03030108 I CITY OF CUPERTINO
BUILDING DIVISION PERMIT Sk I7ti. �;kA,CTORIx+ INFA fO0kRM°r`° A"TTQN'n
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BUILDING ADDRESS: COSMOS ROOFING PERMIT NO.
OWNER' A E: PERMIT
1901 OLD MIDDLEFIELD WY
PTT T I IN
NE: (415) 493-6373 SANITARY %ftOL NO.
ARCHITEC IENGINEERt BUILDING PERMIT INFO
BLDG ELECT PLUMB MBCH
0 0 0 0
IOo LICENSED CONTRACTOR'S DECLARATION
! Ihereby.(fretthat eemffficBdunder pitPniens..cWpkr9(commerocis lob Description
with Sectio 7IXI0)or OiHsiom 3 orthe easiness ane Prorassions cade..na myneenre is
1.full mme.naer el.
sitz License lss, Lie.« REROOF
°eto ARCHITID Ec DN T/0. COMP . SHINGLE, ADD 30 C P �S GLE
7 1 understand my plans shall M used as public records
)kD
I Licensed Profcssieral
OWNER-BUILDER DECLARATION APR 0 7 2003
S 1 hereby strum Met 1 am exempt from Ne Convector's License Law for Mm
0 O following mama(Section 70313.Business and Pmfavtlrns Code:Any city or county
S2 which reyuims a Permit to concoct,altar.improve,demolish,m repair any stmctum
_2> prone its issuance.also mluims the Allotment for such Permit to file a signed statement
< that W is licensed pursuant to the pmvisiomaf the Cantraclwi License Law(Chapter 9 Sq.Ft.Floor Area buitcMdon
` $ (commencing with Section 7000)of Division 3 of the Business and Proressime,Cock)or
Nb at he exempt thmarmm and the humxe
id far the ali.g.d emption.Any viciauan of
Section 7031.5 by any applium fon permit subjects the applkansso a civil penalty of APN Numbe
not fume man five hundred dellen($5007. Number ecu Pane Y EYP
E]1.as owner of Ne property,Or my employees with wages as their sok compensation, 35918053 . 00
will do Ne work and the,wcmre is not intended or.ffernd fmaek(Sec.7W4,Business
and Prorusiass Code:The counselors Liccme Law doer not apply in an owner or Required Inspections
propenywho builds or improves thereon,and who doessuchwork himselfor thmugh his 305 — FRAME
own employees,provided that such improwments art notimemmul moremd(orate.if.
however,the building or improvement is mid within one year Or completion,the owner- 307 — INSULATION
builder will have me burden of proving that M aid not wild or improve for purpose of 601 — ROOF TEAR OFF
saki
0 I,as sumer of the properly.em exclusively contracting with licensed conpaelom to 602 - ROOF PLYWOOD NAIL
concoct the projeel(Sec.7044,Business and Professions Code:)The Contracture U. 603 — ROOF BATTENS
cents law does not apply to an owner of itinerantly who wilds or improves therton.and
who contracts for such prci with a comrscums)licensed pursuant to the Comnnoes 604 — ROOF IN-PROGRESS
License Ls-
0 1 em exempt under Sm. .B&P C for this moon
Owner Date
WORKER'S COMPENSATION DECLARATION
77MI hereby aln,m under Penalty of perjury om of the following declarations:
have and will maintain a CeNrcate of Consent self-insum for WorkereCompen-
n,as provided for by Section 3700 of Ne labor Code.for the performance of the
for which this pconit is issmd.
have and will maintain Worker's Compensation Insurance,as required by Section
of the labor Code,for the performance of Ne work for which this permit is hatred.
Workers ration ..ac/oyrn and Politycomic,art:
(r•a«_. Policy N.511—gT2�//ZS
CERTIFICATE OF EKEMP ION FROM WORKERS'
COMPENSATION INSURANCE - -
(Thbseetim need not tecompmund if the permit is fmone hundred dollams($1M)
Our Tc.s.)
1 certify that in the Performance of Ne work for which this Permit is laced,l shall not -
employ
Lawsoanyperred. my manner anuln bocomc mbjecumhe Wohers'Compensation
lawsca Glifomia Dare
Applicant
NOTICE TO APPLICANT:If,atom making this previsions
of of Exemption,you shoos
become subject comp to it Worker',Compcwsion provi,iom of Nc teem Code,you most
OroMwith comply with much pmvisiou or this Permit shall w dccmrA nrokW.
Z W) CONSTRUCTION LENDING AGENCY
1 hereby affirm that then is a construction lending agency for the Performance of
]i the work for which this permit Is issued(Sec.3097,Cih,C.)
11 Q Lenders Name
L
�z Lender's Address
;)Q 1 certify nel.I o,Nu 1 haus reed this application y f sme that and
above iws rmetion is
yU condingcostrto comply with
yautiand counrynNinesof and duo kw, upon ran OO -how
.and hembyaetict.nrposes.representatives of Nbcity mcnkr upon the
[31 shove-mentiorrcA .pally for emnify anpurposes. _ y'
,Ty En (Wc)agree to outs indemnify and keep harmless the City or against
against
;jzEn liamoseepeumm, fMecoag and expenses which may in any way seems agaiul aid City
inconsegmnmofthegrantingofthis permix Issued Date `WJ 'l •i�:�r�.:
^' APPLICANT UNDERSTANDS AND L COMPLY WITH ALL NON-POINT ��
SOURCE REGULATIONS. B
=�— - �1�_ 3o�a� Re-roofs
Stgnemrt of AppLcanUContnnor -7— Deo
HAZARDOUS M TERIALS,( DISCLOSURE Type of Roof
Will the applicant or future wilding mcupann,rom car hi haardou material
u defined by the Copenino Municipal Code.Chepe,9.12,and the Health and Safety
C
ode.Section sss3z(a)7 .../ All roofs shall be inspected prior to any roofing material being installed.
DYe, p�.0
Will the applicant or future building occupant use equipment Of devices which If a roof is installed without first obtaining an inspection,I agree to remove
it headroimict? om air cormormanta a defned by the Bey Area Air Quality Management all new materials for inspection.
D Yes lin CtryV
I have mad the hvardnus maerieb no.ficmcnu under Chapel 6.95 ofthc Califor-
ealth&SafetyCole,Sections 25505,25533 and 25534.1 understand low it tM Wilding
not curved hums meant,thelilbmymsponsibilitytonual'ythemcupwinfthc
uwm t uslbeme,P' rtoissuamcofaCcnifmmeofacabamq' Signature of pplicant Date
Owner Lir aulhmria dagent D,� All roof coverings to be Class "B"or better
Community Development Department
Building Division
JQa»e' City of Cupertino
10300 Torre Avenue
Telephone: (408) 777-3228
CITY OF
Fax: (408) 777-3333
C U p E I N^
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: Z
Job Site Address: /0S 3 z%� !
Roofing Company Name:
A plicanYs Signature: �o Date: ��3
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper