B-2017-1356CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: ' CONTRACTOR: PERMIT NO: B-2017-1356
20054 WHEATON DR CUPERTINO, CA 95014-2340 (316 23 087) COSMOS ROOFING
INC
MOUNTAIN VIEW, CA
94043
OWNER'S NAME: HSIAO EDWARD T AND SUHUA TRUSTEE
ISSUED: 08/15/2017
OWNER'S PHONE: 408-313-0387 1 1 PHONE NO: (650) 969-7663
License Class C-39 Lic. #285441
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.
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
IFperformance 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. Sq. Ft Floor Area: Valuation: $14510.00
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.
BUILDING PERMIT INFO:
X BLDG —ELECT —PLUMB
_ MECH X RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION:
RE -ROOF; TEAR -OFF; INSTALL OSB; COMP SHINGLE (25 SQ)
Date 08-15-2017
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:
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 applicatiori'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.
Signature Date 08-15-2017
APN Number: Occupancy Type:
31623 087
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
by: Kim Dunbar
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 materials for
inspection. r
Signature of
ALL ROOF COVERINGS TO BE CLASS "A"
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 age
Date: 08-15-2017
C STRUCTION L AGENCY
I hereby affirm that there is a construction lending agency for the performance
of work's for which this 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
CUPER,TINO
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 e buildin cu ertino.or
PROJECT ADDRESS -L%,Vq %_ i1j�r�
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APN# /`j�
`MAIL �J
OWNER NAMEI' 11 L 1A
PHONE
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STREET ADDRESS
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FAX '
CONTACT NAME
ALEJANDRO OCEGERA
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 lel CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
ALEJANDRO OCEGUERA
LICENSE NUMBER
785441
LICENSE TYPE
C39
BUS. LIC. #
403370
COMPANYNAME COSMOS ROOFING
E-MAIL
FAX 650-485-2314
STREETADDRESS 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 SFD' or Duplex ❑ Multi -Family
STRUCTURE: Commercial
ROOF AREA:-2-5
2-5 0Z7
TION:
SSHHINGL❑ OTHER (SPECIFY)
EXISTING ROOF TYPE: ❑, BUILT-UP ROOF ❑ ASPHALT SHINGLES WOOD SHAKES ❑ WOODt.(OSB
REMOVE/REPLACEYES
❑ NO
IF NO,
#LAYERS:
PLYWOOD ❑ /a" ❑
THICKNESS: ❑ 5/8"
PLYWD
TYPE: CDX
PITCH:
12
ROOF
CLASS: `�
PROPOSED ROOF TYPE: ❑ BUILT-UP ROOF ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER
ICC -ES REPORT #
DESCRIPTION OF WORK: ' I ( ' �r — ��
�
W �_ ��SCI
By my signature below, I certify to each of the following: I am the property owner or authorized a e con the property owner's behalf. I have read this
application and the information I have provided is correct. I have read the Description of W verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building construction. I a presentanv Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLE INFORMATION R RE
_ If building is associated with a Home Owne ' Iation, 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
R61ITIvc LIP
❑ OVER-THE-COUNTER
EXPRESS
❑ STaNDAR]n
❑ BUILDING PLAN REVIEW '
❑ r`cANNnvG PLAN REVIEW
❑; FIRE DEPT
❑ OTHER:
ReroofApp_2011.doc revised 03116111
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 • buildin-ga-cupertino.mg
PROJECT ADDRESS �f J'47�/�
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7APN #
OWNER NAME �/ lI. V
PHONEe� - / � 3re ZS
E-MAIL
STREET Z. � S W rl e !' I �% ��
CITYySTATFyG127 �11i� Cf A % `7
FAX
CONTRACTOR NAME
ALEJANDRO OCEGUERA
LICENSE NUMBER
785441
LICENSE TYPE
C39
BUS. LIC. #
COMPANYNAME
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/fastenershave 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 I/4" per foot of slope and must demonstrate there is no ponding.
b. Listings Trom 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.
8. NOTE: If you caul 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 understand ano comp ted above.
Signature of Applicant/Agent: Date:' S
ReroofPoUQ 2010. doe revised 05117110
mFIL
SMOKE / CARBON MONOXIDE ALARMS ?Ott- `16111 ,
OWNER CERTIFICATE OF COMPLIANCE
'• COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
CUPERTINO 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255
(408)777-3228•FAX(408)777-3333• buildinq(a cupertino.orq
iVateNnikatatitrigi3 s g q3 �*r 1 �' --e°a r -' b�
{' ` :Iek RMIT CANNOT�BE F1 ALED UNTIL THIS`GERTIFICATE S BEEN
�p✓�-� � fug .
4 4 Z OMPL] ED,SI 7ED,ANDyRE TI7R�D TO�PTHEB ING DZ � flN
PURPOSE
This affidavit is a self-certification for the installation of all required Smoke and Carbon Monoxide Alarms
for compliance with 2016 CRC Section R314,2016 CBC Sections 420.6 and 907.2.11.2 where no interior access
for inspections are required.
GENERAL INFORMATION
Existing single-family and multi-family dwellings shall be provided with Smoke Alarms and Carbon
Monoxide alarms. When the valuation of additions, alterations, or repairs to existing dwelling units exceeds
$1000.00,CRC Section R314 and CBC Sections 907.2.11.5 and 420.6 require that Smoke,Alarms and/or Carbon
Monoxide Alarms be installed in the following locations:
AREA SMOKE ALARM CO ALARM
Outside of each separate sleeping area-in the immediate vicinity of X X
the bedroom(s)
On every level of a dwelling unit including basements X X
Within each sleeping room X 't`
• Carbon Monoxide alarms are not required in dwellings which do not contain fuel-burning appliances and that
do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with
CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal.
Power Supply: In dwelling units with no commercial power supply, alarm(s)may be solely battery operated.
In existing dwelling units, alarms are permitted to be solely battery operated where repairs or alterations do
not result in the removal of wall and ceiling finishes or there is no access by means of attic,basement or crawl
space.Refer to CRC Section R314 and CBC Sections 907.2.11.4 and 420.6.2. An electrical permit is required for
alarms which must be connected to the building wiring.
As owner of the above-referenced property,I hereby certify that the alarm(s) referenced above has/have been
installed in accordance with the manufacturer's instructions and in compliance with the'California Building
and California Residential Codes. The alarms specified below have been tested and are operational, as of the
date signed below. f
Address: 00�7 aeofmt M- q3- e Permitl�To./�
Specify Number of Alarms: #Smoke Alarms:.J I #Carbon Monoxide Detectors: 13
I have read and agree to corky with the terms and onditions of this statement
Owner(or Owner Agent's)Name:
Signature ,. `�� 1,4'47 Date:
Contractor Name:
Signature Lic.# Date:
Smoke and CO form.doc revised 12/15/16