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11090047 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10885 N STELLING RD CONTRACTOR:WESTERN ROOFING PERMIT NO: 11090047 SERVICE OWNER'S NAME: VALLEY CHURCH OF SANTA CLARA C 15002 WICKS BLVD DATE ISSUED:09/07/2011 WNER'S PHONE: 4087394642 SAN LEANDRO,CA 94577 PHONE NO:(415)648-6472 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL[] License Class e-3 f Lic.# COMM RE-ROOF, 11,000 SQ FT REMOVE EXISTING �� nn GRAVEL Contractor �4{ ri/CDS i�i�rSign&JDate SURFACE REPLACE W/OVERLAY ON TOP OF EXISTING I hereby affirm that I am licensed under the provisions of Chapter 9 SHEATHING (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. 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. Sq.Ft Floor Area: Valuation:$121000 I have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this APN Number:32607027.00 Occupancy Type: permit is issued. �.�f� APPLICANT CERTIFICATION C/� I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DAY R M LAST CALLED INSPECTI N. indemnify and keep harmless the City of Cupertino against liabilities,judgments, ` costs,and expenses which may accrue against said City in consequence of the / granting of this permit. Additionally,the applicant understands and will comply Issued by: Date: with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signature �� Date All roofs shall be inspected prior to any roofing material being installed.If a roof is oe installed without first obtaining an inspection,I agree to remove all new materials for inspection. OWNER-BUILDER DECLARATION Signature of Applican. ^ Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(x)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this f} Owner or authorized age !/ Date: permit is issued. 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 Worker's Compensation laws of California. If,after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address I certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities,judgments, s,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. acing of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C O P E RT I N O Fax: 408-777-3333 CONTRACTOR / SUBCONTRACTOR LIST JOB ADDRESS: �; �j PERMIT# OWNER'S NAME: L LL W;t .' PHONE — GENERAL CONTRACTOR: �� t ,,i / �- ,�' BUSINESS LICENSE # ADDRESS: , jCITY/ZIPCODE: , 1,e i. / z- G� . *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY 1NSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. &- I am not using any subcontractors: `, � Signature Date Please check applicable subcontractors and complete the following information: 6/ SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring/ Carpeting Linoleum /Wood Glass /Glazing Heating Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing RoofingG' Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date 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)777-3333-building(d_)cupertino.org PROJECT ADDRESS / p APN N o OWNER NAME PHONE E-MAIL STREET ADDRESS CITY, STYE,ZIP FAX CONTRACTOR NAME ) , LICENSE NUMBER LICENSE TYPE BUS.LIC.N l C COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,.STATE,ZIP PHONE I UNDERSTAND AND AGREE TO THE FOLLOWING: 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'/" 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 R314 and R315 of the 2010 California Residential Code. Signature of Applicant/Agent: `` �y 7F g ,� ��_ Date: // Reroo1Po1icv 2011.doc revised 02/16/11 Sri CITY OF CUPERTINO V FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 10885 n.stelling rd. DATE: 09/07/2011 REVIEWED BY: bobs. APN: BP#: 'VALUATION: 1$121,000 *PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof PRIMARY Commercial Building PENTAMATION 1COMMLROOF USE: PERMIT TYPE: WORK remove existing ravel surface replace with overlay on top of exisiting sheathing. SCOPE FEE ID ROOF AREA s.f. 1REROOFCOM 11,000 L-T-L- 1:11 - 1 Li NOTE. Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addh 7 info, FEE ITEMS (l,ee Resolution 11-053 I ff'. :'-1,%71) FEE QTY/FEE MISC ITEMS Permit Fee: $848.00 Work Without Permit? 0 Yes 0 No $0.00 Stron„ Motion Fee: IBSEISMICO $25.41 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $5.00 SUBTOTALS: $878.41 $0.00 TOTAL FEE: $878.41 Revised: 07/04/2011 CITY OF CUPERTINO 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 32607027 . 00 DATE ISSUED. . . . . . . : 09/07/2011 RECEIPT #. . . . . . . . . : BS000014687 REFERENCE ID # . . . : 11090047 SITE ADDRESS . . . . . : 10885 N STELLING RD SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER VALLEY CHURCH OF SANTA CLARA C ADDRESS . . . . . . . . . . : 10885 N STELLING RD CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : WESTERN ROOFING CONTRACTOR . . . . . . . : MARK BLEDSOE LIC # 29322 COMPANY . . . . . . . . . . : WESTERN ROOFING SERVICE ADDRESS 15002 WICKS BLVD CITY/STATE/ZIP . . . : SAN LEANDRO, CA 94577 TELEPHONE . . . . . . . . : (415) 648-6472 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 121, 000 . 00 5 . 00 0 . 00 5 . 00 0 . 00 1BSEISMICO VALUATION 121, 000 . 00 25 .41 0 . 00 25 .41 0 . 00 113USLIC FLAT RATE 1 . 00 228 . 00 0 . 00 228 . 00 0. 00 1REROOFCOM SQUARES 110 . 00 848 . 00 0 . 00 848 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 1106 .41 0 . 00 1106 .41 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 1, 106 .41 VISA --------------- TOTAL RECEIPT 1, 106 .41 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 309 EXTERIOR LATH 311 SCRATCH COAT 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 604 ROOF IN-PROGRESS 605 FINAL REROOF REROOF PERMIT APPLICATION --- COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255 (408)777-3228• FAX(408)777-3333 • building cupertino.org I CUPERTIMC3 I ' b (,�� PROJECT ADDRESS )I TA" Q / OWNER NAME PHONE /p p �G E-I 14II STREET ADDRESS ,y - CITY, STAB,ZIP FAX APPLICANT NAPHONE E-MA�- ME AX STREET'ADDRESS CITY,STATE,ZIP F ❑ OWNER ❑ OWNEA-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHrIECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC.# ' -3 COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP ARCHITECT/ENGNEER NAME LICENSE NUMBER BUS.LIC.# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE of ❑ SFD or Duplex [I ROOF AREA: VALUATION:Multi-Family � �• STRUCruRE: ❑ Commercial ifs MSTNG ROOF TYPE: 11CBUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY) REMOVE/REPLACE 11 YES IF NO, l PLYWOOD h" ❑ PLYWD 13 O PITCH: :12 A ROOF L'SNO #LAYERS: THICKNESS: ❑ 5/S" TYPE: CDx CLASS: ICC-ES REPORT# PROPOSED ROOF TYPE: ElBUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ElWOOD SHINGLES ❑OTHER DESCRIPTION OF WORK: ira >trs t its �> By my signature below,I 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 I 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 co trvction. I authorize representatives of Cupertino tc enter the above-identified property for inspection purposes. Signature of Applicant/Agent L G� Date: -� – SUPPLEMENTAL INFORMATION REQUIRED ` If building is associated with a Home Owner's Association,provide letter of approval from HOA. �m — t2— _Provide Planning approval to verify if there any restrictions. _ YAtv�I �>;aivu� 3 Provide copy of Manufacturer's Installation Specifications. ' � D = CippT � g _✓Provide signed copy of Cupertino's Tear-Off Policy. ReroofApp_2011.doc revised 03/02/11