Loading...
15080103NO CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19624 HOMESTEAD RD CONTRACTOR: DAN ELLIOTT'S PERMIT NO: 15080103 ROOFING CO OWNER'S NAME: GOOD SAMARITAN UNITED METHODIST CHU P O BOX 26878 DATE ISSUED: 08/13/2015 OWNER'S PHONE: 4086054504 SAN JOSE, CA 95159 PHONE NO: (408)559-7327 j LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ REMOVE (E) ROOF, INSTALL M #30 FELT, FLASHING License Class Li.. # A,(1-3 3 AND (N) ARCHITECTURAL ASPHALT SHINGLES (37 `. % 3 A- SQUARES) Contractoa 'a CL Ll 3 Date 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 Sq. Ft Floor Area: Valuation: $1 1 191 performance of the work for which this permit is issued. have and will maintain Worker's Compensation Insurance, as provided for by ection 3700 of the Labor Code, for the performance of (he work for which this permit is issued. APN Number: 31605047.00 Occupancy Type: 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 DAYS FROM 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 h/�J Issued by: Date: -5/13,6 with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. ROOFS: � 3 — S Sign atu � Dat % All roofs shall be inspected prior to anyny roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. �- Signature Applic ► Date:"% ❑ OWNER -BUILDER DECLARATIONgvu—�- I hereby affirm that I am exempt from the Contractor's License Law for one of 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(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 the Health & Safety Code, Sections 255 , 25533, rd 25534. Section 3700 of the Labor Code, for the performance of the work for which this —/-� permit is issued. Owner or authorized ager Datee—V 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, ARCHITECT'S DECLARATION 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 GtJPERTINp REROOF PERMIT APPLICATION l %0103 , COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildingOcupertino.ora jV PROJECT ADDRESS t Ck 11 APN # OWNER NAME J ` E-MAIL STREET ADDRESS CITY, STATE, ZIP FA\ CONTACT NAMEI ^ PHONE / –I E-MAIL, STREET ADDRESS! CrrY, STATE, ZIP �,e , `% F O J 134d ❑ OWNER ❑ OwNER-BUILDER ❑ OwNER AGENT a CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTORNAMEc _ LICENSE NUMBER —7 LICENSE TYPE BUS. LIC. # (h I I ;; 14 5� C, c COMPANY NAME 1 ` E-MAIL F 5 7 J STREET ADDRESS , CITY, STATE ZIP r p-7 2 7 (• , r `7 7r ( –5 7 J ARCHrrECT/ENGINEER NAMF LICENSE NUMBER BUS. LIC. # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑ SFD or Duplex ❑ Multi -Family ROOF AREA: VALUATION: STRUCTURE: IN CommercialC U EXISTING ROOF TYPE: ❑ BUILT-UP ROOF ® ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER (SPECIFY) REMOVE /REPLACE M YES I IF NO, PLYWOOD ❑ 'h" ❑PLYWD 11 OSB PITCH: 12 ROOF A 13 No # LA ❑ 5/8" TYPE: ❑ CDX SS: PROPOSED ROOF TYPE: ❑ BUILT-UP ROOF ® ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER ICC -ES REPORT # DESCRIPTION OF WORK: 1 -,,, skk �o w D ) a - i P4,t e '- I L�� �e-�r m e x c C `� sram . By my signature below, I certify to each of the follo 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 ' co t 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 �I i .. n. uthonze representatives of Cupertino to enter the aboveproperty for inspection purposes. j-identtified Signature of Apphcant/Ag Date: l 