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B-2017-1279CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-1279 22635 SALEM AVE CUPERTINO, CA 95014-5657 (342 12 065) WESTSHORE ROOFING INC SAN JOSE, CA 95131 OWNER'S NAME: LAI YEN-MIAU AND LEU KEH-SHIOU DATE ISSUED: 08/03/2017 OWNER'S PHONE: 408-865-1956 PHONE NO: (408) 456-0200 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class C-39 Lic. # Z221 Contractor WESTSHORE ROOFING INC Date 11/30/2018 X BLDG —ELECT _ PLUMB MECH X RESIDENTIAL COMMERCIAL 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. JOB DESCRIPTION: RE -ROOF; TEAR -OFF; INSTALL OSB; COMP SHINGLES - (38 SQ) I hereby affirm under penalty of perjury one of the following two declarations: m. I have and will maintain a certificate of consent to self -insure for Worker's 4@ompensation, as provided for.by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 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 Sq. Ft Floor Area: Valuation: $24300.00 permit is issued. APPLICANT CERTIFICATION 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 APN Number: Occupancy Type: and state laws relating to building construction, and hereby authorize 342 12 065 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, costs, and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additions applicant understands and will comply with all non -point source re " lations . e Cupertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signatur Date 08-03-2017 Issued by: Kim Dunbar OR DECLARATION Date: 08/03/2017 -BUILDER I hereby affirm that I am exempt from the Contractor's License Law for one of the RE -ROOFS: following two reasons: All roofs shall be inspected prior to any roofing material being installed. If a roof is 1. I, as owner of the, property, or my employees with wages as their sole installed without first obtaining an inspection, I agree to remove all new materials for compensation, will do the work, and the structure isnot intended or offered for inspection. sale (Scc.7044, Business & Professions Code) 2. I, as owner of the property, am exclusively contracting with licensed Signature ofApplicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: 08-03-2017 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER m. 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. HAZARDOUS MATERIALS DISCLOSURE 2. I have and will maintain Worker's Compensation Insurance, as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the Section 3700 of the Labor Code, for the performance of the work for which this California Health & Safety Code, Sections 25505, 25533, and 25534. I will permit is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the s. I certify that in the performance of the work for which this permit is issued, I Health & Safety Code, Section 25532(a) should I store or handle hazardous shall not employ any person in any manner so as to became subject to the material. Additionally should I use equipment or devices which emit hazardous air contaminants as defined a Area Air Quality Management District I Worker's Compensation laws of California. If, after making this certificate of will maintain compliance with the Cope unicipal Code, Chapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the Health & Safe ons 2 25533, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized age APPLICANT CERTIFICATION Date: 08-03-2017 I certify that I have read this application and state that the above information is O TR CTIO LEND E CY correct. I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance relating to building construction, and hereby authorize representatives of this city of work's for which this permit is issued (Sec. 3097, Civ C.) to enter upon the above mentioned property for inspection purposes. (We) agree Lender's Name to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in Lender's Address consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code, Section 9.18. 