06030113« CITY OF CUPERTINO
BUILDING DIVISION PERMITCONTRACT�QR,INFORMATION `
BUILDING ADDRESS: PERMIT NO.
10885 N STELLING RD
W NER'S NAME: PERMIT ISSUE DATE
VALLEY CHURCH OF SANTA CLAILA C691 W SAN CARLOS ST 03/20/2006
HONE:
SANITARY NO, CONTROL NO.
4082796171
ARCHTItC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
�Op LICENSED CONTRACTOR'S DECLARATION
4 C I hereby of Nat 1 un licensed under pmvuatos of Chapter 9(commencing b escription
Sz1a wiNSatbn]t]IMI)CfOivisionJofdmBusinevandPro(caiovCode.andmyliccnais REMOVE (E) COM ' 1 � TALL NEW 40YR COMP
n�,� in full tome and affect. i 0
5pz LicenseCl33�a""--��--��--tic.«' CLASS A
Dam Canuucr Lj
£i ARCHITECTS DEC A
C 1 understand my plans shall te used as puhli cC ds MAR 2 g 2006
)yu
«G Licensed Posfessitnal
S OWNER-BUILDER DECLARATION �� �i�■
$ 1 hereby affirm Nat 1 L exempt from the Contractors License Law for the U L
i
no following mamn.Permit
1 ]1131.5•Business and roe professions Cade:Any city or county
Cm� which iu issu a pcnnit re covwct•alcor,improve demolish,m e pair any awment DI any
yii that heor sl icated c.also pursuant on the previsio of thnt fore
such pmmiuoicense gneJ Chapter
ant
< (Comma cingwitpursuantmtheprovisionofNCComsiness ndProehaw(Chapmr9 Sq.F[.Floor Area Valua[i
(cat ht
(Commencing Section](W)mDiasisfr themevinexe andon.Any viCady or
that he u eacmpt Nertlrom and the basis fm the allcbe0 exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil patchy of �pp77ss],T,piaaTp{�
not mala Nan Eve hundred dollars(5500). Occupancy Type
❑I.she,wmk and on,muclum•m mY otinumde with wages u Nei(cote 044.Business will Pr fie work,end Ne he Cor is tor's Lic ctl Law do for ale(Sec.]014.owner of
and property
Code:The Co thercon,License drew dare not apply N an owner is Required Inspections
gangaro whobuildsorimproveschicon•ve who doessuch work orofffedIhmugh his
awnemployees,ping orIded Natwellimprovemantsace not ear of
completion,
the owformic.
if.
however..Ne building or improvement is sold within elle year of improv far Ne Cwe of
builder will have tk burden of proving Nu he did not build or improve for purpose of
ale.).
O 1•as owner of the progeny am exclusively contracting with licensed contractors to
connmct Ne project(Sec.70a4,Boom.read Pro(essiov Cade:)The Contomer's U-
eense Law does not apply N an owner of property who builds or improves thereon,and
who contracts for such projects with a contractor(s)licensed pursuant to Ne Contractor's
Lima.law.
O 1 am exempt under Sec. B&P C far this reason
venal Dam
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under porosity of perjury ane of the following dedications:
❑I have and will maintain a Cenibcate of Covent bulf-insumfmWorkctsCompcn-
sation,as provided for by Section 37M of the Labor Code.for the performance of the
wank for which that permit is issued.
❑1 have and will maintain Workers Compersauan Insurance rs"Coca by Section
37M of the labor Code.for the perfurmanee Clem wants fm which this Permit is issued.
My Workers�C�ma�pmea�tionn,,Insunnce artier and Polity number are:
Carrier. 4'r`9wn.�7 Policy No.:
CERTIFI ATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need nut te completed time permit is foronc hundreEdoliars($10()
or Ian.)
I certify ca in Nc per(ormm"'Pof, the work fm which Nis permit is issucdJ shell not
employ any person in my mm r mb)!T Warkcts Compensation
Laws a Califomi D
NOTl ca t
NOTICE TO APPLICA IL a t fir making sh s Ccnificam of mptio
become subject to Ne Warkc asoma provisions laMr Code,you must
.J O forthwith comply with such provision m u s all te dmmcd rewkctl.
Zy CONSTRUCTION LENDING AGENCY
[—r Iherehy affirm that Nem is a romuuction lending agency for the perftrmmce of
a
the work fur which this permit is issued(Sec.3097.Civ.C.)
t17 Q Underi Name
=Z Lenders Address
V 0 1 certify that 1 have read this application and sum that the above information is
ly correct.1 agree to Comply with all city and county ordinances and sum laws relating to
0,\ building conswcOon,and hereby authoun,representatives Of this city to enter upon the
rG above-mentioned progeny for inepection pugwses.
