14090121 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 1134 HOLLYHEAD LN CONTRACTOR:WORK FORCE ROOFING PERMIT NO: 14090121
WFR
OWNER'S NAME:
SAN JOSE,CA 95133 PHONE NO:(408)892-5096
Er LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL
TEAR OFF(E)ROOF,INSTALL(N)30LBS FELT,CLASS A
License Class 3 Lic.# 6 3 3 ASPHALT SHINGLE(30 SQ'S)
Contractor wo-ck rayu Q31yAi Date O�
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:
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
r' erformance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$18142
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 APN Number:36226026.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FR D INSPECT ON.
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 Issue
with all non-point source regulations per the Cupertino Municipal Code,Section
9 18.
�/� / RE-ROOFS:
Signature / Date 7.d(Y All roofs shall be inspected prior to any roofing material being installed.If a roof is
installed without first obtaining an inspection,I agree to remove all new materials for
inspection.
❑ OWNER-BUILDER DECLARATION
Signature of Applicant:_�� Date: a Ol
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1,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)
I,as owner of the property,am exclusively contracting,with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. I will
I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this
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 Worker's
Compensation laws of California. If,after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C)
Lender's Name
APPLICANT CERTIFICATION Lender's Address
—
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 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, ARCHITECT'S DECLARATION
costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9 18.
Signature Date
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(408)77773228•FAX(408)777-3333•buildingacupertino.org `
Cuft1 TIRO 1
PROJECT ADDRESS /C / L APN# 2 /J C O 2
OWNERNAbfE
Aon q
:p n t . .. r �: PHONE'r;b 6 !rL ! . E-MAIL
STREET ADDRESS_ ( C STATE,ZIP FAX
&4 ! 33
❑ OWNER ❑ OWNER-BUIMEP. ❑.OWNERAGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARC=CT ❑ENGWEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME$C r n ' LI NUMBER LICTE TYPE BUS.LIC.#
COMPANY NAME ( t E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
b ,
ARCHITECT/ENGINEERNAME LICENSENUMBER BUS.LIC.#
COMPANY NAME E-MAIL, FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF SFD or Duplex ❑ Multi-Family ROOF AREA: VALUATION- '
STRUCTURE: ❑ Commercial 3;
EXISTING ROOF TYPE:. ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES OTHER(SPECIFY) �s
REMOVE/REPLACE DYES IF NO, PLYWOOD ❑ 'W' ❑ �PLY7D 11OSB PITCH: ROOF ElNO #LAYERS: THICKNESS: ❑ 5/8" TYP ❑ CDX '12 CLA : A
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF KASPHALT 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 haveiead the Description of Work.and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relaiingto.buildingfcotistructibn. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: Date: !�e? - ��{ 2-01 -
SUPPLEMENTAL INFORMATION REQUIRED R
If building is associated with a Home Owner's Association,provide letter - pro
of approval from HOA. - t
Provide Planning approval to verify if there any restrictions.
Provide copy of Manufacturer s Installation Specifications. 5 rP
Provide signed copy of Cupertino's Tear-Off Policy. -
Reroof p 2011.doc revised 03116/11
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 1134 HOLLYHEAD LN DATE: 09/18/2014 REVIEWED BY: MELISSA
APN: 362 26 026 BP#: *VALUATION: 1$18,142
*PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY PENTAMATION
USE: SFD or Duplex PERMIT TYPE: 1 SFDWLROO
WORK TEAR OFF E ROOF INSTALL N 30LBS FELT CLASS A ASPHALT SHINGLE
SCOPE
FEE ID ROOF AREA
s.f.
1REROOFFRES 3,000
`eriz. 1"cert t/rf<rk Phowb,Plan('heeh
Pel,w;l Fee' Pennir Perm
r1l,
C) tPlurnh Ira!,,?-i/z i`:'c:- PiFfr72t'�, 17 5�7. T r'i': t.-ie( l q. I"�'e
NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc.). Theseees are based on the prelimina information available and are only an estimate. Contact the De t or addn'l info,
FEE ITEMS (Fee Resolution 11-053 E,(f 7/1113) FEE QTY/FEE MISC ITEMS
Plan Chcls 11',Ee:
:SS1,11"pl. N"PCC
Permit Fee: $510.00
i°l r:z3.;; />E Ir.ilsttzc° Per n it Fee:
C'onsirvchon Y'W:
1t';r i,ai4tr,r iia
Fee:
Work Without Permit? 0 Yes No $0.00
62 alion PE'E'S:
Strom Motion Fee: IBSEISMICR $2.36 Select an Administrative Item
Bldg Stds Commission Feer IBCBSC $1.00
® ALS $513.36 $0.00 TOTAL FEE: $
513.36
Revised: 08/20/2014
t .
