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13050147 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 910 OLD TOWN CT CONTRACTOR:COSMOS ROOFING PERMIT NO: 130501.47 OWNER'S NAME: HENRY ZHAO 999 COMMERCIAL ST STE 105 DATE ISSUED:05/21/2013 OWNER'S PHONE: 4082194385 PALO ALTO,CA 94303 PHONE NO:(650)969-7663 Ll LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIALE] X License ClassC Lic.# 7 Sy`N!� (23 SQ'S)TEAR OFF(E)WOOD SHAKE,INSTALL _ LIFETIME COMP Contractor W71n�tt� ^I Date I hereby affirm that I am licensed unde provisions:of Chapter 9 (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:$13230 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 APN Number:35611040.00 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 WITBIN 18 �;F 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 18 S FRO CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in cons ce of the 2` granting of this permit. Additionally,the applicant ds and will comply Issued b Date: with all non-point source regulations per-the. R Municipal Code,Section 9.18. RE-ROOFS: Signature J Date_ 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 aterials for inspection. ❑ ER-BUILDER DECLARATION / Signature of Applic Date: -5/Z i A3I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVER S T CLASS"A"OR BETTER I,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&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors 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. I 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 emifhazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management Dis performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,C .12 and I have and will maintain Worker's Compensation Insurance;as provided for by the Health&Safety Code,Sections 25505,25533,and 25 Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date: permit is issued. I certify that in the performance of the work for which this permit is issued,I shall 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 CONS UC N7 ENDING AGENCY 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 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 ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date REROOF PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION LL, 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 I CUPERTI NO (408)777-3228•FAX(408)777-3333•building(a1cupertino.org ` PROJECT ADDRESS /OJt D T W ) G Z 77APN# — O L(v O NAME 44 C-A) -MAIL4 0 43951 E STREET ADDRESS CITY, TATEZ Ct OOLPT©IJAP-7. , Z 71 A) 7 Aso /� FAX CONTACT NAME WANDA @ COSMOS ROOFING PHONE 650-969-7663 E-MAIL STREET ADDRESS 999 COMMERCIAL STREET 4105 CITY,STATE,ZIP PALO ALTO, CA 94303 FAX 650-485-2314 ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT lel CONTRACTOR ❑CONI[IACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC.# RICH COSMOS 785441 C39 COMPANY NAME COSMOS ROOFING E-MAIL FAX 650-485-2314 STREET ADDRESS CITY,STATE,ZIP PHONE 650-969-7663 999 COMMERCIAL. STREET #105 PALO ALTO, CA 94303 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: STRUCTURE: Commercial Z J CTO "s /3, 23 O cT� EXISTING ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ;KIWOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY) REMOVE/REPLACE §KYES IF NO, PLYWOOD ❑ w, ❑ PLYWD ❑ OSB PITCH: ROOF ❑ NO #LAYERS: THICKNESS: 5/8" TYPE: 39 CDX '12 CLASS: A PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT# DESCRIPTION OF WORK: _✓ 5 � `�7 f A . 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. I have read this application and the information I'have provided is correct. I have read the Description of�W k and verify itis accurate. I agree to comply with all applicable local ordinances and state laws relating to building construction.I authoria rvesCliF hof Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: T SUP TA ION REQUIRED If building is associated with Home Ownees Association,provide letter P1aN;c> cx Tx E xouTnvcsL>p of approval from HOA. eovEx THE-COUNTER ❑ BU"ING PLAN REVIEW Provide Planning approval to verify if there any restrictions. ❑. EXPRESS ❑`. PLANNING PLAN REVIEW Provide copy of Manufacturer's Installation Specifications. ❑ sx ❑ FIRE WEPT Provide signed copy of Cupertino's Tear-Off Policy. OTHER: ReroofApp 2011.doc revised 03116/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 910 OLD TOWN CT DATE: 05/21/2013 REVIEWED BY: MELISSA APN: 35611040 BP#: EVALUATION: $13,230 *PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof PRIMARY PENTAMATION 1SFDWLR00F USE: SFD or Duplex PERMIT TYPE: i WORK �23 SQ'S TEAR OFF E WOOD SHAKE INSTALL LIFETIME COMP SCOPE FEE ID ROOF AREA s.f. 1REROOFFRES 2,300 16 Tech. flan Check Plumb.Plart Cheek Elect.Plan Check Mech.Permit Fee:. Plumb.Permit Fee: Elec. Permit Fee: LiOther Alecrh.Insp. Other Plumb Insrl. Other Elec.Insp. llech.Insp.Fee: Plumb. hup.Fee: Elce.Insp.Fee: NOTE:This estimate does not include fees due to other Departments(La Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). These fees are based on the prelimina information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS(Fee Resolution 11-053 E 711112.)_ FEE QTY/FEE MISC ITEMS . Plan Check Fee: Suppl. PC Fee Plumh.iMec:h.lElec Permit Fee: $345.00 Suppl. Insp Pee .Plumh.liVech./Flee Plumb,111ech.10ec Permit Fee: Conswuction Tarr: Administrative Fee: Work Without Permit? 0 Yes Q No $0.00 Advanced Planning Fees: Travel Doctimentation Fees: � Strong Motion Fee: IBSEISAffCR $1.32 Select an Administrative Item Bldjz Stds Commission Fee: 1BCBSC $1.00 $347.32 $0.00a ti . . . $347.32 Revised: 04/29/2013 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 cuoertino.orp PROJECT ADDRESS D CID -T APN# OWNER NAME C 1�y � A0 PHO r_24C7 �C E-MAIL f4 STREET ADDRESS O 001 7O� 1 I R-7. CITE,S�T�T i!� _r fti0 ^x ! q CO/� FAX CONTRACTOR NAME N (� LIC C'U(,fBER C+ LICENS>T PE --- Gf� m (� 4( C COMPANY NAAMEE� E-MAIL 2-314S T DDRATCCITY,ST / M• 6q-�V3� 0117-7V I UNDERSTAND AND AGREE 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 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 I/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 follo ie: am the property owner or authorized agent to act on the property owner's behalf. I unde and agree to comply with the re-roof policy stated above. Signature of Applicant/Agent: Date: gli l�3 ReroofPolicy_2010.doc revised 05/17/10 Building Department City Of Cupertino 10300 Torre Avenue Cupertino,CA 95014-3255 Telephone: 408-777-3228 C O P E RT I N O Fax: 408-777-3333 CONTRACTOR/SUBCONTRACTOR LIST JOB ADDRESS: TI6 02--5 'Tot-J C-F--T PERMIT# . OWNER'S NAME: n)R Y ?-#fAo PHONE GENERAL CONTRACTOR: '/Z�lA) BUSINESS LICENSE# ADDRESS: 9 ct (feMMtV-C4/r f ,tom O CITY/ZIPCODPS w /IZ--70 *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL :BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED-A,-CITY OF CUPERTINO BUSINESS LICENSE. 1 am not using any subcontractors: e Date Please check applicable subcontractors a plete the following information- t/ SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring/Carpeting Linoleum/Wood Glass/Glazing Heating Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date