09120072 CITY OF CUPERTLvO BUILDING PERMIT
BUILDING ADDRESS: 10601 N BLANEY AVE CONTRACTOR:LOS GATOS ROOFING PERMIT NO:09120072
OWNER'S NAME: PENINSULA BIBLE CHURCH INC P O BOX 1726 DATE ISSUED: 12/11/2009
vNER'S PHONE: 4082027870 LOS GATOS,CA 95031 PHONE NO:(408)298-9399
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIAL
License Class Lic.# RE-ROOF REMOVE ONE LAYER OF EXISTING ROOF,
INSTALL FELT UNDERLAYMENT INSTALL PREMIUM
Contractor Date SHINGLES
I hereby affirm that 1 am licensed under the provisions of Chapter 9 INSTALLNEW METAL DEBRIS 52 SQUARES
(commencing with Section 7000)of Division 3 of the Business&Professions
Code and that my license is in full force and effect.
1 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:$9997
1 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:31602085.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
1 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 DAYS FROM LAST CALLED INSPECTION.
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 er the Cupertino Municipal Code,Section
9.18.
- p RE-ROOFS:
Signature Date �?' �� a 7 All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection,I agree to remove all new materials for
inspection.
OWNER-BUILDER DECLARATION ` � G
( ��' �/ Zl
I hereby affirm that I am exempt from the Contractor's License Law for one oSignature of Applicant: ate:
'
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)
1,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). 1 have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. 1 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(a)should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should 1 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
1 have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections ,25533, nd 25534.
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Owner or authorized agent: `- ate.
1 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 mus 1 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
1 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 relatin€,
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.
..sting 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
Community Development
10300 Torre Avenue
Cupertino CA 95014
ONO, Telephone(408)777-3228
CUPEICIINN Fax(408)777-3333
Building D edryt-mem
Jos ADD ESS:
J6 PERMIT
_ OWNER'S NAME: PRONE„
GENERAL CONTRACTOR F
T ana not using any subcontractors:
Please check applicable subcontractors and coinitle pt�r p - Date
t✓ the follow���lizformation:
SUBCONTRACTOR BUS IN HSS NAME I BUS W SS L CENSLi. ;
I Cabinets &E Millwork I
Cement Finishing I
IElectricaf I
IExcavation I
Fencing I
Flooring: Carpeting
Linoleum/ Wood I
Glass/ Glazi�-ig
IHeating I
insulation I I
Landscaping I I
I Lathing I
Masonry I
Ornamental Sheet Metal
Painting/ Wallpaper I
IPavil-ng I I
IPlastering
I PIumbing
Roofing
Septic Tank
I Sheet Metal I
J--Sheet Rock
I Tile
caner ontra Lor Signature
Date i
CITY OF CUPERTINO
REROOF
CUPERTINO PERMIT APPLICATION
q (2-L"X)-1 �-
APN �!� � D<,2,�k� Date:
Building Address:
low
Owner's Name: // Phone#:
Contractors s Phone#: c;2
Fax#: /r' r
i
Cupertino Business License #: Contractor License#: `
Type of Roof Covering:
Existing: Proposed:
❑ /Built-Up Roof ❑ Built-Up roof
(j 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.
Job Des ription: lej-1tioile, One Cls .0 a#-Jf[N tuq - _T/uF� nc(o' Cc��V�teri r
Residential Commercial ❑
Green Building: Please complete relevant portion of the Confirmed with Planning Dept. if
Green Building Checklist & attach it to the apflication or if there are any restrictions: ❑
applicable, include in plan set & the sheet index.
Valuation:
I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
Signature
Revised 6/16/08
CITY OF CUPERTINO
RERO OF
CUPEkINO FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1REROOFCOM Re-roof Comraercial B 1COANMROOF
1 1BSEISMICO Seismic Carmnercial B
1REROOFRES ' Re-roof Resicential B 1SFDWLROOF
1BSEISMICRE Seismic.Resiciential B
1RER06FMRES Re-roof Mult::-Family B 1MFDWLROOF
1BSEISMICRE Seismic Residential B
1BUSLIC Business License B
Revised 6/16/08
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 a -ree to comply with 2007113C 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 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 C:.ty,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 nEdl inspection is required.
