05060024 CITY OF CUPERTINO
BUILDING DIVISION PERMIT C�l1TRt+,iCTnR I�FO.RMATION
BUILDING ADDRESS: CHURCH OF CHRIST OF CUPERT 711TN05060024
OWNER'S NAME: PERMITISSUEDATE
Adak CHURCH OF rHRTqT OP ("UPPIRTTW)
ONE: SANITARY NO. CONTROL NO.
ARCHITEC rENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
+�+Oj LICENSED CONTRACTOR'S DECLARATION flsm ,a
w 1 hemby affirm that 1 am 1lcensed under provisions of Chapter 9(commencing Job Description AL L
ZW win Section 7")of Division 3 of Ne Businca and Professions Code.and my license is IN
=oi
in Orrte and effccL REROOF W/COMP. SHINGLES
full from
Class Lie.0 .Ill (tC
Dau Cansncmr ^1
Y� ARCHITECTSDECLARATION - N2Z �fjl:J
s�
as< I undersand my plans shall homed u public¢cards
,6U
Licensed Professional
5 Oat I am exempt
fa DECLARATION
Z 1 hreaso .(Sens Nm 11. exempt fs an mc Caren.Co License Law far the
p o following reason. eat,1 Pn LS.Bminess and Professions Cade:Any tiny or county
K m which rets issu a permit ac cnnswct,altea nt for
dem Tail t or repair any mmcmre
v�'^ prior at its issuance.also acquires the applicant for such permiuo Glc asigmmd su¢mcm
Nan he is licensed pursuanuo the provisions of lie Connncer's License Law(Chapter 9 Sq. Ft. Floor Area Valuation
Commencing with Section 7")o(Division3 of the Business and Professions Code)or '
y $ Nan he is exempt themfmm and the hmis for the alleged exemption.Any violation of
Section 7031.5 by any applicant far a penult subjects the applicant to a civil penalty of 3 SNPMNIfDu3M 0 Occupancy-Type
not mom man five hundred dollars($500). P Y YP
f
Ej 1.as,owner of the pmpery,or my employees with wages as meir sole compensation,
will do the work,and the structure is not intended of offered for sale(Sec.7044,Business
and Professions Code:The Conancmr's Limnse Law does not apply to in owner of Required Inspections
property who builds or impmm thereon,and who dauuch wark himself or Brough his
own employees,provided mat such improvements art natinmnded oro@red fm sale.If.
however,the building or improvement is said within ane year of eampladon.the owMr
builder will have the burden of proving mat he did not build or improve for purpose of
sale.).
❑1,as owner of me propcny,am exclusively contracting with licensed ronuremrs to
construct the pmjcct Ism.7044,Business and Professions Code:)The Contrac ori Li
eve Law does not apply to in owner of propcny who builds or improver themon.and
who contracts for such projects with a contractor(s)licensed pursuant o the Contractor's
License Law.
❑I am exempt under Sec. B&P C r the rcuon
137CW
wner_ Date
6 /
WORKER'S COM NSATION DECLARATION
1 hereby aRrm under penahy of perjury one of m¢following dalmtions:
I have and will maintain a CcniGcaa of Comenaoself-insure for WarkaYs Compen-
ion.st provided for by Section 3700 of me Labor Code,for me perlomtana of the
rk for which this permit is issued.
1 have and will maintain Worker's Compensation Insurance,ar required by Section
of Oc Labor Code.for me performance of the work for which this permit is issued
y Worker's Compensation Insurance artier and Policy number am:
rrier: Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE .
(Thissection aM nor be eomplered if the permit is far orc hundred dollars(SIM)
or lass.)
I mmfv mat in me performance of the work for which this Permit u issued,I shall nut
Lawso..,I.;.Oy California.on inany mann bccomc tMWor—�Cpmpcnsauan
I.wl of CalifoDate T_C K
Applicant
NOTICE TO APPLICANT:If.a(daufmakiyS this Cenificau of Exemption,you should
become subject to be Worker k Compensation provisions of the Labor Cade,you must
.J ,Z forthwith comply with such previsions or this permit shall W deemed revoked.
