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B-2016-1761CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-1761 20544 BLOSSOM IN CUPERTINO, CA 95014.4304 (359 18 027) MILLER'S ROOFING SAN JOSE, CA 95124 OWNER'S NAME: BROWN JAMES L DATE ISSUED: 04/14/2016 OWNER'S PHONE: 660-623-9346 PHONE NO: (408) 356-6211 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class ROOFING Lic, #885018 Contractor MILLER'S ROOFING Date 09/30/2016 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: TEAR OFF WOOD SHAKE, INSTALL OSB, CLASS AROOF SYSTEM I hereby affirm under penalty of perjury one of the following two declarations: (11 SQ'S) i. 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. T have and will maintain Worker's Compensation Insurance, as provided for by /} M Section 3700 of the Labor Code, for the performance of the work for which this Sq. Ft Floor Area: Valuation: $4500.00 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 APN Number: Occupancy Type: and state laws relating to building construction, and hereby authorize 359 18 027 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 Cupertino Municipal Code, Section 9.18. 180 DAYS FROM LAST TSPECTION. �the Signature'/ c�C Date 04/14/2016 Issued Date: 04/14/2016 OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the RE - following two reasons: All roofs shall be inspected prior to any roofing material being installed. If a roof is i. 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 inspection. sale (Sec.7044, Business & Professions Code)----� 2. I, as owner of the property, am exclusively contracting with licensed Signature of Applicant %// contractors to construct the project (Sec.7044, Business & Professions Code). Date: 04/14/2016 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER i. 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 maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the permit is issued. s. I certify that in the performance of the work for which this permit is issued, I Health & Safety Code, Section 25532(x) 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 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 Code, Sections 25505, 25533, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall --" be deemed revoked. Owner or authorized agent:' APPLICANT CERTIFICATION Date: 04/14/2016 CONSTRUCTION LENDING AGENCY I certify that) have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance correct. I agree to comply with all city and county ordinances and state laws of work's for which this permitlis issued (Sec. 3097, Civ C.) relating to building construction, and hereby authorize representatives of this city 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, Lender's Address judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands I DECLARATION and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. ARCHITECT'S I understand myplans shall be' used as public records. Licensed Signature Date 04/14/2016 Professional REROOF PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 FAX (408) 777-3333 • _building 5-)cugertino.orq *7 /7 1 L , 17:7-,/- 1 PROJECT ADDRES�j(111 Simon Loae, PNS®ej S q l g D Z ` OWNER NAME �� J 9W PHO NEtl E-NLSIL STREET ADDRESS p � Dov �a ( CITY, STATE, ZIP FAX CONTACT NAME j� [ (2 E-MAIL PHONE t1� qu STREET ADDRESS CITY, STATE, ZIP FAX ❑ Oti']R ❑ OWNER -BUILDER ❑ 0\VNTERAGEN"T CONTRACTOR CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGA*EER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME � n n P LICENSE NUMBER � tS o i 1✓ I U J�-j LICENSE TY PE O BUS. LIC. R 3 3 0 3 2_._ COMPANYNTAME�}A �i � Gf � E _MAIL. FAX " STREET ADDRESCJI�sv CITY, STATE, ZIP V cLE ARCHITECT/ENGINEERNAME LIC ENSENU MER BUS. LIC: COMPANY NAE E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF [�( SFD Or Duplex El Multi -Family ROOF AREA VALUATION: - EXISTING ROOF TYPE: ❑ BUILT -LIP ROOF ❑ ASPHALT SHINGLES - WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER (SPECIFY) REMOVE /REPLACE 4 YES IF NO, I PLYWOOD ❑ w, ❑ PLYWD WOSE PITCH ROOF ❑ NO -LAYERS: Jn'TI-IICICNESS: ❑ 5/8" TYPE: ❑ CDX IZ CLASS: A PROPOSED ROOF TYPE: ❑ BUILT-UP ROOF ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER ICC -ES REPORT 1 DESCRIPTION OF WORK 7 OsBan ItIA011IX, = Corno An ,5 )` A/ By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property mvner'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-idelitified pro rty for inspection purposes. Signature of Applicant/Agent: Date: Z41 , SUPPLEMENTAL INFORMATION REQUIRED If building is associated with a Home Ou ner's Association, provide letter � OS'ERTHE-CO�I3'�TER