B-2017-1238CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-1238
881 COTTONWOOD DR CUPERTINO, CA 950144621 (369 17 038) COSMOS ROOFING
INC
MOUNTAIN VIEW, CA
94043
OWNER'S NAME: EIRC TZOU DATE ISSUED: 07/28/2017
'OWNER'S PHONE: 408-621-0690 PHONE NO: (650) 969-7663
LICENSED CONTRACTOR' DECLARATION BUILDING PERMIT INFO:
License Class C9 Lic. #755-441
Contractor COSMOS ROOFING INC Date 04/30/2019
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:
1. 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.
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
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
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, costs, and expenses which
may accrue against said City in consequence of the granting of this permit.
Additionally, the applicant understands and will comply with all non -point
source regulations per the Cupertino Municipal Code, Section 9.18.
Signatq . Date 07-28-2017
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
r. 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)
2. I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec.7044, Business & Professions Code).
X BLDG —ELECT —PLUMB
_ MECH X RESIDENTIAL — COMMERCIAL
JOB DESCRIPTION:
RE -ROOF; TEAR -OFF; INSTALL COMP SHINGLE (23 SQ)
Sq. Ft Floor Area: l Valuation: $12335.00
APN Number: Occupancy Type:
369 17 038
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: Kim Dunbar
Date: 07/28/2017
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, Iagree to remove all new materials for
inspection.
Signature ofApplican
Date: -2 -2 1
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A"
1. 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.
2. 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
permit is issued. -
3. 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 become subject to the Worker's Compensation provisions of the
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
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 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, costs, and expenses which may accrue against said City in
consequence of the granting of this permit. Additionally, the applicant understands
and will comply with all non -point source regulations per the Cupertino Municipal
Code, Section 9.18•
Signature Date 07-28-2017
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safe Code, Sections 25505, 25533, and 25534.
Owner or authorized ag rt,'.
Date: 07-28-2017
CONSTRUCTION LEMM19��GENCY
I hereby affirm that there is a construction lending agency for the performance
of work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed
Professional
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE s CUPERTINO, CA 95014-3255
CUPERTIPIO (408) 777-3228 • FAX (408) 777-3333 • building .cupertino.org
-2,0
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PROJECT ADDRESS I r� d i -00D APN # 3 / e C1 p
OWNER NAME ,' 21 Tzd
I
PHONE901-b2-1-0670
EMAII
RE
STET DRESS
i 6_0 7 -?d,,1 c R -
CITY, STATE, ZIP
t x) cA 7,501-f
FAX
CONTACT NAME
ALEJANDRO OCEGUERA
PHONE
650-969-7663
E-MAIL
STREET ADDRESS
Old Middlefield Rd
CITY, STATE, ZIP
Mountain View, CA 94043650-584-3078
FFAX1901
❑ OWNER ❑ owNER-BUIIAER ❑ OwNERAGENT EJ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHnEcT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
ALEJANDRO OCEGUERA
LICENSE NUMBER 7LICENSE
785441
TYPE
C39
BUS. LIC. # 403370
COMPANYNAME COSMOS ROOFING
E-MAIL.
FAX 650-485-2314
STREETADDRESS 1901 Old Middlefield Rd
clly sTATE,ZIP Mountain View, CA 94043
PHONE 650-969-7663
ARCHITECT/ENGINEER NAME
LICENSE NUMBER !
BUS: LIC. #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF SFD or Duplex ElMulti-FamilyROOF
STRUCTURE: Commercial
AREAZ y�
✓ ov
VALUA ON:
I a 33.5
EXISTING ROOF TYPE: ❑ BUILT-UP ROOF 9(4ISPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER (SPECIFY)
REMOVE [REPLACE DYES]_�NO,
NOAYERS:
PLYWOOD ❑ w, 11_
THICKNESS: ❑ 5/8"
PLYWD ElOSB
TYPE: ❑ CDX j
PITCH:
:12
ROOF
CLASS:, A .
PROPOSED ROOF TYPE: ❑ BUILT-UP ROOF tg4sPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER
ICC -Es REPORT #
DESCRIPTION OF WORK TG C -M
F -c-7 rA t-�Ml -2-
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this
By
application and the information, I have provided is correct. I have rea4jhclkqcription of Work and verify it is accurate. I agree to comply With all applicable local
ordinances and state laws relating to building constructio lorize r sentatives of Cupertino to the above -identified property for inspection purposes.
Signature of Applicam/Agent: Date:
SUPPL TAL INFORMA UIRED
_ if building is associated with a Home Owner's Association, provide letter
of approval from HOA.
Provide' Planning approval to verify if there any restrictions.
Provide copy of Manufacturer's Installation Specifications.SrA
Provide signed copy, of Cupertino's Tear -Off Policy.
