15100239G
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10449 PLUM TREE IN
CONTRACTOR: COSMOS ROOFING
PERMIT NO: 15100239
OWNER'S NAME:.NISHIMURA AKIHIRO AND HIROKO TRUSTE
999 COMMERCIAL ST STE 105
DATE ISSUED: 10/30/2015
OWNER'S PHONE: 6509600897
PALO ALTO, CA 94303
PHONE NO: (650)969-7663
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL F]
Licerise Class Lie. #
TEAR OFF (E) SHAKE ROOFING; INSTALL (N) ASPHALT SHINGLES
CLASS A ROOFING; INSTALL (1) CDX PLYWOOD (23 SQ)
Contractor.- ZIA Dat 1 1
I hereby affirm that I am licensed unde 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
Sq. Ft Floor Area:
Valuation: $10055
rmance of the work. for which this permit is issued.
e and will maintain Worker's Compensation Insurance, as provided for by
ge
tion 3700 of the Labor Code, for the performance of the work for which this
APN Number: 31633083.00
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 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 FROM LAST CALLED 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
ff
granting of this permit: Additionally, the applicant understands and will comply
Issued by: Date: 10 -27b
with all non -point source regulations per the Cupertino Municipal C e, --Section
9.18.
"
Signatures Date"lb/30/1 S
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installe . If a roof is
installed without first obtaining an inspection, I agree to remove new materials for
. ,inspection.
❑ OWNE DER 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 COVERIN 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 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 25505,25533,19g_25.534. -
Section 3700'of the Labor, Code,, for the performance of the work for which this
Owner or authorized agent: 3
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 dfCalifornia. If, after making this certificate of exemption, I
CONSTRUCT 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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
ARCHITECT'S DECLARATION
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 permii: Additionally, the applicant understands and will comply
with all non-poini source regulations per the Cupertino Municipal Code, Section
Licensed Professional
9.18..x,
i
Signature Date
REROOF PERMIT APPLICATION
is COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
cuPEaTINa (408) 777-3228 • FAX (408) 777-3333 • building(aDcupertino.org
15 (0023°j _.
PROJECT ADDRESS J 1,4 ` j �� ," 1
APN # -.Yom, /_ 3
OWNERNAME I
PHONE C
E-MAIL
STREET ADDRESS
r� 1147Z:zr LA1
CITY, STATE, ZIP
co-TI,Jvv G.a 014
FAX
CONTACT NAME PHONE
Bobby Payne 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 El CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
RICH COSMOS
LICENSE NUMBER
785441
LICENSE TYPE
C39
BUS. LIC. #
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. #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF ;K SFD or Duplex ❑ Multi -Family
STRUCTURE: Commercial
A::�
ROOF AREA:
12-300
�
_
VALUATION: /j 1
W S
EXISTING ROOF TYPE: ❑ BUILT-UP ROOF ❑ ASPHALT SHINGLES WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER (SPECIFY)
REMOVE /REPLACE RYES
ElNO
IF NO,
I # LAYERS:
PLYWOOD ❑ w, ❑
THICKNESS: J21-5/8"
PLYWD 0 OSB
TYPE: 0 CDX
PITCH:
' 12
ROOF
CLASS: A
PROPOSED ROOF TYPE: ❑ BUILT-UP ROOF ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER
ICC -ES REPORT #
DESCRIPTION OF WORK: —_Z
%J/ I F777 1011 Ce -2170 4—
By my signature below, I certify to each of the following: I am the property owner or authorized agent t n -the property owner's behalf. I have read this
application and the information I have provided is correct. I have read the Description of verify itis accurate. I agree to comply with all applicable local
ordinances and state laws relating to building construction. I authorize represe s of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: Date: ( ��
SUP&VE<NTAL INFORMATI QU
_ If building is associated with a Home O r 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
�❑ .OVEWTHE-COUNTER
❑ EXPREss
❑ sTnxnARD
❑ BUILDING PLAN REVIEW
❑ PLANNING PLAN REVIEW
❑ FIRE DEPT
❑ OTHER:
ReroofApp_2011.doc revised 03116111
CITY OF CUPERTINO
OMEN FEE ESTIMATOR —BUILDING DIVISION
19
ADDRESS: 10449 Plum Tree Ln
DATE: 10/30/2015
REVIEWED BY: Phuong
Mech. Permit Fee:
APN: 316-33-083
BP#:
'EVALUATION: 1$10,055
*PERMIT TYPE: Minor Building Permit
PLAN CHECK TYPE: Re -roof
PRIMARY
USE: SFD or Duplex
Phunb. hrsp. Tee:
PENTAMATION
PERMIT TYPE: 1 SFDWLROO
WORK
Tear off shake roofing; install N asphalt shingles Class A roofing; install N CDX plywood 23 SQ
SCOPE
Suppl. Insp Fee
FEE ID ROOF AREA
s.f.
1REROOFFRES 24300
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 Preliminary information available and are only an estimate. Contact the Dent for addn'1 info.
FEE ITEMS (Fee Resolution 11-053 LE 7/1/13)
Meeh. Plan (heck
Plumb. Plan Cherk
Elec. Plan Check
Mech. Permit Fee:
Plumb. Permittee:
Elec. Permit Fee:
Orher Wech. Insp.
other Plumb Insp.
_j
Other, Glec. Insp, Li
L1eclt. Insp. Fee:
Phunb. hrsp. Tee:
Glec. Insp. Tee:
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 Preliminary information available and are only an estimate. Contact the Dent for addn'1 info.
FEE ITEMS (Fee Resolution 11-053 LE 7/1/13)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
'A
__F
Suppl. PC' Fee
Plumb.121fech✓Elee
Permit Fee:
$391.00
Suppl. Insp Fee
Plumb.&Iech./Elee
Plumb.; ll1Iech./Elec Permit Fee:
Construction Tarr:
Administrative Fee:
Work Without Permit? 0 Yes (j) No
$0.00
Advanced Planning Fees:
Travel Documentation Fees:
Strong Motion .Fee: IBSEISMICR
$1.31
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:_
$393.31
$0.00 _° - TOTAL FEE:
$393.31
Revised: 10/01/2015
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 • building(a)cupertino.org
PROJECT ADDRESSto 4 � 1 m � ,R�.�
I—A)
APN #
2 _C) �i
OWNER NAME
PHONE
E-MAIL
STREET ADD ESSj
CITY, STATE, ZIP
�p
FAX
CONTRACTOR NAME RICH COSMOS
LICENSENUMBER 785441
LICENSE TYPE C39
BUS. LIC.#
COMPANY NAMB -
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).
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.
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 au ed agent to act
on the property owner's behalf. I understand to comply with t o policy stated above.
Signature of Applicant/Agent: Date:
ReroofPolicy_201 0. doc revised 05/17/10