06050223 (2) CITY P�o c pPER1IYI �NN0 PERMIT 'fiCONTRACT WR�IAIFUIZMATION
BUILDING ADDRESS: COSMOS ROOFING PERMIT N0.06050223
21733 REGNART CT
OWNER'S NAME: PERMIT ISSUE DATE
DON YUH 1901 OLD MIDDLEF 0
E: SANITARY NO. CONTROL NO.
(650) 969-7663
ARCHrfECf/ENGINEER: BUILDING PERMITINFO
BLDG ELECT FLUMB MECH
!OZ, LICENSED CONTRACTOR'S DECLARATION Job Description
C I hereby affirm that 1 am lisp
ved under provisions or of Chapin 9(mmmrncNg
tJ with Secsion701Kn of Divivon3uf dr Busir,rss orb Pmfessiuru CaM.and mylicenxu
in fun forte and cfgM..�j�_ g TEAR OFF SHAKES ADD A DURA-LOC STEEL TILE License 0.1 l—'J CLASS A ( rr5rr TILE- CONTINENTAL - 1 . 3LB PSF)
p Dao: O Comment
'r-� ARC CrWS DE @
l e 1 understand my plans c a ubl(c rg
JyU 7
Liccntud Professional
OWNER-BUILDER DECLARATION
1 hereby maso alTvm on I nm exempt from Nc Convfeadonctora :Any c law for Nc
p o following sures.(Section 703 L5,Business and Professions Code:Any tiny or county
<m which is isus a permit re enres the alar,improv,mermit i,or repair any structumicarem
Ezi im,ber lo iufensedpaku requires the dpapismsofcarn the for Ccouactot m fik La (chaps ant
<
(commencing
cingwdpSectio 70f(nofDivision
ivions 3ofthe usines'sndce roawsCore) 9 Sq.Ft. Floor Area Valu 1m18425
i�th (commencing vitteeefrom and
the
basis nl of the Business andon.Any
Core)or
y��
that be is cacmpt Nem(mm roti dta buts fa dm alleged exemption.Any violation of
Scouon 703"by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
«mon does few hundred dollers(S500). 35624029 . 00 p y yp
❑L as ownerk.Ne pmpuny,a mY es planed with wage u they mk campeosatioo,
andla the work and the he Contra not s LMW«onmed for sak(ply 70an omuBusr ss
and Rorwho bu cam:The cnnuarem,License law dna rot apply lf an owner or Requited Inspections
property who builds orimprowch impr,and who am not
work himself or through bu
b.c.,lth a WiproWdcd that such impmsemam are not ear ofe oraBered thrsale.I[-
builder the WiWhe hrden of pmennlasold withinarc Weld or completion,Neowrcr-
builder will hose dm burden or proving Nat he tlitl not Wild or improve for purpose of
nk.).
I]1,as owner of Ne p.,ny.am eachaiwly convecting with licensed crnuacmrs m
consumer Ne project(Sec.7064.Business and Fmfosions Code)The Convaaor's U.
came law does not apply in an owner of pmpcny who builds or improve discount,and
who se Lacu for uch projects with a eonvacmr(s)licensed pursuant b thisContractors
License Taw.
❑Ivnesemptundersee .lidl,cr ismasav
Owner Dam /
WORKER'S COMPENSATION DECLARATION `A
1 hereby alTusv wder perulty of perjury now of d,c following mclaratians:
Ihaw and will maintainNfi
aCeeare of Comm emself-inium fa Workeri Compen.
anion,as provided for by Section 3700 of the Labor Com,for Ne performance of use
work for which this pumin is issued. - O
❑1 have and will maintain Workers Compensation Insurance,m required by Section
3700 of the Labor Com,for the performance of dm work for which Nis permit is its«Q '
My Workers Compensation Insurance carrier and policy numbs art:
Cartier.�—fY�di {4trs�l Policy No.: �7 I D 0
CE TIFl� CATEOFEXEMPI70N FROM WORKERS'
COMPENSATION INSURANCE
Mrs section need not W completad lithe permit is forane hundmtl dollars(SIM) r
or less.)
I¢rufy that in the performance of the work for which this permit is Wood.l shall,rot
employ any person in any manrcr so as as become subject to the W«kars'Comp ms.9.
Lawaof Califamia.Data
Applicant
NOTICE TO APPLICANT:Ir.after making Nis Gnifiam of Exemption.you should
become subject to the Woher's Compensation provisions of Ne lahor Code,you muss
.,O raMwith amply with such PMWOM Or Nu permit shall be maned mwked.
ZuW CONSTRUCTION LENDING AGENCY
(-� I hereby an.that dart u a m,uvucuan lending agcnry for ds performance of
CC the work for which this permit a issued(Sec.3097,Civ.C.)
QLenders Name
Z)Z Lenders Address
V Q I terrify than I have read Nis application wm sum that the show information is
IL P cornet.I agree N comply with all tiny and county ordinances and sum laws relating in
pU building construction.and hereby authorim mpresenutives of this city to emer upon Ne
r rA ahovcmcnuuncd pmpc costs
for icspccuon which ms.
