05090053 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION
BUILDING ADDRESS: COSMOS ROOFING PERMIT NO.05090053
i' QTGTNR DR
OWNER'S NAME: PERMIT ISSUE DATE
MAX DUNN 1901 OLD MIT)T)T.FFTRT.T) WY 09/08 /2005
NE: SANITARY NO. CONTROL NO.
(650) 969-7663
ARCHITECTIENGINEER: BURRING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
uOZ LICENSED CONTRACTOR'S DECLARATION JobDescri tion
C I hereby affirm that 1 am lieemed under provisions or Chapter 9(commencing P
aU with Section 7")of Division 3 of the Busircia and Professions Code,and my Recall is
ufull Y°=�and at3 q L1C d Z$S L El REROOF-T/O TAR & GRAVEL, ADD BUR W/ CAP SHEET
F ad Date ono -
,� ARCHITE
I imeersund my plans shall he stud as public mcmds.
J ad
Licensed Poor c..List
p OWNER BUILDER DECLARATION
<F I hereby affirm Nat I am exempt firm dte Convenors License U.far the
p o fallowing mason.(Scedon]W 1.5.Business and Prefessians Code:Any city or county
K m whim requires a permit tu consumer.alter.improve,demolish.or repair any structure $5550
prior to its issuanec,alsomean.thcapplicant far such pcnniva file a signcolaumin
?< that he is licensed pursuant to the previsions of the Contractors Limcnm Law(Charter 9 Sq.Ft. Floor Area Valuation
'l-$ (commencing with Section 70M)of Division 3 of the Business and Professions Code)ar
i 5- out he uem
expt themfmm and the bssa for tial alleged caempdon.Any violadon of
Section 7031.5 by any applicant far•permit subjects rho applka ,an a civil perulty of r 0 J Occupancy Type
not mom than that hundred dollars(3500).
❑1,as owner of the prepcny,or my employers with wages as their sole compensation,
will do the work and the swctum is not intended or offered for sale(Sec.7014,Business
and Pm(essims Coal:The Cantranars Lin"•Law does nal apply in an owner of Required Inspections
prepeny who Wilaf or improves demon,and who doessuchwork himudf orthmugh his
own employees,provided that such improvements are not intended at offered for sale.If,
however.the building or improvement is sold within one your of completion,the owner-
builder will haus the burden of proving that he did not build O improve for purpose of
sale.).
I,as Owner of the propeny.em exclusively convecting with licensed conu¢tors to
constmet the pmject(Sea 7044,Business and Processions Code:)The Conrractar's Li-
ve Law does not apply to an owner of pmpeny,who Wilds or improves demon.and,
who contracts for such projects with a contractor(s)Iicemed pursuant o do Consultors
Lice law.
❑I am exempt under See. ,B&PC for this mason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury am of the fallowing declarations:
1 haw and will maintain a Certificate Of Consent to self-imp d for Waiters COMNn'
smion.as provided for by Section 37W of de Ubor Code,for the performance of do
work for which this permit is issued.
1 have and will maintain Workers Compensation Insurance,as mquired by Section
W of the Labor Code.for the o fotmmee of the work for which this permit is issued.
My Workers Compplemmion Insurance camicf and Policy number am:
Carrie,. 5 ' 'r'f^'�� Policy N-5—ILL-0-4
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not M1e completed if the permit is for one hundred dollars(SIM)
or less.)
1 cenify that in the performance or the work for which this permit a issued.l shall not
employ any person in any manner»az to become subject a the Workers'Compensation
Law,of California.Date
APplkam
NOTICE TO APPLICANT:If,aftef making this Certificate or Exemption,you should
become subject in the Worker's Compensation provisions of the Labor Code,you most
.J z foMwith comply wid such Previsions or this permit shall Er.deemed mvoked.
ZO CONSTRUCTION LENDING AGENCY
F.N. Ihereb affirm that then is a construction Lending ac Indo f f
r g g my r performance u
a ) the wash c whim this permit u issued(Sec J09 ,Civ.C.)
LU Lender's Nunc
0.
az Lender'Address
U 0 1 ceni(y that I have and this application and sum that thi,and
show information muting is
comm.I agral,omm c comply with all city and county ro imnsOf and Cute laws relating to
�U abilvi°meomuudtlon.and hembyeudome¢preCcnudrcs of this city to toter upon do
r W
above (We) nedare to ertysaw,for indmnify an pmpoxs
(We)agree to cove,indemnify and hick hay in an do City of Cupertino id Ctagainst
Uz incoassits.judgments,the graving expenses which may in any way accrvc againa said City
U z in come A or D gaming of Ibis c mi tt
^ SO ICA DUST D ID WILL MPL WITH AL( -POINT Issued by: Date
SOURCE GULAT 9l// �
Re-roofs C7 A,"a
Signature of ApplicanUConvacmr Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle hanasdous material
az dented by the Cupenhad Municipal Code,Chapter 9.13,and the Health and Safety
ode. 0yea;zss3z(a)1 All roofs shall be inspected prior to an roofing material being❑ref g�—� P P Y g g installed.
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it hazardous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection.
7dau
QYcs ❑No
Iha Saks thehvarthmsmatcrialsre33umI anderClupocr 95 ofde Calding Heald&SafetyCode,Sttdons25A)515533 and2553d.1 undersand du ifdo building not curecndy have a tenons that it is my responsibility to notily theocearoutofthe
aircon, - hmmrbcmctPri ixuana C[NMallorOcsvpancy el Signature of Applicant Date
wner t ri. assn All roof coverings to be Class 'B"or better
09/07!2005 16:12 7075287663 PERMIT SERVICES INC PAGE 03
Sep 07 05 04: 14p Cosmos Roofing L6501969-9905 p.2
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Community Development Department
n 'l � Building Division
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
UPEkTINO Fax: (408) 777-3333
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-manufactureis 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, .
ME 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: /U 7 2—
Roofing
Roofing Company Name: —
Applicant's Signature: • �_/�� Date: / �S
Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
e` CITY OF CUPERTINO
REROOF DMZ /6CITY 01
CUPEkTINO PERMIT APPLICATION FORM
APN # Date:
Building Address:
/Q72 /
Lo rl
:
Owner's Na Phone#
m 2-5 2 ' ZO
Contract Phone#:
660 96 -Ab License 2 ?-5 y 4y
Contact:( Phone#: Cupertino Businss License#:
C/ `f
Type of Roof Covering:
Existing: Proposed:
75 Built-Up Roof ';Zf- 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.
Al I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description TJ �� �� � a R/w
Residential ,/ Commercial ❑ L
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Det. if
there are any restrictions: LJ
Cost of project: a Type of Construction: Occupancy group:
�SSo
Qty. if
Applicable Fee M 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