1 SUPPLEM N ORMATION UIRED OFFICE USE ONLY PLAN CHECK TYPE s� ROUTING SLIP If building is associated with a Home Pr's Association, provide letter of approval from HOA. OVER-11WCOUNTER ❑ BunjxNG PLAN REVIEW Provide Planning approval to verify if there any restrictions. [Vol E,RM ❑ PIANNWG MAN REVIIEW Provide copy of Manufacturer's Installation Specifications. ❑ srANDmw ❑ FIRE DEPT Provide signed copy of Cupertino's Tear -Off Policy. ❑ OTMF- ReroofApp_2011.doc revised 03116 '11 \Cel) • C O►1, CITY OF CUPERTINO I "On FEE ESTIMATOR — BUILDING DIVISION FEE ID ROOF AREA s.f. 1REROOFCOM 3,700 ADDRESS: 19624 Homestead Rd DATE: 08/13/2015 REVIEWED BY: PAUL Ilv APN: 316 05 047 BP#: *VALUATION: $11,191 nPERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re -roof PRIMARY USE: Commercial Building Plumb.1 1ech.iElec PENTAMATION PERMIT TYPE: 1COMMLR00 A WORK Remove E roof, Install N #30 Felt flashing and N architectural asphalt shingles 37 Squares) SCOPE Suppl. Insr.? Fee FEE ID ROOF AREA s.f. 1REROOFCOM 3,700 NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the preliminary information available and are only an estimate Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 Ejf 7/1,,13) Mech. flan Check Phimb. Plan ChecA Jec. flan Check Ffe111 Permit Fee: Plumb. Permit Fee: Elea Permit Fee . - Other Mech. lnsp ether Phrmh IrrsnLi I ether Elec. Insp.F"', Fe"' Plumb.1 1ech.iElec 11"(' NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the preliminary information available and are only an estimate Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 Ejf 7/1,,13) FEE QTY/FEE MISC ITEMS Plan Check Fee: suppl. PC Fee Plumb.1 1ech.iElec Permit Fee: $394.00 Suppl. Insr.? Fee Plum b.%/Alech.IElee Plumb.:11ech.%Elec Permit Fee: Construction Tczr: .-Administrative Fee: Work Without Permit? ® Yes Q No $0.00 9dvanced Planning Fees: Travel Doeumenlation Fees., Strong Motion Fee: IBSEISMICO $3.13 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $398.13 $0.00 TOTAL FEE: $398.13 Revised: 07/02/2015 CUPERTINO REROOF TEAR -OFF POLICY COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 - FAX (408) 777-3333 - building(g-�cuoertino.org PROJECT 7I SS APN7)T—O- 5 O'"^yIPR NAME\ PHO _ / E-MAIL STREET ADDRESS �n � v?ti to CITY, STATE, ZIP FAX C CTOR NAME/ 01 LICENSE NWIBER LJrZNSE T -i P A ` U2 yMP BUS. C. 44 N i 4£ ` ir -14A e—O — FAX ST T CITY, STATE, ZIP �rz P _ SIT 7-3z 7 I UNDERSTAND AND AGREE TO THE FOLLOWING: 1. The re -roof project shall comply with all applicable provisions of the 2013 California Codes. 2. An inspection request can be scheduled up to one business day before the requested inspection date. Please schedule inspections online or call (408) 777-3228 from 7:30-3:30pin (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. The hours for this service are: 7:30-10:30am and 12:30-3:30 (Mon-Thurs) and 7:30-10:30am and 12:30-2:30 (Friday). 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 -dozen or removed prior to this inspection. 4. If plywood is installed, a plywood Nailina 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 -roofing is completed. To receive a final sign -off, the following items will be verified: a. Flat roofs shall have a minimum of 1/4" 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 requi -ed to be installed in accordance with Sections R314 and R315 of the 2013 California Residentia C e. r - Signature of Applicant/Agent: t Date: U Reroo)Tclicy_2014.doc revised 01/15/14 Address .7 SMOKE!:ICARB.O.