05100141 CITY OF CUPERTINO .<
BUILDING DIVISION PERMIT 9>zCOiVTRACTOR INF.ORMATIO,N �;
BUILDING ADDRESS: COSMOS ROOFING PERMIT NO.05100141
20217 BOT, INGER RD
OWNER'S NAME: PERMIT ISSUEDATE
MINNICK WILLIAM
rNE:
SANITARY NO. CONTROL NO,
(650) 969-7663
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG EIECT PLUMB MECH
O O D O
°00 LICENSED CONTRACTOR'S DECLARATION
w❑ I hereby affirm that I am licensed under provisions or Chapter 9(commencing Job Description
iW with Section 7")of Division 3 of the Built an Profu�ir Cd.a mylicenfeis
�„ inrallraaana�uy�' [(SA H'/O SHAKES RESHEET OSB . ADD LANDMARK TL COMP
>a�z License Class I z
—c Dam INGLES
ARCH TTE DECLARATION r�
5 1 understood my plans shall N used as public records
>au Yv
Licensed Professionali0 OWNER-BUILDER DECLARATION
<S I hereby affirm Nat 1 am exempt from the Con lector's License Law for the if �'a 1 sq
4 c 0 following mason.(Section 703 1.5.Business and Pmfesems Code:Any city or county l�(�l
5= which requires a permit to consumer,silts.improve,demolish,or repair any structure Jr�
prior to its lssaarmc,also requires the applicant for such permit to Glc a signed sutcmenl
F o that he is licionscil puratent to the provisions of the Contractor's License Law(Chapter 9 Sq. Ft. Floor Area _ ,� 1U(J5 Val4ipg060
,c (commencing with Section 7000)of Division 3 of the Business and Pmressiare Code)or pp y
i $
that N u exempt storefronts and the bus for Ox alleged exemption.Any violation of A d
Section 7031.5 by any applicant for•permit subjects the applicant o a civil penalty of a E: a, J
not mom wn ew.hundred dollars n!KX)). a (.Oce�upancy Type
❑1,ax owner or the pmpeny,W my employees with wages as their sole compensation, 36935027 . 00
�� t�t2ra
will do the work.and Ne swcmre is not intended or offered for sale(Sac.04
7 <,Business
and Profcasimot Cade:The Cantractoh a License Law does not apply to an owner of Required Inspections
property who builds or improves thereon,and who does such work himself or through his
own employee,provided Nat such improvements are not intended Or offered for sale.If, v
however,the building or improvement is sold within ane)ear of completion.the owner-
builder will have Use human of proving that he did not Nib or improve for purpose of
sale.).
❑1.as owner of the property,am exclusively contracting with licensed conoamors to
consumer Ne project(Sec.7044,Business and Profusions Cade:)7T.Camra ms's Li.
cense Law does nal apply loan no,orpmpeny.wh t Wilds or improves thereon,and.
who contracts for such projects with a commercials)licensed pursuant o the ContoctoYs
License Law.
❑I on exempt ander Sec .B Ar P C for this reason
Owner Data
WORKER'S COMPENSATION DECLARATION
40 1 hereby affirm under penalty of perjury one of the following declarations:
1 have and will mainoin aCcniFiate of Consent o self-insum for Worker's Creation.
.tion,u provided for by Scene.3700 of the Labor Cad.,for the perfonamer of the
work for which this Permit is issued.
have and will maintain Worker's Compensation Insurance,ne required by Section
700 of the Labor Code,for On performance of the work for which this Permit is issued.
My Worker's Cnm nsaonn lnsu.nm eaffier and Polmy nuro am:
Carrier. S' `^A-- Policy No�7/—�S�//ZS
CE IMCATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu seetiw need not becomple¢d i(tW permit is fm one hundred dollars(SIO(0
Icss.)