1 understand my plans shall be used as public records. Licensed Signature Date 08-03-2017 professional REROOF PERMIT APPLICATION - COMMUNITY DEVELOPMENT DEPARTMENT. -,BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95010255,' CUP ��,� NO (408) 777-3228 • FAX (408) 777-3333+ tiuildmclCc�cupert n0;0 PAOiECf ;4DDRESS o) SQ I C./ ► l A Va--• WOODSILAKES lWt)flDSHrrOLES Ciii`NERNAEAE - ' . P (ONE• " 11's 10 E>, A . who -o STREET SS ADD y ZnZ G 3/ J�,/51.t �L�/F'L.. �_ •V�t,2 CI : -STATE, ZIP Cr Cit- �J�b/ l FA" . , E CONTACT NAME r,A !^^ Elf v0 14 W _e z a0FWA 5fiurYro�in (J afliEET DGRESS�!Z[+vy� rfLcn fl`v' � Crr7' 1111 �, 'Lth• .• lea • "© 9tuNER 6� Ot"O,B(IB,DER •D OwNTR.AGENT LY CONTRACTOR ❑ CGtiTRAcioiAGEh'T 11 ARCHITECT El ENGINEER ❑ DEV1 L;)PER. ❑ 7ENAN'f TRAGI'OR:A,tit WOODSILAKES lWt)flDSHrrOLES 6 .1 !01E11SI COSYPANY,". IE Ili./ Av w/ re E 1AIL f�lLort rood n a n.t l I FAX od �z STREETADD E 22SS: J C IA- V / � / p _,Oze ARCHITECTIENGINEEKNAME LICENSE. NUMBER. - - BUS. LIC. COMPANY NAME E-MAIL FAX STREET :ADDRESS CITY, STATE, ZIP - .' '. PHONE USE OF SID C bi1pl6 - Multi Fancily STRUCTURE.- . O Commercial ROOF AREA: 3goo VALUATION: 2 yi3� o FJsISTING.ROOETYPE; DBL'.ILT-itP$OOF 11ASPIIALTSHiNGLES WOODSILAKES lWt)flDSHrrOLES 13OTHER(SPECIFYj .1 !01E11SI FNO, PLYIVOOD ❑�^��� r Itour> .csLte ` ,. of approval from HOA., �T1t I Bt iLi1tGPL #N Rs�t�v r TNiCEs'VESS O.Si@^ ,Yt�D.-:OSBROOFPLLAYERS:. TYPE ❑"'CDX fl PUArttgtnc.vLAI asri v 3 '12 CLAS$ A PROK)SEb ROOF TYPE. BUILT-UP. ROOF LASPHALT SHINGLES ❑ WOOD SHAKES 0-WbO0 S-4-1 OTHER. ICC -ES REPORT+ 61weCR1PTfON QP WOR K+ 0,1 AA I P D 'of I / � tOL �I 119 W / /V 1- / r ay.my signature below, I certify to each .of the following: 1.3191 the property oi57ier or attlhor(Z d. 44'etit to act tin the.propeiiy o%viier'S behalf, 1 -have read this application and the information I h�,Pi!Idimgd,,,trurtZn. t l have read the Description o£ Workand.verifv it Kaccurate. 'I agree to comply with all applicable local ordinances and state laws reiatin L authorize representatives of Cupertino to enter theabvve-'�e i&4 pr 7rI j r inspection p4oses. Signature of ApplicantlAgentr Date: rA SUPPLEMENTAL INFORMATION REQUIRED =_ `- I I -� � � r If building is. associated, with a Honie Owner's association, provide letter i, FI 1b C1fECtCTlP1 ° r Itour> .csLte ` ,. of approval from HOA., �T1t I Bt iLi1tGPL #N Rs�t�v r Pcavide>PI liltting approval to verify if there any restrictions. Tat IIGCOL Ci fl PUArttgtnc.vLAI asri v 3 r�raLss` Provide copy.ofManufacturer",s Installation Specifications: C] " wk Q n rA�rvaltn xitil r%M4 Provide Cupertino's Tear � x � � �' �Q oral�x � >i � y signed copy of , -Off Policy. � � : s Reroofrtpii=2(►1 / doc revised O3lltirl t I i REROOF TEAR -OFF POLICY. COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL R1PEia P#>\98 10300 TORRE AVENUE-.CUPERTINO, CA 950743255, (408) 777-3228 • FAX (408) 777-3333 • buildng(@cupertM6.6ra ' .l UNDERSTAND AND AGREE TO TBE.FOLLO:WING:, 0f2l6_alioiaCdes..l 1he,re rooprojeetshall:complSwithallapplicablepovnhCo 2.. An-inspeption request cart be scheduled up to.one business day beftare the requested ins ee To sci eduleinspeopns call (408.) 777-322$ frorri 7 3©3 3,4pm (xvton Thurs) or 7 30-2 3,0pm Q`rtela��).,to schedule inspection. For'Tear-Off attd:.Nailir g lnspectlonsa you=rntist also call' on the day of the inspection oily after that phase of the work is coritpietect The: building inspector will, be out, to the Job site -within one hour. The hours for this serviceare 7 30 10,�:30am a_>�d 12;30-3;30 (M -on Tlitaxs) and 7:30-1 %30am' and 12130-2:30 (Friday). Final inspections;wiI 'lie given a two hour window. , g. Tea=tDff.:res�ecton is reuui>i=e'd. Any and all dry ratted vuoad;shall tie replaced prior to flits inspect€ixi, lrnless new,plywood roo'sheatng is.praposedthroughout, all the nails/fasteners shall be either completelV knoeked-down or`ren'toved prior to -this inspection:` 4. If plywood is installed;, a plywood Nailing Ins>neetimn ><s reuul rail 5 ,Roofing shall 'not be applied without, first obtaining all prior mspectton'and written approvals front .the y -= `building itispectar,,. Any roofing which is applied without fzst obtauung an approved znspectlon will .require ,the; removal of all new material down to'tho sheathing so- a proper 'inspection, can be performed: 6. A Final Iinstaectidn�and,annroval shall be" obtained from;the bu Iding. nspector`when there roofing is completed