14010015 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 18870 PENDERGAST AVE CONTRACTOR:COSMOS ROOFING PERMIT NO:14010015
OWNER'S NAME: CAROL,BARBARA 999 COMMERCIAL ST STE 105 DATE ISSUED:01/03/2014
OWNER'S PHONE: 6504650700 PALO ALTO,CA 94303 PHONE NO:(650)969-7663
01 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL E]
TEAR OFF(E)CAPSHEET&INSTALL 5 SQ'S OF KOOL
License Class Lic.# 114"1 THERMAL GLASKAP ROOF SYSTEM
Contractor/-(7 Date
I hereby affirm that I am licensed under the provisions�h.,Ie,
(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
Nperformance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$3890
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:37533045 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 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 FRO ED 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 Date: /
granting of this permit. Additionally,the applicant understands and will comply
with all non-point so ce regulations per the Cupertino Municipal Code,Sectio
918.
RE-ROOFS:
Signature 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 new materials for
inspection.
❑ OWNER-BUILDER DECLARATION
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 COVERINGS 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,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date:1
permit is issued.
1 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 CONSTRUCTION LENDING AGENCY
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 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
918.
Signature Date
b
PAREROOF PERMIT APPLICATION (l��
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION \ "
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(408)777-3228• FAX(408)777-3333•buildino(acupertino.org
CUPLRTINO.
PROJECT ADDRESS A
OWNERNANMP ONE M,,UL
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C STATE,ZIP FAX
S
V 0
CONTACT NAME PHONE E-MAIL
STREET ADDRESS CITY,STATE,ZIP FAX
❑ OWNER ❑ OWNER-BUILDER ❑.OWNERAGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCH= ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME 3 LI SE NUMBER LICENSEE BUS.LIC.#
01
COMPANY NAME E-MAIL FAX
A0
ST REFxT DRESS C ST TE ZIP PHONE
q ,2 14 tia L
ARCHITECT/ENGINEERNAME LICENSENUMBER BUS.LIC.#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF p/S`FD or Duplex ❑ Multi-Family ROOF AREA: VALUATION:
STRUCITJRE: ❑ Commercial Lj S tea,r 14-3 1 c/
EXISTING ROOF TYPE: BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY)
REMOVE/REPLACE 11 YES IF NO, PLYWOOD ❑ %d' ❑ PLYWD 11 OSB PITCH: ROOF
11 NO it LAYERS: THICKNESS: ❑ 5/8" TYPE: ❑ CDX :12 CLASS: A
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT#
DESCRIPTION OF WORK IA 11
n
hr,,C V• 10-5- 4C160 P-oa&
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 Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating t it ' construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
S ignature of Applicant/Agent: Date:
SUPPLEMENTAL INFORMATION REQUIRED � _
bFFiCETiSEOl\LIz.
_If building is associated with a Home Owner's Association,provide letter
ag
CHEYP _ ROT I�N6 Si I�P i.
M, Now
of approval from HOA. R; o _ LBU$DGT
LAN'
Provide Planning approval to verify if there any restrictions. a�xPxEss JE P.LAN1 W
_Provide copy of Manufacturer's Installation Specifications.
Provide signed copy of Cupertino's Tear-Off Policy. - L.
4
ReroofApp_2011.doc revised 03/16/11
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 18870 Pendergast ave DATE: 01/03/2014 REVIEWED BY: melissa
APN: 375 33 045 BP#: *VALUATION: 1$3,890
*PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY SFD or Duplex PENTAMATION 1SFDWLR00F
USE: PERMIT TYPE: .41
WORK tear off a ca sheet&install 5 s 's of kool thermal glaskap roofs stem
SCOPE
FEE ED ROOF AREA
s.f.
1REROOFFRES 500
NO
— a r s
a "
;21ech. Plan Check Plumb, Plart Check F_lec..Plan Check
iLlech. llernait hee: Plumb. Permit Fee: Elec. Permit Fee:
t)ther Alech.Insp. Other Plumb Insp. Oiher Elcc.Insp.
Ll
Rtech.Insp.Fete: Plumb. Insp.Fee: Elec.Insp.Tice:
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc.). These fees are based on therelimina information available and are on an estimate. Contact the Dept for addn'1 info.
FEE ITEMS(Fee Resolution 11-053 E . 7ff 11113) FEE QTY/FEE MISC ITEMS
Plan Cheek Fee:
;Suppl. PC.Fee
Plumh.,111c ,%a./Flet;
Permit Fee: $80.00
Suppl. .Irlsp Fee
Plumb./Mech./Elec
Plumb.IMech./Flee Permit Fee:
(.onstruction Tar:
Administrative Fee:
Work Without Permit? ®Yes (E) No $0.00
A(1vanced Planning Fees:
Travel Documentation Fees:
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
$81.50 $0.00 ``�� $81.50
Revised: 10/01/2013
;• REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION O
ALBERT SALVADOR, P.E.,C.B.O., BUILDING OFFICIAL
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 V
CUPERTINO
(408)777-3228• FAX(408)777-3333•building aC�.cupertino.ora l/
PROJECT ADDRESS APN 4 3 _71--5'-5'
OWNERNAMEPl7 �ys, 7 E MAU-
STREET ADDRESS n CITY�S`TE,ZIP \n FAX
CONTRACTORNAME 2 `� LICENSENUMBER LICENSETYPE BUS.LIC.H
7 5 c/4-[
COMPANY NAME os E-MAIL FAX
s
STREET W S ATE'Z 990 q6 01
3
I UNDERSTAND AND AGREE TO THE FOLLOWING:
1. The re-roof project shall comply with all applicable provisions of the 2010 California Codes.
2. An inspection request can be scheduled up to one business day before the requested inspection date.
Please call (408) 777-3228 from 7:30-3:30pm(Mon-Thurs) or 7:30-2:30pm(Friday)to schedule
inspection. For Tear-Off and Nailing Inspections,you must also call on the day of the inspection only
after that phase of the work is completed. The building inspector will be available within one hour.
Final Inspections will be given a two hour window.
3. Tear-Off Inspection is required. Any and all dry-rotted wood shall be replaced prior to this inspedtiori.
Unless new plywood roof sheathing is proposed throughout, all the nails/fasteners shall be either
completely knocked-down or removed prior to this inspection.
4. If plywood is installed, a plywood Nailing Inspection is required.
-5--Roofing shall not be ap-lied without first obtaining all prior inspection and written approvals from the
building inspector. Any roofmg 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.
6. A Final Inspection and approval shall be obtained from the building inspector when the re-roofing is
completed. 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 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,vents painted, gutter/downspouts installed, debris removed.
7. 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. 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 agree to comply with the re-roof policy stated above. I also understand that
smoke detectors and carbon mono ' detectors ar equired to be installed in accordance with Sections R314 and R315 of
the 2010 California Residentia
Signature of Applicant/Agent.
Date:
RerooJPo1icy_2012.doc revised 10/7/12