08020068 CITY OF CUPERTINO - x«,c.rR
BuawnG DIVISSON PERNIIT CaI�IT�RA�TOR�INFQ, ATIO
PERMIT NO.
BUL26CnI1RESs:OLLINGER RD ALLSTATE ROOFING SERVICES 08020068
NER'S NAME: ii PBRMIT WOE DATE
CHURCH OF JESUS CHRIST OF 2690 VISTA VERDE DR 02/12/2008
PHO E. ms SANITARY NO. CONTROL NO.
(800) 544-8033
ARCHTEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
30G LICENSED CONTRACTOR'S DECLARATION Job Descrl tion
r� 1 herebyaffirm Net 1 am licensed mdar pmvisiau of Chapter 9(Commencing P
n�! with Senlon]000)of Dividon3o(uu Buainna and Pmfeaions Code.md mylicense is RE-ROOF,T/0 EXSTNG & INSTL FIRESTONE TOP ENRGY
I.cert force nd err Lt.g py STR
DIZ Lleenm ClW
e'er Dam ARCHITECTS DE�CI.0 TION114 RF SYS. 125SQ, CLS A
y I understand my plans mall W used as public records
76 7
tood� Licensed Pmfcssi.nal
5 OWNER-BUILDERen.ptDECLARATION
ZO S I hereby.(Em lora 11. exempt Item he Commences License Any c Law for the
SO O which following moon.(Section t]051.5,Business and Pmreai.I Cade:Any city or county
$Rei which its in.•panic m cn.thek aloe Impmw,dcmnkh,nr.a it enY limeem
ZS° thatWor anitsissmroImmanelto the tMvisio of Use Contractor's
itm NeuLaw(tstemcm
< Ihatkrlittnsedputstumtothe pmviuonsafduConuacar'sUttnslaw(Ckpter9 Sq.Ft.Floor Area Valuation
�C (Co..endxemiNSecdoom and the
Divisions ofthee inueand P(0ress(ans Code)or $56342
that io r 31.5 b themlrom and the aper for the subjects
the exmpdaa Any it prtion of
.1me man by airy hundred
for s(apermitrvbjttutheapplicantt0arivilpenaltyof Number Occu ane e
rot m.ro than Tion hunamd danaa(s500k � 3 6934 004 � p Y�YP
❑L pe ownerk,the thas"come,a mY employ led.r.rages u utei(rvc.c0mpens ince,
andwildodhnwork.Codd:he Con inorthtended ser oRe dosno,ed apply
in annmor of Required Inspections
Nd Pm,-noWfession.Code:The Convinces ndLicwha Lass does not apply lf ru aWMr is q p
propertywhobuilds provided
intpr andwkdoesamhwmk himselfar Iluough his
awn em.l cn,pdingwi pmsuimpro Ideitart notice a mploroldon.fmale.I-
bawewn Ne building ur impmwmat r sold within mu)earOr I.P.etio.,the owmr-
builder will kw the WNa of poring out k did not build or impfor puryoa of
ab.).
❑1,an owner or the property.am Gelpelwly woMeaing with licensed Co.vactms e
Construct use project(Sec.]Old.BGinea and Pbefeulom Code:)The Coulnnbta U-
cew law does not apply 11.owner of property who Wild.m improves them...and
who Contracts for such projects with a comnclor(l)licensed pmuant In use Cnnuacmls
LICOM Law.
❑10.Gempt under See• .B&P C for this40
mown
nor Dau
WORKERS COMPENSATION DECLARATION
1 hereby T.coder penalty of perjury arc of the(ollowinp decladui0ne
Ikwand will malnWn•CertiOGeof Consent mself-Imam far Warkens Compcm
amor,pe provided(0r by Section 5700 of the Labor Code,for the perfomanm of ate
wmk for which lots permit ie becoo,
hew and will maimaln W.fte,Compound..Insurance,as tequimd by Scotto.
]00 of due labor Code,for the poAomanG ofum work for which this permit is toad. '
My WO Campensarion lnauance tori and PoliyrumWram/:�
Cartier. /`. .�-� h hey No.: 7i 9 B
CER7IFICA OFPXEMPION FROM WORKERS'
COMPENSATION INSURANCE
This anoBm need rot W Completed if the permit Is future hundred dollars(SIM)
or lura)
1 cenify Not in the perfamanco of the work It which this permit r Issued,I shall not
employ anyype ydnersepeichemomn rvEienmdm WorkersCompenadon
Laws of Califo ate
Appod a`
NOTICE TO APPLICANT.If,after making N of E`emption.you mould
become subjem m the Worsens Compensation provisions of loo labor Code,you muse
.,O forthwith Comply with d.ns such provior Cor permit mall k dGmed hewn c .
Z C CONSTRUCTION LENDING AGENCY
[.r I hereby sl Om that Jure iso construction lending agency,for the parfortnance of
ai the work for which this permit is tamed(See.3097,Cin Ca '
W� 0
Le does Name
]z Lcndefs Address
C)Q 1 certify that 1 haw mad lois application and me Out,loo abuw information is
ly U COMM I agla in Comply with ail city and county oNin ams and some rws misting in
-p building Consuvmion,and thereby awhme,romemoldws of thin city a tour upon tiro
Lg7 akw-mentioned Property for inspection purposes
TS. (We)agree In saw,indemnify and knee krmleas the City or Cupertino against
t„inn IlabilidG.judgments.emu and expenses which may in any way sense against said City
) in consequence of the Sousing of this permit. /'Z,
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SO REGULATIONS.
