07060198 CITY OF CUPERTINO
BUILDING DI'v1S10N PERMIT G�1 � TQ INDD?RIT�fJ
PERMIT NO.
BUILD N8g8DRESS:
� 5 N STELLING RD JNSJ RODFING INC 07060198
PERMIT L95UE DATE
OWNER'S NAME:
VALLEY CHURCH OF SANTA CLARA 691 W SAN CARLOS ST 06/22/2007
SANITARY NO. CONTROL NO.
4082796171
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT. PLUMB MECH
0 0
i p p LICENSED CONTRACTOR'S DECLARATION Job Description
%u1 hereby affirm that I am licensed under provisions of Chapter 9(commencing
y with Section 7000)of Division 3 of the Business arta�fcssiuns Code,and my license is REMOVE COMP. SHINGLES ON SOUTH SIDE 0 F BLDG.
>>y in fullnse force and a �-y Lie.x /3"R INSTALL NEW 40 YR COMP.
? LiceClass
p Datc Contractor
F J ARCHITECTS DECLARATION
2 z< 1 understand my plans shall be used as public records
)qU
U.y Licensed Professional
a OWNER-BUILDER DECLARATION
I hereby affirm that!am exempt from the Contractor's License Law for the
p o following reason.(Section 703 1.5,Business and Professions Code:Any city or county
< which requires a permit to construct,alter,improve,demolish,or repair any structure
Z r prior to its issuance,also requires the applicant for such permit to file a signed statement Sq.Ft.Floor Area Valuation
that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 $9560
z (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
i that he is exempt therefrom 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 ofNumber Occupancy Type
not more than five hundred dollars(5500). 32607027 V�
❑1,az owner of the property,or my employees with wages az their sole compensation,
will do the work and the structure isnot intended oroffered for sale(Sec.7044.Business Required Inspections
and Professions Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements are not intended or offered for sale.If,
however,the building or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
❑1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li-
cense Law does not apply to an owner of property who builds or improves thereon,and.
who contracts for such projects with a contractors)licensed pursuant to the Contractor's
License Law.
❑1 am exempt under Sec. B&P C for this reason
Owner Date
WORKERS COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
I]1 have and will maintain a Certificate of Consent to self-insure for Workefs Compen-
sation,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,az required by Section
3700 of the Labor Code,for the performance of the work for which this permit is issued.
My Worker's Compensation Insurance carrier and Policy number am:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars($100)
or Icss.)
I certify that i rformance of the work for which this permit is issued,I shall not
employ an n i become sub' shcWo pensation
Law
plica
NOTICE TO PPLiCA :If, ter making this CerlificaiNf Exemption,you should
ome subj t to the Worker's Compensation provisions of Labor Code,you must
Ofo m y with such provisions or this permit sh deemed revoked.
Z, CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency for the performance of
(Y..7 the work for which this permit is issued(Sec.3097,Civ.C.)
W QLender's Name
aLender's Address
U 0 1 certify that I have read this application and state that the above information is
li. correct.I agree to comply with all city and county ordinances and state laws relating to
0U building construction,and hereby authorise representatives of this city to enter upon the
W above-mentioned property for inspection purposes.
f3. (We)agree to save,indemnify and keep harmless the City of Cupertino against
tE", liabiliti sts and expenses which may in anyway accrue against said City
U Z to uencc of the g rmit. Date
�. PLI A UNDERNDS AND MPLY WITH ALL NON-POINT Issued b):
R RE ON9. t
It Re-roofs
SignatulA of Applicant/Contract Da Type of Roof
HAZARDO S MATERIALS DISCLOS E yP
ticant or future building occupantstore odic hazardous material
as defined by the Cope 2,and the Health and Safety
Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes
If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Managementaallne iaterials for inspection.
District?
❑Ycs
I have read the hazardous materials requirements under Chapter 6.95 oftheCalYO7
nia Health&Safety Code,Sections 25505,25533 and 25534.I untk rstand that ifthe louding t.�does not currently have a tenant,that it is my responsibility to notify the occupant o
requirements which must be met prior to issuance of a Certificate of Occupancy. ;ofApplicant Date
roo coverings to be Class"B"or better
Owner or authorized agent Date
CITY OF CUPERTINO
2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN 32607027 .00
DATE ISSUED. . . . . . . : 06/22/2007
RECEIPT #. . . . . . . . . : BS000001752
REFERENCE ID # 07060198
SITE ADDRESS . . . . . : 10885 N STELLING RD
SUBDIVISION . . . . . .
CITY CUFERTINO
IMPACT AREA
OWNER VALLEY CHURCH OF SANTA CLARA C
ADDRESS
CITY/STATE/ZIP . . . : MOLNTAIN VIEW CA, 94040-4002
RECEIVED FROM . . . . : JNEJ ROOFING, INC.
CONTRACTOR . . . . . . . : STEPHENS, ALBERT J LIC # 20948
COMPANY JN:'J ROOFING INC
ADDRESS 693 W SAN CARLOS ST
CITY/STATE/ZIP . . . : SAN JOSE, CA 95126
TELEPHONE 40E�2796171
FEE ID UNIT QUANTITY INOUNT PD-TO-DT THIS REC NEW BAL
---------- ----------- ------
BPERMFEE VALUATION 9, 560. 00 169 .56 0. 00 169 .56 0. 00
BSEISMICRE VALUATION 9, 560. 00 1.00 0. 00 1.00 0. 00
----------- ---------- ---------- ----------
TOTAL PERMIT 170.56 0. 00 170.56 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
CHECK 170.56 #26796
---------------
TOTAL RECEIPT 170.56
070 (D
CITY OF C'UPERTINO
REROOF
CU CITY orINO PERMIT APPLICATION FORM
D
APN# ate:
027 6 2Z p
Building Address:
Owner's Name: Phone#:
Vt&Q 17 R X61'1 '
Contractor: License#: 73??8 O
Contact: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof L❑ Built-Up roof
®asphalt Shingles W' Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings 4-- ❑ Provide I.C.B.O.Report#
®"'To be Removed ❑ Provide Mfgr.Installation Specs.
.✓ 3 Boo � ,��-.
I Have Read,Understand and Will Comply With Cupertino's Tear Off Policy:
Job Description:
[' ea) S kkl
Residential ❑ Commercial '
Fire Zone: Yes ❑ No 91� Confirmed with Planning Dept. if
there are any restrictions: Ey
Cost of Project: Type of Construction: Occupancy grow
Qty. if
Applicable Fee 1D 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
Community Development Department
' Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
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 buildinE inspector. A final inspection and
approval shall be obtained from the bu:lding 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 i irst 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 ilspection and the job is not ready,
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 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:
Job Site Address:
Roofing Company Name: Jw-TJ ° oz"` '
Applicant's Signa e: Date: 1X' a7
Greg Casteel
Building Official
Revised 11/2/04