*N.'MO.NO-Xlr)F-:.ALARMS- 0 E.71FICATTE OPP. LIANC:E OQ.MMUNITYIOEVELOPMENT DEPARTMENT -i BVILDN G-,.p1V1SjQ.14 10300 TORRA,�N VEr;,U PERT] N6, CA 9'501:4.3255' (4q8) 777322.8-i- FAX (44ap-r,,4�ss buadinqvd6erb-46jord � Peemit No. �508203 PURPOSE This affidavit is a self-certificationfor the -bistallatioxt.9f all'iequdred.Smoke and Itarb.mi Monodde Ala.rmsfor compliance. with 2013 CRC Section -R-314,2013 CBC .$-�dons-420'16 eaId 9072_112.,where no imerior.access for inspections are required. GENERAL INFORMATION Uxlsfin� single-family and mqlti,.family.di.vellirtgs:shalI b.eproVided.withSihbk6 Alarms and Carbon Morioxide alarms. Wheia the valu alf,�edtions, ' on�, m ?eW q its exceeds $1.000.00,.CRC Section 8314 and COC Sections 907:2j1_5.ai4a420,6.. tequiYe.tliat.Sni6ke.-k-l-am-Ls-an4/or'C-aibc)n Monoxide Alarms be installediri::the f611&1V1ftg.lqC4tip1p.. AkEA: wALARX'' Outside of eadiseparaip.sleepthg-- '.i'n the iinm0iate vj&** Ey bfth4: bedroom(s) X. Or eves y -level Of a d1,761Hn X. Witt -tin ear sle,4ptn&.t6= Carlson Nfbaoxi deAArn.L& are 'nbt required: in dWL-11inp.i�:hkh clv not- cmtq1�- appjYAp�ces. aiad that do not have an attached garage. 'd: -.smoke• alarms, shall comp tarb MCOMWqg ..'Mth CBC Sec3ion.Q0.6and shall be app the-gfatet.. rbved the Office of iQ Maxsl1al. Power Supply,.fti dwelling itrdM.w1th_no commercial power su-p p,Yalarxri( In existing dwelling not re-quItin the removal ofwall..aftd ceilixig Wishospr iyie4os of aoi�.,, bas0ment or craiiii ;5pace.,Refer to CRC Section T{31 And.:CBC Sections 90711.1.4ond is rp quiped for. alarms whith. must be cooueod to the building wiring... As owner of the above -referenced -property, .t hereby certizy'tbat the Aarm(s) referenced ab6vehas/have been installed in accordance with the .manufacturer's ijistrac.;tiojis and ih.coinplikice with. the Califor.4a.13vilding and California Residential C6 des, The ala mishave been. tepted: aixd ktrigs E� d be �ne qp.al, -as of th- a -si d. below. Good Samaritan United Methodist Church does riot ha:%re bedrooms, • The ftail4t3 a. ; fully sprinkled, and has fire alirin, cystoai (snoke & heat detectorv,) that :reports to a central monitoring station that is marmed 24/7. 1 have read 9nd s7ee-to, earny io'fh the. iar.m& and Owner (Or OvinarAgerft).Name, Good Samaritan United Hrsthodist:` William Hut chip�on UOntraCWt Natne, WATER-GGNSERVING PLUMBING FIXTURES OWN-ItR CERTIFIC-ATE GF..GGMP I CE" 00mfoUNITY. DEVEtOPMENT.DEPARVOEN7 BGtLI wa(mvisloN, CUPERI`1 iQ 10300 TOP RE AVENUE • CUPERTINO, CA 95014•-=6 (408)777-:322p, - FAX (406:) 777.-3333• ?Gt�hPitino_nro. 15M0103, Owner Name Good Samaritan United Methodist Church :permit No. 1508103 Address 19624 E. Homestead Road,_ Cupertino, .• CA. 95.014 Please refer to dte att4cbed California.Civii Code:Seciions'1 ].01.1--1141.8 winch are part of this Cettification.form.: I. Is your zeal property a registered bistorical site? ❑ Yes . Civil Cod© Seotions.11.Ol ; l t1z oui':110.1..