15100028 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 6611 CLIFFORD DR CONTRACTOR:NEIGHBORS ROOFING PERMIT NO: 15100028
AND GUTTERS
OWNER'S NAME: KU DANNY T AND WEN-HAU TRUSTEE 200 FORD RD STE 236 DATE ISSUED: 10/05/2015
OWNER'S PHONE: 4088889368 SAN JOSE,CA 95138 PHONE NO:(408)472-3869
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
TEAR OFF(E)COMP,INSTALL(N)OSB,30#FELT,
r 3�{
License Class Lic.#_&G S-e e CLASS A COMP ROOF SYSTEM(22 SQ'S)
Contractor Date
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: Sq.Ft Floor Area: Valuation:$11100
r. 1 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 kPN Number:36926007.00 Occupancy T�pe:
performance of the work for which this permit is issued.
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. PERMIT EXPIRES IF WORK IS NOT STARTED
APPLICANT CERTIFICATION WITHIN48VMXYS IT ISSUANCE OR
1 certify that I have read this application and state that the above information is DAY CALLED INSPECTION.
correct.I agree to comply with all city and county ordinances and state laws
to building construction,and hereby authorize representatives of this en /
upon the above mentioned property for inspection purposes. (We)agree to a ssued by Date. a
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.l8. RE-ROOFS:
yy� 111 roofs shall be inspected prior to any roofing material being installed.If a roof is
Si"nature �b ✓ � -�' Date ���- installed without first obtaining an inspection,1 agree to remove all new materials for
�< inspection.
❑ OWNER-BUILDER DECLARATION 1,ignatureofApplicanc. ; f✓�' � -� Date:
I hereby affirm that I am exempt from the Contractor's License L:m for one of ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
the following two reasons:
t. 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 HAZARDOUS MATERIALS DISCLOSURE
sale(Sec.7044,Business&Professions Code) 1 have read the hazardous materials requirements under Chapter 6.95 of the
2. I,as owner of the property,am exclusively contracting with licensed contractors to California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
construct the project(Sec.7044,Business&Professions Code). compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health a
Safety Code,Section 25532(a)should 1 store or handle hazardous material.
I hereby affirm under penalty of perjury one of the following three declarations: Additionally,should 1 use equipment or devices which emit hazardous air
i. 1 have and will maintain a Certificate of Consent to self-insure for Worker's contaminants as defined by the Bay Area Air Quality Management District I will
Compensation,as provided for by Section 3700 of the Labor Code,for the maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
performance of the work for which this permit is issued. Health&Safety Code,Sections 25505,25533,and 25534.
2. I have and will maintain Worker's Compensation Insurance,as provided for by Owner or authorizld agent: _
Section 3700 of the Labor Code,for the performance of the work for which this 6 .+fwle��yzY�- Date:
permit is issued.
3. 1 certify that in the performance of the work for which this permit is issued,I shall CONSTRUCTION LENDING AGENCY
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 I hereby affirm that there is a construction lending agency for the performance of work's
become subject to the Worker's Compensation provisions of the Labor Code,I for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
must forthwith comply with such provisions or this permit shall be deemed
revoked. Lender's Address
APPLICANT CERTIFICATION ARCHITECT'S DECLARATION
I certify that I have read this application and state that the above information is I understand my plans shall be used as public records.
correct.1 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 Licensed Professional
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 applicant understands and will comply with
all non-point source regulations per the Cupertino Municipal Code,Section 9.18.
Signature Date
REROOF PERMIT APPLICATION
f COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
ON
10300 TORRE AVENUE• CUPERTINO, CA 95014-3255
CUPERTINO aD
(408)777-3228 • FAX (408)777-3333• building cupertino.orq /S/�
(�Q
PROJECT ADDRESS / I ( ^ APN N �j ( �J / OO
I i t r' )Jv J V C/rJ
OWNER NAME PHONE �J :�
STREET ADDRESSCITY, STATE,ZIP FAX
C - r. r, ' i( ,
CONTACT NAME PHO E-MAIL
i z,
STREET ADDRESS CITY,STATE, ZIP FAX
OK'NER ❑ ONN'ER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGEN-r ❑ kRC'!,TBCT ❑ ENGP.-EER ❑ DE\'ELOPER ❑ TENAt`7
CONTRACTOR NAME ' LICENSE NUMBER - LICEN�E-CYPE BUS.LIC.N
COMPANY NAME E-MAIL FAX 1
STREET ADDRESS• I CITY,STATE,ZIP r PHONE -
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC.N
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑ SFD or Duplex 2/Multi-Family ROOF AREA. VALUATION:
STRUCTURE ❑ Commercial
i
EXISTING ROOF TYPE. ❑BUILT-UP ROOF 2 ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES aOTHER(SPECIFY)
REMOVE/REPLACE H YES IF NO, PLYWOOD B /i' ❑ PLYWD a OSB PITCH: + L� ROOF
❑ NO I N LAYERS THICKNESS- ❑ 5/8" TYPE: ❑ rny 12 LASS. A
PROPOSED ROOF TYPE. ❑BUILT-UP ROOF 'ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT N
DESCRIPTION OF WORK:
By my signature below,I certify to each of the following: I am the property ovmer or authorized azent 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 relatine to buildi construction I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
S i.-nature of Applicant/Agent:--��`/ .` ` �.r)' Date: i
SUPPLEMENTAL INIFORMATION REQUIRED - OFFICE USE ONTY
_If building is associated With a Home Ov,ner's Association,provide letter PLAN CHECK TITE ROL"TLNG SLIP
of approval from HCA. -- UNTER BLTILDUNG PLAN REVIER'
Provide Planning approval to verify if there any r O EXPRESS
PL.-LNNINc PLAN REN1E
Provide copy of Manufacturer's Installation Specifications. AT,n ❑ FIRE WEPT
Provide signed copy of Cupertino's Tear-Off Policy. C OTHER:
Reroof4pp_2011.doc revised 03/16/11
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 6611 CLIFFORD DR DATE: 10/05/2015 REVIEWED BY: MELISSA
APN: 369 26 007 BP#: 'VALUATION: 1$11,100
`PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY SFD or Duplex PENTAMATION 1SFDWLROOF
USE: I PERMIT TYPE:
WORK TEAR OFF E COMP INSTALL N OSB 30 # FELT CLASS A COMP ROOF SYSTEM 22 SQ'S
SCOPE
FEE ID ROOF AREA
s.f.
