09040054 CITY OF CUPERTINOMA
BUILDING DIVISION PERMIT -Q� NF
PERMIT NO.
BUILDING ADDRESS:
10181 FINCH AVE TBD — TO BE DETERMINED- 09040094
PERMIT ISSUE DATE
OWNER'S NAME:
A In' 12999
'Pmr4"PrT TTTWFR Z1'Nuo IJ?C- SA A CONTROL NO.
INE:
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
RE-ROOF FURNISH AND INSTALL Q D O D
v p C LICENSED CONTRACTOR'S DECLARATION 3 0 I LB FELT GO OVER Vj b Description
v 1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing
zwith Section 7000)of Division 3 of the Business and Professions Code,and my license is I
U y in full force and effe�—�O 7?p 7
Z License Class Le'N
0 Date !lo'- ��' Contractor G�
2 ARCHITECTS DECLARATION
J g d 1 understand my plans shall be used as public records
ryU
u.rn Licensed Pmfessional
OWNER-BUILDER DECLARATION
Gn
I hereby affirm that I am exempt from the Contractor's License law for the
i O O following reason.(Section 7031.5,Business and Professions Code:Any city or county
m Pi which requires a permit to construct,alter,improve,demolish•or repair any structure
u Z a prior to its issuance.also requires the applicant for such permit to file a signed statement $q.Ft.Floor Area Valuation
< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9
YtZ-C (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
y that be is exempt therefrom and the basis for the alleged exemption.Any violation of Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number
not more than five hundred dollars(5500).
0 I,as owner of the property,or my employees with wages as their sole compensation,
will do the work and the structure is not intended or offered for sale(Sec.7044.Business Required Inspections
and Professions Code:The Contractor's License Law dors 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.).
0 I,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 contractor(s)licensed pursuant to the Contractor's
License Law.
0 I am exempt under Sec B&P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
have and will maintain a Certificate of Consent to self-insure for Worker's compen-
sation,as provided for by Section 3700 of the Labor Cote,for the performance of the
work for which this permit is issued.
allmvc and will maintain Worker's Compensation Insurance,as required by Section
3700 of the Labor Code,for the performance of the work for which this permit is issued
My 5/f 74r
insurance carrier and Policy number are/- L�
Cartier. / 74r �#V n Policy No.:
41
CERTIFICATE of EXEMP I ION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars($100)
or less.)
I certify that in the performance of the work for which this permit is issued.I shall not
employ any person in any manner so as to become subject to the Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
Oforthwith comply with such provisions or this permit shall be deemed revoked.
Z CONSTRUCTION LENDING AGENCY
[~-t I hereby affirm that there is a construction lending agency for the performance of
p,> the work for which this permit is issued(Sec.3097,Civ.C.)
Lia A Lender's Name
►0 z Lendees Address
U C) I certify that 1 have read this application and state that the above information is
V.H corrccL I agree to comply with all city and county ordinances and state laws relating to
O V building construction,and hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes
(We)agree to save,indemnify and keep harmless the City of Cupertino against
„Hy rA liabilities•jud ts.costs and expenses which may in any way accrue against said City
V Z in cot a of granting of this permit. Date
APPLI ND RSTAN �tNO WILL COMPLY WITH ALL NON-POINT Issued b'r:
SOU EGUL ONS /!
Re-roofs -
Sign ure o pplicant/Contrector Dae
HAZARDOUS MATERIALS DISCLOSURE Type of roof
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Code,Section 25532(a)? All roof: shall be inspected prior to any roofing material being installed.
SYS pNo
Will the 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 hazardous air contaminants as defined by the Bay Area Air Quality Management all new I natal ials for inspection.
strict? - C
❑Yes e]No
I have read the hazardous materials requirements under Chapter 6.95 of the Califer- 9,
nia cty Cade,Sections 25505.25533 and 25534.I undcr=d that if the building t t
docs of curtcn y have a to that it is my responsibility to notify the occupant of the
req mems ich mus me prig to issuance of a Certificate of Occupancy. ignaturof Applicant Date
r All roof coverings to be Class'n"or better
Owner or authorized agent Date
CITY OF CUPERTINO
RE,ROOF
CUPEkTINO PERMIT APPLICATION
APN # Date.
