B-2017-1417do
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-1417
11773 TRINITY SPRING CT CUPERTINO, CA 95014-5108 (366 53 033)
LANDMARK
ROOFING
SAN JOSE, CA 95127
OWNER'S NAME: KIM KYUNG MIN
DATE ISSUED: 08/23/2017
OWNER'S PHONE: 408-807-6400
PHONE NO: (408) 674-4503
{
LICENSED CONTRACTOR'SDECLARATION
BUILDING PERMIT INFO:
License Class CC=39 Lic. #1014538
Contractor LANDMARK ROOFING Date 05/31/2018
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:
REROOF; TEAR OFF; COMP SHINGLES (18 SQ)
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.
64ihave and will maintain Worker's Compensation Insurance, as provided for by
Ypl,il Section 3700 of the Labor Code; for the performance of the work for which this
Sq. Ft Floor Area:
Valuation: $11000.00
permit is issued.
APPLICANT CERTIFICATION
certify that I have read this application and state that the above
APN Number:
Occupancy Type:
informationIs correct. I agree to comply with all city and county ordinances
and state laws relating to building construction, and hereby authorize
366 53 033'
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
may accrue against said City in consequence of the granting of this permit.
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally; the applicant understands and will comply with all non -point
source regulations per the Cupertino Municipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
ignaturea c 't2 Date 8/23/2017
Issued by Abby Ayende
Date: 08/23/2017
OWNER -BUILDER D . RATION
I hereby affmrm 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
r. I,i as owner of thepropertyor 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 is not intended or offered for
inspection.
sale (Sec 7044 Business ,& Professions Code)
�,
1. I,1 as owner of the property, am exclusively contracting with licensed 40
"Signature of Applicant:
contractors to construct'the project.(Sec.7044, Business & Professions Code).
Date: 8/23/201
I hereby affirm under, penalty of perjury one of the -following three declarations:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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.
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 ihc,Labbr'Code, for the performance of the work for which this
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
I ernt is issued.'
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
3. c that, in theerformance of the work for which this permit is issued, I
ertify P
Health -& Safety Code, Section 25532(a) should I store or handle, hazardous
material. Additionally, should I use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the
air contaminants as defined by the Bay Area Air Quality Management District I
W&ker;'s Compensation laws of California. If, after making this certificate of
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
exemption, I become subject to the Worker's Compensation provisions of the
the Health & Safety Code, Sections 25505, 25533, and 25534.
Labor Code;I must forthwith comply with such provisions or this permit shall
be deemed
��
revoked
ner or authorized agent: e "(cGd
APPLICANT CERTIFICATION
Date: 8/23/2017
I certify, that I have read this application and state that the above information is
CONSTRUCTION LENDING AGENCY
correct. I agree to comply with 611. 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.
Signature Date 8/23/2017
Licensed
professional
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 __3c�
(408) 777-3228 • building@cupertino.org PEMIT #B - °�d� - 14(..(�
1�—
CUPERTINO REV # DEF #
F-1 NFW CONSTRT TCTTON n ADDITION n AT.TF.RATION n T T n MF.P n RE -ROOF n SWIMMING POOL/SPA
PROJECT DDRESS
APN # r 0/J
33
I S 4 A
OWNER NAME PHONE
-MAIL
' A / - [
O ®ia
JE rn i ins % (0 C6
STREET ADDRESS
CITY, STATE, ZIP
i ,A) c [
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CONTRACTOR NAME ❑ (5WNERABUILDJ COMPANY
NAME I
LICENSE NUMBER LICENSE
TYPE
AM,Ad ,10.r
LciA -Rd I
/cel 5,3 B'
C.31
e) al
STREET A DRESS V
k
CITY, STip
-7J
_%A-.5bb
E-MAIL PHONE BUS. LIC #
in )A Cgjo L a ae l s
❑ CHrrE ❑ OWNER ❑ OWNER, ANT KcoNTRACTORAGENT ❑ ENGINEER ❑'DEVELOPER ❑ TENANT
CONTACT NAME
°
E-MAIL'
1 C4001 L) r
, q0t) cA Q ° I'ctr 70M ,-vi 1'
STREEDRESS
CITY, ATE, Z PHONE
,30b
DECRIPTON -
w m fod a
ASINGLE-FA , ILY/DUPL"EX ❑ MULTI -FAMILY ❑ INDUSTRIAL ❑ COMMERCIAL
USE
TYPE
OCC
SQ.FT.