1REROOFFRES 2,200
T_
Alech.Plan Chc,
Other Al;,,i F-1 I LJ7_
NOTE: This estimate does not include fees due to other Departments(i.e. Planning, Puhlic Works, Fire,Sanitary Sewer District,School
District,etc. . Thesefees are hosed on the reliminnr>>information available and are Dolt an estimate. Contact the De t or addn'1 in o.
FEE ITEMS (Fee Resolulion I1-0.53 El': 7111"13) FEE QTY/FEE MISC ITEMS
Plan Check Fec:
51111/1/. l'(' Fcc.
Plunth. T/c•ch. Floc
Permit Fee: $374.00
5711)111. 111.511 F",
11Inrlh. Mech. F/cc
Phimh. Mach. l:lec Pertni!Fe,
Con.clt•uclion
icI'm ini's It'cIli rc l C
Work Without Permit? O Yes No $0.00
A(lvanced Planning Fees:
I t-avc/ 0ocutnc'11411ion 1 c'.N.
Strong Motion Fee: IBSEISMICR $1.44 Select an Administrative Item
Bldiz Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $376.44 $0.00 TOTALFEE-7 $376.44
Revised: 07/02/2015
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
vwws
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
10300 TORRE AVENUE- CUPERTINO, CA 95014-3255
CUPERTINO
(408)777-3228 • FAX(408)777-3333•buildinaQcupertino.org
PROJECT ADDRESS / / 1 Pr APN N / 7 O
V l ) V r
OWNER NAME PHU 4��T� %✓i bbSJJJ
E-T1AIL
STREET ADDRESS CITY, STATE,ZIP I FAX
CONTRACTOR NAME 'fit, LICENSE NUMBER.6G.E `c C�y LICEJ� I PE BUS.LIC. J 7
COMPANY NAME A/� `A / MAIL >> C `j FAX
STREET ADDRESS � `. ��/ / CITY STATE.ZIP / PHONE _ f
"5 e- L
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 uo to one business day before the requested inspection date.
Please schedule inspections online orIcall 408 7_322Wrom 7:30-3:30pm (Mon-Thurs) or 7:30-
2:30pm (Friday) to schedule inspection Vor 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 7:30-1.0:30am 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/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 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 C)Ot'
Signature of Applicant/Agent: '" Date:
Reroo)Tolicy_2014.doc revised 01/1.5/14
WATER-CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT- BUILDING DIVISION
GUPERTIIVO 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255
(408)C77-3'428t FAX(408 77,7-3333• building(cDcupertino.org 1 ( ODA
Owner Name iYl v Permit No.
v
Address J
1. Is your real property a registered historical site?
❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
-14 1KNo 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.
Skip the rest of the forn and sign bottom of form.
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. 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 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.
XYes My real property is built and available for use or occupancy on or before January 1, 1994.
z4 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).
❑ Myproperty 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.
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).
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 110 1.1
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 following page.
Owner or Owner Agent's Signature: go Date: ..,Y
Upon completing and signing this Certificate,plea return it to the Building Division in order to final your building permit.
SB407 2015.doe revised 08/26/15
'6'Jj J
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE 0'.ME
a
COMMUNITY DEVELOPMENT DEPARTMENT- BUILDING DIVISION
CUPERTINO 10300 TORRE AVENUE- CUPERTINO, CA 95014-3255 b
(408)777-3228- FAX(408)777-3333- buildingCcDcupertino.org 1 0_0 Q�
' f �1P�TYY11�0'
�Ad&64 '�#—_of_A1arnrs—_9-m_c)ke? earb—oiffMb—noxfide:
. ..................... ............... .................
PERMIT CANNOT.13K FINALED,AND.COMPLETED UNTIL TIH&CERTIFICATE A
AS BEEN'S 1 ANDRETURNED,TOTME BUMDIN , .,.,.DIVISION
�,,�
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 shagle-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) 0
On every level of a dwelling unit ipcludin4,basemerjis XA� X
Within each sleeping room tyew. ea £a moo X
Carbon Monoxide alarms are not required in dwellings which do not contain fuel-bunging 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 h-i 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.
I have read and agree to comply with the terms and conditions of this statement
DQAI
LA_ �_S_jgnat.................. .................................................
__4 !4 ,!.:.... ..... ..........i:Date:-_ z../..1...........
Contractor Nab e•
6"t,re ..................................................................�-rc# ....................................:.Date: ..............
Smoke and COforin.doc revised 03118114