B-2017-1755 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1755
10881 SANTA TERESA DR CUPERTINO,CA 95014(356 15 005) ALL SEASONS
ROOFING&
WATERPROOFING INC
SAN JOSE,CA 95112
OWNER'S NAME: UPADHYAY AMIT J AND MINALA DATE ISSUED: 10/12/2017
OWNER'S PHONE:408-784-8861 PHONE NO:(408)971-4455
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-39:B Lic.#759091
Contractor ALL SEASONS ROOFING&WATERPROOFING INC Date 02/28/2019 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(5 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
yam"ormance 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. Sq.Ft Floor Area: Valuation:$3905.00
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 356 15 005
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 Cit in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant derstands and will comply with all non-point
source regulatio per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
oftgnatur /Li , , Date 10/12/2017 Issued by:Abby Ayende
� Date: 10/12/2017
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 mat- al being installed.If a roof is
1. I,as owner of the property,or my employees with wages as their sole installed without first obtainin' .n inspeion,I agr-. o remove all new materials for
compensation,will do the work,and the structure is not intended or offered for in•.ection.
sale(Sec.7044,Business&Professions Code) /
2. I,as owner of the property,am exclusively contracting with licensed , i " ature of Applic.
contractors to construct the project(Sec.7044,Business&Professions Cod Date:10/12/2017
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERIN OBE 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 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 become subject to the material. Additionally,should I use equipment or devices which emit hazardous
air contaminants as defined by the Ba , •a Air Quality/agement District I
Worker's Compensation laws of Califomia. If,after making this certificate of will maintain compliance with the perti o Municipa 'de,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety C: e,Sect'ins 25505,2 n 3,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked.
'Owner or authorized ag= t: / e
APPLICANT CERTIFICATION Date:10/12/2017
I certify that I have read this application and state that the above information is I N ; . TION LE I AGENCY
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a constructio tiding 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. I understand my plans shall be used as public records.
Licensed
Signature Date 10/12/2017
Professional
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
51'!9J\
(408) 777-3228 • building@cupertino.org PEMIT#B- OP r 1-1-SS
CUPERTINO REV# DEF#
❑ NEW CONSTRUCTION .❑ADDITION ❑ALTERATION ❑T.I. ❑MEP ❑RE-ROOF ❑SWIMMING POOL/SPA
PROJECT ADDRESS /o Q'(j'1 s� ,� jj SJ%f �s/y (1/f���ttt APN# ' I C OD`
OWNER NAME A _-�L 14 ,,s, ' PHON �D�� /` >3,a/ E-MAIL
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� anDER CLICENSE NUMBER LICENSE
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1STREETAj lit, AveTY S/p• CA 95112-
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0 ARCHITECT 0 OWNER ❑OWNER AGENT 0 CONTRACTOR AIT 0 ENGINEER 0 DEVELOPER 0 TENANT
CONTACT NAME joider
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- STREET ADDRESS U Art- . •'�,I /►SSTTAATE,ZIP A 95112 �'' P i
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DECRIPTON gue00-F 5 sqy de_P
['SINGLE-FAMILY/DUPLEX ['MULTI-FAMILY 0 INDUSTRIAL 0 COMMERCIAL
EXISTING USE EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES# TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION($)
REMODEL REMODEL KITCHEN REMODEL OTHR GARAGE 0 ATTACHED /�,f�o�
BATHROOM SF SF SF SF 0 DETACHED L1
FIRE
EXISISPRINKLERS 0 NG 0 ESO EICHLER 0 0 YES
O SECOND STORY ADDITION ❑❑O
DWELLING SECOND DWELLING 0 YES 0 ATTACHED DETACHED OTHER
UNITS# UNIT ADDITON: ❑,NO S F
POOLS( 0 FIBERGLASS 0 VINYL-LINED 0 GUNITE 0 PREFABRICATED
POOL-SF SPA-SF I SPA ATTACHED❑YES 0 NO TOTAL-SF
RECEIVED BY: � P� TOL T VALU TION:
Commercial or Multi-Family Buildings with Public Swimming Pools requires Department of Environmental Heath approval l/`�V� (/,�/a /'�
RE-ROOF EXISTING ROOF TYPE: I=1 BUILT-UP ROOF❑ASPHALT SHINGLES❑WOOD SHAKES 0 WOOD SHINGLES TILE OTHER(SPECIFY) UUU til lJ
REMOVE/REPLACENO 1 IF NO PLYWOOD ❑'� ❑3/8" PLYWOOD TYPE: PITCH: ROOF CLASS
y #OF LAYERS THICKNESS 1:1 5/8" OTHER ECM I=1 CDX OTHER :12 A
PROPOSED ROOF TYP :❑BUILT-UP ROOF DASPHALT SHINGLES 0 WOOD SHAKES❑WOOD SHINGLES 0 OTHER
*Provide a signed copy of 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 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 construction. I authorize representatives of Cupertino to •
enter the above-identified property for inspection purposes. I acknowledge and authorize all information contai ed on this application form
to be made availablefor public re1zz2• 1V
Signature of Applicant/Agent: (( �/litigilanhly Date: V !.
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 Planning 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
BldgApp_2017.doc revised 08/01/17
•
yft. REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT 6 BUILDING DIVISION
ALBERT SALVADOR, P.E.,C.B_O.,BUILDING OFFICIAL
CUPERTINO I pa)TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228• FAX(408)777-3333•building@cupertino.orct
PROJECT ADDRESS og& 51
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OWNER NAME tAPHONE E-MAIL mo- . \ vi- --:2
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I UNDERSTAND AND AGREE TO,THE FOLLOWING:
I. 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 requeited inspection date.
To schedule inspections call (408) 777-3228 from 7:30130Pirt( on-Thur ) or 7:30-2:30pm(Friday) to
• schedule inspection. For Tear-Off and Nailing Inspections,you must also call on the day of the
inspeetion 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: 730-10:30am 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 priorinspection 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 obtairted:froni tbe:builcling inspector when the re-roofing is
• completed. To receive a final.Sign-off,the following iterris will be:verified:
a. Flat roofs shall have a minimum of'A"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 te-inspection fee shall be paid before another inspection can be •
scheduled.
O By lily signing below,I certify each of the following is Ice: I am the property owner or authorized agent to act on the
property owner's behalf. I understand and agre%o corns y with the re-roof policy stated above. I also understand that
smoke detectors and carbon mon. id• detecttri are rec/aired to be installed in accordance with Sections R314 and R.3.1 5 of
the 2016 California Residential 'odc. /
'Ianateire Applicant/Agent: 'Date;
•
Air -
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RerogtPoliey._2014,doc revised 0610117
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION
BSi'EFl€` N� 10300 TORRE AVENUE o CUPERTINO,CA 95014-3255
(408)777-3228^FAX(408)777-3333°buildinqacutDertino.orq
P..._ I _CNNfJ ..P ' N :,EP: TIL:TS°CE2TICAT .: I :.OEES
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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,R315,2016 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,R315, 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 X X
bedroom(s)-(Smoke alarms shall not be located within 3 feet of bathroom door)
On every level of a dwelling unit including basements and habitable attics 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 \Q ` S a le,es., 1t ° Cc.�r��t Permit No, / / 70,-(
Specify Number of Alarms
#Smoke Alarms .6.-' #Carbon Monoxide Detectors. "
I have read and agree to comply with the terms and conditions of this statement
Owner(or Owner Agent's)Name:
Signature ' !�...�� .... .. Date:. L L..
Contractor Name:
Signature . .. ... Lic.# Date: .
Smoke and COform.doc revised 01/10/2017