15110004 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 22035 CREEKSIDE CT CONTRACTOR:PERFECT HOMES PERMIT NO: 15110004
CONSTRUCTION CORP
OWNER'S NAME: DANIEL MARTIN&MARY CUSICK 382 LASSENPARK CIR DATE ISSUED: 11/02/2015
OWNER'S PHONE: 4088874688 SAN JOSE,CA 95136 PHONE NO:(408)600-8033
Tr LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL EJ COMMERCIAL E]
TEAR OFF(E)WOOD SHAKE,INSTALL(I)30 it FELT,OSB,CLASS A
License Class-.woW Lie.# COMP ROOF SYSTEM(25 SQ'S)
may,-.
Contracts"M �{�'�� Rau
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
on performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$12000
ave and will maintain Worker's Compensation Insurance,as provided for by
ection 3700 of the Labor Code,for the performance of the work for which this APN Number:32639040.00 Occupancy Type:
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 WITIHN 180 DAYS T 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 D LLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the L
granting-of this permit. Additionally,the applicant understands and will co Is
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
v�l� RE-ROOFS:
Sign tore^ ate All roofs shall be inspected prior to any roofing material being installed.If a roof is
yz. installed without first obtaining an inspection,I agree to remove all new materials for
inspection.
❑ OWNER-BUILDER DECLARATIOND Q
Signature of Applicant--V Date•� ,- l_r,,
I hereby affirm that I am exempt from the Contractor's License Law for one of ` {,
the following two reasons: ALL ROOF COVERIN 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. 1 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 25505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this
Owner or authorized agent: r: + Date:
permit is issued. "1
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 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
.,: REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE• CUPERTINO, CA 95014-3255
GUP)=RTthlO
(408)777-3228 • FAX(408)777-3333• buildino(Qcupertino.orq
PROJECT ADDRESS . n I t APN 9 _03 Z,/ 3 ®
OVdNERNAME J P ",6
E-MAIL
STREET AD �/ d, CITY, STA 7_ I FAX
C�M
CONTACT NAME PHONE E-MAIL
ST E RES ' CIT T TE, IP ~ FAX
t
❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENAI.'T
CONTRACTOR NA 4tLICEN NU1,%BER t' � � LICENSE TYPE fYf BUS.LIC.R
COMPA�� � E-MAIL FAX
ST A RE CITY,S ZI I PHONE r
J
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.I.IC.R
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑ SFD or Duplex ❑ Multi-Family ROOF AREA: � VALU TION:
STRUCTURE: El Commercial CommerClal �v l/ ` 6-D
EXISTING ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES PIS IOOD SHAKES ❑WOOD SHIINGLES ❑OTHER(SPECIFY)
REMOVE/REPLACE KYES IF NO, PLYWOOD ❑ /" ❑ PLYWD ❑ osB PITCH: ROOF❑ NO 1 9 LAYERS: THICKNESS: El 5/8- TYPE: P<DX 12 CLASS: `4
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES 1AIOOD SHINGLES ❑OTHER ICC-ES REPORT R
DESCRIPTION OF W
By my signature below,I certify to each of the follo,,a,ing: 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 building con uction. I Athorize representatives of Cupertino to enter the above-identified propertyfor ins ection purposes.
Signature of Appl icant/Agent: Date: ��
SUPPLEMENTAL III RMATI01\ QUIRED
x OFFiCEUSE01tLI
If building is associated with a Home Owner's Association;provide letter IT oaEGKTYPE, RovTlrc sL>p
of approval from HOA. ❑ Buu bine rt
Provide Planning approval to verify if there any restrictions. E;,p �"" ❑ � ,iv PLAn
3
Provide copy of Manufacturer's Installation Specifications. sT ❑ JIREDEPT 5°
—Provide signed copy of Cupertino's Tear-Off Policy. - - ,❑r oTxER7 0 ,
Reroof4pp_201 1.doc revised 03/16/11
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 22035 CREEKSIDE CT DATE: 11/02/2015 REVIEWED BY: MELISSA
APN: 326 39 040 BPA: *VALUATION: 1$12,000
*PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY PENTAMATION
USE: SFD or Duplex PERMIT TYPE: 1 SFDWLROO
WORK TEAR OFF E WOOD SHAKE INSTALL N 30# FELT OSB CLASS A COMP ROOF SYSTEM 25
SCOPE SQ'S)
FEE ID ROOF AREA
s.f.
1REROOFFRES 2,500
Afech. Plan Check Plwnh. Plan Check F_7ee.Plan Check
Fly_,ech' Perrrli[Fee: Plumb. Permit Fee: Elec. Permit Fee:
Other'AIech. Irasp. Other Plumb Insp. Li I Other Elec.Insp.
