02100073 (2)CITY OF CUPERTINOP'Wl,
null,DING DIVISION PERMIT
CONTRACTOR INFORMATION:
H
BulL1)L0(9•816Es,SANTA TERESA DR
COSMOS ROOFING
PERNHrN®2100073
,wAN AmKLEIN
1901 OLD MIDDLEFIELD WY
APPLICATITIOP'l gY2002
IONS
(415)493-6373
SANITARY NO.// CONTROL NO.
ARCHITEC(ENGINEER:
BUILDING PERMIT INFO
BI.DG ELECT PLUMB MECH
0 0 0 0
LICENSED CONTRACTOR'S DECI.ARA'IION
Job Description
Ihereby afrom 'bar um,ficenkdanderpnvitionlofChapter agonnmerring
REROOF
with section 700) of DivLdon 3 of Be Business and Professions Code, and my license is
in full lima and (i .
hiccn. (TSI Liv'. X J
vow
_�
,)a. .9 0�—Gnnleaelor
ARCHITECPSDECLARA' ION
I my be used as records
OCT 18 2002
unacrnand plansshall public
1.iccnrod Pit nnal
OWNER-BUILDER DECLARATION
1 hereby affirm that 1 am eacmpl from the ContracmLs Ucenac Law for the
BUILDING $14000
following meam. Station 7031.5, Business and Professions Code: Any city or eoanly
which requires a .it In a histruel, alter, improve, demchod. or repair any Structure
prier to its issuance, also requires the applicant(oraoch permit In file a signed Statement
'y
3
Valuation
that he is licensed pursuant s the provisions of the Contractor's LicenTaw(Chapter 9
,amgM3at®dAI@l0
(a'ndrmcncing with Section 9100) of Division 3 of the Business and Prnfrs.,do, Code) or
that he it cxcmpt therefrom and the basis for the alleged exemption. Any violation of
-3 UkPI`llNiWWE Occupancy Type
Section 7031.5 by any applicant for a Permit subjects the applicant o a civil penalty of
not more than nae hundred dollars (s500.
3 07 — INSULATION
I, as owner of the property. or my employees with wages as their aide compensation,
will do the work, and the structure is not intended or offered for sale (Sec. 704, Business
and Professions Code: The Convenors License Law does not apply to an owner of
602 - ROOF P nWAcj pns
property who builds or improves thereon, and who drcs such work himsel f or through his
own cmPloyer, provided thmsach impro.rienls arc nm imendcdoroBcrcd fnrsalc.If,
603 — ROOF BATTENS
however, the building or improvement is sold within one year of completion, the owner-
604 - ROOF IN-PROGRESS
builder will have the burden of proving that he did not hold or improve for purpose of
sale.).
I, as owner of she property, am eachervely contracting with licensed cantracmrs to
construct the project (Sec. Trill Business and Professions Cade) The Characters Li.
scroll law does not apply to an owner of propeny who Wilds or improves Infrared, and ,
who contracts for such projects with a convidetm s) licensed pursuant to the Contractor's
License Uw.
❑ l am exempt under Sec. .B&P C for this arasor
Owner Date
WORKER'S COMPENSATION DECLARATION
e:
1 hereby affirmunder penally of perjury, one of the fnlluwing declarations:
have and will maintain a Cenincam of Comenuo self-iiuure for Worker's Camped.
salon, as provided for by Section 3700 of the labor Code, for the performance of the
work for which this Karl is issued.
11 have and will maintain Worker's Compensation Insurance, as required by Section
(J IMI of the Labor Code, for Ne pconrmante of the work for which this permit is issued.
My Wnrkcr's Ca pcasm... lmurunce camicr end Policy¢¢n�umaMru
Policy No �V
Cartier: _,•kC
ROMWG
C R )FIC FROM WORKERS'
COMPENSATION INSURANCE
OMP SAI ION
(This section need not be completed if the permit is fnnmc hundred dollars (SIIH)
Icso.)
1 eenify that in the performance of the work for which this permit is issued. I shall not
employ any Person in any manner a, as to Maome subject m the Workers Compensation
Laws of California. Date
Applicant
NOTICE TO APPLICANT: IL of In making this Cc nilicme of Neem ptino, you shoe to
become subject to the Worker'I Compensation Prov signs al the labor Code, you must
fonhwi tit comply with such provisions or this permit shall W deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby afford that there is a construction lending agency tot the performance of
the work for which this Permit is issued (Sec. 3097. Ci, C.)
Lenders Name
Lender's Address
I certify that 1 have read this application and state that the above ws relating i,,
correct. 1 agree m comply with all city and county ntain and curt lows relating
es c)f a
building construction,omiland hereby inspectionpurposes rnutivca of this city m cntcr upon tM1c
abuvc-mentioncdpmpc .
fond
(We) agree to save, indemnify and keep harmless the City of CvNrlino against
psis
un ex, whihmay
thensuang ca penscernit. mayin any way aamc against land City
A [PLICANTL of the granting of this pefmll.
incoisiesjner, of
I APPLICANT UNDERSTANDS AND WILL COMPLY WI ALLAppLICANT UNDERSTANDS AND WILL COMPLY ALL N�P�T
(� v
Issued by: Date
l
SOURCE REGULATIO
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Re-roofs
Type Roof
Signature of ApplicanatConvacb, Dec
HAZABDo S MATERIALS DISCLOSURI3
of
Will the applicant or future building occupant slore or handle hvallous material
as defined by the Cupenine Municipal Cade, Chapter 9.12, and the licalth and Safety
codr, Secfod 255321a)7
All roofs shall be inspected prior to any roofing material being installed.
❑Yes N
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant.1future building occupant use equipment or devices which
mit hvallous air contaminants as defined by the Bay Arca Air Quality Management
all new materials for inspection.
District?
�,�� /
[D yes LV
I have mad the haesrdous mate-rale requirements under Chapter 6,95 of the Califon
/
Z,
ria health& Safety Cale. Sections 25515,25533 and 255311 andemand than if the building
I
!/I
dies an currently have a tenant, flat it is my Tesla, rdbility to anti I tM occupant of the
rcquircmentswi- nor pp or to au anr,rccifil�eteafa� p�
Signature Date
All roof coverings to be Class "B" or better
Owner maathorneda di Date
Building Division
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: (408)777-3228
CITY 0 Fax (408)777-3333
CUPEI�TINO
Building Department
Subject: Reroofing policy for the City of Cupertino.
1. Prior to permit issuance, you must agree to comply with 1997 UBC Standards
and manufactures specifications on reroofing.
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 reroofing 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) Preinspection 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 that the
proper City inspection can be performed.
IMPORTANT:
1. Flat roofs must have a minimum of 'Y4" 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 of inspection
We understand the above policy on reroofing and will comply with this policy.
Homeowners Name:
Address:
Reroofing Company Name:
C;
Applicants Signature: Date:Z—
Joe Antonucci
(Chief Building Official)
6/25/01