B-2016-2267 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2267
20641 SUNRISE DR CUPERTINO,CA 95014-2928(359 10 022) A L RESIDENTIAL&
COMMERCIAL
ROOFING
SAN JOSE,CA 95110
OWNER'S NAME: TEO DESIREE H ET AL DATE ISSUED:07/05/2016
OWNER'S PHONE:408-373-8943 PHONE NO:(408)729-6100
LICENSED CONTRACTOR' DECLARATION BUILDING PERMIT INFO:
License Class C-39 Lic.#792347
Contractor L RESIDENTIAL&COMMERCIAL ROOFING Date 03/31/2017 X BLDG —ELECT _PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing MECH X RESIDENTIAL_,.COMMERCIAL
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;INSTALL OSB;INSTALL COMP SHIN LES(24 SQ'S)
I hereby affirm under penalty of perjury one of the following two declarations:
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.
z. 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:$10000.00
APPLICANT CERTIFICATION
1 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 3591002 2
representatives of this city to enter upon the above mentioned property for
inspection purposes. (We)agree to save indemnify and keep harmless the i
City of Cupertino against liabilities,judgments,costs,and expenses whichi 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 regulptions per the Cupertin Municipal Cod,,,Section 9.18. 1 180 DAYS FROM LAST CALLED 114SPECTION.
I
Signature E Date 7/5/2016 Issued by:Abby A ey nde
0 CI Date:07105/2016
OWNER-BUILDER DECLARATION j
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 be' g 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 rem ve all new materials for
inspec6o
compensation,will do the work,and the structure is not intended or offeredfor i
sale(Sec,7044,Business&Professions Code)
z. I,as owner of the property,am exclusively contracting with licensed t Signature of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code): Date:7/5/2016
I hereby affirms under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"' R 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 DIS LO URE
z. 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 whicII this. California Health&Safety Code,Sections 25505,255 3,and 25534. I will
maintain compliance with the Cupertino Municipal Cod ,Chapter 9,12 and the
permit is issued.
Health&Safety Code,Section 25532(5)should I store handle hazardous
s. I certify that in the performance of the work for which this permit is issued,I
I material. Additionally,should I use equipment or device which emit hazardous
shall not employ any person in any manner so as to become subject to the f air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California. If,after making this certificatlfIe,,of will maintain compliance with the Cupertino Municipal ode,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Coae, etons 25505,255 ,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:7/ 201
(
certify that I have read this application and state that the above information i N TR ON LENDING
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending age cy for the performance
of work's for which this permit is issued(Sec.3097,Ci
relating to building construction,and hereby authorize representatives of this city 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, 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 ARCHITECT'S DE L RATI
and will comply with all non-point,source regulations per the Cupertino Municipal I understand my plans shall be used as public records.
Code,Section 9.18.
Licensed
Signature Date 7/5/2016 Professional
a '
. l
1
REROOF PERMIT APPLICATION
1+
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE-CUPERTINO,CA 95014-3255
I
(408)777-3228 FAX(408)777-3333•building(dcupertino.org �y
PROJECT ADDRESS o1 ✓ �t a a J p APN#7
OWNER NAME E_( °zv r P g�yN_E�t4! 0 ,373— E-MAIL
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STREET ZADDRESS! � � CITY,STATEFAX
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CONTACT AMEPH
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STREET ADDRESS CITY STATE,ZIP FAX n
❑OWNER ❑ owNER-BUIIAER ❑ OWNER.AGENT ` CONTRACTOR ❑CONTRACTOR AGENT E ARCHITECT ❑ENGINEER ❑ DEVELOP M ❑ TENANT
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CONTRACTORNAME LICENSE NUMBER LICENSE TYPE BUS.LIC.,#
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COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC.#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑ SFT)or Duplex ❑ Multi-Family ROOF
}AARE,tA: VALUATION:
STRUCTURE: EICommercial ✓` Ld 1 e r
EXISTING ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES q<WOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY)
REMOVE/REPLACE JER23'4ES IF NO, PLYWOOD ❑ '/:" ❑ PLYWD PVOSB PITCH: s ROOF
❑NO #LAYERS: THICKNESS: ❑ 5/8" TYPE: ❑ CDX 12 CLASS
A
ICC-E REPORT#
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES 6WOOD SHAKES ❑WOOD SHINGLES ❑OTHER
DESCRIPTIO OF RK:
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30
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 re ad 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 rely, to building construction. I authorize representatives of Cupertino to enter the above dent fie property for inspecrio purposes.
Signature of Applicant/Agent: Date: I a
1
' r, OFFICl ON
SUPPLEMENLY
TAL F AT N REQUIRED USE
If building is associated with a Home Owner's Association,provide letter PLANCrTECxTleE* RotiTirr SLIP
of approval from HOA. ❑-ovL�rHE CornviR ❑ BUILDrniGrANE �s
Provide Planning approval to verify if there any restrictions. ❑ Pt ANNINGPL zzPvw
_
Provide copy of Manufactures s Instal Specifications. ❑' s rm a � ❑ y > _PT.,
Provide signed copy of Cupertino's Tear-Off Policy. ❑ oFla R
ReroofApp_2011.doc r wised 03116111
1
1 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
CUPERTI it
(408)777-3228•FAX(408)777-3333=building
(a�cupertino.org
PROJECT ADDRESS ` y r` j1 7APN
OWNER NAME ( 1 t cv-, PHONE E-MAIL
STREET ADDRESS CITY, STATE,ZIP FAX
CONTRACTOR NA) ¢ CENS�EPE BUS.LIC.#
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COMPANYNAME 1 C� E MAIL `L J FAX
a0421 A C, ,0)
STREET ADDRESS - gS CITY,STATE, PHONE
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 re uested ins a tion 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: 7:30-1030am and 12:30-3:30 (M n-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 thiE 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 inspect on 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 1/"per foot of slope and demonstrate there is no ponding.
b. Listings from approved testing agencies for all pre-manufactured products used shal 1 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 ins ection 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 mon ox d,e detectors are re fired to b installed in accordance with Sections 8314 and R315 of
the 2013 California Residential Code., ..Z
Signature of Applicant/Agent: Date. L
ReroofPolicy_2014.doc r wised 01115114
F t
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION
CUPERTtNO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 1
(408)777-3228 FAX(408)777-3333 building
(a)cupertino.org
Permit No.
Address o�-�61f- S tt m Y c 5-c_' Old (9P�Y t7 #of Alarms Smoke ` Carbon Monoxide:
P,E�T CANNOT BE'FINALED Al'�D COMPLETED i�TIL°THIS,�ERTIETCATE �, �
s, I;
...ui wer..want+
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. I
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 the X X
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 have been tested and are operational, as of the date signed
below.
1 have read and agree to comply with the terms and conditions of this statement
Owner(or Owner Agent's)Name:
LlehCh Si nature........... .. ...Date:
Contractor Name:
t; ►""e,5 Si nature......... ic:#......................................Date:
Smoke and CO form.doc revised 03118114