To''receive:a fatal sign=off_ the followirie item :wiil?be verged a. Flat roofs ,shall have a minimum of I/V per foot of slope;:and demonstrate the e is no potzding, b. Listings from ,approved testing agencies for all pie manufactured -products used shall.be available' on-site to review at the time of the inspeetton C_ x roper sp' alk arrestor installation, vents painted: _gutter/dowrispciuts-iristalled'debrs removed-. .. :NOTE: If*ou,call`, for a tear -off or plywood nailing inspection and the work is not complete, you "ill, be charged a Ke -inspection fee. The re -inspection fee shall ire'isaid:-before;another iinspeet€ore Bari be sr4laedule€:� . ley my signing below, I certify each of the following is true: 1 am the prop, rty owner or authorized agent to'act ori :the ptoperiv owi2e� behalf i understand and agree to comply with the re roof golzcy stated above.4 also understand that smoke detectors and Car on mo '' ode detectors are tequxred to;be installed in accordance with Sections R31 and R31 S o i the 2016 Caltforiiia Resident Ode h t *r ji S.g�ature of'ApplicantlAgent Date •-h _. z w.q� r .:�k,.,; , ReroojP61i ZOl4.dac'a vi ed o3�`Cil � ;Ii p U I iii p. CO °stALitilifit+i�Ir°:?%fTRI�aiz?1tti "ctllfislr'lSil33k' t ' _ 03,10 CO E Fcl PURPO NS �� kC�.r��p.�'ih.� elf-ve i—fl-a��t�ii.��3A �:tY 3:' 5�� 7��liszi u�.�•�� ret,ti7tit� s&� �si�� x%11 �e'.s_�€)It trls)Ytt3xii�� Ale�L'�St� ; %CES : i?t I �i c:tfawt 4? 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':1 �.,3;71Ci i3f"x �i1<ilL3„1'i..S ...'? . �21k1 i ,�gttts-aa e aS',;fi'��i FF iStila #�2ie Ei}ire,'Cizt�, aYaiE1$t tld tx3zf4 xcia�1c':° i 1i?SY,I?'CSCCri3p-Py with tia sLdEit-3G� I1tc Lat£72%ae i11i E ..1 ,(Fd. Ciii`x #;°Eti:r.i7€�* iiaict `aF'n'7 iT3 ti`Sb {,E:,; 2�S..ii?'.'., i?i.0 .,c., n;,t17 m it,'<CT� }'...�.1'.M- } g DivisiC,. T%.t.°.PiL.i' .�:2 t,i)Fi ys"1l1?" �:wiiitS.'I�, SMOKE I CARBON MONOXIDE ALARMS OWNERCERTIFICATE F COMPLIANCE i - COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION UTiter 10300 TORRE AVENUE• CUPERTINO,CA 95014-3255 (408)777-3228• FAX(408)777-3333• buildinq(a�cupertino.orq pt. .otro 1, ': T LE;D N iL TfflS CERTIMATE+ CA.rE :.BEEN COMPLETED,SI1i NE `D RE-TI: ',.E TO TO"Buff DINGDIVISION ... ...�.... .. .... .. ._.�...„..,• .,,-r-r:.,..„ter- ..r^n.:... .:,::.:. ".� PURPOSE This affidavit is a self-certification for the installation of all required Smoke and Carbon Monoxide Alarms for compliance with 2016 CRC Section R314,2016 CBC Sections 420.6 and 907.2.11.2 where no interior access for inspections are required. GENERAL INFORMATION !!; Existing single-family and multi-family dwellings shall be provided with Smoke Alarms and Carbon Monoxide alarms. When the valuation of additions, alterations, or repairs to existing dwelling units exceeds $1000 00, CRC Section R314 and CBC Sections 907.2.11.5 and 420 6 require that Smoke Alarms and/or Carbon Monoxide Alarms be installed in the following locations. AREA SMOKE ALARM CO ALARM Outside of each separate sleeping area in the immediate vicinity of X X the bedroom(s) On every level of a dwelling unit including basements X X Within each sleeping room X I Carbon Monoxide alarms are not required in dwellings which do not contain fuel-burning appliances and that do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with CBC Section 420 6 and shall be approved by the Office of the State Fire Marshal. Power Supply In dwelling units with no commercial power supply, alarm(s) may be solely battery operated. In existing dwelling units, alarms are permitted to be solely battery operated where repairs or alterations do not result in the removal of wall and ceiling finishes or there is no access by means of attic,basement or crawl space.Refer to CRC Section R314 and CBC Sections 907.2.11 4 and 420 6.2. An electrical permit is required for alarms which must be connected to the building wiring. As owner of the above-referenced property,I hereby certify that the alarrn:(s)'referenced above has/have been installed in accordance with the manufacturer's instructions and in compliance with the California Building and California Residential Codes The alarms specified below have been tested and are operational, as of the date signed below Address° 2.