13110038lii:
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20900 MCCLELLAN RD
CONTRACTOR: FLORY CONSTRUCTION
PERMIT NO: 13110038
INC.
OWNER'S NAME: CUPERTINO CHURCH OF THE NAZARENE
2325 VERNA CT
DATE ISSUED: 11/06/2013
OWNER'S PHONE: 5104836860
SAN LEANDRO, CA 94577
PHONE NO: (510) 483-6860
91 LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL El COMMERCIAL
Class Le�, Lic. # r%�i 3 AJ (0
(15 SQ'S) TEAR OFF (E) SHINGLE, INSTALL 30 YR
License
COMP, CLASS A ON PITCHED PORTION OF ROOF ONLY
Contractor FLZ11Z l CWSMA.,C11DN_( Date Lt AdL3 .
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: $17000
have and will maintain Worker's Compensation Insurance, as provided for by
APN Number: 35920029.00
Occupancy Type:
Section 3700 of the Labor Code, for the performance of the work for which this
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 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 DA LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
City in consequence of the
6
costs, and expenses which may accrue against said
b Date
/_3granting
of this permit. Additionally, the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code, Secti %
RE-ROOFS:
being installed. If a roof is
9.18.
/,
t / �o
Signature !/�` Date
All roofs shall be inspected prior to any roofing material
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
❑ OWNER-BUILDER DECLARATION
Signature of Applicant: Date: L �
I hereby affirm that I am exempt from the Contractor's License Law for one of
4ASS
the following two reasons:
ALL ROOF COVERINGS TO BE "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(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 Cupertino Municipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
for
the Health & Safety Code, Sections 2 505,25533, and 25534. �?
< <O l
Section 3700 of the Labor Code, for the performance of the work which this
Owner or authorized agent:(/Date: 7
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
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 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,
costs, 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
CUPERTINO.
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • build ing(a-)cupertino.Drg
PROJECT ADDRESS `U A4\\ 00
APN # _ n O ' O �Q/
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�WNER ❑ OWNER -BUILDER ❑ .OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CO CPOR NAME
1�C 4 e N S 1 TZ0M o fQ t w.
LICENSE NUMBER
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LICENSE TYPE
BUS. LIC. #
COMPANY NAME
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ARCHITECT/ENGINEERNAME LICENSE NUMBER
BUS. LIC. #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF E] SSFD or Duplex ❑ Multi -Family
ROOF AREA:
VALUATION:
l5�
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STRUCTURE: l,[T-ommercial
EXISTING ROOF TYPE: ❑ BUILT-UP ROOF ❑ ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES OTHER (SPECIFY) CdA f, j
REMOVE /REPLACE YES
IF NO,
PLYWOOD ❑ %d' ❑
PLYWD ❑ OSB
PITCH:
(O
ROOF
❑ NO
# LAYERS
THICKTQESS: ❑ 5/8"
TYPE: ElCDX
CLASS:
PROPOSED ROOF TYPE: ❑ BUILT-UP ROOF ❑ ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER
ICC -ES REPORT #
DESCRIPTION OF WORK
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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 buut._ldin ,ns ction. I authorize representatives of Cupertino to enter the above -I entifie property for inspection purposes.
Signature of Applicant/Agent: L!vv `� Date: �f G
SUPPLEMENTAL INIIFORMATION REQUIRED
If building is associated With a Home Owner's Association, provide letter
:
190 -8 o-� s PI SN CHECK TYPEr 3 x ROUT]1�G`SLIP
QV,E TH)-COVN7ER�
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of approval from HOA.
— Provide Planning approval to verify ifthere any restrictions.
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Provide copy of Manufacturer's Installation Specifications.
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Provide signed copy of Cupertino's Tear -Off Policy.
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ReroofApp_2011.doc revised 03116111
CITY OF CUPERTINO
.I����m FEE ESTIMATOR — BUILDING DIVISION
imlADDRESS:
20900 MCCLELLAN RD
DATE: 11/06/2013
REVIEWED BY: MELISSA
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APN: 359 20 029
BP#:
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*VALUATION:
1$17,000
*PERMIT TYPE: Minor Building Permit
PLAN CHECK TYPE: Re -roof
PRIMARY Commercial BuildingPENTAMATION
Permit Fee:
1COMMLROOF
USE:
PERMIT TYPE:
WORK
15 SQ'S TEAR OFF E SHINGLE
INSTALL 30 YR COMP CLASS A ON PITCHED PORTION OF
SCOPE I
ROOF ONLY
FEE ID ROOF AREA
s.f.
1 REROOFCOM 1,700
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, sanitarysewer utstrict, scnoot
a.,. Th,.. Foxe aro hacod an rho nroliminary information available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff 711/13)
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NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, sanitarysewer utstrict, scnoot
a.,. Th,.. Foxe aro hacod an rho nroliminary information available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff 711/13)
FEE
QTY/FEE
MISC ITEMS
Plan Chock Fire:
Suppl. PC Fero
Pl ulnh.i_tlet:h. I>le�
Permit Fee:
$383.00
suppl. hlsp Pce
f'ltttrtlt.iit� c:h..%F'lcc
1'ltrruh.i:llecll.il:'le'c /'crrrtllt tTc'c':
Construction
,Idlnilii.sir it v1'cc:
Work Without Permit? 0 Yes Q No
$0.00
,ldvaiwe l Phovtrngr Fees:
11-a cel 0oclortentutioll Fkres:
Strong Motion Fee: 1BSEISMICO
$3.57
Select an Administrative Item
Bldp:Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$387.57
$0.00 TOTAL FEE:
$387.57
Revised: 10/01/2013
CUPERTINO
REROOF TEAR -OFF POLICY D�
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION `O
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 \
(408) 777-3228 • FAX (408) 777-3333 - building 5cupertino.org
PROTECT ADDRESS
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APN # c7 / C��/ O Z
OWNER NAME
PHON'HE-MAILN
STREET ADDRESS
CITY, STATE�ZIP
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FAX
CON7RACTORNAMEO
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COMA NAME
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STREET ADDRESS
2325 rZN1a. Ci
CITY, STATE, ZIP
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ONE _
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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 one business day before the requested inspection date.
Please call (408) 777-3228 from 7:30-3:30pm (Mon-Thurs) or 7:30-2:30pm (Friday) to schedule
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.
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. A Final Inspection and approval shall be obtained from the building inspector when the re-roofiAg is
completed. To receive a final sign -off, the following items will be verified:
a. Flat roofs shall have a minimum of I/4" 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.
7. 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. 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. 41 /
Sienature of AnOicant/Agent: Date: I ( / � ( 1-3
ReroojTo1icy_2012.doc revised 10/7/12