OFFICENSE ONLY
PLAx cHECICTYPEROIUUNG
SLS
❑ "OVER-THE-COUNTER.
❑ EXPRESS '
❑ "suu nnvG PLAN REVIEW
❑ PiANNsrc PLAN RE ,1 Ew r y
❑mE D�
❑ OTMR-
�k
ReroofApp 2011.doc revised 03116/11
REROOF TEAR -OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
�68��11t'fi1N't8 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 FAX (408) 777-3333 • building@cupertino.org
PROJECT ADDRESS APN k `
OWNER NAME ct7 le -e- PHONE E-MAIL
STREET ADDRESS i
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CITY, STATE, ZIP r
FAX
CONTRACTOR NAME
LICENSE NUMBER7eg .<1 f� 1
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LICE TYPE
BUS. LIC, #
COMPANY NAME /^ ` f^'
E-MAIL
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STREET . D ESS
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I UNDERSTAND AND AGREE TO THE FOLLOWING:
1. The re -roof project shall comply with all applicable provisions of the 2016 California Codes.
2. An inspection request can be scheduled up to one business -.day before the requested inspection! date.
' To schedule inspections call (408) 777-3228 from 7:30-3:30pm (Mon-Thurs) or 7:3072:30pm (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 out to:the
job site within ,one: hour, The hours for this service are: 7:30=10 30am and 12;30-3:30 (Mon -Theirs)
and 7:30-10:30am and 12:30-2:30 (Friday). ,Final Inspections will be given.a two hour'window.
3. `fear -Off Inspection:is required. Any and all dry -rotted wood shall be replaced prior to this inspection.
Unless new plywood toof sheathing is proposed throughout, all the nails/fasteners'shaI1 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/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 ori=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 tiionoxide detectors are required to, be installed in- accordance with Sections, R314 and, -R31 j `of
the 2016 California Residential Code.
7'�.�
,Signature of Applicant/Agent Date
L�� Reroofl'oUcy_2014.doc revised 0610117
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
CUPERT[NO 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildingCcDcupertino.org
PERF! °I CAN t ,T 3E I]aTAL D U I T I S CER IFC TE TAS' -BEEFY
CC3ililET1;D,D RFI'fi7RNFn FCi TFI BITI1VDil<G DIII1
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 8314 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
the bedroom(s)
X
X
On every 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
CSC 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, alarms) 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 CSC Sections 907.2.114 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 specified below have been tested and are operational, as of the
date signed below J
2
-7 �/
Address- x 1 , ? 0 - Permit No. /J ?
Specify Number of Alarms: # Smoke Alanns. # Carbon Monoxide Detectors
Owner (or Owner Agent's)
Contractor Name:
l have read and
Signature
and conditions of this statement
Lic.#
Date:
Smoke and CO fornz.doc revised 12/15116
•
WATER -CONSERVING PLUMBING FIXTURES ��
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISIONFILE
CUpERTtIKE3 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
-17 W1
ii (4� 777-3228 --FAX (408) 777-3333 • building aC�cupertino.ora
Owner Name �G �� Z r i ( Permit No �7— /2-25
Address t f ,4P41120 _ / L,--
Is your real property a registered historical site?
Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
No Go to Question 2.
Does your real property have a licensed plumber certifying that, due to the age or configuration of the propertyor its
plumbing, installation of water -conserving plumbing fixtures is nottechnically feasible?
El Yes Civil Code Sections 1101.1 through 1101.8 do not apply.
El The licensed plumber's certification has been provided to the Building Division.
Skip the rest of the form and sign.bottom of form.
K] No Go to Question 3.
2.
Is water service permanently disconnected for your building?
Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
No Go to Question 4.
Is your real property builtand available for use or occupancy on or before January 1, 1994?
CI 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.
JZ 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..
Please check ONE of the following:..
My propel ty is a single fancily residential real property. See Civil Code Section 1101.4.
On and after January I; 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.
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).
Mypropeityis a commercial real property. See Civil Code Section 1101.5.
On and after January 1, 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, as the owner or owner's agent of this property, certify under penalty of peijury that non-compliant plumbing fixtures will be
replaced prior to date specified above with water-conselving plumbing fixtures in accordance with Civil Code Sections 1101.1
through 1101.8, the current California Plumbing Code and California Green Building Standards Code, and manufacturer's
installation requirements, and that the water-conseiv' plumbing fixtures comply with the requirements as indicated in the
table on the following pane.
Owner or Owner Agent's Signature: ��' o/ Date: & V,612L� I
Upon completing and signing this Certi � , plea return it to the Building Division in order to final your building permit.'
SB407
ermit'
SB407 2015.doc revised 01105117