ZO CONSTRUCTION LENDING AGENCY
E'er I hereby aTim mat mere is a commotion lending agency for the performance of
C the work for which this permit is issued(Sec.3097,Ci,C.)
0 Landmi,Name
Z Icndefs Address
U O 1 certify mat I have read this application and sure Out the above information is
D, P correct.1 agree to comply with all city and county ordinances and stale laws relating to
0U building communion,and hereby authorive opresmmuives of this city to enter upon the
W shove-mcmionedproperty for epensesmmon purpowhich may
(We)agree m save,indemnify and keep harmless the City of Cupertino against
HabilUZ incoisiequene Of theosmang expenses permit. meyinanyway a¢rvc against said
U 2 in UNDERSTANDS
of this permin.
^ APPLICANT UNDERSTANDS A ILL COMPLY WITH ALL NON-POINT Issued by: Dale
SOURCE REGULATIONS.
Signature of 0� Re-roofs
AppliavmUConmaot Data
HAZARDOUS MA IALS DISCLOSURE Type of Roof
Will Or applicant or future buildin occupmt Sumeter handle havallous material
as defined by the Cupertino Municipal Code.Chapter 9.11,and the Health and Safely
We.Section25532(a)7
[3 Y. All roofs shall be inspected prior to any roofing material being installed.
Will mea applicant or future building occupant use e If a roof is installed without first obtaining an inspection,I agree to remove
pp 6 P a Air
g
.mit herardnus air contaminants as defined by the Bay Area Air Quality Management
District? all new materials for inspection.
❑Ycs &<-
I have mad the hmaNvms materials requirements under Chapurti.95 of the Califor-
nuHmIO&Safely Cadc.Saxim.25505,25533 and 25534.1 undcrwM lhatifthe building
does not currently have a unank mat it is my responsibility b redly da:aceupant of me
oximmmcnts which muss W met p' i s sofa Ccoifauaf Ocapan Signature of Applicant Date
l/O °�
Owner ter authorimd.gem Da All roof coverings to be Class"B"or better
s Community Development
10300 Torre Avenue
F✓' Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPERTINO
Building De artment
JOB ADDRESS: PERMIT#
20o S �o I P-4 1 n SO 6 OO�
OWNER'S NAME: PHONE # QoL— 36k— o
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors: '
Signatur Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR 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
Sheet Metal
Sheet Rock
Tile
Owner/Contractor'SignatL&6 Date
OWNER-BUILDER VERIFICATION
1. (Check one) I or my immediate family (parent, spouse or child) will perform:
A. All the work authorized by this permit
=
B. 1-,A portion of the work
C. None of the work
If B or C is checked, complete 2 or 3 below.
2. A state licensed contractor will be hired to do: A_ �
A. _ All of the work
B. A portion of the work (complete section below)
Contractor Address/City Phone # State License # Type of work to
be performed
3. _ 1 will utilize unlicensed person(s) other than my immediate family to perform all or
® portions of the authorized work. I understand that I may be an employer (see reverse side). A
Certificate of Insurance covering workers' compensation must be on file at the City of
Cupertino Building Department office.
Person/Firm Address/City Phone Number Type of work to be
_performed
.....................................................................................................................................................................................
I declare under penalty of perjury that the above is true and correct. I have read and understand the
Owner-Builder Information (reverse side .
Property Owner's Signature: n n Date:
Job Address: Z°e 1 S 3° l',,PJ-P✓ I I Permit# s:'�GZf0 t t
Any changes to the information provided on this form shall be submitted to the City of Cupertino Build
Department.
•
a yfl
fl
City of Cupertino Building Department
CITY OF 10300 Torre Avenue&
C I 1 P E kT I N 0 Phone: (408)777-3228
Dear Property Owner.
