03090235 (2) CITY OF CUPERTINOA
BUILDING DIVISION PERMIT CONTRAtlFOR,IlVF RMATION
BUILDING ADDRESS: PERMIT NO.03090235 3090235
OWNER'S NAME: PERMIT ISSUE DATE
CHURCH OF THE APOREL OCl/9912nni
NE: SANITARY N0, CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELF.Ci PLUMB MECH
0 0 0 0
00 LICENSED CONTRACTOR'S DECLARATION IObDDSCTI IIOn
I u 1 hereby affirm that 1 am licnnacd under provisions or Chaptcr 9(contmcncing P
i� with Simian 7IXM))ofDldakin J of NC Bumincasend Professions Codc.and my license is
a in full fortq�o effe0
tr
.Lli Llanmcld' - `f Le.• M REROOF
Da —v can oar h CONTRACTOR: A VIAT ROOFING l
ARCHITECTS—EC{4ATION O
I understood my plans shall be used co cel emcnNa
a Licensed Professional >a O
'0S OWNER-BUILDER DECLARATION
<I 1 hereby ofirm that I em eaL from the Commences License Law for the
CIO following mason.(section 7031.5.Business and Profession,Code:Any city or county
i m which requires a permit to construct,alley,improve,demnliah,or repair any structure
prior us its icosoce,aIs.mquirca the applimamr.,such permiuo 0 lc a signed statement
Rthat he is licensed pursuant to the provision,of the Contractor's License Law(Chapter 9 Sq.Ft. Floor Area ValuO)a 000
2�0 (cncementingwith Section 701X)of Division J ofthe Business and Professions Codc)or V
,'3$
that be is exempt thercfmm and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of - 3AFD1 lhber00 Occupancy Type
not more than five hundred dollars(S500), P Y YP
❑1,to owner of the property,or my employees with wages their sole eompenutlon,
will do the work.and theswcmm is not intended or offered for sale(SO.7044,Business Required Inspections
and Professions Code:The Cornmelor's Licence Law does not apply to an owner of 305 - FRAME q p
progeny who builds or improves thereon,and who does such work himself or through his
own employees,provided Nat such improwmenta ase not intended or offered for sale.If, 307 — INSULATION
however.One building or improvement is mid within one yeas ar completion.the Iranian'
builder will hove the burden of proving chat he did not build or improve for purpose of 601 - ROOF TEAR OFF
ole.).
❑I,as owner of the property,am eaclusively contracting with licensed convectors to 602 - ROOF PLYWOOD NAIL
construct the projem(Sec.7D44,Business and Professions Cole:)The Contractor's U. 603 — ROOF BATTENS,
came taw docs not pply to an owner or propeny who Wilds or improves themon.and, 604 — ROOF IN-PROGRESS
who contracts for such projects with a conuanor(s)licensed pursuant to the Conuaetob
me law.
Iem aempt under sec. ,B&PC far this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penally of perjury one of the following declarations:
I haw and will maintain a Cenifcame of Consent to ulfdnsure for Workers Compare
7:31].00
on,u providW for by Seniors J]W of Nr.labor Code,fm On Performance of the -
k for which this permit is issued.
1 have and will maintain Worker's Compensation Imuran",u squired by Section
of the labor Cote,for the performance of the work for which this permit is issued.
Workers Compensation Insurance carrier and Policy number artrtier. Policy Na.: _
CERTIFICATE OF EX EM PEON FROM WORKERS'
COMPENSATION INSURANCE
(This section need not hucomplcled If the permit Is furnace hundred dollars(51(XE
or less.)
I certify Nat in the porforramee of the work for which this permit is issued,1 shall not .
McmPlayany person in ymanrX3m last strpjn:r to the WoIkeri Compcnu. .
aof CalifoJ' cl —/—��s 7
Applicant •"""
NOTII����TO AP ICA NT.If, it,,making this Certificate of Exemption,you should
hecotpLhubjc0 to the Worker's Compen-tion provisions of the tabor Curb,you must
7z forthwith comply with such provisions mine permil shall ft deemed cooked.
Z CONSTRUCTION LENDING AGENCY
1 hereby affirm Nat there is a comwctinn lending agency rat the performanm of
Ya the work for which this permit is issued(Sec.3097.Civ.C.1
Q Lender's Nene
Z)z Lender's Address
;)Q 1 certify Nat 1 have read this application and state that the above information is
g• f+ correct.I agree to comply withall city and county crdiomces and m¢laws misting to
DU Willing construction,and hereby authorim representatives of this city to enter urim the
N a "hove-mentioned property,for inspection purposes
r (We)agree to save,indemnify and keep harmless the City of Cupenino against
h Iiabilidcs,judgments,costs and expenses which may in any way same against mid City
J Z in consequence of the granting of this perm it.
•"" APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date -
S URCE RE CATIONS.
?y^U Re-roofs
Signatumof Ap IicanUConuacmr Dow
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building Occupant store or handle hazardous material
as dcfincd by the Cupertino Municipal Code,Chapter 9.11,and the Health and Safely
Code. Dyed,zssu(a)7 All roofs shall be inspected prior to an roofing material being Installed.
❑Yat AN. P P Y g g
Will Ne applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it haaamnn,air contaminants to dcfncd by the Bay Area Air Quality Management all new materials for inspection.
uict? a!
❑Ycsr QjJa
[how read thc hmmdousmacrialsmquimmenm under Chaper6.95 of thc Colifor- /
niaHmlth&Safny Cade Scn.o 505.25533and25534,1undcra ci ddaifthehuilding
docs not cumendy haw a enant that it is my mspomibilily m notify the necupmt of the
mquimmenu w 'h must be met prior to issumce of a Certificate of Occupancy. IgnatufC Of Applicantate
v._ - -" All roof coverings to be Class "B" or better
l7goer or authorircd agent Date
Community Development Department
Building Division
City of Cupertino
aaattt 10300 Torre Avenue
Telephone: (408) 777-3228
CITY OF
U n E kT I N 0 Fax: (408) 777-3333
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.
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: To AA07(Iirr
Job Site Address: olo 1 o h4 c C l'C U u a j
Roofing Company Name: A R op.'uu
L
iP'AicDate: y o3
Jteant'
el
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF
CUPEII;TINO PERMIT APPLICATION FORM
APN # , q� Date: 2�— O
Building Address: 1
0924 �C -c I ti
Owner's Name: Phone#s
IOM tT F of qug 9912— 57/
Contractor: Phone#: License#:
-T'w 4) ,ter v8 3 0, '70j6
Contact: Phone#: Cupertino Business License#:
T V t K08 390 -701L
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ 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 Will Comply With Cu ertino's Tear Off Policy: ❑
Job Description:
7 O EP C C o
Residential ❑ Commercial
Fire Zone: Yes [9 No ❑ Confirmed with Planning-M t. if
there are an re ti c ions: L8p
Cost of Project: , Type of Consfruciion: Occupancy
I0 Qdo
Qty. if
Appli4e 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
z3 3
7