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13080158 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21211 RAINBOW DR CONTRACTOR:COSMOS ROOFING PERMIT NO: 13080158 OWNER'S NAME: MARK COLBRIE 999 COMMERCIAL ST STE 105 DATE ISSUED:08/22/2013 OWNER'S PHONE: 4082527955 PALO ALTO,CA 94303 PHONE NO:(650)969-7663 IX LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIAL U License Class C37 Lic.# -_79 34-1 (39 SQ'S) TEAR OFF(E)SHAKE&IN,TALL(1) :v 9 ,Z� 13 LIFETIME COMP 5 Contractor 4! 05 V0 O Date ZS I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000)ofDivision 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 p ance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$24500 h e and will maintain Worker's Compensation Insurance,as provided for by e ion 3700 of the Labor Code,for the performance of the work for which this APN Number:36210053.00 Occupancy Type: pe it 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 DAY T 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 DAY M L LED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the 2Z j 3 granting of this permit. Additionally,the applicant understands and will com ssu Date: with all non-point source regulations per the Cupertino Mde,Section 9.18. RE-ROOFS: Signature Date Z2' 13 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 remo new materials for inspection. ❑ Zj�LLDER DECLARATION 7f I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: the following two reasons: A OF R TO BE 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) 1,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 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, ter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,25533,and 2 Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Dater ZZ 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..1f,after making this certificate of exemption,I CONS CTION LENDING 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 O COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION % 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 O CUPERTINO (408)777-3228•FAX(408)777-3333•building ancupertino.org PROJECT ADDRL /L-i ' '�/. � r� 1O� APN# 2 t 0 , 05 3 ,/�/�l OWNER NAME �ZK Y, / 'K I c PHO O . Z5 71551 E-MAIL STREET ADDRESS _1-2 / I�A 1 d g©� CITY,STATE, 01 C % A 501Lf FAX CONTACT NAME WANDA @ COSMOS ROOFING /C PHONE 6,5`0-969-7663 1 E-MAIL STREET ADDRESS 999 COMMERC IAL STREET #105 CITY,STATE,ZIP PALO ALTO, CA 94303 FAX 650-485-2314 ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT KI CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC.# RICH COSMOS 785441 C39 COMPANYNAME COSMOS ROOFING E-MAIL FAX 650-485-2314 STREET ADDRESS 999 COMMERCIAL STREET #105 CITY,STATE,ZIP PALO ALTO, CA 94303 PHONE 650-969-7663 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC.# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE -7 _ USE OF ;KSFD or Duplex ❑ Multi-Family ROOF AREA: VALUATION ^: y�� STRUCTURE: Commercial 9�� ' Grq' EXISTING ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES WOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY) REMOVE/REPLACE I9YES IFNO, PLYWOOD ❑ w, ❑ PLYWD ❑ OSB PITCH: ROOF ❑ NO #LAYERS: I THICKNESS: ❑5/8" TYPE: ❑ CDX A.12 CLASS A PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT# DESCRIPTION OF WORK: tf^ _ � rr7� �► f G �s 1—C By my signature below,I certify to each ofthe following: I am the property owner or auth2jiggd agent to act on the property owner's behalf. I have read this application and the information I have provided is correct. I haver ead the Descripti ork and verify itis accurate. I agree to comply with all applicable local ordinances and state laws relating to building construction. I authorize re atives of Cupertino to enter the above-ident'led property for inspection purposes. Signature of Applicant/Agent: Date: Z SUPPLEMENTAL INFORM�er?sAssc QUIRED o>iGr;usE ONLY If building is associated with a Ho ciation,provide letter PLAN;CHgCK TYPE ROUTING SLIP of approval from HOA. ❑ OVER-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.doe revised 03116111 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 21211 RAINBOW DR DATE: 08/22/2013 REVIEWED BY: MELISSA APN: 362 10 053 BP#: *VALUATION: 1$24,500 *PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof PRIMARY SFD or Duplex PENTAMATION 1SFDWLR00F USE: PERMIT TYPE: WORK 39 SQ'S TEAR OFF E SHAKE & INTALL N LIFETIME COMP SCOPE FEE ID ROOF AREA s.f. 1REROOFFRES 3,900 IRISH i' Mech. Plan Check 7Phimb.Plan Check Elec.Plan Check Fech. Permit Fee: Plumb.Permit ree: Flec.Permit Fee: Other Alech.Insp. Other Plumb Insp. Other Elec.Insp, 11ech. Insp.Fee: Plumb. Insp.ree:• Elec.Insp.Fee: NOTE:This estimate does not'include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). These fees are based on the prelfinina information available and are only an estimate Contact the Dept for addn'1 in o. FEE ITEMS (Fee Resolution 11-053 E f 7/1/12) FEE QTY/FEE MISC ITEMS Plan Check Fee: Suppl. PC Fee P1umb.1l1!lech./Flee Permit Fee: $624.00 Sultpl. Insp Fee> Plumb.iillfech./Elec Plurnb./Mech.%Elec Permit Pee: Conswuction Tax: Administrative Fee: Work Without Permit? ®Yes (E) No $0.00 Advanced Planning Fees: Travel Documentation Fees: i Strong Motion:Fee: IBSEISMICR $2.45 Select an Administrative Item. Bldg Stds Commission Fee: IBCBSC $1.00 grin ,: u $627.45 $0.00 - T( , $627.45 Revised: 07/01/2013 REROOF TEAR-OFF POLICY 13 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•buildina(a)cupertino.org PROJECT ADDRESS _12_1 I p- IAPN# / / OWNER NAME .iA . ._ / PHONELfog .- ��?CJ ['T77 V 25 STREET ADDRESS���) 1 2#+1J �R CITY,STATE ZIP I� ^� FAX CONTRACTOR NAME RICH COSMOS LICENSE NUMBER 785441 LICENSETYPE C39 BUS.LIC.# COMPANY NAME E-MAIL. FAX COSMOS ROOFING 925-485-2314 STREET ADDRESS 999 COMMERCIAL ST. #105 CITY,STATE,ZIP PALO ALTO, CA 94303 PHONE 925-969-7663 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 1/4"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 understand an complT6-roo policy stated above. Signature of Applicant/Agent: Date: ReroofPolicy_201 0.doc revised 05/17110