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10050162 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10882 S BLANEY AVE CON TRACTOR:COSMOS ROOFING PERMIT NO: 10050162 OWNER'S NAME: BAKER MYRTLE E AND ROBERT Y TR 1901 OLD MIDDLEFIELD WAY STE 22 DATE ISSUED:05/21/2010 ER'S PHONE: 4082210675 MOL NTAIN VIEW,CA 94043 PHONE NO:(650)969-7663 LICENSED CONTRACTOR'S DECLARATION 1 BUI'.DING PERMIT INFO: BLDG ELECT PLUMB —7 License Class C Li,.# 7� S q'41 MECH RESIDENTIAL COMMERCIAL Contractor ate Zi f I hereby of rm licensed r the provisions of Chapter 9 JOB DESCRIPTION:RE-ROOF,TEAR OFF EXISTING WOOD SHAKE.RESHEET (comme n th et' n 7000) ivision 3 of the Business&Professions W/O.B&INSTALL 30#FELT&30YR COMP SHINGLE.CLASS Code an at my use is in full force and effect. A 21'Q 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.F t Floor Area: Valuation:$9140 permit is issued. APPLICANT CERTIFICATION APN Number:36923045.00 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 ]HERMIT 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 D YS FROM tt T CALLED INSPECTION. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Z( Issu'd by: ' if/ f J �-/��/ /rate: Signature Dated L N R-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: insta led 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, inspc ction. will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) Sign,aure 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 R OVERINGS 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 ha-e read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. Cali'ornia 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 Safe y Code,Section 25532(a)should I store or handle hazardous material. Add tionally,should I use equipment or devices which emit hazardous air permit is issued. cont rminants 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 mah tain 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 Owr er or tl forthwith comply with such provisions or this permit shall be deemed revoked. ONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is I herby 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 inify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. I unc',erstand 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: I,ot: APN . . . . . . . . : 36923045. 00 DATE ISSUED. . . . . . . : 05/21/2010 RECEIPT #. . . . . . . . . BS000010455 REFERENCE ID # . . . : 10050:.62 SITE ADDRESS 10882 S BLANEY AVE SUBDIVISION . . . . . . CITY CUPER-INO IMPACT AREA . . . . . . OWNER BAKER MYRTLE E AND ROBERT Y TR ADDRESS 10882 S BLANEY AVE CITY/STATE/ZIP . . . : CUPER-INO CA, CA 95014-4544 RECEIVED FROM . . . . : JEFF IMINEY CONTRACTOR COSMOS, RICHARD LIC # 18844 COMPANY COSM0:3 ROOFING ADDRESS . . . . . . . . . . : 1901 OLD MIDDLEFIELD WAY STE 2 CITY/STATE/ZIP . . . : MOUNTAIN VIEW, CA 94043 TELEPHONE (650) :)69-7663 FEE ID UNIT QUANTITY AMO1JNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---- ------ ---------- ---------- ---------- 1BCBSC VALUATION 9, 140 . 00 1. 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 9, 140 .00 1 . 00 0 . 00 1 . 00 0. 00 1REROOFRES SQ FEET 21. 00 273 . 00 0 .00 273 . 00 0 . 00 ---- ------ ---------- ---------- ---------- TOTAL PERMIT :275 . 00 0 . 00 275 . 00 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- - ------------------- CREDIT CARD 275 . 00 VISA --------------- TOTAL RECEIPT 275. 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 604 ROOF IN-PROGRESS 605 FINAL REROOF ctTY Of CITY OF CUPERTINO III REROOF CUPERT1140 PERMIT APPLICATION APN# J Date: Building Address: 10882 SOUTH BLANEY AVENUE Owner's Name: BAKER Phone#: 408 221-0675 HOA: Yes ❑ No X❑ If yes, provide letter 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 29 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. JobDescription: REROOF - TEAR OFF EXISTING WOOD SF-AKE. RESHEET WITH OSB. INSTALL 30# FELT AND30 YEAR COMP SHINGLE. CLASS A. 21 SQUARES. Residential ❑ 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: $9, 140 . 00 I Have Read, Understand and Will Comply with Cur ertino's Tear-Off Policy: Signature Revised 02/05/09 CITY OF CITY OF CUP ERTINO REROCIF CUPERTINO FEE SCHEDULE Number of Fee ID Fee Description Fee Permit Type Squares Group 1REROOFCOM Re-roof Commercial B 1COMMLROOF 1BCBSC Cal Bldg Standa:-ds B ALL PERMIT TYPES Commission Fee 1BSEISMICO Seismic Commercial B 1RER00FRES Re-roof Residential B 1SFDWLR00F J 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fec: 1BSEISMICRE Seismic Residential B 1REROOFMRES Re-roof Multi-Family B 1MFDWLROOF 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICRE Seismic Residential B 1BUSLIC Business Licens B 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 CUPERTINO (408)777-3228•FAX(408)777-3333-buildingacupertino.ora PROJECT ADDRESS I `� 2 _g )-t A t �APN# OWNER NAMEBA r_L-�Z_ PHONE of Z 1-OK ;�5 E-MAIL STREET ADDRESS CITY, STATE,ZIP FAX / DSS Z S . CONTRACTOR NAME ;.Z I L ��l�� LICEN NUMBER LICENSE PE BUS.LIC.# COMPANY NAME - E-MAIL FAX ��Sc'NU� 7 1,✓� -- Z 650 9bf STREET ADDRESS2 Z CITY,STATE,ZIP i �n 1; h n Uc� P4 ii>DL�r i 217 (1 C I UNDERSTAND AND AGREE TO THE FOLLOWING: 1. The re-roof project shall comply with all applicable p-ovisions of the 2007 California Building Code. 2. You must schedule all needed inspections a minimurr of one day before the requested inspection date. Please schedule inspections online or call (408)777-3:228 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 al. dry-rotted wood shall be replaced prior to this inspection. A building inspector will be available wilhin one hour. There are special hours for this service: 7:30 — 10:'-,0am and 1:00—3:30pm (Mon—Thurs); 7:30 — 10:'-,0am 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 ar.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 i:ems will be verified: a. Flat roofs shall have a minimum of I/4" per foot c f slope and must demonstrate there is no ponding. b. Listings from approved testing agencies for all p-e-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 behal understand and agree to com ith the re-roof policy stated above. Signature of Applicant/Agent: Date: ReroofPolicy_2010.doc revised 05/17/10 May 10 12: 06p Cosmos Roofing (650)969-9905 p. 3 ComomN*pvwd&plM 10300 TOM AVOM C patiao CA 95014 =`Aj 7V-3U3 CUP INO Buildi�nj; Department JOB ADDRESS: - PEYtwr# OINNWS NAME: 1 ,%P, PHONE 71,&3 G7NERAL CONTRACTOR: FA,X# I am not using any subwntraf v �-' - t Data Please cineck avplkablembcwtracCors co tele the folio ' amu. SUBCONTRACTOR BUSDM 5 NAME BUSHOSS LICENSE# Cabinets k MMwork Cement fitactrtcal EkTavaticm Fendng Flomtw-Oupeting Linoleum/Wood Glace/GhZing Headng huuladw landscaping . Masorw i.athutg Ornamental Sheet Metal Paiyn*%/Wallpaper Paving Plasftdng P u"An Roofing Se Tank Sheet Metal • Sheet Rock T ontmctor Sigm6ue Date f