06040159 CITY OF CUPERTINO
BUILbING DIVISION PERMIT
BUILDING ADDRESS COSMOS ROOFING PhAnal.NV.06040159
10401 PRUNE TREE LA
OWNERSNAME FiRM17 ISSUE DAM
Aft KENEO LANDA 1901 OLD MIDDLEFIELD WY 04126/2006
Ir NE: (650) 969-7663 SANITARY NO. CONTROL NO.
ARCHITECT�GIKEER: BUILDING PERMITINFO
BLDG MITCH
LICENSED CONTRACTOR'S DECLARATION
UW I hereby affirm that I am licensed wider provisions of chapter 9(commencing Job Description
tzor with Section?")of Division 3of On Business anal Prolessionct Cado.and my license:In
!=�& infullfinc TEAR OFF COMP SHINGLES AND BUR ADD 1 LAYER WINT
Cl Lic.9
Comurietter GUARD .1 LAYER 15 FEET AND 50 YEAR CERTAITED
AR M�GN PRESEDENTIAL COMP SHINGLE WITH 31 TORCH ON FLAT
EC2 a
lundereandinypla . 1 .12C
Licanned Professional
OWNER-BUILDER DECLARATION
I Itcochy ffims am,I ina.."form ths,cmas=ws Licerms Law ro;due
C following...a.(Section 703 1.5,B ushrons and Professions Codc:My city or county
which onclums.Fammitu,crousti shn,improve,dcnreflim.m�repair my somettare A is Pam
prior to its issuance.shut ex,ofies the applicant for such Permit to rile a signed statement
Sq.Ft.HOOT Area Liation
'hot he is licensed pursuant to the provision of am Contractor's Liccum,Law(Chapter 9
(Oancomraning with Section 7000)of Division 3 of On Buz.and Praficasiones Code) $13375
chat M is aamn,n t1heraft.and tim handis for On all.lich!exemption.Any vi.lhen of
Section 7031.3 by a"applicant for 2 permit shoijimudic applicion in a civil Penalty Of APN Number ccupancy Type
no, am than five hundred dollars(MI + 20W
0 l,u�roftmpmKnymmyempl�cowi�wmu�irwiccomK=don.
will do the work.and ft samicaure 6 no,annealed car offerod far shadis(See 7044,Business
and Profession.Code:Man Cirmacte's Licc.Law does.1 apply in Em crow.,Of RETdjLDj& Do
propony who builcusorimpeaves themon,andwho doessuch work biressaffortionitigh his
ommemployansiL,rovicled that such improvements.Out intended oraffered farricale.If. N
however.the building or improvement is mid within one year ofcomplation.ft camet-
builder will haw the lumber of pmving chat In did not Wild or improve for purpose Of
ask
C]1.a,..,of the .,n,..sischesivel,...an,wide licensed courracaurs;W
Occentruct ft p.jca(Sec.7044,Business and Pnifinswas Code)The Ciaretramor'S Li-
,a.,Ls.does a.,apply to.owracr.1'property who eild..,im,neven ft...and.
who contracts for such pmjc=with acentraccuar(s)licensed pursomal Ed use Commences
Liccom Law
[]I arn mmmpt under See �.B&P C for this nessom
O�rvr case
tWORKER S COMPENSATION DECILARATION
I hereby affirm mother penalty o(perjuary am at the following
I hii,e ad will mountain.Ccr�ificmc of Consent in selfAmoure for Wanker's Compan-
sammi.as umvichad far by Section 37M of thic Labor Coula.I.On perfinion.of ft
we&far which gas Permit in issued.
have aral will maincern Workees Compensation Insurances.ra;nottifired by Section
of due Lather Code.for ft Ferforearce claim woric for which this peret,is intend.
My witolutt"4�'71 . a ca..or and Policy manithe,am:
T-= peficy ..:S-7 1-0 5-//2-5
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Thai=am need net be,completed if ft permit is foram haressial dodher,($IW)
or 1.1
I Onolly thta.in due Performance of to work far which this Permit is named.Ishall Out
employ any pennon in any manner an an in became subject in due Worked CompenshoutIon
La.of California Gain
Ap,licarr,
NOTICE M APPLICANT.If.after making thin Certificate of Exemption, an Amid
beennum Imbin"an ft WOolmS COMPossurEmn previsions of Me Labor Code,you raw,
forthwith comply with each provisions or this parmil mall be destreal revoked.
z C
C
CONSTRUCTION LENDING AGENCY
I hereby taffirm OAL dia.is.Oian.leading Monacy far tom perficurnance,of
ft work(as which Ois permit I,issued(St..34A)7.Cil C.)
