B-2017-1333CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: I PERMIT NO: B-2017-1333
10299 AINSWORTH DR CUPERTINO, CA 95014-1002 (326 13 115) CUPERTINO ROOFING
INC
SAN JOSE, CA 95129
OWNER'S NAME: FOSTER DEREK
OWNER'S PHONE: 408-242-6171
LICENSED CONTRACTOR'S DECLARATION
License Class C39 Lic. #5115437
Contractor CUPERTINO ROOFING INC Date 03/31/2018
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.
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 liabilitiesJudgments, 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
sour, ions per the Cupertino Municipal Code, Section 9.18.
Signature' Date 08/11/2017
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
1. 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).
I hereby affirm under penalty of perjury one of the following three 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. 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.
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 08/11/2017
ISSUED: 08/11/2017
NO: (408) 973-9427
BUILDING PERMIT INFO•
X BLDG —ELECT —PLUMB
_ MECH X RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION
RE -ROOF, TEAR -OFF, COMP SHINGLES - (40 SQ)
Sq. Ft Floor Area: I Valuation: $22000.00
APN Number- Occupancy Type:
32613 115
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by Kim Dunbar
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
Signature of Applicant:
Date: 08/11/2017
COVERINGS TO BE CLASS "A"
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 comp tT ce with upertino Municipal Code, Chapter 9.12 and
the Health& Safety Code, ctions 25505, 25533, and 25534.
Owner or authorized agent:
Date: 08/11 /2017
=QX
O
1 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 TEAR -OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
10300 TORRE AVENUE - CUPERTINO, CA 95014-8255
(408) 777-3228 FAX (408) 777-3333 - buildina a—cmerting.org
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I UNDERSTANDAND AGREE TOT11E FOLLOW M.
1. The re-roofic
project shall comply, vrith all. applkable provisions. of the 2016 Califomia Codes.
2. An inspection request can be schedued. gai-0:
To schedule inspections call (408) 71713228 from 7:30_3.:Opui n4.fiurs) or 7,.'_3)0-2:30pm (Friday) to
schedule inspection. For Tear -Off and Nailing Inspections, you must also call on, the day of the
inspectiononly after that phase of the wort c is completed, The building inspector will be out to the
job site within one hour. The hours for this service are: 7-30-10:30ani and 1.2:30-3:30 (' tin -Thur
and 7-30-10,30am and .12,30-2-30 (Friday). Final Inspections will be giNQn a two hour vNindmv.
3. 'fear Qff Inspection is reqyjrRJ Any and all dry -rotted woodshall be replaced prior to this inspectioi,
Unless new plywood roof shcatYmg is proposedthrou,,ghoM all the nails/fasteners shall be either
completely Unocke&down or reinbvod prior to this i4sPevt'
4. If plywood is installed, a, plywood Nailin fnstsection is'Murred,
5. koofitia- shall not be, applied -without first obtaiiiii,-ig,allpn'*Orl.n'spec I tidnAnd written approvals from the
building inspector. Any rooftag whichis applied w liiotit first, an -approved inspectio will
pbtaining 1 11
require the removal of all new material down to the sheatl iitgso a proper inspeai.oft can be performed.
6. A Final Iiia e ticatt ari l rovAl.shaltbe obtained.4o1r; m , thebuild' " ector when . , in inthe. re -roofing is
.9. sp
Completed.
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a. Flat roofs shall have a rainimurn of p r sot of sjope,aad demonstrate there. is no pondin..
V Q f
b. L isti.i.-i from approved- testing agg ie, fo all ul"actured products used shall be
gs i r tman
available o n- s ite to review at th o time 0 f 11-1c ifts 0,
c. broiler mark arrestor installation. vents painted. aspou s installed, debris removed.
top gutter/do,%vi t
7. NOTE: If you call for a tear -off or plywood tailing inspection and the work- is not completc. You will be
char' I I ther itis acting eanbe�
charged a re -inspection fee. 1`he re -inspection fee _sball be paid bef�ore a��o
sehe€ ided.
or authorized agem to act on the
['By, my signing hof 'b fiolloVving is true: I ar�j the property ov,,aer d
pro cnviler�_, ear
agree to comply W police staled above. I also understand that
property s behalf I tin��r d rind ith, the re-rpof p cy
P
i%oke detectors aitd car. M0110, 4eteptom are aqui red to be installed hi, accoi-dance with Sections 8314 and W3 15 OF
the 2016 Catif6rilia Residem, I 0,ode
Ire r
y - SMOKE / CARBON MONOXIDE ALARMS g o
OWNER CERTIFICATE OF COMPLIANCE mai _
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
r:'yi9 t:,9-fp
CUPERTINO 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255
(408)777-3228•FAX(408)777-3333• buildinq(a cupertino.org
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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
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 specified below have been tested and are operational, as of the
date signed below.
Address: / T2 ? 7 ' A g 6 t-! "b(2. CAA it Trn).�, C A/ 9S^u i " Permit No. 2 i - - 1133
Specify Number of Alarms: #Smoke Alarms: I I #Carbon Monoxide Detectors:
I have read and agree to co ply with the terms a d.00nditions of this statement
Owner(or Owner Agent's)Name:
Signature.... Date:
Contractor Name:
Signature Lic.# �� 3 Date:
Smoke and CO fonn.doc revised 12/15/16