B-2016-2150 i
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2150 l
915 FERNGROVE DR CUPERTINO,CA 95014-4664(375 39 055) COSMOS ROOFING
INC
MOUNTAIN VIEW,CA
94043
I
OWNER'S NAME: KIRBY ROBERT E AND MARY L TRUSTEE DATE ISSUED:06/16/2016
OWNER'S PHONE:408-255-0180 PHONE NO:(650)969-7663
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class CC-39 tic.#Z85441 XBLDG _ELECT _PLUMB
Contractor COSMOS ROOFING INC Date 04/30/2017 —
MECH X RESIDENTIAL_COMMERCIAL
I hereby affirm that I am licensed under the 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. JOB DESCRIPTION:
TEAR OFF;INSTALL 4-PLY TAR AND GRAVEL(24 SQ'S)
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
er' 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. Sq.Ft Floor Area: Valuation:$12860.00
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above APN Number: Occupancy Type:
information is correct.I agree to comply with all city and county ordinances 37539055
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 PERMIT EXPIRES IF WORK IS NOT STARTED
City of Cupertino against liabilities,judgments,costs,and expenses which
may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PER�IT ISSUANCE OR
Additionally,the applicant understands and will comply with all non-point
source regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LA CALLE INSPECTION.
d
�,Sl r1ature Date6116/2016Issued by Alex VallelunEa
Date:06/16/2016
OWNER-BUILDER DECLARATION
RE-ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of the All roofs shall be inspected prior to any roofing material being installed.If a roof is
following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for
1. I,as owner of the property,or my employees with wages as their sole inspection.
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 Signature of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:6/16/2016
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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 HAZARDOUS MATERIALS DISCLOSURE
performance of the work for which this permit is issued.
2. I have and will maintain Worker's Compensation Insurance,as provided for by 1 have read the hazardous materials requirements under Chapter of the
California Health&Safety Code,Sections 25505,25533,and 25534.34. I will
Section 3700 of the Labor Code,for the performance of the work for which this maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
permit is issued. Health&Safety Code,Section 25532(a)should I store or handle hazardous
3. I certify that in the performance of the work for which this permit is issued,I material. Additionally,should I use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized�t: ,
APPLICANT CERTIFICATION Date: 1 1: -�
CONSTRUCTION LENDING AGENCY
I certify that 1-have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance
correct.t agree to comply with all city and county ordinances and state laws of work's for which this permit is issued(Sec.3097,Civ C.)
relating to building construction,and hereby authorize representatives of this city Lender's Name
to enter upon the above mentioned property for inspection purposes. (We)agree
to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Address
judgments,costs;and expenses which may accrue against said City in
consequence of the granting of this permit. Additionally,the applicant understands ARCHITECT'S DECLARATION
and will comply with all non-point source regulations per the Cupertino Municipal I understand my plans shall be used as public records.
Code,Section 9.18.
Licensed
Signature Date 6/16/2016 Professional
1 w REROOF PERMIT APPLICATION
I
} ELI COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE-CUPERTINO, CA 95014-3255
(403)7-77-3228• FAX(408)777-3333•buildinga1cupertino.org
CUPERTINO
PROJECT ADDRESS APN RJ
OVTERNAME I.PHOj e E-MAIL
STREIqWS TY, STATE,ZIP I FAX
ZZ 0AAQ&NLS�n,_6
CONTACT N.kNIF,, PHONE E-R3AIL
—7W2 I
ST ET ADDRESS CIATE, IP FAX
��,// f
ORR�'ER ❑ OWNER-BUILDER ❑ OIdTNERAGEh'f t3'hCON TRACTOR ❑CONTRACTORAGEI�Tr ARCHITECT El ENGINEER 13 DEVELOPER 11 TENANT
CONTRA RNAME LICENSE NUMBER LIC 'SET BUS.LIC.m + �`
F
CO NAME
E-MAIL FAX 1
1
c CITY,STATE,ZB? j
STREET ADDRESS PHONE
�.yj 40 ci I a
ARCHITECT/ENGINEERNAME LICENSENUMBER I BUS.LICA,
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP L PHONE
USE OF SFD or Duplex ❑ Multi-Family ROOF AREA: VALUATION:
STRUCTURE: ❑ Commercial
EXISTING ROOF TYPE: UrBUILT-UP ROOF ❑ASPHALT SFM\'GLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY) gJ
REr201E/REPLACE £S IF NO, PLYWOOD El '/:" 11PLYWD ❑ OSB PITCH: ROOF
E3 NO RLAI°ERS: THICKNESS: CDX
❑ 5/8" TYPE: ❑ :12 CLASS: A
ICGES REPORT R
PROPOSED ROOF TYPE: BUILT-UP ROOF ❑ASPHALT SHINGLES ElWOOD SHAKES ElWOOD SHINGLES 13OTHER
DESCRIPTION OF WORK: �—
By my signature below,I certify to each of the following: I am the properly owner or authorized agent to act on the property o\vner/stehal£ I 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 to building construction. I authorize representatives of Cupertino to enter the abov-identified property for inspection purposes.
Signature of Applicant/Agent: '4(y Date:
Co ICO-1110
SUPPLEMENTAL INFORMATION REQUIRED �A o�zcEusEoni�
If building is associated With a Holme Owner's Association,provide letter rLAn CHECKTYPE � ��ouTrnc sL�
of approval from HOA. l ov R Tz cou�TER mrJJr mcP>AI REv
Provide Planning approval to verify if there any restrictions. �1 ExP i�ss � � � P�33�ItII�GFLAA RE�iE�
Provide copy of Manufacturer's Installation Specifications. FdRF9EPT
s _ v �
Provide signed copy of Cupertino's Tear-Off Policy.
� C1 OTHER `c�
Reroof-4pp_2011.doc revised 03/16/11
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION I
I
ALBERT SALVADOR, P.E., C.B.O.,BUILDING OFFICIAL I
10300 TORRE AVENUE•CUPERTINO.CA 95014-3255
CUPERTINO (408)777-3228• FAX(408)777-3333•building(a�cuoertino.org
I
I APN 4
EOWNERNAME
P"
IPHONE E-MAIL
CITY,STATE,ZIP I FAX
STREET ADDRESS
LICE' E hTLfi4BER LI SE TYPE BUS.LIC.n
COhTRACTORN E- � `
I
el
E-MAIL FAX
COMPANY 'Ah? 9 �
CITY,�;Tf,4 ,ZIP �y PHONE x-
STREET ADDR�S ,� CJS /� a jj�i��
1
I UNDERSTAND ND AGREE TO THE FOLLOWING:
1. The re-roof project shall comply with all applicable provisions of the 2013 California Codes.
2, An inspection request can be scheduled up to one business day before the requested inspection date.
Please schedule inspections online or 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. The hours for this service are: 7:30-10:30am and 12:30-3:30 (Mon-Thurs)
.and 7:30-10:30am and 12:30-2:30 (Friday). Final Inspections will be given a two hour window.
3. -rotted wood shall be replaced prior to this inspection.
Tear-Off Inspection is required. Any and all dry
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 Nailin6 Inspection is required.
5. Roofing shall not beapplied without first obtaining all prior inspection and written approvals from the
building inspector. Any roofing which is applied without first obtaining an approved inspection will
to the sheatlung so a proper inspection can be performed.
require the removal of all new material down
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 monoxide detectors are required to be installed in accordance with Sections R3 14 and R315 of
the 2013 California Residential ..
D ate: 12
Signature of Applicant/Agent:
ReroofPolicy 2014.doc revised 01115114