B-2018-0032CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2018-0032
869 BROOKGROVE LN CUPERTINO, CA 95014-4633 (375 39 018) COSMOS ROOFING
INC
MOUNTAIN VIEW, CA
94043
OWNER'S NAME: CHANG HSIAO YUNG AND LIN PEI YING TRUSTEE DATE ISSUED: 01/05/2018
OWNER'S PHONE: 408-426-0377 1 1 PHONE NO: (650) 969-7663
License Class C_-a,Q Lic. #785441
Contractor COSMOS ROOFING INC Date 04/30/2019
1 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 fuff force and effect.
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
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.
V \, 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.
Signature
D R DE LATION
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 thew 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. 1 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.
A_PPL.ICANT 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.
Signature Date 1/5/2018
BUILDING PERMIT INFO:
$ BLDG —ELECT _ PLUMB
_ MECH $ RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION:
REROOF; TEAR OFF; INSTALL BUILT UP ROOF (28 SQ)
Sq. Ft Floor Area: Valuation: $13995.00
APN Number: Occupancy Type:
375 39 018
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: Abby yende
Date: 01/05/2018
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.
Signature of Applicant:
Date: 1/5/2018
ALL ROOF COVE 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: 1/5/2018
I hereby affirm that there'rss a con ction len 't>Q ency for the performance
of work's for which this permit is is ec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed
Professional
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
PEMIT #B - C�O 1q- - 00 b2-
I�
(408) 777-3228 a building@cupertino.orJ
CUPERTINO
F-1 NEW CONSTRUCTION n ADDITION M ALTERATION F1 T.I. M MEP RE -ROOF ❑ SWIMMING POOL/SPA
PROJECT ADDRESS967 `TIC '` (-,j�'N
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OWNERNAME C I ( A n O 'G ^ PHO
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STREET ADDRESS
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CITY, STATE, Z[P
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CONTRACTOR NAME ❑ OWNER -BUILDER
COMPANY NAME
LICENSE NUMBER
LICENSE TYPE
COSMOS ROOFING
785441
C39
STREET ADDRESS
CITY, STATE, ZIP1901
OLD MIDDLEFIELD WAY #4
MOUNTAIN VIEW, CA 94043
E-MAIL
PHONE
BUS. LIC #
650-969-7663
❑ ARCHITECT ❑ OWNER ❑ OWNER AGENT M CONTRACTOR AGENT❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTACT NAME
E-MAIL
JEFF RAINEY
jeffrey.rainey@att.net
STREET ADDRESS
CITY, STATE, ZIP PHONE
1069 EDGEMERE LANE
HAYWARD, CA 94545
510-785-6340
DECRIP TON
SINGLE-FAMILY/DUPLEX ❑ MULTI -FAMILY ❑ INDUSTRIAL ❑ COMMERCIAL
USE
TYPE
OCC
SQ.FT.
VALUATION ($)
EXISTING USE
EXISTmG SF
NEW FLOOR SF
PORCH
SF DECK SF
I DEMO SF
I STORIES #
I TOTAL NET SF
REMODEL
REMODEL KITCHEN
REMODELOTT R
GARAGE ❑ ATTACHED
BATHROOM SF
SF
SF
SF ❑ DETACHED
EXIFIRE PRINKLERS ❑ NO
EICHLER a O
SECOND STORY ADDITION ❑YES
❑ NO
DWELLING
❑ YES []ATTACHED[] DETACHED OTHER
JSECONDDWELLENG
UNITS #
UNIT ADDITON: ❑ NO SF
POOLS ❑ FIBERGLASS ❑ VINYL -LINED ❑ GUNTTE ❑ PREFABRICATED
POOL - SF SPA - SF SPA ATTACHED ❑ YES ❑ NO I TOTAL - SF
Commercial or Multi -Family Buildings with Public Swimming Pools requires Department ofEnvironmental Heath approval
REEIVD BY: ��
(l'r?/�V, ��1
VALUATION:
jJJJ
RE -ROOF EXISTING ROOF TYPE: BUILT-UP ROOF ❑ ASPHALT SHINGLES❑ WOOD SHAKES ❑
WOOD SHE4GLES []4TLE OTHER (SPECBM
REMOVE /REPLACE ❑ NO
ONO `
ON`t
PLYWOOD ❑ w ❑ w
PLYWOODTYPE:
PITCH-
`-1 :12
ROOF CLASS
A
YES
# OF LAYERS
THICKNESS Cj 5/8' OTHER
XIOSB ❑ CDX OTHER
PROPOSED ROOF TYPE: PkUILT-UP ROOF ❑ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER
C� -Z-1
*Provide a signed copy of the Cupertino's Tear -Off Policy SF #of SQUARES
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 construction. I authorize representatives of Cupertino to
enter the above -identified property for inspection purposes. I acknowledge and authorize all inf on this application form
to be made available for public record. I S '
Signature of Applicant/Agent• Date:
SUPPLEMENTAL INFO A SQUIRED
*New SFD/Second Dwelling Units/Multifamily Dwe 0 5;Demllition permit is required prior to issuance of a building permit for all new construction.
*Commercial Buildings: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project.
*Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application.
*HOA -Provide a letter of approval from the Home Owner's Association
BldgApp 2017.doc revised 08/01/17
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 - buildinga-cupertino.org
PROJECT ADDRESS /7 QI -- e.y�.�c j� ` L& / ! 1
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APN #
OWNER NAME I f
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PHONE
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LICENSE NUMBER C� t� I
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I UNDERSTAND AND AGREE TO THE FOLLOWING:
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).
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 '/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 authorized agent to act
on the property owner's behalf. I unders agre o compl - o po icy stated above.
Signature of Applicant/Agent: Date: i l S11
RerooJPolicy 2010.doc revised 05/17/10