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13090096 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 6033 SHADYGROVE DR CONTRACTOR:COSMOS ROOFING PERMIT NO: 13090096 OWNER'S NAME: CHARLES ROSENBERG&WENDY FAN 999 COMMERCIAL ST STE 105 DATE ISSUED:09/12/2013 OWNER'S PHONE: 6504501576 PALO ALTO,CA 94303 PHONE NO:(650)969-7663 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIAL License Class 6- 3 / Lic.# 7 ` y I (23 SQ'S)TEAR OFF(E)T&G,NO RE-SHEET.INSTALL `�� � (N)4-PLY CAPSHEET Contractor a f ' ) zz � Date r'Z r� I hereby affirm that I am licensed a 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 erformance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$11300 I have and will maintain Worker's Compensation Insurance,as provided for by ection 3700 of the Labor Code,for the performance of the work for which this APN Number'37540003.00 Occupancy Type: ermit 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 F 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 the13- �' Z granting of this permit. Additionally,the applicant understands and will comply 50: L3 with all non-point source regulations per the Cupertino . ipal Code,Section 9.18. RE-ROOFS: Signature Date 1 �-!� All roofs shall be inspected prior to any roofing material being ipstalled.If a roof is installed without first obtaining an inspection,I agree to r ve all new materials for inspection. ❑ OWNE UIL R DECLARATION �/ �'rr 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 COVE S 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) 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 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, apter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,25533,and 255 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 CONSTRU 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 Al REROOF PERMIT APPLICATION O COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION R�� 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 /I (408)777-3228•FAX(408)777-3333•build ing(a-cugertino.org PROJECT ADDRESS / � ff4.DY6? w 1� X- APN# —DO OWNER NAME �.,t yJGK1►SOS n1�E''iZF-G(� YI` V ONE50. ,1�`/S ` E-MAIL STREET ADDRESS/O`�3 FAJ7Y Go20cJE CGTtYJ,�T�,A2TE41P,)O eb 01� FAX CONTACT NAME vWANDA @ COSMOS ROOFING PHONE 650-969-67-6/613 E-MAIL STREET ADDRESS 999 COMMERCIAL 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 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: VALUATION: �+gy.ye� ry STRUCTURE: ® Commercial 2-300 $ /11 �L/�,/ C EXISTING ROOF TYPE: ;K BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY) REMOVE/REPLACE YES IF NO, PLYWOOD ❑ %" ❑ PLYWD ❑OSB PITCH: 7 ROOF ❑ NO #LAYERS: THICKNESS: ❑ 5/8" TYPE: ❑CDX ` '12 CLASS: A PROPOSED ROOF TYPE: K BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT# DESCRIPTION OF WORK: 1 er� 'fA_Q_f— C V�IrL_ © '2_ to . fA)S 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 d verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building construction. I Ailthorize repres of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFO UIRED OFFICE USE ONLY If building is associated with a Home Owners Association,provide letter PLAN CHECK TYPE ROUTING SLIP Of approval from HOA. OVER=THE=COUNTER ❑ BUILDING PLAN REVIEW Provide Planning approval to verify if there any restrictions. "r❑ EXPRESS _ ❑. PLANNING PLAN REVIEW Provide copy of Manufacturers Installation Specifications. ❑ STAND'ARD ❑ FIRE DEPT Provide signed copy of Cupertino's Tear-Off Policy. ❑ OTHER: ReroofApp_2011.doc revised 03/16111 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION 91 ADDRESS: 6033 SHADYGROVE DR DATE: 09/12/2013 REVIEWED BY: MELISSA APN: 375 40 003 BP#: "VALUATION: 1$11,300 *PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof PRIMARY SFD or Duplex PENTAMATION 1SFDWLROOF USE: P PERMIT TYPE: WORK 23 SQ'S TEAR OFF E T &G NO RE-SHEET. INSTALL N 4-PLY CAPSHEET SCOPE FEE ID ROOF AREA s.f. 1REROOFFRES 2,300 Mimi Xtech. Plant Check Plumb.Plan Check Elec.flan(."he(,,k :Llech.Permit Fee.. Plumb.Permit fee: Elec. Permit fee: Other A(ech.Insp. Other-Plumb Insp. Other Elec,Insp. A11ech.In.sg). Fee: Plumb.Insp.Tee: Elee.Insp.Fee: NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). These fiW are based on the prelimina information available and are only an estimate. Contact the Dept for addn'1 info. FEE ITEMS(Fee Resolution 11-053 Eff. 7/1/13) FEE QTY/FEE MISC ITEMS Plan. (..hoc%Fee: SuFhl.PC Fee Plumh.l Ilfech./Llec Permit Fee: $368.00 Sul)pl. 117s19 Fee Plumb./11fe ch./Elec Plumb./Mech.1E'1ec Permit Fee: Consiruction :Tia: Administrative Fee: Work Without Permit? ® Yes (j) No $0.00 Advanced Planning Fees: Travel Documentation Fees: Strona Motion Fee: IBSEISMICR $1.13 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 F �a�_ WSAPNI3,° $370.13 $0.00 � L r $370.13 Revised: 08/01/2013 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•build inq(d)cupertino.orq PROJECT ADDRESS 6 O 3 Z L� 0` e C 21Z APN# © /1 3 OWNER NAME 6,ro� 905 1 L- 6 P60s"' , qs� 7 /1 E-MAIL l l! STREET ADDRESS `�-(O �`^^/ � re CITY,STAT 1� L/V FAX CONTRACTOR NAME RICH COSMOS!/ ,J LICENSE NUMBER 7854441 LICENSE TYPE 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 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 following is true; I am the property owner or authorized agent to act on the property owner's behalf. I understand and ree to comply with the r - oof policy stated above. Signature of Applicant/Agent: Date:L7"Im ReroofPolicy_201 0.doc revised 05117110