1 cenifv dim in the Performance of the work for which this permit is issued.I shall not
employ any person in any manncrso as to become subject o the Workers Compensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:IL after making Nu CCNficate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code.you most
.JZ forthwith comply with such provisions or this permit shall Ise deemed ranked,
Z O CONSTRUCTION LENDING AGENCY
[-+ I hereby affirm that there is a construction lending agency l or the Performance of ,
C the work for which this permit is issued(Sec.3097.Civ.C.)
V] Undcr'a Name
D.Z 1 C.Z's Address
U 0 1 certify that I ham read this application and suit that On aW ve mrarmatiun is
fi P correct.I agree to comply with all city and county ominerners and state laws relating in
0 building construction,and hereby activation mpreenutives of this city to cancer upon the
roe above-mentioned property for inspection pur)pus.
(We)agree move,indemnify and keep harmless the City of Cupertino against
r N
liabilities,judgments,costs and expenses which may in any way accrue against said Cny
U in consegeencc of eSanting of this t.
'—' APPLICANT ERSTAN ILL C LY N{fTH ALL NON-POINT Issued by: Date ��/er-61—
SOURC R LATI 40
dltS l0 5 Re-roofs k
Z11—
Signadmol'Applicant/Carroactor Dae
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant ser future building Occupant store or handle haramous material '
Or defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Cade.section 15532Wy1 B� All roofs shall be inspected prior to any roofing material being installed.
❑Yu
Will the applicant or(.,a.building«tuym use egaipmcar ar device whim If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardous air contaminants u defined by the Bay Area Air Dimity Management all new materials for inspection.
District?
❑Yes tN i yn
1 have read the Wramous materialsrequiremen¢under Chxp m&95 of the Califon
nix
Brett&Safety[ Sections 15505.255 and 25534.1 undersand thatifthe Wilding
I. rpt cunently h tenant. r esponihi Won y the ace Pant of the f
regaincou, whi asrN or .i .. r -m ry Signature of Applicant Date
/a a9I All roof coverings to be Class "B" or better
Owner or authorized agcm Dam
CITY OF CUPERTINO
1 of 2 PERMIT RECEIPT OPERATOR: kiersaw
COPY # 2
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36935027.00
DATE ISSUED. . . . . . . : 10/19/2005
RECEIPT #. . . . . . . . . : 31669
REFERENCE ID # . . . : 05100141
SITE ADDRESS . . . . . : 20237 BOLLINGER RD
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER MINNICK WILLIAM A AND JOANN B
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4434
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 13, 000.00 201.96 0.00 201.96 0.00
BSEISMICRE VALUATION 13, 000.00 1.30 0.00 1.30 0.00
__________ __________ __________ ----------
TOTAL PERMIT 203.26 0.00 203.26 0.00
•
10/18/2005 07:16 7075237E63 PERMIT SERVICES INC PAGE 06
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CITY OF CUPERTINO 05100 YAI
REROOF
�UPEkTiNO PERMIT APPLICATION FORM
APN # Date: /
Building Address:
Z-0 2! 3 -1 CIL.
Owner's Name: Phone#:
1-faF LSS -keV7 b
Contractor, Phone#: License #:
19,50 F0 -)41,3 7
Contact: Phone#: Cupertino Business License #:
65a qao —214i L / E-41
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles �A Asphalt Shingles
Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
.❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings 1 ❑ Provide I.C.B.O. Report#
ATo be Removed ❑ Provide Mfgr. Installation Specs.
dhT Have Read, Understapd andAVill Com 1 With Cu ertino's Tear Off Policy: ❑
Job Description: 710 05 Jg • a T L C.rv_�
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Project: Type of Construction: Occupancy group:
l2 OGU • 6z
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
Community Development Department
Building Division.
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
CITY DF Fax: (408)777-3333
CUPEkTIN®
Building Department
Subject: Re-roofing policy for the City of Cupertino
1. Prior to permit issuance,you mus"t 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 policy on re-roofing.
Homeowner's Name: &-,?/
Job Site Address: ZO Z 3 -7
Roofing Company Name:
Applicant's Signature: .(-� �iv Date:
Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper