05060063 CITY OF CUPERTINO
BUILDING DIVISION PERMIT iXCONTRACTORINFORMATION
BUIIDINCADDRESS: COSMOS ROOFING PERMIT NO.05060063
OW NEWS NAME: PERMIT ISSUE DATE
ONE: SANITARY OL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG EhECf PLUMB MECH
y m Z 0 t� 0 l�
00 LICENSED CONTRACTOR'S DECLARATION a•
¢ C I Mrcby a(finn that 1 am liatvcd under provisions of Chapter 9(mmmcncing lob Desciiph�tf'ij
<Z. with section 70[(1)of Division ofthe Business and Professions Code,and my license is tlG � (!
n<a, in full forte and cR a
`gi ED
ucenaaays x-34 LK.Y � & Vag I REROOF W/TAR & GRAVEL �'
a Da¢ /o ioL Contractor JUL
sc
ARCHITECTS DECLARATION
'�a I unMmanJ my plans shall he uxd a public mcnnds z�OC
> 9 dd
urn Licensed Pmfcssinnel
O S OWNER-BUILDER DECLARATION
0 0 1 hereby reaso alum Nal 1 1. exempt s an the Contractor's License Law for the
O O following rtaxnn.(Seeti0"]1D L5,Business and Professions Calc:Any city or county tl �T�
K S which ayuirn a pcimit to consumer,alter,improve.demolish,or repair any svumum
prions is issuance.also rquira the applicant!orsuch permit to file a signed statement
that he is licensed pursuant o the provisions of the Contrum's Lirnu Law(Chapter 9 Sq. Ft. Floor Area Valuation
QFC (commencing with Section 7")of Division 3 of the Business and Permissions Cotic)or
Wthat he is cscmpt therefrom and the bases for the allegod exemption.Any violation of �A�p�i�Tap�.a,3�
Section 7031.5 by any applicant for.permit subjects the applicant to a civil penalty or 3 1A"9+J�V'rtl R9er O 0 Occupancy Type
oat mom than five hundred dollars(S50 y.
1,as owner of the property or my employees with wages ss their sole compensation,
will do the work,and the swcture is not intended or offered for sale(Sec.7W,Business
and Profusions Code The Contractor's License law docs not apply to an owner of Required Inspections
progeny who builds or improver thereon,and who does such work himself or through his
wm employees,provided our such improvements are not intended oroRered for sale.If,
however,the building or improvement is sold within one year of completion,the owmer-
builder will have the burden of proving that be did not build or improve for purpose or
sol,1.
❑1,as owner of the progeny,am eaclnsively contracting with licensed comractors to
consumer the pmjca(Sec.7W,Business and Protractors Code:)The Contract iLi.
cense law does not apply to an owner of property who builds or improves thereon.and.
who contracts far such projects with a conuactor(s)licensed pursuant to the Comtrsetors
License law.
m
❑1 i exempt under Sec B&P C for this mason
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a Certificate of Consent to calf-insumfor Worker'sCompen-
ration,ssprovided for by Section 3]00 of the labor Code,for the performance of the
W
ork for which Nis permit is issued.
I have and will maimain Workers Compensolion Insurance,as repimd by Section
]00 of the labor Code,for the performance of the work for which this permit is issued.
My Workers eCoompensation Insunn¢,Cartier and Policy number am:
Cart .J
Carrier: - 7D(--aL Policy No.:571—0 4—)I ZS
CERTIFICATE OF FXEM MON FROM WORKERS
COMPENSATION INSURANCE
musuction need not he completed if the permit is fm one hundrd dollars(Slip)
or less.)
I certify that in the performance of the work for which this Permit is issued,I shall nut
employ any person in any manner ao as in became subject a the Workers'Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If,after making this Cenificate of Eaemption,you should
become subject w On Worker's CamPCnaall m previsions of the Lora,Code,you must
O forthwith comply with such provisions or this Permit shall M deemed revoked. ,.
z'" CONSTRUCTION LENDING AGENCY
[r Ihemby affirm Nat then is a construction lending agmay for the performamc of
C' the work for which this permit is issued(Sec.3091,CO.C.)
(s] Q Linda's Namc
=z Lcnderr Address
U Q 1 etnify that I have read this application and sate that Ne above information is
(y P: correct,1 agree to comply with all city and county ordinances and state laws relating to
pU building Construction,and hereby authorize representatives of this city to enter upon Ne .
r Cil above-mentioned property for inspection purposes.
n(1 (We)agree to save,indemnify and keep harmless On City of Cotonou against
N liabilitica,judgmcmu,costs and expenses which may in any way accrue agnnst said City
U z in consequence of the granting of this permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY W ITN ALL NON-POINT Issued by: Date
SOURCE REGULATION f
��S Re-roofs
signs— ApplicanUCo ton Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the odicam or futom building occupaol atom or handle bkordous material
as defined by the Cupertino Municipal Code.Chapter 9.12.and the Hcalth and Safety
Code.Section 25532(4)? �S All roofs shall be inspected prior to any roofing material being installed.
Yes 1�ipi
Will the applicant or future building occupant use equipment or devicer which If a roof is installed without first obtaining an inspection,I agree to remove
it harardnus air contaminants in defined by the Bay Area Air Quality Managcmcm all new materials for inspection.
n?
❑Yea 4No —
I have mad Ne hvardous materials mquimmuds under Chapter 695 afthc Califor-
ria Health&Safety Cade,Smums 25505.25533 and 25534.1 understaM that if the Wilding
4.not currently have a unana that it es my responsibility m notify the Occup.,of One
ayvimmemrwhichm rprior in cc oma Ccnifuam omgc pan Signature Of Applicant Date
l 9 ° All roof coverings to be Class"B"or better
Owner car authorized age Dau
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
�UPEI�TINO
Building Department
JOB ADDRESS: q3 7 �Q A � /,M,� I PERMIT#6 5 - C7 g OO (03
OWNER'S NAME: � 140 19 PHONE #99G 2 -2—
GENERAL
GENERAL CONTRACTOR: FAX #
nn
cc
I am not using any subcontractors: L 9 oS
SignA6re Date
Please check applicable subcontractors and complete the following information:
66 SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum / Wood
Glass/ Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile y
Owne'rfContractd Signature Date
(w Community Development Department
r Building Division
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408) 777-3228
Fax: (408) 777-3333
U P E IST I N O
Building Department
Subject: Re-roofing policy for the City of Cupertino
1. Prior to permit issuance,you must 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.
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: �1'��Gf�C
Job Site Address: .?-3 ] 6^—uL4,9, r ,,yam
Roofing Company Name:
A plicant's Signature: C/-rte Date:
eel 9 U�
C�l/�S1ilSD(�c)
Greg t
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROOFCITY
CUPEf�TINO PERMIT APPLICATION FORM
APN# 73 � 5 O �— O Date.
1,37
3
Building Address: J/1 p
G 7
Owner's Nam Phone
Contractor:/tea' PhG,SD 969-7663 License#:
Contact: Phone#: Q Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
A Built-Up Roof )6 Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O.Report#
❑ To be Removed ❑ Provide Mfgr.Installation Specs.
eI Have Read, Understand and Will Comply With Cu ertino's TearOff Polic : ❑
Job Description:7r/. �c� R a�� Z" d- �i o, , Q C y is Q 4,71,
Residential l L Commercial ❑ I
Fire Zone: Yes ❑ No ❑ Confirmed with Planning De t. if
there are any restrictions: LJ
Cost of Project: v� Type of Construction: Occupancy group:
/DU
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