B-2016-2447 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2447
979 NOVEMBER DR CUPERTINO,CA 95014-4120(362 13 047) WILLIAMS-TYLER
INC
SAN JOSE,CA 95118
OWNER'S NAME: KAREN DINGER DATE ISSUED:08/02/2016
OWNER'S PHONE:408-306-8669 PHONE NO:(408)277-0800
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class GENERAL BUILDING CONTRACTOR Lic.#501852 X BLDG _ELECT _PLUMB
Contractor WILLIAMS-TYLER INC Date 10/31/2016 —
_
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:
RE-ROOF;TEAR OFF;INSTALL OSB;COMP ROOF SYSTEM(22
I hereby affirm under penalty of perjury one of the following two declarations: SQ'S)
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.
tpz % 1 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:$9750.00
APPLICANT CERTIFICATION
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 36213047
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 ap I'cant underst �s and;will comply with all n n-point
source regulati rr p r ti Cup mo rticlpal Code,Section 9.1°8, 180 DAYS FROM LAS LED INSPECTION.
` Gy
Signat .� � '" Date 08/02/2016 Issued by:MELISSAN
Date:08/02/2016
OWNER-BUILDER DECLARATION
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 •or 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 firstob
ta�nin ani pecti a -remove all new materials for
compensation,will do the work,and the structure is not intended or offered for d ecti
sale(Sec.7044,Business&Professions Code) l
z. I,as owner of the property,am exclusively contracting with licensed Signature of A pho
contractors to construct the project(Sec.7044,Business&Professions Code). Date:08/02/206
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
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 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.
Health&Safety Code,Section 25532(a)should I store or handle hazardous
a. I certify that in the performance of the work for which this permit is issued,I
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 Cupe o Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,S 't?ns M5,25 33 d 25534..
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized a ent ,�/
APPLICANT CERTIFICATION Date:08/02/2016
I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY
correct.I agree to comply with all 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
I understand my plans shall be used as public records.
Code,Section 9.18.
Licensed
Signature Date 08/02/2016 Professional
..................._._.____-______
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION
10300 TORRE AVENUE CUPERTINO,CA 95014-3255
� , (408)777-3228-FAX(408)777-3333-buildingCa)cupertinoTINO .org
CUPE2v4-
PROJECT ADDRESS APN# 3 c Z r / v
OWNER NAME Ktv f PHONE j0r -30(c 9 EMAIL
STREET ADDRESS q7 y i 6 CITY,STA[TE�,ZIP �_A B- f FAX If
CONTACT NAME L t �c3 W L PHO �^7 !i M7 I . 1 b�✓ `��✓G�„—
STREET ADDRESS CITY�STa?TE,ZIPS}}�_ , ( �9(Vl ��✓ FAX J
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR S❑CONTRACTORt , �( "AGENT (•�❑l ARCHITECT p❑ENGINEER. ❑ DEVELOPER -❑TENANT
CONTRACTOR NAME, / � �, g LICENSE NUMBER LICENSE T 3 BUS.LIC.#
COMPANY NAME SFU f<Y�'f J "(-e4L h E-MAIL / FAX
STREET
. SS1drJ. C CITYr$TA�TE'.8 vJeC4 q- d v/ P€,; {j t,+� d.D
ARCHITECT/ENGINEER NAME LICENSE .NUMBER BUS.LIC.#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF SFDorDupleX ❑ Multi-Family ROOFAREA: VALU TION:
7�U
STRUCTURE: Commercial
El
EXISTING ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES AWOOD SHAKES ❑WOOD SHINGLES OTHER(SPECIFY)
REMOVE/REPLACE 5irYES IF NO, PLYWOOD jkw, ❑ PLYWD OSB PITCH: ROOF
El No #LAYERS: THICKNESS: El5/8" TYPE: ElCOX 5'12 CLASS: A
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT#
DESCRIPTION OF WORK:
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 In cog onstruction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Age ^a Date: iJ�
SUPPLEMENTAL INFORMATION REQUIRED
,.OFF'TCE USE ONLY
PLA "
If building is associated with a Home Owner's Association,provide letter NCHECKTYPE. `xflu�irlG SLIP ,,. ;
of approval from HOA. D civEx-Tim COI7NT Ek CL:sull.DiNGFLAN1 viEw.
r ,
Provide Planning approval to verify if there any restrictions. Q EXEi2Ess' ❑,PLANNING PLAN>tru> fv"
Provide copy of Manufacturer's Installation Specifications. ''�sTAN >IRE DriPT
Provide signed copy of Cupertino's Tear-Off Policy.
