15070006G
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19763 WINTERGREEN DR
CONTRACTOR: COSMOS ROOFING
PERMIT NO: 15070006
OWNER'S NAME: YOUNG TAK K AND GLORIA M
999 COMMERCIAL ST STE 105
DATE ISSUED: 07/01/2015
OWNER'S PHONE: 4083868806
PALO ALTO, CA 94303
PHONE NO: (650)969-7663
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
TEAR OFF (E) COMP (NO RE -SHEET). INSTALL (N) CLASS
C�
License Class G Lic. # S -I
A, PRESIDENTIAL COMP ROOF SYSTEM (33 SQ'S)
^
ContractorDate
I hereby affirm that I am licensed unde 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
Sq. Ft Floor Area:
Valuation: $13500
ertoRance of the work for which this permit is issued.
and will maintain Worker's Compensation Insurance, as provided for by
fSrejit
on 3700 of the Labor Code, for the performance of the work for which this
APN Number• 36909027.00
OccupancN"l pe:
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 PERMIT 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 D AST C D INSPECTI N.
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 w ply
Is e:
with all non -point source regulations per the Cupertino M ' rpal Code, Section
9.18.
RE- FS:
Signature Date --7/1S
All roofs shall be in ed y roofing material being installed. If a roof is
installed wi taming an inspection, I agree to remove all ne aterials for
inspection.
❑ OWNEW96ILDER DECLARATION
/'
Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
A ROOF COVE G 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, ter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
for for
the Health & Safety Code, Sections 25505, 25533, and 25W.-_
Section 3700 of the Labor Code, the performance of the work which this
Owner or authorized agent: Date:
permit is issued.
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
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 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
CUPERTINO
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 - FAX (408) 777-3333 - buildingQcupertino.org / 000/'
PROJECT ADDRESS 3 T��&�tT 2
o' j — Q Z -7 -
APN #[97�
OWNER NAME /�O [ ^�
I t ,-7 /
PH t-fF�„�� 3q 64U
(y
E-MAIL
STRE T ADDRESS,
6,J?11-G i A) iz ,
CITY, STATE, ZIP
7 t,,,V e--,4 9 Sni
FAX
CONTACT NAME
Bobby Payne
PHONE
650-969-7663
E-MAIL
STREET ADDRESS 999 COMMERCIAL STREET #105
CITY, STATE, ZIP PALO ALTO, CA 94303
FAX 650-485-2314
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT KI CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
RICH COSMOS
LICENSE NUMBER
785441
LICENSE TYPE
C39
BUS. LIC. #
COMPANY NAME COSMOS ROOFING
E-MAIL
FAX 650-485-2314
STREET ADDRESS
999 COMMERCIAL STREET #105
CITY, STATE, ZIP
PALO ALTO, CA 94303
PHONE 650-969-7663
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC. #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF ?�SFD or Duplex ❑ Multi -Family
STRUCTURE: Commercial
ROOF AREA:
33
VALUATION:
1 J
EXISTING ROOF TYPE: ❑ BUILT-UP ROOF $ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER (SPECIFY)
REMOVE /REPLACE %YES
11NO
IF NO,
I # LAYERS:
PLYWOOD ❑ %," ❑
THICKNESS: ❑ 5/8"
PLYWD ❑ OSB
TYPE: 11CDX
PITCH:
:12
ROOF
CLASS: A
PIZOPOSED ROOF TYPE: ❑BUILT-UP ROOF ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER
ICC -ES REPORT #
^
DESCRIPTION OF WORK: r / , ^1 A_ '7 ,Aj �
By my signature below, I certify to each of the following: I am the property owner ora a 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 Des n 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 sentatives of Cupertino to enter the above-identifie property for inspection purposes.
Signature of Applicant/Agent: Date: l
SUP L INFORMA N REQ ED
_ If building is associated with a Hornw ssociation, provide letter
of approval from HOA.
Provide Planning approval to verify if there any restrictions.
_ Provide copy of Manufacturer's Installation Specifications.
Provide signed copy of Cupertino's Tear -Off Policy.
OFFICE USE ONLY
PLAN CHECK TYPE
ROUTING SLIP
VER -THE -COUNTER
❑ EXPRESS
❑ STANDARD
❑ BUILDING PLAN REVIEW
❑ PLANNING PLAN REVIEW
❑ FIRE DEPT
❑ OTHER:
ReroofApp_2011.doc revised 03/16/11
CITY OF CUPERTINO
N M-7 FEE ESTIMATOR—BUILDING DIVISION
FEE ID ROOF AREA
s.f.
1REROOFFRES 3,300
ADDRESS: 19763 WINTERGREEN DR
DATE: 07/01/2015
REVIEWED BY: MELISSA
:Vech. Permit Fee:
APN: 369 09 027
BP#:
*VALUATION: 1$13,510
xPERMIT TYPE: Minor Building Permit
PLAN CHECK TYPE: Re -roof
PRIMARY SFD or Duplex
USE:
r,+rh. Insp. Tee:
PENTAMATION 1 SFDWLROOF
PERMIT TYPE:
WORK
TEAR OFF E COMP NO RE -SHEET). INSTALL N CLASS A PRESIDENTIAL COMP ROOF
SCOPE
SYSTEM (33 SQ'S)
FEE ID ROOF AREA
s.f.
