B-2017-1910 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1910
1124 DERBYSHIRE DR CUPERTINO,CA 95014-5072(362 21 034) WESTSHORE
ROOFING INC
SAN JOSE,CA 95131
OWNER'S NAME: YEH CHESTER AND LEE REGINA TRUSTEE DATE ISSUED: 11/06/2017
OWNER'S PHONE:408-219-8018 PHONE NO:(408)456-0200
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-39 Lic.#787221
Contractor WESTSHORE ROOFING INC Date 11/30/2018 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:
RE-ROOF;TEAR-OFF;INSTALL OSB;COMP SHINGLES-(30 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
J( performance of the work for which this permit is issued.
1�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. Sq.Ft Floor Area: Valuation:$20673.00
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 362 21 034
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 regulaf• s per the C ertino MuniciCode,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
L�
Signature , , ate 11/6/2017 Issued by:Jasmine Archbold
Date: 11/06/2017
OWNER-BUILD 31' DECLRATION
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 material being installed.If a roof is
1. I,as owner of the property,or 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 in section.
sale(Sec.7044,Business&Professions Code)
2. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant: lic,_2,,S.' strarD--
contractors to construct the project(Sec.7044,Business&Professions Code). Date:11/6/2017 I
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 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
3. I certify that in the performance of the work for which this permit is issued,1 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 Bay Area Air Quality Management District I
Worker'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 C.de,Sections 2 505,2553 nd 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent: £' '^
APPLICANT CERTIFICATION Date:11/6/2017
I certify that I have read this application and state that the above information is CONSTRU s ON LE 'DING AGENCY
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a co struction ending 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 11/6/2017 Professional
/� CONSTRUCTION PERMIT APPLICATION
\��� COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
(®.�` 10300 TORRE AVENUE • CUPERTINO,CA 95014-3255
40yt.iyJj
(408)777-3228 • building@cupertino.org PEWIT#B-2-0 I -< t b
CUPERTINO REV# DEF#
El NEW CONSTRUCTION ❑ADDITION ❑ALTERATION ❑T.I. 0 MEP ❑RE-ROOF 0 SWIMMING POOL/SPA�
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CONTRACTOR NAME ❑O R-BUILDER COMPANY NAME r LICENSE NUMBER LICENSE TYPE
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0 ARCHITECT 0 OWNER ❑O ER A ;NT i"CONTRACTOR AGENT 0 ENGINEER 0 DEVELOPER 0 TENANT '
CONTACT NAME -....-..,5 I A . E-MAIL
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week 5 #8e- . 1/ ,-r/1 9r40, 476- 14.e
WI OLE-FAMILY/DUPLEX 0 MULTI-FAMILY ❑INDUSTRIAL 0 COMMERCIAL
E STING USE EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES It TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION($)
REMODEL MODEL KITCHE REMODEL OTFI�-I GARAGE ED fa A
BATHROOMS SF MODEL
SF ❑DETACHED 1!/ C/ �D/ `/J 7�
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FIRE SPRINKLE NO EICHLER NO SECOND PI70 ❑NO
DWELLING 1 SECOND DWELLING ' s ❑ATTACHED❑D ACHED 1 OTHER---"
UNITS I UNIT ADDIT 0 NO S F 1?
