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12110156 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 867 FERNGROVE DR CONTRACTOR:COSMOS ROOFING PERMIT NO: 12110156 OWNER'S NAME: MOORE JOHN C AND CATHERINE K 999 COMMERCIAL ST STE 105 DATE ISSUED: 11292012 ��..0,,,///WNER'S PHONE: 4082194499 PALO ALTO,CA 94303 PHONE NO:(650)969-7663 pfl LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG T_ ELECT r PLUMB r License Class c3? Lie.# �7,? S 4 MECH r RESIDENTIAL r COMMERCIAL r Contractor "05MC* ZV-P. Date' I hereby affirm that I am licensed and the provisions of Chapter 9 JOB DESCRIPTION:REMOVE AND REPLACE TAR AND GRAVEL ROOFING (commencing with Section 7000)of Division 3 of the Business&Professions (2800 Code and that my license is in full force and effect. SQFT) I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance of die work for which this Sq.Ft Floor Area: Valuation:$13160 permit is issued. APPLICANT CERTIFICATION APN Number:37539048.00 Occupancy Type: I certify that I have read this application and state thatthe above information is correct.I agree to comply with all city and county ordinances and state laws relating to building construction,andhereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may Accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Signature - 'Date "t rZ Issued by: Date: /� f}lG/� ❑ OW - UILDER DECLARATION RE-ROOFS: 1 mm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior many roofing material being installed.If a roof is the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for I,as owner of the property,or my employees with wages as their sole compensation, inspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) Signature of Applicant Date: !fZr7/ 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROO O GS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: HAZARDOUS MATERIALS DISCLOSURE 1 have and will maintain a Certificate of Consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material. Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534. Compensation laws of California. If,after making this certificate of exemption,I - become subject to the Worker's Compensation provisions of the Labor Code,I must Owner or autho ' It: forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is I liaffirm that there is a construction lending agency for the performance of work's correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address costs,and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. I understand my plans shall be used as public records. Signature Date Licensed Professional REROOF PERMIT APPLICATION ( Z ( I t COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228• FAX(408)777-3333•buildina(a)cuoertino.ora PROJECT ADDRESS q/ 7 t�� nOic - APNH OWNERNAME b / r '` PHONE E-MAIL) c,4-�ff EK i E ovs� o - zI �f 99 STREET ADDRESSCITY, STATE,ZIP FAX FtQnJGeoJE 2. ccJPA171A)6 CONTACT NAME NANDA O COSMOS ROOFING PHONE 650-969-7663 E-MAIL STREET ADDRESS 999 COMMERCIAL STREET #105 CITY,STATE,ZIP PALO ALTO, CA 94303 FAX 650-485-2314 ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT EI CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC.N RICH COSMOS 785441 C39 COMPANY NAME COSMOS ROOFING E-MAIL FAX 650-485-2314 STREET ADDRESS 999 COMMERCIAL STREET #105 CITY,STATE,ZIP PALO ALTO, CA 94303 PHONE 650-969-7663 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC.a COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF lK SFD or Duplex ❑ Multi-Family ROOF AREA: q-� VALUATION: / �J"0 STRUCTURE: COTnRIeiClal L bV v 1 / 3 r 16 0 1 EXISTING ROOF TYPE: BUILT-UPROOF ❑ASPHALT SHINGLES 13 WOOD SHAKES ❑WOODSHINGLES ❑OTHER(SPECIFY) REMOVE/REPLACE KYES IF NO, PLYWOOD ❑ w, ❑ PLYWD ❑ OSB PITCH: ROOF ❑ NO #LAYERS: THICKNESS: ❑ 5/S" TYPE: ❑ CDX �'12 CLASS: A PROPOSED ROOF TYPE: IX BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOODSHAKES ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT k DESCRIPTION OF WORK: ( �c - AAD _ /rte V � 5 e—E-7. E7.J — �/hZ cr G tZ�t ✓C �, By my signature below,l certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information 1 have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building cons uthorize representati no to enter the above-identified property for inspection purposes. Signature of ApplicanVAgenC Date: SUPPLEMENTAL�Oer's QUIRED OFFICE USE ONLY _ If building is associated withciation,provide letter PLAN CHECHTYPE ROUTING SLIP of approval from HOA. :OVER-THE'COUNTCR lBUILDING PLAN REVIEW Provide Planning approval to verify if there any restrictions. EXRRESS /[—..I PLANNING PLAN REVIEW Provide copy of Manufacturer's Installation Specifications. ❑ STANDARD ❑ FIRE DEPT Provide signed copy of Cupertino's Tear-Off Policy. ❑ OTHER: ReroojApp_2011.doc revised 03116111 REROOF TEAR-OFF POLICY COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION ALBERT SALVADOR, P.E.,C.B.O., BUILDING OFFICIAL CUPERTINO 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 (408)777-3228•FAX(408)7773333•building ancuoertino.orD PROJECT ADDRESS 8/ 7 V ZO-1 C l� O APN N OWNER NA A -T Ct Kl jr ro ME_ J/`PHO ,��j' �),t� /y�E-MAIL STREET S I E tl 00�C1'I. Y 9-' CIT'1�S'rA h. `T 7/4. / 501/ FAX FEReJ CONTRA (CfQR'NAj.1E-.O LICENSENUUMMBBJER N GLICEN$� J(/ BUS.LIC.N COMPANY NAME A/ &MAIL G- Fp�J(� , STREET ADDRESS ' ^ / CI ,STATE,ZIP D C�+ �J P(-t7450 /90N� 69. 