6. Any roofing which is applied withot.t first obtaining an inspection,
will require the removal of all new material down to the.shead-dng,
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-in8pection f:e of$176.18. The re-inspection fee must
be paid before another inspection coin be scheduled.
IMPORTANT:
1. Flat roofs must have a minimum of lei "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: Ez ja19�
r f o
Roofing Company Name:
Applicant's Signature: x,-\ J;"�1 �' L Date:
PP � . � .
Greg Casteel
Building Official
Revi3ed 07/30/08
Green Points Rating SySitem for Remodeling Ptojacts
Due to the diversity of remodeling project types,assigning a°tc tal points'value to a project to be considered environmentally friendly is
not feasible.However,25 measures have been highlighted to r.ignify that every effort should be made to incorporate them into your
projects. These items have been chosen based upon their impact on the environment and the health of the home in coordination with
ease of implementation and relative low cost. These measure.,;can be used as a starting point for'greening"your project.
A.Site
a 5 9 STE �� Dzrno� o e
65 pom•r5 `=Noin Rs�BO'��=4 points
up to 4 Resource pts 0
2.Safvj—q Reusable Building Mgenals 4 Resource pts y--yes 0
3.Remodel for Mixed Use,Adaptive Reuse,and
Historic Preservation 4 Resource pts y—yes 0
4.Protect Native Soil 2 Resource pts y—yes 0
5.Minimize Disruption of Existing Plants&Trees 1 Resource pt Y--yes. 0
6.Implement Construction Site Stormwater Practices 2 Resource pts y=yes 0
7.Protect Water Quality with Landscape Design 2 Resource pts y=yes 0
B.Design Resource-Effici„nt Landscapes and Gardens 4 Resource pts y=yes D
9.Reuse Materials/Use Recycled Content Materials
for Landscape Areas 2 Resource pts y=yes .0
10.Install High-Efficiency Irrigation Systems 2 Resource pts y=yes 0
11.Provide for On-Site Water Catchment/Retention 2 Resource pts y--yes 0
B.Foundation
1.Incorporate Recycled Flyash in Concrete
25%Recycled Flyash=2 points;Add 1 point for every 10%
increase of flyash,up to 5 points up to 5 Resource pts 0
2.Use Recycled Content Aggregate 2 Resource pts y—yes 0
3.Insulate Foundabon/Slab before backfill 3 Energy pts y=yes 0
C.Structural Frame
1.Substitute Solid Sawn Lumber wiith Engineered Lumber 3 Resource pts y=yes 0
2.Use FSC Certified Wood for framing
(For every 10%of FSC lumber used=2 points,up to 10) up to 10 Resource pts, 0
3.Use Wood kJoists for Floors and Ceilings Resource pts y—yes 0
4.Use Web Floor Trusses Resource pts y=yes 0
5.Design Energy Heels on Trusses 6°or more 2 Energy pts y=yes 0
6.Use Finger-Jointed Studs for Vertical Applications Resource.pts y=yes 0
7.Use Engineered Studs for Vertical Applications Resource pts y=yes 0
8.Use Recycled Content Steel Studs for Interior Framing Resource pts y=yes 0
9.Use Structural Insulated Panels(SIPS)
a.Floors 3 Energy pts y=yes 0
b.Wall 3 Energy pts y=yes 0
c.Roof 3 Energy pts y=yes 0
10.Apply Advanced Framing Techniques 11 Resource pts y=yes 0
11.Use Reclaimed Lumber for Non Structural Applications 3 Resource pts y=yes 0
12.Use OSB
a St�bfi(oors Resource pt y=yzs 0
b.Shea#fnng Resource pty=yes e 0
■ I€ i f