POOLS' ❑FIBERGLASS ❑VINYL-LINED [J GUNITE CUZEFABRICATED
POOL-SF SPA- SPA ATTACHED YES ❑NO I TOTAL-SF ' I
RE'!•EIVEDBY: 1 TOTAL VALUATION:
Commercia or Multi-Family Buildings with Public Swimming Pools requires Department of Environmental Heath approval ` ' _00,
—01 Zp `_
RE-ROOFI EXISTING ROOF TYPE: 0 BUILT-UP ROOF O''ASPHALT SHINGLES❑WOOD SHAKES❑WOOD SHINGLES 0 TILE OTHER(SPECIFY) ,O 1
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REMOVE/REPLACE❑NO IF NO PLYWOOD ,h.. ❑3/B" PL OOD TYPE: PITCH: ROOF CLASS
11 yEs I I OF LAYERS THICKNESS 5B" OTHER OSB 0 CDX OTHER •121 A
PROPOSED ROOF T ❑BUILT-UP ROOF SPHALT SHINGLES CI WOOD SHAKES❑WOOHINGLES 0 OTHER
*Provide a signed copy of the Cupertino's Tear-Off Policy SF 3000#of SQUARES '0
By my signature below I certify to each of the following: I am the property owner or authorized agent to ad 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 in ion purposes. I acknowledge and authorize all information c ntaine on this application form
to be made available for public record. �/
Signature of Applicant/Agent: ^ Date:
SUPPLEMENTAL INFORMATION REQUIRED
*New SED/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
, . 1
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
4, � ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
CUPERTINO 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(408)777-3228• FAX(408)777-3333• buildinq( cuDertino.orq _2 t "1,... (9 ID
PROJECT ADDRESS i 2 -1 .2 k bis H I R -' APN#
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OWNER NAME t5- l L y R )t PHONE .)JOg✓ 2) E-MAIL
STREET ADDRESS CI STATE,,-IP FAX
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CONTRACTOR NAME Q o Lv (l• v Li2 I R39 LICENSE Te...3 BUS.LIC. SIJ# J
COMPANY NAME W 4_htre -r: E-MAI 4'I• FAX
STREET ADDRESS .2 ^` 1,QrT U^1P:Dt_ CITY,STATE,ZIPS N �Q i 2 PHONE*g.-Lis-6 :C4►�'^yry�®
c 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 7:30-2:30pm (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 out to the
job site within one hour. The hours for this service are: 7:30-10:30am and 12:30-3:30 (Mon-Thurs)
and 7:30-10:30am 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'/"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 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 monoxide de -ctors are required to be installed in accordance with Sections R314 and R315 of
the 2016 California Residential Code.
Signature of Applicant/Agent: '* �, Date: 1 0 6 17
ReroofPolicy 2014.doc revised 06/01/7
SMOKE.!- CARBON MONOXIDE ALARMS
OWNER CERTIFICATE- OF COMPLIANCE
commUNiTY DEVELOPMENT DEPARTMENT-BUILDING DIVISION
cuPERTINo 10300 TORRE AVENUE i CUPERTINO,CA,95014-3255.
(408)77743228•FAX LAM)777-3333 buildingai).euuertino.er,Q
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PIF-NPOSE
This affidavit is a self-cerfificatiOn for the insta-Qation of 011 re_quired Smoke and Carbon Mono3dde 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 roniti-fa4,..---nlly clwellirw shallbe provided with Smoke Alarms and Carbon
Monoxide alarms. Vliben the valnation of a_dditions,alterations,or repairs to existing,dwelling units exceeds-
$1000.00,CRC.Section R31-4,R3151.and CBC Se.ofiona 907.2.11,5 and 420.6 require that Smoke Alarms a.ncljor
Carbon Monoxide Alarms be Installed in the following locations:
AREASMOXE ALARM CO ALARM I
Outside-of each separate sleeping area Lathe immediate vicinity of The e X X
bedroom(s)-(Smoke alarms shall not he located within 3 feet of bathroom door)
On evQ level of a clwellin?unit mcindm balgT1S,anj lxibitareattics X X
Within each sle- in: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 theState Fire,ivlarshal.
Power Supply:In chlling units Witti nO CunMiercial power supply,alarm(s)may be solely battery operated.
In existing dwelling-units,alarms are permitted tobe Solely battery operated where repalig or alterations do
not result in the removal of wall and ceiling finishes:or there is no access by means of atfic,,basement or crawl
space.Refer to CRC-Section R314 and CBC Sectors 907.211:4 and 420.6-.2-_An electrical permitis required for
alarms which must be connected lathe building wiring.
As owner of the above-referenced property,Iltereby certify that the alarm(s)refuence.d ebove hasfhave been
inqWIIPri in accordance with the mextufactarer's instaraciions and in compliance with the California Building
and California Residential Codes.Me alarms spedfiedberow have been-tested and are operational,as of the
date signed below
fry.0-1-` PermitNa. I °
Address: ft
Specify Number Alarms: #Smoke Alans.: j #.CarbcaMonox-ideDctcctors-: ta-=
1 have read and agree fa comply wiliz The terms arid condition of 1bie ataternept
Owner(or Owner Agent's)Nam
d// /Z i/VX7
Signature, / 113
- Contractor Name:
Signature- Date: ........ .
.
Sake(aid COlorizi.doe revised 0117012017