$ do r�flt: apply: Sl;�p tkra iet.df the fozin qui d sigxr boitciszi o� fprin. U NO Go to Question 2, 2. Does your real property havo.a licensed litnibcr cwfi#ying: that, due: to fhe.age xrr conf guratibn of the property or its plumbing,. installation ofwater-eoriserrvirig plbfubai g fi\turi es is nottecl icaX1 feasiblE? ❑ Yes Civil Code Sections .1101:1 througir.1101.8 do not apply.. ❑ �e lzoetasc�l plumber s wertificaiiort Itas laoeit prot.ided to turf Builrlizrg ,i~iiy�sian; . . Skip the zest of the form aad signbottoiii. of f�nn. 0 No Go to Question 3. " 3. is water sezLice permanently discgz nected:for y�iur building?. :...• . ❑ Yep Civil Code Sections 1101.1 thr'QdQ.not:apply, •Skiff floe zest of fire fornx:and sigh bottomof fornz, M No Go•to Question 4;- 4. XS your real property built. and aNailahle for use.or occupar-icy, on Qr before:J6nuar.;y:1, 194? ❑ No My real property is bu>1t. and• available for-uso or occupancy. after January. i;1994.. Civil Code Sections 11ol.1 t ikeugb1101:8 do not apply: Sk1p tbz rest of thojbim grid si,gzt bottom of foznz. Yes My real .property is -built and available for use ar occupano}''ort or before 7anuaxy 1, 1994., Ci0 Cade Sections 1.101.1 through°110) .S ap ilv: Chock onok of the.thsee following ,tatemggts and sign bottom df form.. d My property is ashy glc-Amilyr`esident+aftE-d••prope*.. See -Civil Code 5ection.111i1.4. On and after 7anuary 1, 2414, building- aiteratians ox iuzprovexnents &hall requizp alt.non.-compliant:.pluinbing fixtures to be replacsd'lvxth wrier-conser<Tiijg:plumban tures thra ghout thebuildiiig, 0� oxbefozeJagrz=iryl, X017; all:rz4ii-:' . compliant plumbi�dg fixture shall be, reQla�ed.with. water=consQr}.t� plumbing lixtau�s (ragaaclleas of-��h then :. . property undergoes alteratioids or hpprp vemp.b;'), ❑ My property is a mullipmir v residqudaf real properly. On and after. January 1, 201;4,specified building a tnz tioirs or it�iprovemea s.•Sla�l) require non= cozi►phant plumbitigfixtures tobereplacedwitlrtvatet-cosrseri7ngglt bi�pgfixtures,; :•'. On or before January 1, 200 9, all. nor;-(Iomp)iaot-piiurzbirzg tutu t �s: shall be roplacO wjth water - conserving plumbing fixtures drrousirout the builditig..(regardless ¢f �vlt�thez.propc tJt undergoes altzratioris or' improvements). R) My property is a cornnrercW real property: Si e Ciel .Cade Se coon. ,11()1..3; On and after January 1, 2014, specified building alteration's or mpzoverneats.5l .all require non- cQwpliarit plurnbing fixtures to be -re wiili. c� ate' oonsct�ng plutnbiixtut cam. On or before January 1, 2019, all non-oompliatit•pluinbing. xttires shill be. replaced with "%atex- cons 'ring plaTiibiug fixtures throughout tii:e. building (regardlbas ofwh4or.prbporty uY.L�es alterations or. improverraeiti2sj:,... L1n'e, the owner(s) ofthis. propenx, certaiyiinder.petialtof perjUrilaatndn-coinpl3a�t pluzz�biii fXtii> es wi11'h: replaced .prior to date spec ied above with water-eousening plunibing iv:mres in: acoordat)ce with Ci�i1 Code Secfions 1101:1 through 1101..8, the cunLmt California PlwAbing Code.mo California G7reeu Building S:canda 6 Codb..srid: nxaz.i6,cture's installation requirements, =d that. the u*atei-copsen?j1%pluiubi �itures aomljy witli.fbaregbirements as indicated in tbe:.table on the fc;llowjng 2age, Owner's (or Owner Age'nt's) Signature; Good Samaritan united methodist churDate: 09-02-15 S15�Q720,1�.tluc revised 08/2Sff