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10020036 CITY OF CUPERThvO BUILDING PERMIT BUILDING ADDRESS: 10505 MILLER AVE CONTRACTOR:PETERSEN-DEAN INC PERMIT NO: 10020036 OWNER'S NAME: FIRST BAPTIST CHURCH 7980 ENTERPRISE DR DATE ISSUED:02/05/2010 NNER' PHONE: 4087050178 NEWARK,CA 94560 PHONE NO:(510)494-9982 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL El COMMERCIAL License Class C ' y Li,.# -116 V/ 7 RE-ROOF 60 SQUARES TEAR OFF COMP AND INSTALL 50YR Contractor,C)Ci'�7CS0/V beV11 '' DateJ2 �a Sr / y COMP SHINGLE CLASS A I hereby affirm that I am licensed under the provisions of Chapter 9 (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:$12000 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:36916026.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION 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 relatin; 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 FROI� 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 Issued by: Date: granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signatu Date C O All roofs shall be inspected prior to any roofing material being installed.If a roof is _ installed without first obtaining an in ection,I agree to remove all new materials for inspection. J OWNER-BUILDER DECLARATION S"—j p Signature of Applican. Date:(j� I hereby affirm that I am exempt from the Contractor's License Law for one if 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 compensatic n, 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 tc 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. 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 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 Cupertoro Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sect' 255 ,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: 1� Dater�y$� permit is issued. I certify that in the performance of the work for which this permit is issued,I shay not employ any person in any manner so as to become subject to the Worker's CONSTRUCTION LENDING AGENCY Compensation laws of California. If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,I micst 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 lemnify and keep harmless the City of Cupertino against liabilities,judgments, ts,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting 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 CITY OF CUPERTINO 3 ITEMS OF 3 PERMIZ RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blk_: Lot: APN 36516026 . 00 DATE ISSUED. . . . . . . : 02/ 05/2010 RECEIPT # . . . . . . . . . BS(i00009697 REFERENCE ID # 10020036 SITE ADDRESS 10_`)05 MILLER AVE SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER FI:2ST BAPTIST CHURCH ADDRESS . . . . . . . . . . : 10305 MILLER AVE CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM PETERSEN-DEAN CONTRACTOR PErERSEN, JAMES LIC # 14030 COMPANY PErERSEN-DEAN INC ADDRESS 7930 ENTERPRISE DR CITY/STATE/ZIP . . . : NERARK, CA 94560 TELEPHONE (510) 494-9982 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ____ -- ---------- ---------- ----------- ---------- 1BCBSC VALUATION 12, 000 . 00 1. 00 0 . 00 1 . 00 0 . 00 1BSEISMICO VALUATION 12, 000 . 00 2 . 52 0 .00 2 . 52 0 . 00 1REROOFCOM SQUARES 60 . 00 506 . 00 0 .00 506 . 00 ------0_00 ---------- ---------- ---------- TOTAL PERMIT 509.52 0 . 00 509 . 52 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- ------ CHECK 509 .52 7119 --------------- TOTAL RECEIPT 509.52 VOICE ID DESCRIPTION VOICE ID DESCRIPTION _ ___ -------- ---------------------------- -------------------------- 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 604 ROOF IN-PROGRESS 605 FINAL REROOF -- CITY OF CUPERTINO REROOF CUPEkTINO PERMIT APPLICATION M2()D3 c.p APN # Date: 3LOC1 )CP (�2CD •Ov - Building Address: S-V 57 Owner's Name: /�sr �ff�S T C,4/�/e Phone #: HOA: Yes ❑ No If yes, provide letter from HOA Contractor: Phone Fax #: Cupertino Business License #: Contractor License #: 46 cf. ill Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof Ir"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. �S/ ri drJ s irV�'� J Description: Residential ❑ Commercial 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: Z jOov I Ha Re nderstand and Will Comply wit-i Cupertino's Tear-Off Policy: re Revised 02/05/09 CITY OF CUPERTINO REI OOF CUPERTINO FEE SCHEDULE Number of Fee ID Fee Description Fee Permit Type Squares Group 1REROOFCOM Re-roof Commercial B 1COMMLROOF I 1BCBSC Ca1"Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICO Seismic Commercial B 1REROOFRES Re-roof Residential B 1SFDWLR00F 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICRE Seismic Re:,idential B IREROOFMRES Re-roof Multi-Family B 1MFDWLROOF 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICRE Seismic Residential B 1BUSLIC Business Lixnse 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 r.-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 b gilding 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 na 0 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 pe:-formed. 7. NOTE: If you call for a plywood nail inspection and the job is not ready, you will be charged a re-inspection fE e of$176.18. The re-inspection fee must be paid before another inspection czn be scheduled. IMPORTANT: 1. Flat roofs must have a minimum of li "per foot slope and demonstrate that there is no ponding. 2. An I.C.B.O.report is required to be o 1 the job site at the time on inspection. I understand and will comply with the above stated policy on re-roofing. Homeowner's Name: j T/ f Job Site Address: �,�� l �L C e_X A Roofing Company Name: �' tj� e x Applicant's Signature: Date: Greg Casteel Building Official Revised 07/30/08 M.Indoor Air Quality and Finishes • 1.Use iLowlNo-VOC Paint IAQ/Health pts y=yes 0 2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes 0 ves 3.Use Low/No VOC Adhesi :3 IAQ/Health pts y=yes 0 4.Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes 0 5.Use Engineered Sheet Goods with no added Urea Formaldehyde 31AQ/Health pts y=yes 0 6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 0 7.Seal all wed Parpdeboarld or MDF 4 IAQ/Health pts y=yes 0 8.Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes 0 9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y=yes 0 10.Install Whole House Vacuum System 3 IAQ/Health pts y=yes 0 N.Flooring 1.Select FSC Certified Wood Flooring 1;Resource pts y=yes 0 2.Use Rapidly Renewable Flooring Materials Resource pts y=yes 0 3.Use Recycled Content Ceramic Tiles 4 Resource pts y=yes 0 4.Install Natural Linoleum in Place of Vinyl 5 IAQ/Health pts y=yes 0 5.Use Exposed Concrete as Finished Floor I Resource pts y=yes 0 6.Install Recycled Content Carpet with Low VOCs Resource pts Y=Yesi 0 . 1 0010 Total Points Avallable:1 140 130 57 Total Points Project Received: a/-�'O`ZO 0 0 0 G:data/progs/grE enbuildingguidelines/remodelers/greenpointsfinal2.12.D4protected.xis Community Development 10300 Torre Avenue {:. Cupertino CA 95014 . , Telephone(408)777-3228 ._.,. CITY OF_ Fax(408)777-3333 'UPEkTINO Buildin De artment JOB ADDRESS: PERMIT # p -&//c C-e7! /,� OWNER'S NAME: /k' P" 13.4P-,'7JT fv/l�l� PHONE # S�/� -y 910&2 GENERAL CONTRACTOR �� i / AZA rJ FAX# S'/o % -%C� S 7 I am not using any subcontractors: SignatureDate Please check applicable subcontractors and complete the followinginformation: jZjS-U-k0NTRACT0R BUSINESS 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 Septic Tank heet Metal Sheet Rock ElOwner// Contractor Signature Date