1REROOFFRES 3,300
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addh 7 info.
FEE ITEMS (Fee Resolution 11-053 Eff 7%1-13)
ifech. Plan Check
Plumb. Plan Check
E/eco. Plan Check
:Vech. Permit Fee:
Plumb. Permit Fee:
Flec Permit Fee
Other A4ech. Inslr.Li
Other Plumb Insp.
Other Llec. Insl�, Li
11ech. Insp. I -'et,
r,+rh. Insp. Tee:
l�lec. Imp. Fey
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addh 7 info.
FEE ITEMS (Fee Resolution 11-053 Eff 7%1-13)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
Suppl. P('Fee
I'lttnz/�.%,'taecla.:� l'let
Permit Fee:
$561.00
Suppl. Insp Fee
Plttrrth. `�1leclt.:'�lc�c
P/ttntb.:11ti�c°hJls'lcc I'cr'rttil Fere .
Construction Tax:
Administrative Fee:
Work Without Permit? 0 Yes E) No
$0.00
_Advanced Planning Fees:
_r rc>t2tczfhm I.
Strong Motion Fee: IBSEISMICR
$1.76
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$563.761
$0.00 TOTAL FEE:
$563.76
Revised: 05/07/2015
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 • buildingacupertino.org
PROJECT ADDRESS_
I?o i`17 D g
APn
-9� /O
O
OWNER NAME 1A jl�VA)
�_
PHONE
E-MAIL
STREET ADDRESS r I
J7c6-a.,- ,J
CITY, STATE, ZIP
4
FAX
CONTRACTOR NAME RICH COSMOS LICENSE NUMBER 785441
LICENSE TYPE C39
BUS. LIC #
COMPANY NAME
COSMOS ROOFING
E-MAIL
FAX
925-485-2314
STREET ADDRESS 999 COMMERC IAL ST. #105
CITY, STATE, ZIP PALO ALTO, CA 94303
PHONE 925-969-7663
I UNDERSTAND AND AGREE TO THE FOLLOWING:
The re -roof project shall comply with all applicable provisions of the 2007 California Building Code.
2. You must schedule all needed inspections a minimum of one day before the requested inspection date.
Please schedule inspections online or call (408)777-3228 between 7:30-3:30 (Mon -Fri).
3. Tear -off roof inspection is required. Please call for tear -off inspection after the roof is torn off and all
the nails/fasteners have been removed. Any and all dry -rotted wood shall be replaced prior to this
inspection. A building inspector will be available within one hour.
There are special hours for this service: 7:30 — 10:30am and 1:00 — 3:30pm (Mon — Thurs);
7:30 — 10:30am and 1:00 — 2:30pm (Friday).
4. If plywood is installed, a plywood nailing inspection is required.
5. In -Progress roof inspection is required. Call for an in -progress roof inspection to verify building is
weather tight after installation of approximately 25% of the roofing material.
6. New roof coverings shall not be applied without first obtaining all inspections 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.
7. A final inspection and approval shall be obtained from the building inspector when the re -roofing is
complete. To receive a final sign -off, the following items will be verified:
a. Flat roofs shall have a minimum of 1/4" per foot of slope and must 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.
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 of $126.00. 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 understa e o comply with the re -roof policy stated above.
Signature of Applicant/Agent: Date:
7757z 3
ReroofPolicy_2010.doc revised 05/17/10
uol
CUPERTINO
Address
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 • buildingQcupertino.org
FILE
7 rt
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 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.
t have read and agree to comply with the terms and conditions of this statement
Owner (or Owner Agent's) Name:
ujogi,q 7&v4- 9% 74 Y
/
Si natur Date:7 /5 .2Q1
Contractor Name:
Signature...................... ............................................. Lic.#...................................... Date: ...................
Smoke and CO jorm.doc revised 03/18/14
CUPERTINO
Owner Name
Address
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 • buildinga-cuoertino.or4
FILE
(�07 oeDS
PERMIT CANNOT BE FINALED AND CONIPLETED UNTIL THIS CERTIFICATE
HAS BEEN S. :NFD AND RET[ RNFD TO THE BUI [.DING DIVISION
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: � 4 Date: 7/l0 /2c v kj--
I!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
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: �� 41,o � Date:
C�No Go to Question 3.
3. Is water service permanently disconnected fo your bu' g?
❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Sign below and skip the rest of the form.
Owner' Signature: �i�� Date:
Q!No Go to Question 4.
4. Is your real property built and available for use or oc c n 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. Sign below and skip the rest of the form.
Owner' Signature: Date: �6
L�Yes My real property i uilt and availa or use o cy on or before January 1, 1994.' /
Civil Code Sections 110 1. 1 through 1101. y. Refer o 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 201 S. doc revised 02104115
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
.Amprw a&nts).
I/We, the owner(s) 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 vluynbing fixtures comply with the requirements as indicated in the table below.
Upon completing and signing this Certificate, pleaseAturn �A the Building Division in order to final your pen -nit.
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 2015.doc revised 02/04/15
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 2015.doc revised 02/04/15