-/2-amu✓ Re-roofs /V
Signmocof Applicanonusee Dau
H 5 MAD OSURE ,Type of Roof
WlO dte appliuntmlmmc Wllding0ttup nom orkndl.lonomousmamrid
@Oned the Cupertino Munici W I Code.Oupter 9.12 and tlm Hallo atl Safely
.seed.m.25552(.)7
YG All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future Wilding mxupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
moll havuMm air conuminmts as defined by Ne Bay Ama Air Quality Management all new materials for inspection.
District?
QYG
T haw mad the havrd" mu materials requirements under Chapter 6.95 or f C.1irar.
nr Health&Safety Com,Sanctions 25505.15533 and 25534.1 understood!tha if see building
dux t CumndY kw•tense,than(t r my responsibility m nedly tlw oauPat of tlw
ba whxhm kmet 'ora Wharbee.fa Certificate.rucapwmy. Signature of Applicant Date
Ounnm.reuth.dr .gem Dam".'' All roof c rugs to be Class"B"or better
00
� � ' CITY OF CUPERTINO
REROOF
•CUPERTINO PERMIT APPLICATION
APN # � O() Date: 2 _!Z— O P
Building Address: Z atz
Owner's Name: Phone #:
373,-?v3 1-
Contractor: / Phone#:
A `1t4k,vcee Iso tl�� l�Oc Lw�
Fax #: !✓ojp—
Cupertino Business License#: Contractor License #:
Type of Roof Covering:
Existing: Proposed: 7ipp /�7eM 6�4.• <-
P+ Built-Up Roof Built-Up roof
❑ Asphalt Shingles Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
41 ❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O.Report# .Y/6
To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description: 7/— ,, 6F�Xoj VR �J s-k/� rel e sAd-.LTPp
0-4edY S�°✓' �S�S vt� J( c! tSA'D
/ ZS s S C.lgrr ,4
Residential H Commercial
Fire Zone: Yes ❑ No ZRI, Confirmed with Planning Det. if
there are any restrictions: Ll
Valuation:
I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
Signature
CITY OF CUPERTINO
REROOF
CUPEkTiNO FEE SCHEDULE
Number of
Squares Fee ID Fee Description Fee Group Permit Type
ZS REROOFCOM Re-roof Commercial B COMML-ROOF
BSEISMICOM Seismic Commercial B
REROOFRES Re-roof Residential B SFDWL-ROOF
BSEISMICRE Seismic Residential B
REROOFMRES Re-roof Multi-Family B MFDWL-ROOF
BUSLIC Business License 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 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 I.C.B.O. report is required to be on the job site at the time on inspection.
I understand and will comply with theabovestated policy on re-roofing.
Homeowner's Name: L 9 d , ,��f S
Job Site Address: 20
Roofing Company Name: C(6t4vt C G I L U I Cmc • :7�_c_
Applicant's Signature: Date: 2'<Z-p
Greg Casteel
Building Official
Revised 11/2/04
CITY OF CUPERTINO
2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36934004 .00
DATE ISSUED. . . . . . . : 02/12/2008
RECEIPT #. . . . . . . . . : BS000003917
REFERENCE ID # . . . : 08020068
SITE ADDRESS . . . . . : 20125 BOLLINGER RD
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : CHURCH OF JESUS CHRIST OF LATT
ADDRESS . . . . . . . . . . : 20125 BOLLINGER RD
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : EDWARD A GREGORY
CONTRACTOR . . . . . . . : RAMIRO RODRIGUEZ LIC # 27308
COMPANY . . . . . . . . . . : ALLSTATE ROOFING SERVICES
ADDRESS . . . . . . . . . . : 2690 VISTA VERDE DR
CITY/STATE/ZIP . . . : SAN JOSE, CA 95148
• TELEPHONE . . . . . . . . : (800) 544-8033
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
--------- ------------- ---------- ----------- ---------- ---------- ----------
1RER00FC0M SQUARES 125 . 00 796 :00 0. 00 796 .00 0. 00
BSEISMICOM VALUATION 56, 342 . 00 11'.97 0. 00 11.97 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 807 .97 0. 00 807 .97 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 807 .97 VISA .
---------------
TOTAL RECEIPT 807 . 97
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
305 FRAME 307 INSULATION
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
603 ROOF BATTENS 604 ROOF IN-PROGRESS
605 FINAL REROOF
Community Development
10300 Torre Avenue
510Cupertino CA 95014
Telephone(408)777-3228
� CITY OF Fax(408)777-3333
UPEkTINO
Building De artment
JOB ADDRESS: �-Z� PERMIT # D
2 01Zs za//,N,
OWNER'S NAME:T-:,7 ( PHONE # YDe'— 3Z3-3o3 �—
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors: 7 -/Z-o jF*
Signature ��- 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 �4; ce r'� C C `c7E774
Septic Tank
Sheet Metal
Sheet Rock
Tile.
f. G11 2 -1-7-Owner/Contractor Signa e Date