B-2017-1159CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-1159
20689 PARK CIRCLE W CUPERTINO, CA 95014-1962 (326 32 011) COSMOS ROOFING
OWNER'S NAME: KAO KO -PEI AND YING-CHIAO ET AL
OWNER'S PHONE: 408-867-0878
License Class C-39 Lic. #785441
Contractor COSMOS ROOFING INC Date 04/30/2019
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.
I hereby affirm under penalty of perjury one of the following two declarations:
t. 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.
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.
I 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 per the Cupertino Munici��Date7/18/�2017�
al CodeSection 918
Signatu
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
1. 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)
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:
m. 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
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 per the Cupertino Municipal
Code, Section 9.18.
INC
MOUNTAIN VIEW, CA
94043
DATE ISSUED: 07/18/2017
PHONE NO: (650) 969-7663
BUILDING PERMIT INFO:
X BLDG —ELECT —PLUMB
_ MECH X RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION:
REROOF; TEAR -OFF; COMP SHINGLES (38 SQS)-APT COMPLEX
AND CARPORT
Sq. Ft Floor Area: Valuation: $23575.00
APN Number: Occupancy Type:
326 32 011
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: Abby Ayende
Date: 07/18/2017
RF 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 materials for
inspection.
Signature of Applicant
Date:
ALL ROOF C GS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
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(a) 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
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, Sections 25505, 25533, and 25534.
Owner or authorized agent:
Date: 7/18/2017
Cowrki�T -ION LE
I hereby affirm that there is a construction d' gency for the performance
of work's for which this permit is issued 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed
Signature Date 7/18/2017 Professional
CUPERTINO
16-201--1 lel
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(cDcuaertino.ora
PROJECT ADDRESS -W/ q 7 CI e I (�� ! 3 '7
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APN a �� �-Z O 11
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OWNER NAME I !
PH"E4e)q
E-MAIL
STREET ADDRESS Z� / (� Cy � � �f 2c CITY, STATE.
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FAX
CONTACT NAME
ALEJANDRO OCEGUERA
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 SI CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
ALEJANDRO OCEGUERA
LICENSE NUMBER
785441
LICENSE TYPE
C39
BUS. LIC. #
COMPANY NAME COSMOS ROOFING
E-MAIL
FAX 650-485-2314 U1t
STREET ADDRESS 1901 Old Middlefield Rd
CITY, STATE, ZIP Mountain View, CA 94043
PHONE 650-969-7663
ARCHITECT/ENGINEERNAME
LICENSE NUMBER
BUS. LIC. #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF ❑ SFD or Duplex Multi -Family
STRUCTURE: or Commercial 4-d,J17 -r k6c,
ROOF AREA:
3
VALUATION:
N 0-10
EXISTING ROOF TYPE: BUILT-UP ROOF 11 ASPHALT SHINGLES 11 WOOD SHAKES 13 WOOD SHINGLES 1-1 OTHER (SPECIFY)
REMOVE /REPLACE -YES
❑ NO
IF NO,
# LAYERS:
PLYWOOD ❑ w, ❑ _
THICKNESS: ❑ 5/8"
PLYWD ❑ OSB
TYPE: ❑ CDX
PITCH:
:12
ROOF
CLASS: A
PROPOSED ROOF TYPE: -EBUILT-UP ROOF ❑ ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER
ICC -ES REPORT #
DESCRIPTION OF WORK: _ 11 2L ti t— !"C�ci �p 1�- � �[ f Z %
Ajo s14L-F7. /J�J77/I�' ���G - r �� �, ��
o iL-T
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 to building co au rize representatives of C e above -identified property for inspection purposes.
Signature of Applicant/Agent: Date: %Z 1 9/ 1
SUPPLEMENTAL INFORMATI UIRED
_ If building is associated with a Hom per'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 03116111
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CUPERTINO
REROOF TEAR -OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 - FAX (408) 777-3333 - buildinq(d)cupertino.org
PROJECT ADDRESS ZC) L 7 r �1 `
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LICENSE NUMBER �'r
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STREET ADDRESS
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I UNDERSTAND AND AGREE TO THE FOLLOWING:
1. The re -roof project shall comply with all applicable provisions of the 2016 California Codes.
2. An inspection request can be scheduled up to one business day before the requested inspection date.
To schedule inspections 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 out to the
job site 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. Tear -Off Inspection is required. Any and all dry -rotted wood shall be replaced prior to this inspection.
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 applied 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
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/" 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 R314 and R315 of
the 2016 California Residential Code. �----�
Signature of
Date: _� / fl;�, / I
RerooJPolicy 2014.doc revised 0610117