Building Address:
Owner's Name: Phone #: -Zs z i'3-/ Z
HOA: Yes ❑ No If Yes, provide letter from HOA
Contractor: Phone #: S o
K 6 Ao J f.: , ) Fax #: St 0 7
Cupertino Business License #: Contractor License #:
77L�) 77�
Type of hoof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
d Asphalt Shingles �'® Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other (Specify) ❑ Other (Specify)
Number of existing coverings ❑ Provide I.C.C.E.S. Report#
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description: j�ec,r— o-6 z:V 41V OI, 4<U()
Fe �� �O �fh uYe (',� C `-4 ` e. ,
Residential ❑ Commercial 131,
Green Building: Please complete relevant portion of the Confirmed with Planning Dept. if
Green Building Checklist & attach it to the application or if there are any restrictions: ❑
applicable, include in plan set & the sheet index.
Valuation: qo, O 00 D -
I fad, .nderstand and Will Comply witli Cupertino's Tear-Off Policy:
7
Signa
Revised 02/05/09
a
CITY OF CUPERTINO
REROOF
CUPEkTINO FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
S 1 REROOFCOM Re-roof Commercial B 1COMMLROOF
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee
1BSEISMICO Seismic Commercial B
IREROOFRES Re-roof Residential B 1SFDWLR00F
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commissio l Fee
1BSEISMICRE Seismic Re,,idential B
1 REROOFMRES Re-roof ML.lti-Family B 1MFDWLROOF
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee
1BSEISMICRE Seismic Residential B
f 1 BUSLIC Business L..cense B
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 2007 IBC Standards
and manufacturers specifications on re-roofing.All roofs are Class "A"per Cupertino
municipal code 16.04.080.
2. New roof coverings shall not be applied without first obtaining all inspection
and written approval from the buildbtg 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 Ciiy,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 na it inspection is required.
6. Any roofing which is applied withou:first 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 inspection 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/ "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: si41-14- 6 re C O.r r ,I� �-� •`�• t s (r
Job Site Address: f � ig *
Roofing Company Name: ,et) O �E �.
Applicant's Signature: Date: `�^l�`a y
Greg Casteel
Building Official
Reviled 07/30/08
44y Community Development
, 10300 Torre Avenue
w ;': ;: Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
';UPEkTINO
Buildin De artment
JOB ADDRESS: PERMIT #
OWNER'S NAME: PHONE #(I/ox
GENERAL CONTRACTOR: U FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSI14ESS 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 "�� �~ �o �•4i �
Septic Tank
Sheet Metal
Sheet Rock
e
Owner/Contractor Signature Date
388 MRRTIN RVENUE
FILL STRUCTURRL SRNTR CL.RRR, CR 95050
PHONE: (408)559-0340
FRX: (408)559-2015
April 15, 2009
May FILE
To Whom It M y Concern:
SUBJECT: Reroofing
ttTM Fftw;WA ven u e V
Cupertino
p
Dear Sir or Madam:
At the request of the owner I have inspe::ted the roof structure for the Bethel Lutheran
Church located at the above address.
The roof structure consists of 3x6 T&Ga decking overlaid by 1/4" plywood, and 1"
fiberboard. The decking is exposed a: the interior and it is supported by exposed
beams.
I have inspected the inside of the decking and at any suspicious locations that seemed
to have stains I have exposed the deckir g from above. Also I have inspected the whole
decking for soft spots. I have found 2 locations with damages, one above the organ
area and one at the east side of the building above the conference room.
I have requested the contractor to replace the decking the plywood and fiberboard
between the decking supporting beams. I have reinspected the contractor work after
the repair and the repair was performed correctly.
At this time, it is my opinion, the decking is sound and ready for the installation of the
new composition roofing.
Should you have any questions or regUire supplemental information, please call.
Sincerely,
ALL STRUCT FEs
CONSULTI
W
z
m
George Di P�t *
Structural En 1F