766 W I UNDERSTAND AND AGREE TO THE FOLL�LOWING: G 1. The re-roof project shall comply with all applicable provisions of the 2010 California Codes. 2. An inspection request can be scheduled up to the day before the inspection date. Please call (408)777- 3228 from 7:30- 3:30pm (Mon-Thurs) or 7:30 - 2:30pm (Friday)to schedule the next day inspection. For Tear-Off and Nailing Inspections,you must also call on the day of the inspection only after that phase of the work is completed. The building inspector will be available within one hour. Progress and Final Inspections will be given a two hour window. 3. Tear-Off Inspection is required. Any and all dry-rotted wood shall be replaced prior to this inspection. Unless new plywood roof sheathing is proposed throughout, all the nails/fasteners shall be either completely knocked-down or removed prior to this inspection. 4. If plywood is installed, a plywood Nailing Inspection is required. 5. Roofing shall not be applied without first obtaining all prior inspection and written approvals from the building inspector. Any roofing which is applied without first obtaining an approved inspection will require the removal of all new material down to the sheathing so a proper inspection can be performed. 6. Progress Inspection is required when approximately 50%of roof covering is installed. 7. A Final Inspection and approval shall be obtained from the building inspector when the re-roofing is completed. To receive a final sign-off, the following items will be verified: a. Flat roofs shall have a minimum of 1/4"per foot of slope and demonstrate there is no ponding. b. Listings from approved testing agencies for all pre-manufactured products used shall be available on-site to review at the time of the inspection. c. Proper spark arrestor installation,vents painted, gutter/downspouts installed, debris removed. 8. NOTE: If you call for a tear-off or plywood nailing inspection and the work is not complete,you will be charged a re-inspection fee of$126.00. The re-inspection fee shall be paid before another inspection can be scheduled. By my signing below,I certify each of the following is true: I am the property owner or authorized agent to act on the property owner's behalf. I understand and agree to comply with the re-roof policy stated above. I also understand that smoke detectors and carbon monoxide detectors are required to be installed in accordance with Sections 8314 and R315 of the 2010 California Residential Code. Signature of Applicant/Agent: Date: I Z9 1 Z ReroofPolicy_2011.doc revised 02116/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION IQ ADDRESS: 867 Ferngrove Drive DATE: 1112912012 REVIEWED BY: Sean APN: BP#: `VALUATION: $13,160 *PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof PRIMARY SFD or Duplex PENTAMATION 1SFDWLROOF USE: PERMIT TYPE: WORK Remove and replace tar and gravel roofing 2800 sq ft). SCOPE FEE ID ROOF AREA S.f. 1REROOFFRES 2,800 X , Mec.h. Plan Check Plumb.Plan Check F.la% Plan Check mech. Permi(Fee: Plumb. Permit Fee: 1:1" Permit Pee: Other Afech.Insp. Other Plumb Insp. Other Dec. Insp. ;Mach. Insp. Pee: Plumb. Lisp.Fee: Elec.Insp. Fee. NOTE:This estimate does not include fees due to other Departments(Le,Planning,Public Works,Fire,Sanitary Sewer District,School District etc). These.fees are based on the prelimin in ormaton available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 Elf• LL! I2) FEE QTY/FEE MISC ITEMS Plan Check Fee: Stuppl. PC Fie Plumb.11lec:h./Flee Permit Fee: $420.00 Suppl. lnsp Fee P1umh.lMech.lElec Phrmh.11fechlElee Permit Fee: Construction Tax: Administrative Fee: Work Without Permit? O Yes 0 No $0.00 Advaoiced Planting Fees: Travel Docrnnentalion Fees: A Strong Motion Fee: IBSEISMICR $1.32 Select an Administrative Item Bldg St ds Commission Fee: IBCBSC $1.00 .,•i as A $422.32 $0.00 TOTAL FEE; $422.32 Revised: 10/01/2012 U #}rg 26 11: 17a Cosmos Roofing (650)969-9905 p. l 19010W Middlefield Wey,1122 Commfter4 to Excelrence Bus.(650)969-7663 Mountain View,Ca.94043 c Fa Fully i 969-9905 Lir.*785441 Since 1975 44owmrsW FullyInsured Resklenriai•Industrial Sir=1975 This letter hereby authorizes Brad Rickard,Julie Rickard, Howard Vanlandingham, Jim Davis, Kathy Peterson,Jefferey Rainey,Julie Wilson and all currently authorized persons on behalf of North Bay Permit Services to sign for any and all building permits and licenses required by our company. Sincerely. ( l y, Richard Cosmos,Owner Cosmos Roofing 1901 Old Middlefield Way,R2 Mountain View, CA 94043 is i Nov 27 12 12: 22p Cosmos Roofing (6501969-9905 p. 7 COm vuwiwDmlopwM 10300 Tare Aveaee CapmCneCA 95014 Teie*=(4M"T•3223 F=(4M 777.3333 CUPO TINO Bnildin De artment 08 ADDRESS: F6 FEk4)&kVV'c )A, PELt1MDT OWNER•SNAME rnook.S PHONE# -?6 GENERkLCONTRACIOR: FAX# Lam not using any subcox( Date Please check sabooalCrutoca an -caathe ' it1[o>atetioc7 SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE# Cabinets&M17hvork CementM shuig Madlical ExcMdon pendw FI Lkwl am/Wood CL-M/Glaft HeatbW rns►ilatian Ornamenw sheet Metal Pam*q/Wail P! Roofing Septic Tank SheetMetal SbeatRock 2 O G7i outrattoc Date 2072-7i-27 72A0 6509699905 Page