02080047 OF
• CI BUILDING DIVISION
PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10345 WUNDERLICH DR. COSMOS ROOFING 02080047
OWNER'S NAME: APPLICATION SUB DATE
MICHAEL CARSAN 1901 OLD MIDDLEFIELD WY 08/09/2002
PHONE: SANITARY NO. CONTROL NO.
p (415) 493-6373
In O O ARCHITECTTNGINEER: BUILDING PERMIT INFO
E BLDG ELECT PLUMB MECH
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a�'E LJ "—t LJ I--1
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o S di LICENSED CONTRACTOR'S DECLARATION Job Description
z—!e Ition7 ),vffirm marIam.flheBundermdPion.of Chapter.,¢ommendng REROOF
pmtw with Section 7000)of DivisionJofthe Businew aril Pro4ssiansCNc.and my liccnu
6 Y F J
Eon;
d as 6 taj Liccnu 1 Liv.x 1
Dam I s Contractor
u3_.I,� ARCHITECTS DECLARATION
d 1 u Wersmnd my play shall be used as public records
d Y
i S pe s Licensed Professional
w OWNER-BUILDER DECLARATION
1 hemby affirm that 1 am exempt from the Conuanor's License Law for she
t 3 a following mason.(Section 7031.5.Business and Professions Cade:Any city or county $3975
F o which requires a permit to coromet,alter,improve,demolish,or repair any structure
ou 3 m poor so its issuance.also mqubes the applicant for such Permluo file a signal statement
that rte is liccnx0 puntimuto tM1e prov¢ions of the Conmstois Littme Lsochaper9 3 1 .,r+1fYfDr QPea-rNr J . Valuation
withSmion 7000)0(DIvI5lonJof rhe Busimu and Profesumns Codd ��LJiaii : {-J 'f7-IhLY Ya1e:tAf31: i_r�i:
or that he is wimp,therefrom and the basis farina all<ged.exemption.Any violation
of Section 703 L5 by any applicant for a permit subjects she applicant to a civil penalty p{kft�s7a�n
of not mom than five hundred dollar.(S51M), 3 0 5APN tira MG ':'er'1 ' Occupancy Type
❑1.as owner of the property.or my employees with wages as their sole compensation, - INSTRATTON ,
-w111'do the work:and the swctum is not intended or offend for sale'(Sec:7064t,' - - - -
B¢sixse and Professions Cale:ram Conuaw
cr's License Lar.does not apply to an 601 — ROOF TEPIRgg90FInspections''
owner of property Who builds or improves thereon,and who does such work himself 602 — ROOF PLYWOOD NAIL
or through his own em,layim, provided thin such inpor,orem,am mo Incanted or
'f- -sale.If"M1 _ the building m fov<mcin IJ th ri one Y' ""' "'_... ....__ _. .--.. _. .._ _.._. .. . .
completion,the owner Wilder will have te homen of proving that he did nut wtid w -6 0 3 — ROOF BATTENS—
offered -
imprnvehaparpo. araale.). 604 — ROOF IN—PROGRESS
_ r of the prnpenY am exdusivdY`nntra<en6 with licenutl conuon t ..
construct the project(Sec 70,14.Business and Professions Codc:)The Contractor's I .
License Law does not apply to an owner of prapcny,who builds or improves thereon.
- _ara who.contracts for.such pmjacts with.a contracsor(s)becmed.pursuant.m gine --------
01 dols pt enseand,Le
_ ❑1 rept unJer Stt. PCbaits rt
Owner
WORKER'S COMPENSATION DECLARATION �w
I hDateereby affirm under,penalty of perjtr one of be following declarations:- 1 AUG r. b 2002
❑ 1 have and will'mainmin a Cerificam"of Conent4u self-insure for Worker's
Compensmhot. as provided for by Section-37W m-the Labor Code, for the
performance of the work forwhich this permit is issued.: BUIL
have and will maintain Worker-sC.axamsadmi linumme,as«quited by Section
37 of the Labor Cade.for the performance of the work for whichthispermit is
bruncid My W rk ' C p t m Inter n e d Policy umber arc
it /�al .., n. 1_.. _ .. _..... ...._ .. ... ........ ..... .......