C (We)ague no save,indemnify and keep harmless dr City of Cupertino against
rF-c % liabilities,judgments,costs and expcnus which may in any way accrue against said City �J A-
the 9MLiO
V z APPUCA race DER IDT Ns I'rWILL MPLYaWITH ALL NON-POINT Issued by: Dale ��
SOURCE LATI �i
Re-roofs
Signmun of ApplipHAZARDO Dam
HAZARDOUS for us MATE RIALS DISCLOSURE Type of Roof
Will y t e Cupem mforum Wilding«cupam Stam or handle Hearmus material
az defined by the Cupertino Municipal Cade,Gaptar 9.11.and Ne HeaIN and Safety
Code.Section 25732(a)7 All roofs shall be inspected nor to an roofing material being installed.�4n—
Will the applicant or future building _
Occupant
If a roof is installed without first obtaininginspection,I agree to remove
eme r um it haiardnua conminansa defined byft Bay Ara.AirequipnOum .
ily Ma cmcnor dc�cc% h an p g
Disuiety all new materials for inspection.
pyns bw6— .
Iha,S l.n Nehxnmoonmamriabmquiame 3534.1 Chapmel ftifNeWilding
nus not SaksyCade,Secu«u 21505,25533 am12s534.1 urWcrsiMc rext,:Wilding
arcs not t dy naw a tis my r ansinniny m notify dm occupant of taw
re nim mwbirn ner nrmiu canciirmataora tyC/ Signature of Applicant Date
�� pG
owner or mthornmd agent Dam All roof coverings to be Class "B"or better
Community Development Department
Building Division
City of Cupertino
i.
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
Fax: (408)777-3333
C U P E kTI 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 readv,
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 LC.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: LT \,
Job Site Address: Z _733 l/��ecyyl J- l
Roofing Company Name: w! ..ra/ S
Applicant's Signature Date: �S/� d
•
Greg Casteel
Building Official
Revised 11/2/04
May 24 06 09: 03a Cosmos Roofing 16501969-9905 p. 2
CommumW Development
10300 Toes Avmun
Cupmtino CA 95014
TWeAbwe(408)777-3228
CUPEINO FIt(404)m-3333
Buildin De arhnent
JOB ADDRESS-, PFRMTT N
21-1-73 66 N P k-t �1 r
OWNER'S NAME: -D k)L4H PHONE# 6 st) 9t. -7/.673
GENERAL 9MTRACI'OR r /U FAX# (c 5`D 9 i 9 GZ5
X I am not using any subcontractors; lZ D
Si r NESDatePlease check a linable subcontractors and h:te the fdlowin information
SUBCONTRACTOR BUSIS NAME BUSINESS LICENSE #
Cabinets&Millwork
cement Finishing -
F1eclrical
Euaoation
FwdnB
Fl
Linoleum/wood
Glass/
• Heating
Inailatioa
Iar+dsmPing —
Iathin
Mas
0tz3aat bd Shm Metal
Pain / Well
Pa '
Plumbing
Roofing
' Tank
Sheet Metal
Sheet Rock
Tile
X s
owner/c.n ture
Date
•
CITY OF CUPERTINO,
!m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 35624029 . 00
DATE ISSUED. . . . . . . : 05/25/2006
RECEIPT # . . . . . . . . . : 34563
REFERENCE ID # . . . : 06050223
SITE ADDRESS . . . . . : 21733 REGNART CT
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER DON YUH
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
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 20, 000 . 00 . 277 . 56 0 . 00 277 . 56 0 . 00
BSEISMICRE VALUATION 20, 000 . 00 2'. 00 0 . 00 2 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 279 . 56 0 . 00 279 . 56 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
OTHER 279 . 56 VISA
TOTAL RECEIPT 279 . 56
•
(LG, CITY OF CUPERTINO
REROOF
,CUPE"kilN0 PERMIT APPLICATION FORM
APN # -3 5 _ a y O z a Date:
Building Address: 2 / 733
Owner's Name: Phone#:
QMX87 -ZO5 8
Contractor:n Phone#: License#:
la (-/. 50-) 969- 7663 _79S4441 1
Contact: a. Phone#: � Cupertino Business License#:
I88�
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
LAsphalt Shingles C3Asphalt Shingles
Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) I Other(Specify)
Number of existing coverings '0fJ Provide I.C.B.O. Report# 45 P_ - 12-
L3
2❑ To be Removed ❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description: 7' o a _ ezepa a _ S�Q a o
S f. k� - - j 1.3
s
Residential )n' Commercial ❑
Fire Zone: Yes ❑ No J4 Confirmed with Planning De t. if
there are any restrictions: LJ
Cost of ect: :' Type of Construction: Occupancy group:
4, x/25 �L—
Qty. if
A licable Fee ID Fee Description Fee Group
/ BPERMFEE Bldg Permit Fees F BUILDING
BENERGY Energy BUILDING
/ BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
•