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13100051 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10281 JOHNSON AVE CONTRACTOR:COSMOS ROOFING PERMIT NO:13100051 OWNER'S NAME: SHETTY ANILKUMAR D AND MEGHA A 999 COMMERCIAL ST STE 105 DATE ISSUED:10/07/2013 OWNER'S PHONE: 4086031173 PALO ALTO,CA 94303 PHONE NO:(650)969-7663 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL /License Class C 3 9 Lie.# RE-ROOF 26 SQ-PITCH AND FLAT PORTION,INSTALL 3 PLY CAPSHEET Contractor� N1 0 ?r�i Date j Q 7 I hereby affirm that I am licensed undea 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:$10200 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:37518031.00 Occupancy Type: ` permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above,information is PERMIT WIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHVFM YS 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 DA LAST CALLED SP ON. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply Issued by: Da e: with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signature Date 10 7 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 new materials for inspection. ❑ OWNER- LD ECLARATION � Signature of Applicant: ate: l _ I hereby affirm t xempt from the Contractor's License Law for one of the following asons: ALL ROOF COVERING E 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 oroffered for sale(Sec.7044, Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to RDOUS 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,C 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 2553 Section 3700 of the Labor Code,for the performance of the work for which this f�}I permit is issued. Owner or authorized agent: Date: / 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 CONSTR J� LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is 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 l COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408)777-3228•FAX(408)777-3333•building a)cuoertino.oraCUPERTINO (� PROJECT ADDRESS O APN# �G OWNER NAME A� )L 14 E7T PHO 409 -603- 11? ✓ E-MAIL STREET ADDRESS CI-- TATE,ZIP FAX OZ- ! JOl+/JS6nD /�£ CL) & /..1O G i4 • `�S0/ CONTACT NAME WANDA @ COSMOS ROOFING PHONE 650-969-7663 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 7 LICENSE NUMBER LICENSE TYPE BUS.LIC.# RICH COSMOS 785441 C39 COMPANY NAME 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 USE OF �<SFD or Duplex ❑ Multi-Family ROOF AREA: VALUATION: STRUCTURE: Commercial ����-/ �✓� EXISTING ROOF TYPE: KBUILT-UP ROOF 6kASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY) REMOVE/REPLACE 13 YES IF NO, PLYWOOD ❑ w, ❑ PLYWD ❑OSB PITCH: `Z-S - IZ ROOF ❑ NO #LAYERS: THICKNESS: ❑ 5/8" TYPE: ❑CDX I --ff—'12 CLASS: A PROPOSED ROOF TYPE: MUILT-UP ROOF M.pSPHALT SHINGLES 11 WOOD SHAKES ❑WOOD SHINGLES El OTHER ICC-ES REPORT# DESCRIPTION OF WORK: P1 7 C A--AD 1-14-7 FC(Z-7'© J + "PlIc N- TES OK C-&,1-7 F - AJ a iZ C-5rtr__T �9-MC_ i rj--7jejF e-&9>v /fi`l" 7F n z Ot- r_ 'S FF[--T7 - JO 1 1 C7 <H1--& By my signature below,I certify to each ofthe 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 Ihave provided is correct. I have read the Description of Work and verify itis accurate. I agree to comply with all applicable local ordinances and state laws relating to building construction. presentatives he above-identified property for inspection purposes. Signature of Applicant/Agent: Date: bq 7 SUPPLE L INFORMATI D OFFICE VSE ONLY If building is associated with a Hom er s Association,provide letter t'PLAN CHECK TYPE ROUTING SLre Of approval from HOA. OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW Provide Planning approval to verify if there any restrictions. 1-1 EXPRESS ❑ PLANNING PLAN REVIEW Provide copy of Manufacturer's Installation Specifications. ❑ STANDARD ❑ FIRE DEPT Provide signed copy of Cupertino's Tear-Off Policy. '14 ❑ OTHER: ReroofApp_2011.doc revised 03/16/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: I DATE: REVIEWED BY: APN: BP#: *VALUATION: 1$10,200 *PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof PRIMARY SFD or Duplex PENTAMATION 1SFDWLR00F USE: P PERMIT TYPE: WORK SCOPE 'FEE ID ROOF AREA s.f. 1REROOFFRES 2,600 4 u ' :G KY ;L1ech. Flan Check Phimb.Plan Check Elec.Plan Check tleclt.Permit Fee; Plumb.Permit Fee: Elec. Permit Fee: F ;heck Insp, Other Plumb Insp. Other Elec.lisp.. Insp. Fee: Plumb. Irish.Fee: Elec.Insp. Fee., NOTE:This estimate does not include fees due to other Departments(ie.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). Theseees are based on the relimina information available and are onlyan estimate. Contact the Det or addn'1 info. FEE ITEMS (Fee Resolution 11-053 E . 711/13) FEE QTY/FEE MISC ITEMS Plan Check hee: Suppl. PC 1-,ee Phimb.11fech.;Elee. Permit Fee: $416.00 Suppl. Insp flee Plumb./11ec;h.lElee Plumb.l ech.11slec:Permit Fee: Consiruction Tar: Aelininistrative Fee: Work Without Permit? ® Yes (E) No $0.00 ,1clvancecl Planning Fees: Travel Docilmi.entation Fees: � Strong Motion.Fee: 1BSEISMICR $1.02 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 01 $418.02 $0.00 :. L $418.02 �� . Revised: 10/01/2013 REROOF TEAR-OFF POLICY 10 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 ina(a.cupertino.org PROJECT ADDRESS APN# ,.+j®f-fAt1 ln n7 OXWA L C PHO �Q 3, tI E-MAIL STRD (S C�Y�SjTATEpt7Z.-I1tt �-4 e / 50N FAX CONTRACTOR NAME) LIC ENSECN►U`]E LICENSE TYPE BUS.LIC.# o �1 C7 7 q 1 c COMPANY NA .V o _�t�j fD E-MAIL 12 j( / O , �, STREET ADDRESS CITY,STATE,ZIP PHONE cdw►0f�zcr146,7- 1C / o ,f,,�p cA 9Y-303 � 0 96 - - M6 3 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 unde a agree to comply with f policy stated above. Signature of Applicant/Agent: Date: /0/-7z/ ,3 ReroofPolicy_2010.doc revised 05/17/10