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B-2017-1309CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-1309 1121 STAFFORD DR CUPERTINO, CA 950144911 (362 06 011) EXECUTIVE ROOFING SAN JOSE, CA 95139 OWNER'S NAME: HSU CHIEH-YIN TRUSTEE OWNER'S PHONE: 408-255-0966 LICENSED CONTRACTOR'S DECLARATION License Class C-29 Lic. #595001 Contractor EXECUTIVE ROOFING Date 01/31/2019 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. I hereby affirm under penalty of perjury one of the following two declarations: 1. I have nand 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 erformance of the work for which this permit is issued. have and will maintain Worker's Compensation Insurance, as provided for by t/, Section 3700 of the Labor Code, for the performance of the work for which this (}/ permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct.] agree to comply with all city and county ordinances and state laws ;relating to building construction, and hereby authorize 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 may accrue against said City in consequence of the granting of this permit. Additionally, the apoicant understands and will comply with all non -point source regulationslqerth'e Cupertino Municipal Code, Section 9.18. Date 8/9/2017 OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1. I, as; owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) 2. I, as owner of ihe'property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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 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. 3. I certify that in theperformance 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 Worker's Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. ' APPL.ICANT CERTIFICATION I certify that I have read this application and state that the above information is correct.,) agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (V11e) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence; of the granting of this permit. Additionally, the applicant understands and will comply' -with all non -point source regulations per the Cupertino Municipal Code, Section 9:18. Signature Date 819/2017 DATE ISSUED: 08/09/2017 PHONE NO: (408) 386-6104 PERMIT INFO: BLDG —ELECT _ PLUMB , MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: RE -ROOF; TEAR OFF; INSTALL OSB; COMP SHINGLES - (26 SQ) Sq. Ft Floor Area: I Valuation: $11686.00 APN Number: Occupancy Type: 362 06 011 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Jasmine Archbold Date: 08/09/2017 RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without fust obtaining an inspection, I agree to remove all new materials for ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code; Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or deviceswhich emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and th ealth & Safety Code, Sections 5505, 25533, and 25534. authorized agent: .8/9/2017 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional REROOF PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, 'CA 95014-3255 CUFiERTINO (408) 777-3228 • FAX (408) 777-3333 • building Cftuaertino.org �- PROJECT ADDRESS ) 17 j rr 5-1,;L � P, --A �(I I r APN A ,QE v OWNER NAME � b- fu +5V PHONEVOGi �' O / / (O ( OIIJ -MAIL STREET ADDRESS e n '1 Z rlB% /�_ ''J CITY, STATE, ZIP A� FAX CONTACT NAME % JI PHONE goyc• ?d/„ &/0 t _J E.MAI �C• �f (1 Q� Y� l! cU STREET ADDRESS /ir. `�It/IOWNER CITY, STATE. ZIP �33_ N p�l FAX . ❑ OWNER 11OWNER-BUILDER/I AGENT [�%CONTRACTOR ClCONTRACTOR AGENT 11 ARCHITECT ❑ ENGINEER ❑• DEVELOPER 10 TENANT CONTRACTOR NAME LICENSE NUMBER 59Soa / LICENSE TYP X351' BUS. LIC: l: S�- COMPANY NAME,5�^J E-MAILr �� �� � �„ ,7LM �`` ��n/ • U(/ / STREET ADDRESS C-�T'AGTF/f p / ,/rlI PHONE ,1�-5 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS: LIC, k COMPANY NAME E-MAIL FAX STREETADDRESS' CITY. STATE, ZIP PHONE. USE OF I SFD or Duplex ❑ Multi -Family ROOF AREA: VALUIA(IO STRUCTURE: ❑ Commercial ` EXISTING ROOF TYPE: ❑ BUILT-UP ROOF ❑ ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES D.� OTHER (SPECIFY) REMOVElREPLACE ��YES {F NO, PLYWOOD �3jv" ❑ PLYWD OSB PITCH: ROOF • ❑'NO k LAYERS: THICKNESS- ❑ S/8" TYPE: ❑ .DX ' 12 CLASS_ PROPOSED ROOF TYPE: 0 BUILT-UP ROOF"', � ASPHALT SHINGLES i ❑ WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER ICC -ES REPORT d DESCRlATION OF WORK;. 1/ 011Wl lri t Qo7 rot, By my signature below, t'eertify to each ofthe 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 1 have pro sided 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 ng onstruction. i authorize representatives of Cupertino to enter the ab a -i entified property for in purposes. 