15090044CITY OF CUPERTINO BUILDING PERMIT
I BUILDING ADDRESS: 21890 RUCKER DR I CONTRACTOR: COSMOS ROOFING I PERMIT NO: 15090044 1
I OWNER'S NAME: MACEVICZ STEPHEN C AND PHILLIPS CYN 1999 COMMERCIAL ST STE 105 1 DATE ISSUED: 09/08/2015
OWNER'S PHONE: 6508929848 1 PALO ALTO, CA 94303 1 PHONE NO: (650)969-7663
71 LICENSED CONTRACTOR'S DECLARATION
License Class/ e '3:� L
Lic. it L( I
Contractor L—U7 wl N Date j
I hereby affirm that I am licensed under provisions 01 Chapter
(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:
1. 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.
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
permit is issued.
APPLICANT CERTIFICATION
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
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 with
all non -point source regulations mo Municipal Cod eetion 9.18.
l <
❑ OWNER�DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
1. 1, 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)
2. I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three declarations:
1. 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.
2. 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
permit is issued.
3. 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
become subject to the Worker's Compensation provisions of the Labor Code, I
must forthwith comply with such provisions or this permit shall be deemed
revoked.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
convect. 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
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 with
all non -point source regulations per the Cupertino Municipal Code, Section 9.18.
Signature Date
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
TEAR OFF (E) WOOD SHINGLE & INSTALL (N) OSB, 30 #
FELT, CLASS A COMP ROOF SYSTEM (27 SQ'S)
Sq. Ft Floor Area: I Valuation: $1 i06i
CPN Number: 35614025.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS O��IT ISSUANCE OR
180 DAYS CALLED INSPECTION.
Date:
RE -ROOFS:
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 mate ' for
inspection.
Signature of Applicantate: / /t
ALL ROOF COVERINGS T ASS "A" OR BETTER
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(x) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I Hill
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505, 25533, aLSOI M.
Owner or
Date:—(Z/1 S
I hereby axlliere is a construction lending agency for the performance of work's
for whic -s permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
REROOF PERMIT APPLICATION
[a COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
CUPERTINO (408) 777-3228 • FAX (408) 777-3333 • building(a1cupertino.org /
PROJECTADDRESS q90 �� l I -
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APN# 3 i Y
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OWNERNAME �C� Ir
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PHONE Q77-- 7 Lfq
E-MAIL
ST EET D ES
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CITY, STATE, ZIP
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FAX
CONTACT NAME
Bobby Payne
PHONE
650-969-7663
E-MAIL
STREET ADDRESS
1901 Old Middlefield Rd
CITY, STATE, ZIP
Mountain View, CA 94043
FAX
650-584-3078
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT gl CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
RICH COSMOS
LICENSE NUMBER
785441
LICENSE TYPE
C39
BUS LIC. u
COMPANY NAME COSMOS ROOFING
E-MAIL
FAX 650-485-2314
STREET ADDRESS 1901 Old Middlefield Rd
CITY, STATE, ZIP Mountain View, CA 94043
PHONE 650-969-7663
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC. a
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF IkSFD or Duplex ❑ Multi -Family
STRUCTURE: Commercial
ROOF AREA:
(/
VALUATION:
� 15',06,5' ��
I��yyy11?v
EXISTING ROOF TYPE: ❑ BUILT-UP ROOF ❑ ASPHALT SHINGLES y�+ WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER (SPECIFY)
/❑
REMOVE /REPLACE RYES
❑ NO
IF NO,
#LAYERS:
PLYWOOD ,/" ❑
THICKNESS: 5/8"
PLYWD OSB
TYPE: COX
[PITCH:1.12ROOF
CLASS A
PROPOSED ROOF TYPE: ❑ BUILT-UP ROOF P�ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER
ICC -ES REPORT tt
DESCRIPTION OF WORK: /')'�
f 1 A— 4 1
X13 — r I Al
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. 1 have read this
application and the information 1 have provided is correct. I have read the Description of Work and verify it is accurate. 1 agree to comply with all applicable local
ordinances and state laws relating to building constr ut ori: epresentatives of Cupertino t -identified prroope for i spection purposes.