VALUATION ($)
EXISTING USE
EXISTING SF',
NEW FLOOR SF
' PORCH
SF DECK SF
DEMO SF
STORIES #
TOTAL NET SF
REMODEL
RE11 .MODEL KITCHEN
REMODELOTHR GARAGE
❑ ATTACHED
BATHROOM SF,
SF
SF SF
❑ DETACHED
EXISING " ❑ YES
FIRE SPRINKLERS ❑ NO
EICHLER, ❑YES
! ❑ NO
SECOND STORY ADDITION ❑ YES
❑ NO
DWELLING SECONDDWELLIIVG❑yES ❑ATTACHED❑DETACHED OTHER
UNn# UMT,ADDITON:.❑.NO SF
POOLS - ❑'FIBERGLASS, ❑ VINYL -LINED ❑ GUNITE ❑ PREFABRICATED
POOL'- SF SPA - SE SPA; ATTACHED El YES ® NO TOTAL - SF
IRECE
D BY:
TOTAL VALUATION:
Commeecial or Multi-Fmiitlu Buiidmgs with.Public Swimndne Pools requires Department of Envir onmental Heath a roval
! .,,,/ /1
V� ��L
IUM
I ,
RE -ROOF EXIST&G ROOF TYPE: ❑ BUILT-UP ROOF ❑ ASPHALT SHINGLES)o WOOD SHAKES ❑
1 I.
WOOD SHINGLE ❑ E OTHER (SPECIFY)
REMOVE /REPLACE ❑ NO,;IF
NO
PLYWOOD ❑ 1h- ❑ 3/8" PLYWOOD
TYPE:
PITCH:
ROOF CLASS
❑ YES,
1 I # OF LAYERS' I
THICKNESS ❑ 5/8" OTHER
❑ OSB E]CDX OTHER
12
A
PROPOSED ROOF TYPE ❑BUILT-UP ROOF' QkASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER
i
*Provide a- signed copyof the Cupertino's Tear -Off Policy SF #of SQUARES
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 ahi's applicaiition acid ,tle information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree
to comply with all apphcabi'e local .ordinances and state laws relating to building construction. I authorize representatives of Cupertino to
enter the above Identifiedl prgper,ty for inspection purposes. I acknowledge and authorize all information contained on this application form
to be made available for public reco
Signature Applicant%Agent: Date:
lof [3
SUPPLEMENTAL INFORMATION REQUIRED
*New SFD/Second Dwelling Units/Multifamily Dwellings: A Demolition permit is required prior to issuance of a building permit for all new construction.
*Commercial. Buildings; ',Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project.
*Copy of Planriing:Approval,Letter or Meeting with Planning prior to submittal of Building Permit application.
*HOA -Provide a letter of approval from the Home Owner's Association
I
BldgApp_2017.doc revised 08/01117
CGOEWF i0
PROJECTAMPESS
OWNER NAME
COMMUNITY DEVELOPMENT DEPARTMENT - BUILPING DIVISION
ALBERT SALVADOR, P.E., C.B.C., BUILDING OFFICIAL
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 - FAX (408) 777-3333 - building 0._cupertino-.oLg
APN -, V
'2-j /_
A—C -55-033
PHONE I E-MAIL
S'I'REETADDRESS CITY, STATE. Zi?' FAX
7 73, Zri v\1J11 .<I�nflAa CA- J 9 S CD
CON] RA(TOR N A' IME (-ICPI.qsf N BER LENISElYPE
M lei L) 1) C -3 17
CONWINNY NANAE FAX
jkpO 6
S'FRELET ADDFM9 CITY, STATE, ZIP PHONE
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C,
I UNDERSTAND.ANTI) AGREE To TFIE FOLLOWING:
The re -roof project shall comply with all applicable proNripsions of the 2016 California Codes.