-2455S- . e,Izivve iL C10/1474 (A-91V itt Permit No.zew 7- Specify Specify Number of Alarms: #Smoke Alarms #Carbon Monoxide Detectors. ? I have read and agree to comply%yvith the tam,and conditions of this statement Owner(or Owner A ent's) 40111W‘r Date. gi ��dd 1` Yf C—C �G'l Signature Y...... �� Contractor Name: Signature Lic.# Date. Smoke and CO form.doc revised 12/15/16 WATER-CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT. BUILDING DIVISION ..„4"< ,44"•:). 10300 TORRE AVENUES CUPERTINO, CA 95014-3255 CUPR-rit,40 i • 1(408)777-3228 FAX(408)777-3333. buildinocuoertino.oro ..i in.,..--) Ii Owner Name OA— gh ii.)Lk Lo idi Permit No. LI-ii i /1---' Address 72)-641. Sod Ave rw. 1.‘vv-9 e-itt3 ti3 ii-t- ' - ".....w, at, 11- • 1. . Is your real property a registered historical site? _ n es Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. af/Y r.`,To Go to Question 2. 2. Does your real property have a licensed plumber certifying that,due to the age or configuration of the property or its plumbing,installation of water-conserving plumbing fixtures is not technically feasible? 0 Yes Civil Code Sections 1101.1 through 1101.8 do not apply. — 0 The licensed plumber's certification has been provided to the Building Division. Skip the rest of the form and sign bottom of form. P, I_ csIo Go to Question 3. 3. Is water service permanently disconnected for your building? 0,Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. Go to Question 4. 4. Is your real property built and available for use or occupancy on or before January 1, 1994? 0 No My real property is built and available for use or occupancy after January 1, 1994. Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. E(Yes My real property is built and available for use or occupancy on or before January 1, 1994. Civil Code Sections 1101.1 through 1101.8 apply. Check one of the three following statements and sign , il bottom of form.. ' , , 5. Plpse check ONE—of the following: , I WV My property is a single-family residential real property. See Civil Code Section 1101.4. CI On and after January 1, 2014, building alterations or improvements shall require all non-compliant plumbing fixtures to be replaced with water-conserving plumbing fixtures throughout the building.On or before January 1,2017, all non- compliant plumbing fixtures shall be replaced with water-conserving plumbing fixtures (regardless of whether property undergoes alterations or improvements). 0 My property is a multifamily residential real property. See Civil Code Section 1101.5. On and after January 1,2014,specified building alterations or improvements shall require non-compliant plumbing fixtures to be replaced with water-conserving plumbing fixtures. On or before January 1,2019,all non-compliant plumbing fixtures shall be replaced with water- conserving plumbing fixtures throughout the building(regardless of whether property undergoes alterations or improvements). , r [1 My property is a commercial real property. See Civil Code Section 1101.5. On and after January 1,2014,specified building alterations or improvements shall require non-compliant plumbing fixtures to be replaced with water-conserving plumbing fixtures. . , On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water- conserving plumbing fixtures throughout the building(regardless of whether property undergoes alterations or improvements). , , I I,as the owner or owner's agent of this property,certify under penalty of perjury that non-compliant plumbing fixtures will be replaced prior to date specified above with water-conserving plumbing fixtures in accordance with Civil Code Sections 1101.1 , 1 through 1101.8,the current California Plumbing Code and California Green Building Standards Code,and manufacturer's 11, , 1 , I installation requirements, and that the water-conserving_1 mbing fixtures comply with the requirements as indicated intthe It ' table on the following page. ..0er .,...."` ... . Owner or Owner Agent's Signature. An,. A/ ,A0/0, Date: g- Iv 2ivi . Upon completing and signing this Certificate,please return it to the Building Division in order to final your building permit. SB407 2015.doc revised 01/05/17