Le miss Name,
Lamiees Addreas
z
U 0 1 certify tat I haw mad this application and state chat dic,:Ww infoornadun is
UL P: correct.I agree to comply with all city and county eminences and coalawstclatingto
0 U building construction.and hereby stathourim mpresencifives ofthis city 1.coUn.'a ft
LL 2how-mentmoccl pm,perly for inspccdon purposes,
0. (We)ag=to saw.m&nutif,and keep harmicas ft City of C.,sartino Maine.
rA liatnihics.juaignicnis.conts and Cx,,aaw3 which may in my way acewc Mains,mid City
in consequence of the granting of this permit.
APPLICAN7 by: Date
.�,tK1)ER�:?NDS-0P9D WILLOOMPLY WITH ALL NON-POINT Issued
SCHIRCE-REGULATU)
Vf�� �,'f lob Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will ft appliances,or form Wilding assicuperni stana 0,handle hissimmuto intacrid
sa defined by Oc Cupertino Municipal Code.Chapter 9.12.sea On Health and Safety
Coun.Section 25532(.)? PH. All roofs shall be inspected prior to any roofing material being installed.
Will On.1plicam.,for.building .,at.a,utprocal.,de,ona which If a roof is installed without first obtaining an inspection,I agree to remove
ecafthan�yk` � finc
' aterit"Onachouncile de do
District? 7 Y the Bay Area Air Quodily Managemen, all new materials for inspection.
0y. No
I have max!On tivardams;materialsacquirenneres unaerClapany 6.95ofthe Califor,
nia HasithEk SaboyColle.Secuorms MM5.25533 anal 25534.lundcomed matifille Welding
does I act comently haw a ishom,Oat it 4 my responsibility w notify ft ocrupam(or am
onitancom. which..I bMt "to I of a acmilanate gb
-MD�& Signature of Applicant Date
All roof coverings to be Class "B"or better
Rpr 24 06 11:46a Cosmos Roofing (650) 969-9905 p. 2
•
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Buil De
JOB AD
MBnt
10401 I'RUuErk&,� LAAs.E D Y q 9
PWN$R'9NAty� $HON&M G.SD 44.4 Z (o'S
CONTRACTOR C'nSMOS p�y� FAXN
r-
X Tam not using any mhwftactm.o
snbeaattractpis and �eEe tT►e foII�►e foII - informatiDate
on:
SUBOONTRACT01t RUSDMS NAME BVSDms LICENSE!
Cabine(s&Millwork
Cealeiu i
wood
Sheetblew
�RirAl
HawvAdeaf
Fencing
r7oorio&
t�
/w
ltoo@nB '
Tank
ShM4 Metal
,Sheet Rod(
Ile
Date
Z0 30Vd ONI 5301A63S 1IWJ3d E99LGZ9L0L 00:ZT 903Z/bZ/b0
Community Development Department
` Building Division
VQt City of Cupertino
10300 Torre Avenue
• CITY OF Telephone: (408)777-3228
Fay: (408)777-3333
C O 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.
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: /&14/O
Roofing Company Name: 44
Applicant's Signature: Date:
iL 6.6
• Greg Casteel
Building Official
Revised 11/2/04
CITY OF CUPERTINO
am 1 of 4 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 31633034 . 00
DATE ISSUED. . . . . . . : 04/26/2006
RECEIPT # . . . . . . . . . : 34149
REFERENCE ID # . . . : 06040159
SITE ADDRESS . . . . . : 10401 PRUNE TREE LA
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : KENEO LANDA
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-2022
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 14 , 000 . 00 212 . 76 0 . 00 212 . 76 0 . 00
BSEISMICRE VALUATION 14 , 000 . 00 1 . 40 0 . 00 1 . 40 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 214 . 16 0 . 00 214 . 16 0 . 00
•
57� CITY OF CUPERTINO REROOF
• CUOF
PERTINO PERMIT APPLICATION FORM
APN # 3YLy 33 034 Date:
Building Address: lot/6l
Owner's Name: c/o R- Phone #:
aS2-zos/
Contractor: n „� Phone5 License #:
Contact: Phone#: J Cupertino Bsi e s License#:
Type of Roof Covering: Yj
Existing: Proposed:
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.
• I Have Read, Understand and W' 1 Comply With Cu ertino's Tear Off Policy:
Job Description: 7o y " ' 10', ^ is
Residential Commercial ❑ art
Fire Zone: Yes ❑ No .Q Confirmed with Planning Det. if
there are any restrictions: [5
Cost of Project: of Type onstruction: Occupanc group:
/ 3 7.5 ( -3
Qty. if
A licable 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
•