2. An inspection req . Uest can be -scheduled up..to one business day before. therequested insj2eenon.,date.
.Fcschedult.in.spctionsea11 408 777-3228 fi-oin7:303SOP—P.`ftn-Thurs)or. 7:30-2:30pn(Friday, ) to
schedule, in.sP: ection. For Tear -Off and Nailing Inspections, you -must, also call on. the day of the.
inspection. only after, that phase of the work is compteted. The building inspector will be out to the
=N NIS one liour. The hours for this service are: 7iX04.0:30.am and 1.2:30-3:30 (Mon-Thurs),
04,0-'30a,m. 'And, 1.2:30-2:30 (Friday). Final Inspections will. be given a two hour window.
3. T6r-Off'Iii, Pecuon.is reguired. Any and all diy-rotted wood shall be replaced prior to this inspection.
uniess, new plyw6&4"Iroof sheathing is proposed throughout, all the nails/fasteners shall be either
Completely.. Knocked: down or 'removed prior to this inspection.
4. If plywobdis installed, q plywood Naffing Inspection is required.
5. Roofing shall not be applied without first obtaining all prior inspection and written approvals from the
building Jnsj)ectdr.'!Any roofing which is applied witbo w fira o Raining an approved inspection will
require. the eqrnoval of all. new material down to the shead p.g. so a proper inspection can be performed.
6. A Final 1.*ns6ecti.6n'...aiid.aLipi7ov.at shall be obtained.Trctnl t1ie:building inspector when the re=roofing is
compl6t'ed'Tor'e''cei-c,,e.afiil8L-IS�ic off. fl-lefollowil-1,-it,,bn-iswil.1-be verifired.
01-
a. Flat roofs shall have a minimum of 114.' .1 per foot of slope and'
demonstrate there is no ponding.
b. Lis ' tings from approved testing agencies for all, pte-manufactured. products used. shall be.
vai
a lable on-site to review at the time of the inspection.
,
c. Proper spark. arrestor installation, vents painted, gutter/downspouts installed. debris removed.
ou call fora. tear -off or plywood nailing inspe -i , rk- no complete, you will. be
7. :TOTE 1fy' �tio'n and the � 7o isnot
C prged'a re- inspection. fee. The re -inspection fee shall.bejjaid before another inspection can be
Bynay I certify each of the following is true: 1,,im.the property owner oTautho'rized agent to act on the
I I I I -
property ��Nm6esl behalf., I Luiderstand and agree to comply tiNith the re -roof policy sMted above. I also understand that
,11 11
si-noke detecgat anbond car. monoxide defectors are required to be: installed in aceardance with Sections R314, and 8315 of
. I ! ;CalifoIrnI V
the 2016 California Residential Code.
sianature of Avbj caht/Aaenf: Date:
ReroolPolicv 2014.ehic revised O&OL'?
•
•
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
CUPERTINO. 10300 TORRE AVENUE• CUPERTINO,CA 95014-3255
(408)777-3228• FAX(408)777-3333• building cupertino.orq
Yb }i s '�r• �.4 s s 4 L `' * g w Y M rr,�a y.Ne y€ -:. 3, rk.S. £ y„
l f S � } �k ' ] �,� - k ae"E ��:. £k�� R �� y 'A �4,�.'' 15 '+.y'� $
¢ �PEBMiT OANI ()` BE .INALED II�TIL THI S CERTiFICA I'E'HAS BEEN
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.; ,,cONiv TEDINTG iY,�A �D +TUR EDiTO TiiFA3i� W DIVISION ' �� �
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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: 1 1773 I Yh (''`f SJ f (v Gf
J f � � � � Permit No. 8_ Za/7 y/7
Specify Number of Alarms: #Smoke Alarms: Leti #Carbon Monoxide Detectors: 1 '.3 I
I have read and agree.to comply with the terms and conditions of this statement
,,/Owner(or Owner Agent's)Name: / �y
k GLS R( h (�' Signature �j tr.,, . . Date: l3 j/Z° /
Contractor Name: ,A /
Signature i 4& .e-f:........ ....(/T!!Yr. Lic.# ../bl 53r Date:
•
•
Smoke and CO form.ddc revised 12/15/16