06080021 FIJI�ALDING
OF CUPF.RTINO "
DING DIVISION PERMIT >n�ONTRACTOR�INRORMATION
rKr%"t*a1it -z
ADDRESS: COSMOS ROOFING, "Rm`YND06080021
7 BARNHART AVE
AME: PERMIT LSUE DATE
` KAREN MARKUS & MICHAEL GUI TO1901 OLD MIDDLE
NE: SANITARY NO. CONTROL NO.
(650) 969-7663
ARCHITECTYFNGINEER: BUIIDWG PERMIT INFO
BLDG ELECT PLUMB MECH
:00 LICENSED CONTRACTORS DECLARATION Job Description
I hereby.r0,m Ibt 1 un Psnwn,under p pavan of ChaWr 9(cccn a n6
ix�y rilb Ssl R)r10)dDlMdaa 3ofthe Business uW ptdcukw Cnde.utl myB i.
TEAR OFF TAR & GRAVEL. ADD TAR & GRAVEL 4 PLYWO
'�� DLkm� ,lca l>Wr ROOF SYSTEM CLASS A
1-
ARCHITECTS DECLARATION
iF IuMaaanJ my PWu mall be ued u public rccorJ,
i �
.LLp LwetucJ Pmftavaal
OWNER-BUILDER DECLARATION
c c 1 hcrcbY,f&m Jw I J. uentpt Ilam IhC Conuutars luny far far ft
y
0 0 whkbrck�in'masoa snit n 1031.5,B ni.td=. Pt Pmfcsei«n Code:1111 MY mtmty
$ nart Icquirr-+a pamll r,c«u ti,, ,Nus.I i f.cci dMalit ar rtpoir wy,sKluc
-z p,Wrmiuusuarcx.alwtcquirvthe,pplkamf«sochpermtlnBkasiered,unmal t%6650
_ < ,c.nciin,wJp�action7")Pmn:fn 3.rteoaB,elar,L�nsL,n.cc,ia9 Sq.FL Floor Area Value
i�0 (commcnclnt wit�Section W7 the v an 3 or NC Basi u,M on,A Tease bn d .
e�� the b a upon tne,cfr«n W Ibe buu f«the alkerd evmptWn Avy.iwti'on d
Scctibn M1.5 by uty,pp t few.Wn,11 Ubit=Ine.pplr.r W a cnl pm.hy Of ppN Number Occupancy Type
sa mart tbtt five la ndaeL,Wlan(S500). 3 7 517 0 5 0 . 0
❑ L u order or Itis propcty,«my empbYeu rhh raW u the'v mle aappeuW a,
ute.ork.,,tatxwndtneutt«Inlem�d«artaMJf«,.e(sa.rou.Bw,� Raired Ins 'a
attd Profuslom Code:The CmucW S U—Law doo e"Wyly W u crow d q
properly rho btaWs«ini m lhveot9 and who doa,ac hlmvJf«thrwph his
owo employ MbitrldcAdpr and 1, issemwiihin ld lvtrsfccnn c .f«ak
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conwac Ihtp .. (Sec W. Bnsiten sad Pmresd wi Code)The Coobem a
cense Lard«ao«.h cwmmccnp.-Wi rho Wdiar.thm C. .od
who -Laeu fa such pmjeeu wiW•concun,(s)Braved pu,a• ,W tk Capurnr,
Llmea.lar.
❑lam aumn«Wa See ,B&PCla thu rraWa
Due
WORKERS COMPENSATION DECLARATION
I bcrdy,Qam mtler Malty d Mitay ate d Ne rcb &decleW vtte
I harcend will nt nufn.Cz`ir t of Cnmml W ulr-Yw,c r«W«teZC M`-
,.tma..,plavldrd r«by s«II«t 3'100 d Ilse lab«coda.r«tm Pvf«m.«e d Be
rat r«.bKe Ina palati u i»«n.
1 hale W nil ouinuin Waters CamPenwfan losunat¢.u RquinW by Section -
TWdtheLab«Cade.rctheMfa of the w«t for sbirh Thu Mnnn uLuted
MY W«tcr,Cao btamncccamkr uW Pdi y numbs as
Carrier: S �--- Polity No.:S 7 r - 1 s-117 5
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
Mibi Wm.ttd sot Ni c«aP Bth Mcnit It I--nttadtcd dnBua(SIOD)
I Rniry ib.,in the Mr..on d ibc wart f«which Nu Mrn t is tined.I,bR W
cmpby My p.in My mautcr sa u in become wbjal W the Wo 'C..Mcctbnn
laws d CUir«oiL Due
NN Tans
QnCE TOAPPLICANT:If.C=ps= tnls Ccn ordEae Cn.yea,marl
beware sv comply
y Ile W«trr,Campcu,Boo pt fit" b tb labor Code lea rnut
,J Q f«awiN amply riW,tied prwivm,c Thu permit,hN h dcmN rt.ated. .
z CONSTRI/CfIONLENDINGAGENCY
[-.,-+ IlercbY affirm WU Nerc u.can,Runiin ktWln�.ecocy Tor the peRtnnueeaT
IY, .1 B.c wah fur which Ikl nnnit 6 LssuM(Sa.J041,Ch.CJ
6W.Q Lenders Num
D z I<nders Addrtu .
UO I c ify that I b,e,rad Ihl.appBcuian Md sue thu the shore infmmulon u
U.E coned.I aprc in comply with JI Oily sad ratnty mJtateas ani a»e laws rclatine n
O Wildiae rnnstwction.std M rcbY wlhorirz rcprucnuli.cs d Nu city to rntaupnn Da:
r LL; above-rncn.aned nopcny for in,, .putruas.