An application for a building permit has been submitted in your name listing yourself as the builder of
the property improvements specified.
For your protection you should be aware that as owner-builder you are the responsible party of record
on such a permit Building permits are not required to be signed by property owners unless they are
personally performing their own work If your work is being performed by someone other than yourself,you
may protect yourself from possible liability if that person applies for the proper permit in his or her name.
Contractors are required by law to be licensed and bonded by the State of California and to have a
business license from the city or county. They are also required by law to put their license number on all
permits for which they apply.
If you plan to do your own work,with the exception of various trades that you plan to subcontract,you
should be aware of the following information for your benefit and protection
If you employ or otherwise engage any persons other than your immediate family, and the work
(including materials and other costs) is$200 or more for the entire project, and such persons are not licensed as
contractors or subcontractors,then you may be an employer.
If you are an employer,you must register with the state and federal government as an employer and
you are subject to several obligations including state and federal income tax withholding, federal social
security taxes,workers compensation insurance,disability insurance costs,and unemployment compensation•
contributions.
There may be financial risks for you if you do not carry out'these obligations, and these risks are
especially serious with respect to workers' compensation insurance.
For more specific information about your obligations under federal law,contact the Internal Revenue
Service (and,if you wish,the U.S.Small Business Administration). For more specific information about your
obligations under state law,contact the Department of Benefit Payments and the Division of Industrial
Accidents.
If the structure is intended for sale,property owners who are not licensed contractors are allowed to
perform their work personally or through their own employees,without a licensed contractor or
subcontractor, only under limited conditions.
A frequent practice of unlicensed persons professing to be contractors is to secure an owner-builder
building permit,erroneously implying that the property owner is providing his or her own labor and material
personally. Building permits are not required to be signed by property owners unless they are performing
their own work personally.
Information about licensed contractors may be obtained by contacting the Contractors' State License
Board in your community or at 1020 N Street,Sacramento,California 95814.
Please complete and return the enclosed owner-builder verification form so that we can confirm that
you are aware of these matters. The building permit will not be issued until the verification is returned.
Very truly yours,
Building Department, ,
City of Cupertino
Pnnled on Recycled Paper
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
ppCITY OF II Telephone: (408)777-3228
U f E�I 'I V® 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 1997 UBC Standards
and manufacturers specifications on re-roofing.
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 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 nail inspection is required.
6. Any roofing which is applied without first obtaining an inspection,
will require the removal of all new material down to the sheathing,
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-inspection fee of$176.18. The re-inspection fee must
be paid before another inspection can be scheduled.
IMPORTANT:
1. Flat roofs must have a minimum of 1/4" per foot slope and demonstrate
that there is no ponding.
2. An LC.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: �^ � 1 C uti r--h r�o p
Job Site Address: Z00
Roofing Company Name:
Applicant's Signature: Date: 3 ��S
• Greg Casteel
Building Official
Revised 11/2/04
Printed an Recycled Paper
CITY OF CUPERTINO
REROOF
�CUPEkTINO PERMIT APPLICATION FORM
APN # �6 , a o Date: (� 3 S/
cl — , o
Building Address: Z� S & I I \
Owner's Name: Phone#: o
Cl�itVLl1 Ih C aI I✓b 34& ---2-70q
Contractor. ®w N L� �w Y on #: License #:
Contact: Phone#: 40 Cupertino Business License#:
awes e� 6g - o
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles - ❑ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
• Wood Shingles 0 Wood Shingles
❑ Other(Specify) M�Other(Speciify) 54,
No ber of existing coverings 11 Provide I.C.B.O.Report v
�To be Removed ❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ❑
IV' Job Description: 1 GJ
Residential ❑ Commercial
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Project: Type of Construction: Occupancy group:
000 .— 2 ✓ CG�.orGCt
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
BENERGY Energy BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
°�. V/