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION
ALBERT SALVADOR, P.E.,C.B.O.,BUILDING OFFICIAL
G U P E RT[N Q 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408) 777-3228•FAX(408)777-3333•building(cDcupertino.org
PROJECT ADDRESS r t-� APN# / Z
-7
OWNER NAME -
t r c I FAX
CONTRACTOR NAME "; I
LICENSE NUMBER LICENSE TYPE TS
C.#
COMPANY NAME f E-MAIL FAX
Wpm f
STREET ADDRESS CITY,STATE,ZIPS P ONE
l (off se
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 (NIon-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 I/"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 detectors are required to be installed in accordance with Sections R314 and R315 of
the 2013 California Residential /
Signature of Applicant/Agent: ( Date: (�
ReroofPolicy_2014.doc revised 01/15114
CUPERTINO
WATER - CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255
(408) 777 -3228 • FAX (408) 777 -3333 • building cDcupertino.org y
Owner Name �� � Permit No. / y U 9 O
Address
Please refer to the attached California Civil Code Sections 1101.1 - 1101.8 which are part of this Certification form.
1. Is your real property a registered historical site?
❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Sign below and skip the rest of the form.
Owner' Signature: Date:
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?
❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply.
❑ The licensed plumber's certification has. been provided to the Building Division.
Sign below and skip the rest of the form
Owner' Signature: Date:
�No Go to Question 3.
3. Is water service permanently disconnected for your building?
❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Sign below and skip the rest of the form.
Owner' Signature: Date:
No Go to Question 4.
4. Is your real property built and available for use or occupancy on or before January 1, 1994?
'1 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. Sign below and skip the rest of the form.
Owner Signature: L'f Date: Lt
❑ Yes My real property is built and available for use or occupancy on or before January 1, 1994.
Civil Code Sections 110 1. 1 through 1101.8 apply. Refer to the attached.
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.
SB407 2014.doc revised 03118114
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
unprQvements).
I/We, the' owner(s) of this property, certify under penalty of perjury that non - compliant plumbing fixtures have been replaced
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 below.
Owner's (or Owner Agent's) Signature: Date:
Upon completing and signing this Certificate, please return it to the Building Division in order to final your pen-nit.
Non - Compliant
Water- Conserving Plumbing Fixture
Plumbing Fixture
(Fixture Complying with Current Code Applicable to New Construction)
Maximum Water Usage/Flow Rate
Fixture Type
Water Usage
2013 CPC Ch. 4
2013 CPC Ch. 4
2013 CPC Ch. 4
/Flow Rate
2013 CALGreen Div. 4.3
2013 CALGreen Div. 4.3
2013 CALGreen Div. 5.3
Single- Family
Multi- Family
Commercial
Residential
Residential
Water Closets
Exceed 1.6
Single flush toilets: 1.28 gallons /flush
(Toilets)
Gallons /flush
Dual flush toilets: 1.28 gallons /flush effective flush volume (the composite,
average flush volume of two reduced flushes and one full flush
Urinals
Exceed 1.0
0.5 gallons /flush
Gallons /flush
Showerheads
Exceed 2.5
2.0 gallons per minute @ 80 psi. Also certified to the performance criteria of
gallons per minute
U.S. EPA WaterSense Specification for Showerheads
(A hand -held shower is considered a showerhead.)
For multiple showerheads serving one shower, the combined flow rate of all
showerheads and /or other shower outlets controlled by a single valve shall not
exceed 2.0 gallons per minute @ 80 psi, or the shower shall be designed to
allow only one shower outlet to be in operation at a time.
Faucets —
Exceed 2.2 gallons
Maximum 1.5 gallons per
Within units:
0.5 gallons per minute @ 60
Lavatory
per minute
minute @ 60 psi; minimum
Maximum 1.5 gallons
psi
Faucets
0.8 gallons per minute @
per minute @ 60 psi;
20 psi
minimum 0.8 gallons
per minute @ 20 psi
In common and public
use areas: 0.5 gallons
per minute @ 60 psi
1.8 gallons per minute
60 psi
Faucets —
Exceed 2.2 gallons
1.8 gallons per minute @
1.8 gallons per minute
1.8 gallons per minute @ 60
Kitchen
per minute
60 psi
@ 60 psi
psi
Faucets
May temporarily increase
May temporarily
up to 2.2 gallons per
increase up to 2.2
minute @ 60 psi, and must
gallons per minute @
default to maximum
60 psi, and must"
1.8 gallons per minute @
default to maximum
60 psi
1.8 gallons per minute
Where faucets meeting
@ 60 psi
the above are unavailable,
Where faucets meeting
aerators or other means
the above are
may be used to achieve
unavailable, aerators or
reduction.
other means may be
used to achieve
reduction.
1. If the existing plumbing fixture water usage /flow rate is equal to or lower than the figure shown, it is not required to be upgraded.
SB407 2014.doc revised 03118114