(We)agree he arc,indemnify and trap harmless the City of Cupertino against
fM fA Iimilitivjudgmcnts,costs and expenses which may in any way accnm against aid City
V Z is con gmnce of the grmung of this
permit.
^ APP ND WILL COMPLY WITH ALL NON-POINT Issued by: Date
S •ibEBB ONS.
s'7° �� Re-roofs
Signah of Applicande nuactor Dam
HAZARDOUS RIALS DISCLOSURE Type of Roof
Will dm applicant or f Rdug occupant store or handle hava lous material
as define mo Municipal Code.Chapter 9.13•and the Health and Safety
Code.Section 33532(a)? All roofs shall be inspected prior to an roofing material being[j Y. tg4«r p p y g g installed.
Will the applicant or future building=Upon(use equipment of dcvias which If a roof is installed without first obtaining an inspection,I agree to remove
emit havardous air contaminants as dcOncd by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes '♦?NO
1 haw rear)em haamous materials reyvimmcnts undcrChepter tl.95 of Ne Califor-
hisHes lth& relay CCM,&cuov25N13.35533am1]55J4.1.n&.uMNuiflM Wilding , 1S _�„0�
LWt�l u my mspovihility b mufy dm aaupml of Um 3
dmuimm ts hichmu:item ws�, aanaattfaccnifc..Vc Cyy Si care fApplicant Date
Gwnermauthon,< a nn �1 6 Dam roof coverings to be Class "B"or better
CITY OF CUPERTINO
1 of 1 PERMIT RECEIPT OPERATOR: kiersaw
COPY # 2
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 32607027.00
DATE ISSUED. . . . . . . : 03/20/2006
RECEIPT #. . . . . . . . . : 33648
REFERENCE ID # . . . : 06030113
SITE ADDRESS . . . . . : 10885 N STELLING RD
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : VALLEY CHURCH OF SANTA CLARA C
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : MOUNTAIN VIEW CA, 94040
RECEIVED FROM . . . . : JNSJ ROOFING, INC.
CONTRACTOR . . . . . . . : STEPHENS, ALBERT J LIC # 20948
COMPANY . . . . . . . . . . : JNSJ ROOFING INC
ADDRESS . . . . . . . . . . : 691 W SAN CARLOS ST
CITY/STATE/ZIP . . . : SAN JOSE, CA. 95126
TELEPHONE . . . . . . . . : 4082796171
•
FEE ID UNIT QUANTITY AMOUNT .PD-TO-DT THIS REC NEW SAL
__ __ __________ __________ __________ __________
BPERMFEE VALUATION 10,000.00 169.56 0.00 169.56 0.00
BSEISMICOM VALUATION 10, 000.00 2.10 0.00 2.10 0.00
__________ __________ __________ ----------
TOTAL PERMIT 171.66 0.00 171.66 0.00
METHOD OF PAYMENT AMOUNT NUMBER
_ ____________ __________________
CHECK 171.66 25318
TOTAL RECEIPT 171.66
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
________ _____-__________-___-_______
305 FRAME 307 INSULATION
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
603 ROOF BATTENS 604 ROOF IN-PROGRESS
•
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
4WUPERTINO
Building Department
JOB ADDRESS: PERMIT #
108as Ste; ��. 0663 � �
OWNER'S NAME: Va r_Uw., PHONE # qQ% z�y-617
GENERAL CONTRACTOR: QA r ) FAX #
I am not using any subcontractors: 3-2o-off
Signature Date
Please check applicable subcontractor corn Tete th information:
60 SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
• Linoleum/ Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
•
3- 26-06
Owner/Contractor Si tore Date
O(o03o1 �
"� CITY OF CUPERTINO
• � ' REROOF
CUPERTINO PERMIT APPLICATION FORM
APN # Date:
326 - o7 - nz7 -20 -OG
Building Address:
io gas ". goo)
Owner's Name: val uwrfA Phone #: 739_ y6 "Z
Contractor: '31,4S,3 n t' T o rk3 License #: /713 X978 ])
Contact: t Cupertino Business License #:
1
Type of Roof Covering:
Existing: Proposed:
U Buill-Up Roof ❑ Built-Up rool'
Er" Asphalt Shingles Ul/Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Oiher(Specily) ❑ Other(Specil'y)
Number of existing coverings ❑ Provide I.C.B.O. Report#
Ear To he Removed ❑ Provide Mfgr. Installation Specs.
• 1 Have Read, Understand and Will Comply With Cu ertino's Tear Off Polic
Job Description: %Ileyc to) Crmc. 5is'7L- w.Aj 4or Lop.P. Q-ess nA r
Residential ❑ Commercial [�
Fire Zone: Yes ❑ No 0,1 Confirmed with Planning De t. if
there are an restrictions:
Cost of Project: Type of Construction: Occupan group:
Qty. if
Applicable 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