.I loch.Insp.Fee: Phurtb. In j p. Fee: Elec.Insp.Fee:
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). Thesefees are based on the prelinmdina information available and are only an estimate. Contact the De t or addn'l in o.
FEE ITEMS (Fee Resolution 11-053 E(C 711132 FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Suvvl. PC Fee
Plum b.IjAllech.`Elee
Permit Fee: $425.00
SttpPl. Insp Fee
Plum b.lillfech.,Elec:
Plzy.rnb.,'11ech.iElee Permit l,ee:
Construction Tax:
Administrative Fee:
Work Without Permit? 0 Yes (j) No $0.00
,=Advanced Planning Fees:
Travel Documentation Fees:
Strong;Motion Fee: IBSEISMICR $1.56 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS:, $427.561 $0.00 _ TOTAL"FEE: $427.56
Revised: 10/01/2015
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
Sk 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255
CUPERTINO
(408)777-3228 • FAX(408)777-3333• building ancupertino.org
PROJECT ADDRESS - G APN
\
OwrNERNAME P UNE E-MAIL
STREET DDRESS / CITY,ST?TE IP h I FAX
7
CONTRACTOR NAME ` LICENSE NU ER LICENSE PE BUS.LIC.R
COMPANY N E-MAIL FAX
STREET ADDRE CITY,STATE, I PHO E
i
I UNDERSTAND AND AGREE TO THE FOLLOWING:
1. The re-roof project shall comply with all applicable provisions of the 2013 California Codes.
2. Ari 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 7:30-1.0:30am 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-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-roofing 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 o��ner 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 R31 5 of
the 2013 California Residential Code.
S igliature of Applicant/Agent: Date:
Re7-oo)Tolicy_2014.doc revised 01/15114
SMOKE I CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION
CUPIE[I;.TINO
10300 TORRE AVENUE•-CUPERTINO,CA 95014-3255
(408)777-3228--FAX(408)777-3333• building(Wcupertino.org p
.� �Pernnit I�Ta4
f Xla
A i ess - r i I ,ld TJ rms Sinoke• garboi N onox de• l
PEIZ IIT CANNOT BE FINAT�ED Al�M W-NIP FETED UNTIL THIS CERT IFICATI
:1IAS BEEN 5LQ,-N_ F_,U AND RETJMM4 D_T01 THE, BLILDPqO DB S Oi
PURPOSE
This affidavit is a self-certification for the installation of all required Smoke and Carbon Monoxide Alarms for
compliance with 2013 CRC Section R314,2013 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 thefollowinglocations: "
AREA SMOKE ALARM CO ALARM
Outside of each separate sleeping area in the immediate vicinity of the X X
bedroom(s)
On ever level of a dwelling unit including basements X X
Within each sleeping room X
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 alarm(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 have been tested and are operational,as of the date signed
below.
1 have read and a re to co ply wit terms an o this statement
o �— enro-Name:
Saa
u . ... .......... .... ......nr" . . ..:Dafe
Confofor--Nam
Si o e ......... Lic ...............Date.Q.:.�t3..... ..
.Smoke and CO form.doc r ellised 03118114
WATER-CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CUPERTINO 10300 TORRE AVENUE-CUPERTINO,CA 95014-3255
(408)777-32 8 FAX(408)777-3333•buildingP-cupertino.org t
Owner Name }. i v t�C_ fl IU Permit No. 4
Address -faZCS 9SQSfy
1. Is your real property a registered historical site?
El Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
Cl Ei- o 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?
El Yes Civil Code Sections 1101.1 through 1101.8 do not apply.
The licensed plumber's certification has been provided to the Building Division.
Skip the rest of the forin and sign bottom of form.
' Cl' o Go to Question 3.
3. Is water service permanently disconnected for your building?
El Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
i`
E3--N6 Go to Question 4.
4. Is your real property built and available for use or occupancy on or before January 1, 1994?'
--El`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.
LJ —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
bottom of form..
5. Please check ONE of the following:
i CTMy property is a single-family residential real property. See Civil Code Section 1101.4.
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).
❑ 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. 4
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).
❑ 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 unprovements).
1,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
through 1101.8,the current California Plumbing Code a oinia Green Building Standards Code,and manufacturer's
installation requirements,and that the w - nservin plumbin fixtures y wi equireinents as indicated in the
table on the following age
Owner or Owner Agent's Sion a'ra ,.J_ Date'__ -
Upon completing and signing this Certificate,please return it to the Building Division in order to final your buildi g p rmit.
SB4072015.doe revised 08/26/15