Cam y_�2 LL PohYNOJ�J'�Q7'O-IIZ—S y.y -'L":
-,CERTIFICATION OF EXEMPTION FROM WORKERS't (� s + .
" •'
... ..,...'COMPENSATION.IN. SURANCE.",. nese _
: ..i ..... ...........--..._.._ _ r . ........�, ...-_... .
(This unimi need not be ctmplcmd if the permit is for one hundred dollen
(SIM)or le".l
shall
'I cenify that n she fire romance of the work for which th s permt ti issued,l
Nal'ndemploy any person in any manner so rat to become subject to the Workers
Cop pen son Laws r C 1 r mor Dam
N(ITICE TO APPLICANT ICafter making this Certificate of Exemption,you should 1 "
become subject o tic Worker's Compensation pmvoioos'of the Labor Cade,you must
Q 0 forthwith comply-with iuch provisions or this permit shall be deemed revoked.
ti 'CONSTRUCTION LENDING AGENCY
Ih ' by iffrm that them is a conormcnim leadirig agen4friche pedor "ce
'I' k f which th permit su d(See:3097 Cie C 1 "
,tate].ti .. __.. .. .......... ... .. .. --__ .._
Leader's Nam •. - u __ __-_._ . ..._. _ . _. ���...(((�tI
Z Isndc .s Add - - ..._- . .
U
UQ 1 gfy lhilh read this mppl t d.t mlWtthc ab f i is
//V/�-•-�
[v F. n t 1 8 f o piwith all city and county ordinances and state laws relating'
'0 U to Wilding constmct'n d hereby a di a mpre.ventatives of this cry to enter upon
}-W the above mentioned!ppery for, Cupertino against
inspection pusses ...
�.y (We)agrcctouvve.indemnifyandkeep harmless theCity yofA
h liabilities,judgments,costs and expenses which may in any way accrue against.said (DLJ
U.i Chyy in canscquenee of therun
grunting of this permit.
.APR
.. LICvAiNTUN'D'ER$TANUS WILLC'ONPI WITHAL
-C�io
Issued Date
SOURCEREGULATIONS. Yr
SigrtamreofAPPhano� ti' am 1'. Re-roofs
HAZARDOUS DISCLOSURE
goci,w l handle amrmt In th pphc i f 'bo
. ...Type of Roof.,_ .f_ti ..... - -„ .... ......... ._ ._,.....
in by th caper . tncipal CoO Ch ps 9.12 amu lh H Ire ands rty. t -
C, esti- 255J2( I L nsfl3ll� ad ;,;i !e I t s 4 I ) . t . .�a '-.
es
_ - _ All roofs shall,be mspecied pnor.to.any roofing material being installed.
ion the pplc mo future building cactipant useequipment ordevices which -�if a roof is insialled'Without first obtaining an inspection I'agree t0:'remove
e t 1m ash r< t mina i.a def d by ih Bay Are Air Q utility M migration
Dsoo trrr" all new materials for inspection. Applicant understands and,will.eomply with
°Y I -. all non-point source regulations
1 h e d the hxzwdou,nartenall milmoments under Chapter 695 of the
California Hiolon&5 fety Cciake,Sections 25505 25533 and 25534 I understand that �y •♦
'if the hl Iding docs not currently have a tenant.that my speni bty tdnotithe
fy ' Z'�
uccup to of The r u Ls H2h'nu t Wmet"o".. summe.1 a Ce rcoa of, (/
Signature of Applican Date a
r � - .. _. .. .-.
own«own«nn,aln��e aB tag t Dole All roof coverings to be Class"B" or better
' - OFFICE-
Building Division
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
IRUPEkTINO
Building Department
Subject: Reroofing policy for the City of Cupertino.
1. Prior to permit issuance, you must agree to comply with 1997 UBC Standards and
manufactures specifications on reroofing.
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 reroofing 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) Preinspection 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 that the proper City inspection
can be performed.
We understand the above policy on reroofing and will comply with this policy.
Homeowners Name: nn
Address: 1054 ,5 GA
��M '&c ' (D'
Reroofing Company Name: �IL
Applicants Signature:
Joe Antonucci
(Chief Building Official)
6/13/00