Signature of Applicant/Agent: Date:
SUPP ENTAL INFORMATION IRED
If building is associated with a Home er's Association, provide letter
of approval from HOA.
_ Provide Planning approval to verify if there any restrictions.
Provide copy of Manufacturer's Installation Specifications.
Provide signed copy of Cupertino's Tear -Off Policy.
OFFICE USE ONLY
PLAN CHECK TYPE
ROUTING SLIP
❑ OVER-THE-COUNTER
❑ EXPRESS
❑ STANDARD
❑ BUILDING PLAN REVIEW
❑ PLANNING PLAN REVIEW
❑ FIRE DEPT
❑ OTHER:
ReroofApp_2011.doc revised 03116/11
���� CITY OF CUPERTINO
19M- 1 FEE ESTIMATOR - BUILDING DIVISION
191
ADDRESS: 21890 RUCKER DR
DATE: 09/08/2015
REVIEWED BY: MELISSA
A -tech. Perm;; ! o'r.
APN: 356 14 025
BP#:
"VALUATION:
1$15,065
PERMIT TYPE: Minor Building Permit
PLAN CHECK TYPE: Re -roof
PRIMARY SFD or Duplex
USE:
I�:lec. Fce.
PENTAMATION 1SFDWLR00F
PERMIT TYPE:
WORK
TEAR OFF E WOOD SHINGLE & INSTALL N OSB 30 # FELT CLASS A COMP ROOF SYSTEM
SCOPE
(27 SQ'S)
FEE ID ROOF AREA
s. f.
1REROOFFRES 2,700
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 Dreliminary information available and are only an estimate. Contact the Dept for addn7 info.
FEE ITEMS (Fee Resolution 11-053 a.' 7/1113)
Alech. Plan Check
Plumb. Plan Check F71
Elee. Plant Check
A -tech. Perm;; ! o'r.
Plumb. Permit Fee:
Elec. Permit Fee:
Other 11c ch. Insp.
),her Plumi:� In"p,
Other kicc hist
hr ,P. fees
P:`_r;r,h. Insp. Fec°
I�:lec. Fce.
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 Dreliminary information available and are only an estimate. Contact the Dept for addn7 info.
FEE ITEMS (Fee Resolution 11-053 a.' 7/1113)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
.S`uppl. PC Fee
Ph1mb./A,fech.1E1ec
Permit Fee:
$459.00
.S uppL Insp Fee
Plumb./Mech./Elec
Plumb./Mech./Elec Permit Fee:
Construction Tax:
Administrative Fee:
Work Without Permit? 0 Yes No
$0.00
A'I dvanced.Planning Fees:
1 r(ivel Documentation Fees:
Strom Motion Fee: IBSEISMICR
$1.96
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$461.961
$0.00 TOTAL FEE:
$461.96
Revised: 07/02/2015
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 - buildingacupertino.org
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PROJECT ADDRESS Z Q J� L) C_�1Z TD l`
7AI. ✓507e371� / , O
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OWNER NAME
Z
kcrvic
PH6NE 1 L. " �
E-MAIL
STREET ADDRESS 2_1 Cg q®
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STATE, a/
--7I�
FAX
CONTRACTOR NAME RICH COSMOS
LICENSE NUMBER
LICENSE TYPE C39
BUS. LIC .#
COMPANY NAME
E-MAIL
FAX
COSMOS ROOFING
650-584-3078
STREET ADDRESS
1901 Old Middlefield Rd
CITY, STATE, ZIP
Mountain View, CA 94043
PHONE
650-969-7663
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).
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.
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 under ag e to comply with the re-rooLpeRcy"stated above.
Signature of Applicant/Agept: / l / Date:
ReroofPolicy_201 0. doc revised 05117110