ReroofApp_2011.doc revised 03116111
{e
ILEREROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
ALBERT SALVADOR,P.E.,C.B.O., BUILDING OFFICIAL
+ UPEEYTN.# 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228-FAX(408)777-3333•buildina(&cupertino.org.
p
PROJECT ADDRESS ! /°`/6 f/° P"� {!�+ '`a0. APN# �j f - Q /�—
(/(,�Vtjj� PV'1
OWNER NAME P O 1c) EMAIL
STREET ADDRESS/ fJ J ` d � CIT ,STATE,ZIP FAX
Is d6dq' g 46 ,r .. k t
CONTRACTORNAME LICENSE NUMBER y( LICENSEEE BUS.LIC.#
COMPANY NAME �ll�"�{� ��� /
J'T" r' �'L.�il ,9 EMAIL FAX
STREET ADDRESS g CIT YTQTE,ZIP j �� PHONE_ 2-_,;; 7 Q�
I UNDERSTAND AND AGREE TO THE FOLLOWING: d
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-Th-urs) 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 InssRection 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
sinoke detectors and carFt: 7;;;=
ed to be installed in accordance with Sections R314 and 8315 of
the 2013 California Res
Signature of Applicant/AgDate:
ReroofPolicy_2014.doe revised 01/15/14
SMOKI MONOXIDE ALAS
1 Q1 0 CIERTIMCAMOVOOMPUANM F i,LL-Z-1
eR 'M•,fink 9501 4.126
(408)777-3226-,F 771-1333
5
7
,, "Me 's'.
-+•aAs
04 Aanit b- seff-Mtific .tion for to i tanation of&I,reqed Stoke and ObanMonoxid
e Alums
for
d CS- tion 8314, l CRC mg-47-0.6 w-i -7
required. .21,1-2 he e no mteripT atcesq
d e t i provided i Smoked
MOO" ams. WhCat
€ � ,cry ei d
. 'f SK�4 and CDC . Md 420.6 rue,fat Smoke,alarms and1
or
MIMI Of llar � in
� cr�
cow
��ae septarm in, e ate
x
ear eP Owe,
ms . c
smake
Offi&Sfatehre
4F,h�eMV9 WM to,' s` �,a1a ireal-
SOWel
. ' �_rnwfil* � e� �operae cap e
b Must
inst
a&d int a eWA
r� ims axid. eampfigaze
and Ca asd esiden a= C s. mebten tested and are A stRe
lt .
w
Iftmea and
ma,Of this amim,an ti
WATER-CONSERVING PLUMBING FIXTURES F11 .
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT o BUILDING DIVISION
CUPERTI 10300 TORRE AVENUE CUPERTINO,CA 95014-325
(4 7, 3 8 FAX(408)777-3333 o b_uiidingftuaertino.org _
Owner Name;1 Permit No b 7 61� zy
Address d
1. Is your real property a registered historical site?
s 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 2.
2. Does your real property have a licensed plumber certifying that,due to the age or configuration of the property or its
plumbing,installation of water-conserving plumbing fixtures is not technically feasible?
Q Yes 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.
No Go to Question 3.
3. Is water service permanently disconnected for your building?
❑ _. 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 Jan zary'l, 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. se check ONE of the following:
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 properly undergoes alterations::or
improvements). .
❑ Mypropertyis a commercial real property. See Civil Code Section 1.10.1.5.
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-cornpliant 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 followin p age. 1 ,
Owner or Owner Agent's Signature, /' pate: j JOWIK
Upon completing,and signing this Cei rcate,please retum it to the Building Division in order to final your building permit.,
SB407 2015.doc revised 08/26/15