m "❑ B'[JILDIIyGP.LAD,REVIEW'-" of approval from HOA. — Provide Planning approval to verify if there any restrictions. _. � r 5 T - EXPRESS fl P34TiN�GPLANRESiEV _ Provide copy of Manufacturer's Installation Specifications. sTAnDARD Y F7RFDEPT .v z .: _ Provide signed copy of Cupertino's Tear -Off Policy. _ ❑ o�xER Reroof-4pp_2011.doc revised 03/16/11 CUPERTINO REROOF TEAR -OFF POLICY COMMUNITY DEVELOPMENT -DEPARTMENT • BUILDING DIVISION ALBERT SALVADOR,_ P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 FAX (408) 777-3333 • buildingcDcuoertino.orQ V7 Z0 ( (. I _�_6 PROJECT ADDRESS APN n OMNIER NAME PHON E-MAIL STREErADDRESS CITY, STATE, ZIP FAX CONTRACTOR NAME A LICENSE N IMBER fj LICEivSE TYPEA!� BUS. LIC. n COMPANY NAMEIEJ4 4 f v � S v y _ Ad't r E-h1.41L a FAX FrREFTADDRESS� � tM � tff' CITY, STATE, ZIP �� p p I UNDERSTAND AND AGREE TO THE FOLLOWING: 1. The re -roof project shall comply with all applicable provisions of the 2013 California Codes. 2. An inspection request can be scheduled up to one business day before the requested inspection date. Please schedule inspections online or 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 available 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. S. 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 V4" 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 are -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 detectors are required to be installed in accordance with Sections R314 and R31 the 2013 California Residential Code. of Applicant/: Date: I ReroofPo1icy_2014.doc revised 01115114 FF -I -L 7!� SMOKE / CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE S�,T COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION CIJPIERTINO 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 - FAX (408) 777-3333 - building(-cupertino.org 0, 176f PURPOSE This affidavit is a self -certification for the installation of all required Smoke and Carbon Monoxide Alarms for compliance with 2013 CRC Section R314,2013 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, 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 1110 access by means of attic, hasement or crawl space.. Refer to CRC Section R314 and CBCSections 907.2.11.4 and 420.6.2. An electrical permit is required for alarms whicla must be connected to the building wiring. 0' As owner cf the above -referenced property, 1, hereby certify that the alarm(s) referenced above has/have been, in -stalled in accordance with the marmf actuarer's, instructions and in compliance with the California. Building and California Residential Codes. The allarm s, have been tested a -lid areoperational, as of the date signed b elo1w. CUPERTINO Owner Nari e •, Gt WATER -CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3A8 • FAX (408) 777-3333 building a(icupertino,org 0 -17691 Is your real property a registered historical site? ❑R Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. r_ No Go to Question 2. 2. Does your real property have a licensed plumber certifying that, due to the age or configuration of the property or its lu bing, installation of water -conserving plumbing fixtures is not technically feasible? s Civil Code Sections 1101.1 through 1101.8 do not apply. ❑ The licensed plumber's certification has been provided to the Building Division. Skip the rest of the form and sign bottom of form. X_ -No Go to Question 3. 3. Is water service permanently disconnected for your building? W 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. 4. Is your real property built and available for use or occupancy on or before January 1, 1994? ❑ 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. 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.. 5. Please check ONE of the following: ,4<'My property is a single-family residential real property. See Civil Code Section 1101.4. On and after January 1, 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). ❑ My property is a commercial 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). 1, as the owner or owner's agent of this property, certify under penalty of perjury that non-compliant plumbing fixtures will be replaced prior to date specified above with water -conserving 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 -conserving plumbing fixtures comply with the requirements as indicated in the table on the following page. _.0 e2 Owner or Owner Agent's Signature::�VVgA 08 0(, 9!%2rrn._ Date: -1 No/ t Upon cora letine and sianina this Ce ificate, please return it to the Building Division in order to final your building permit. SB4072015.doc revised 08/26/15