17 Signature of Applicant/Agent Date: SUPPLEM E TAL 1AWORMATION REQUIRED ` PGAN CIiECRTYPI ~ t2Ot 5LtP If buildmg,is associated with a 1-Iome Owner's Association, provide letter i] Ottt PJIIFGOTJ>urR = ©I}TiTLUiNY1yIYAEyIgiv of approval from HOA. y —Provide Planning approval to verify if there any restrictions. (kR> 53 } P1�CPiN'tt�v>itY Providecopy of Manufacturer's Installation Specifications. jTANDat2[ F� Tret _ Provide,signed copy of Cupertino's Tear -Of Policy. ` k ReroofApp1:coc revised 03/16/11 it a IREROOF TEAR -OFF POLICY COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL CUPERTINO 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 � _ 2(7 l f �'j — 130 �-- (408) 777-3228 - FAX (408) 777-3333 - building(v7cuaertino.org l PROJECT ADDRESS 112 STA4� OWNER NAME ��G PHONE O�/ / (! E-MAIL STREET ADDRESS 1121 C,�.,�/ A A n /% ,I •v I'� CITY; STATE. ZIPPC y FAX CONTRACTOR NAME ^ rrJnl LICENSE NUMBER �j-ir7Yi1 / LICENSE TYPEC,�� BUS. LIC. k,( CU1J��,JV COMPANY" NAME � r&r f 1 FAX ► STREETADDRESSI Pn1 /�� ClT�Yr"r�ZP ^SI PHONE// (�pi/_ 61W 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':30-2:3'0pm (Friday) to scheduleinspection. 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/fasfeners,shall be either completely knocked-dowh 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 approval's from the building inspector. _ Any roofing which is applied without first obtaining an approved inspection will, ji . require the removal,.of all new material down to the sheathing so a proper inspection can be performed. 6. A Final inspecti6n 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: I' a. 'Flat roofs shall have a minimum of/4" 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 agentto 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 detecto s ar ,required to be -installed in accordance with Sections R31.4.and.R315.of the 2016 California Residential Code.. Signature of Applicant/Agent:— � . gate:-.. Y,Fl ReroofPo1icy_2014.doe revised 06101/7 CVPERTINO SMOKE / CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(aDcupertino ora 'ERIYIAN1�10 T$E FINAI;ED:INTI:T3S:CERTIFICATE TAS BEET 0MPLEi3, AND RF TIJR7 T`{� 3,B�T ria) DIVISION, PURPOSE This affidavit is a self -certification for the installation of all required Smoke and Carbon Monoxide Alarms for compliance with 2016 CRC Section R314,2016 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 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 no access by means of attic, basement or crawl space. Refer to CRC Section R314 and CBC Sections 907.2.114 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 alarin(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 bellow Address: G / ZIL No. _v'3 3 617 Specify Number of Alarms: # Smoke Alarms.EZD_ # Carbon Monoxide Detectors. I have read and aarAB to cmmnly with the terms anrl nnan'ifin— of fl— �f.,f - _...,_.� ..._.. ...- tenms Owner (or Owner Agent's) Name: �117AieA ... ... Signature �.-.. Date: Contractor —am e: Signature Lic.# Date: Smoke and C0fo7-?7?.doe revised 12/15/16 Owner Name MATER -CONSERVING PLUMBING FIXTURES OWNER.CERTIFICATE OF COMPLIANCE COMMUNITY -DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 Address rot Is your real property a registered historical site? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply No Go to Question 2. Skip the rest of the form and sign bottom of fonn. i2. 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? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. j ❑ The licensed plumber's certification has been provided to the Building Division. Skip the rest of the form and sign bottom of form. j No Go to Question 3. {3. Is IA=ater service permanently disconnected for your building? ❑ 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. i4. Is your real property built and available for use or occupancy on or before January 1, 1994? s ❑ 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: 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 7nultifamily 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). j ❑ Mypropertyis 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. I 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). r _ , f I, 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 follo'��jing page. r Owner or Owner Agent's Signature:_ '' Date: P I Upon: completing and signing this Certifieate, pleas return it to the Building Division in order to final your building pennit. SB407 2015.doc revised 01105117