(We). c Wvr
l. ,indcmmand hthe
ly cnp harmless City or CUm
Pcna a6.iml
rF-t%] liabRiam todctvsu.c=Milup...,-.which uay In MY r.Y.asuc a,ttw d City
Uz in c«sti,, od the panda{dmu Pcmit. Dale V
,-. APPLICANT UNDERSTANDS AND WILL COMPLY WITH All N-POINT Issued by:
SWRCE_g�goq+TIONS.
1S��K-= s/° 6 Re-roofs
Sienuttrt of Appl
HAZARDOUS MATERIALS DISCLOSURE D,sc Type of ROOF
WN the,Mb Mi a futttrc bdWlae.,"ear«hulk hm,dm mat.W
u deflnM by the Cugenlac M Wricllul Cade.(h-Pt 9.12,,M de Helm and SLnY
Code.S,,,J.255324)' All roofs shall be inspected prior to any roofing material being installed.
❑YaCdLP-
Wtu tbc.MkMt n,F.I.beim.,oecalum.waiPaMn cc wbkh If a roof is installed without first obtaining an inspection,I agree to remove
-Omit Waaduo+Mr coni.. by Ne Bay Ata Air Quilty Muuewct all new materials for inspection.
UarcsOT frau A /.
Ibsa read thchva,6uimaWriW rryu'vcmcnu unt\r Cfapau 6.93 dtbc Ulf«. �! ( , D 7/3/06
/3 /O/
nuN 1"S,faycode Sn cres25505,25533 ua125334.l tndavudditiff l Icbne \/'i"�^/—� Il l/ V
J¢,nalcarutoy uw,•t LLul it i,my,rsp nniily n ndify Je o=y.ar Je
rcyubcmcn r tm,abemet n:ssna«edaca iczteoro / ` Signature ofApplica t Date
�7D 873 o All roof coverings to be Class 'B"or better
CITY OF CUPERTINO
6m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 37517050 . 00
DATE ISSUED. . . . . . . : 08/03/2006
RECEIPT # . . . . . . . . . : 35504
REFERENCE ID # 06080021
SITE ADDRESS . . . . . : 18747 BARNHART AVE
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : KAREN MARKUS & MICHAEL GUISTO
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
RECEIVED FROM . . . . : BONITA JENKINS
CONTRACTOR . . . . . . . : COSMOS, RICHARD LIC # 18844
COMPANY . . . . . . . . . . : COSMOS ROOFING
ADDRESS . . . . . . . . . . : 1901 OLD MIDDLEFIELD WY
CITY/STATE/ZIP . . . : MOUNTAIN VIEW, CA 94043
TELEPHONE . . . . . . . . : (650) 969-7663
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
- -- - - - - - - - - ------------ - -- ------- --- --- - ------ -------- ---
BPERMFEE VALUATION 7, 000 . 00 137 . 16 0 . 00 137 . 16 0 . 00
BSEISMICRE VALUATION 7, 000 . 00 0 . 70 0 . 00 0 . 70 0 . 00
TOTAL PERMIT 137 . 86 0 . 00 137 . 86 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
- - - - - - - - - - - - - -- -- ------ - ----- ------ --
OTHER 137 . 86 VISA
TOTAL RECEIPT 137 . 86
•
r ,
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
Fax: (408)777-3333
Building Department
Subject: Re-roofing policy for the City of Cupertino
1. Prior to permit issuance,you must agree to comply with 1997 UBC Standards
and manufacturers specifications on re-roofing.
2. New roof coverings shall not be applied without first obtaining all inspection
and written approval from the building inspector. A final inspection and
approval shall be obtained from the building inspector when the re-roofing
is completed.
3. All roofs shall be inspected prior to any roofing installation.
4. To receive a final sign off from the City, the following steps are
required:
1) Pre-inspection and/or tear off approval.
2) In-progress inspection approval.
3) Final inspection approval.
a) Spark arrester installation.
5. If plywood is installed, a plywood nail inspection is required.
6. Any roofing which is applied without first obtaining an inspection,
will require the removal of all new material down to the sheathing,
so a proper City inspection can be performed.
7. NOTE: If you call for a plywood nail inspection and the job is not ready,
you will be charged a re-inspection fee of$176.18. The re-inspection fee must
be paid before another inspection can be scheduled.
IMPORTANT:
1. Flat roofs must have a minimum of 1/4 " per foot slope and demonstrate
that there is no ponding.
2. An I.C.B.O. report is required to be on the job site at the time on inspection.
I understand and will comply with the above stated Lpolicy on re-roofing.
Homeowner's Name: w" n.�Q�o L,--.
Job Site Address: "- Q —
Roofing Company Name:
Applicant's Signature: Date: 6
• Greg Casteel
Building Official
Revised 11/2/04
Aug 02 06 09410a Cosmos Roofing 16501969-9905 p. 3
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CITY OF CUPERTINO D O - ` 4
Sa REROOF
CUPEkTINO PERMIT APPLICATION FORM
APN# 3-15_ I—i _ cF)O Date: O 6
Building Address:/97q7! n n
Owner's Name: I'} Phone#:
Gum -57 - `73fr
Contractor: License#:
Ll
Contact: ,Cupertino Business Licens #:
Type of Roof Covering:
Existing: Proposed:
Built-Up Roof Built-Up roof
Asphalt Shingles Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O. Report#
To be Removed ❑ Provide Mfgr. Installation Specs.
' I Have Read,Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description: TO rte: �� P , ,QQO� f
Residential Commercial ❑
Fire Zone: Yes ❑ No tT Confirmed with Planning Dept. if
there are any restrictions: U
Cost of Pr9 iect: Type of Construction: Occupancy groun-
09L7
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
BENERGY Energy BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING