceramic Tiles 4 Fesource pts y=yes 0
4. Install Natural Linoleum in Place of Vinyl 5 I\Q/Health pts y=yesl 0
5.Use Exposed Concrete as Finished Floor 4 Fesource pts y=yes 0
6. Install Recycled Content Carpet with Low VOCs 4 F esource pts y=yes 0
1 1
■ 1 I I
Total Points Available: 1 1401 130 57
Total Points Projec01 01 01
G:data/progs/greenb iildinggu��,Tpointsfin.12.nprotected.xls
CITY OF
CITY OF CUPERTINO
RE ROOF
CUPERTINO PERMIT APPLICATION
APN # i Date: /
Building A dress:
�_ Lr
Owner's Name: 1-.J) �� Phone #:
ii
HOA: Yes ❑ No x❑ If es, provide letter from HOA 01? -4q6-
Contractor:
1? 4 `T6Contractor: 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 A Asphalt Shingles
/ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other (Specify) ❑ Other (Specify)
Number of existing coverings ❑ Provide I.C.C.E.S. Report #
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description: I Z � r x�S iJ��r� Sr sHA— � 4,/l USS.
SNS A-i1 Lt X71OA t— Gc>►-'7 P SN +,Je, 1, Z7 5ejtj^--A�3 . C/ t-5s A
Residentialx❑ 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: '7:5,5
� S
I Have Read, Understand and Will'Comply with Cupertino's Tear-Off Policy:
Signa
;�,�
Revised 02/05/09