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15100090 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21405 RUMFORD DR CONTRACTOR:T', PERMIT NO: 15100090 OWNER'S NAME: WOLFSON C J 2 AND DAWNA S TRUS DATE ISSUED: 10/13/2015 OWNER'S PHONE: 4082530238 PHONE NO: LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ ROOF REPAIR-REMOVE APPDX.4 COARSES OF CLAY License Class 3 Lic.# TILES.INSPECT FOR DRYROT AND REPAIR.REPLACE WITH 1 1 LAYER OF ICE BUSTER SHIELD AND 1 LAYER OF 90 L Contractor r,r_4�6Vi JJn Crn_26j�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:$2500 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. APN Number:32641051.00 Occupancy Type: �. I have and will maintain Worker's Compensation Insurance,as provided for by �ection 3700 of the Labor Code,for the performance of the work for which this ermit is issued. PERMIT EXPIRES IF WORK IS NOT STARTED APPLICANT CERTIFICATION WITHIN 180 DAYS OF PERMIT ISSUANCE OR 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 180VDAYSOM LAST CALLED INSPECTION. to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save r indemnify and keep harmless the City of Cupertino against liabilities,judgments, Issued b Date: (ol1 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 sourcelregulat'ons pe e Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signature/^:�,/ i,l' / Date,�(�—'r,�`iL��� 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: 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. 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) 2. I,as owner of the property,am exclusively contracting with licensed contractors to I have read the hazardous materials requirements under Chapter 6.95 of the construct the project(Sec.7044,Business&Professions Code). California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& I hereby affirm under penalty of perjury one of the following three declarations: Safety Code,Section 25532(a)should I store or handle hazardous material. 1. I have and will maintain a Certificate of Consent to self-insure for Worker's Additionally,should I use equipment or devices which emit hazardous air Compensation,as provided for by Section 3700 of the Labor Code,for the contaminants as defined by the Bay Area Air Quality Management District I will 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 Section 3700 of the Labor Code,for the performance of the work for which this Owneu or' ed a t: permit is issued. Date: Date: 3. 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 CONSTRUCTION LENDING AGENCY 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.) must forthwith comply with such provisions or this permit shall be deemed Lender's Name revoked. Lender's Address APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is ARCHITECT'S DECLARATION correct.I agree to comply with all city and county ordinances and state laws relating I understand my plans shall be used as public records. to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save Licensed Professional 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 k W. REROOF PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255 (408)777-3228 • FAX (408)777-3333 • buiiding(5)cupertino.org CUPERTtNO 5 1 -1 0 „\ q0 PROJECT ADDRESS101- ,r 4/6 S lot-)"j. f APN# ^ 'I ' — 05 1 GMrNER NAME PIVN • � E-MAIL §TREET ADDRES CITY, S TE,ZIP FAX 'SLl fivrn o r 4 rip ✓'G 4 CONTACT NAME (IVr l PHO 0 `�G, E-MAIL STREET ADDRESS �.q CITY,STATE, ZIP FAX ❑ OWNTER ❑ OWNER-BUILDER ❑ OWNTER AGENT CONTRACTOR ❑coNTTRACTOR AGENT ❑ ARCHITECT ❑ENGLNTEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME /� LICENSE NUMBER LICENSE TYPE BUS.LIC.# Z, COMPANY NAME E-MAIL / FAX •r A A � ) l i' , STREET ADDRESS A ' CITY,STAT ZIP PHON ARCHITECTJENGINEER NAME 111E SENUMBER I BUS.LIC.# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑ SFD or Duplex [I Multi-Family ROOF AREA: VALUATION: STRUCTURE: ❑ Commercial 60 / z; sj 00 , EXISTING ROOF TYPE: ❑BUILT-L'P ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES OTHER(SPECIFY) J/j REMOVE/REPLACE 1:1 YES IF NO, PLYWOOD ❑ ''/1" 13PLYWD 13 OSB PITCH: ROOF .WNO 4-LAYERS: THICKNESS: ❑ 5/8" TYPE: ❑ CDX , •12 CLASS: A PROPOSED ROOF TYPE: I-]BUILT-UPROOF ❑ASPHALT SHINGLES 11 WOOD SHAKES El WOOD SHINGLES Jo OTHER ICC-ES REPORT# DESCRIPTION OF WORK: y A0 J -fld, And We- �. �w; /,N n rte*f e ,.4 By my signature below,I certify to eac of the following: I am the property owner or authorized agerrt4o act on the property alf. 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 lava's relating to bui;1 ',1pnstru0ion.,4 authori7,evf resentatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: � �' Date: SUPPLEMENTAL INFORMATION REQUIRED �,. ,OFFICE USE 01\'Ll' If building is associated With a Home Owner's Association;provide letter PiaN CHECK:�PE RouT G SLIP of approval from HOA. OVER Tla±COUNTER ❑ BUILDING PLAIN RENTER' s s s ;.- Provide Planning approval to verify if there any restrictions. E�.PRESS °, x , ❑i PLTItTL'�'G PLAN'REVIEWmp 'rF' Provide copy of Manufacturers Installation Specifications. sTaLDARn y ❑FIREDEPT~ �� g Provide signed copy of Cupertino's Tear-Off Policy. � r ReroofApp_201 1.doc revised 03/16/11 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 21405 Rumford Dr DATE: 10/13/2015 REVIEWED BY: Phuong APN: 326-41-051 BP#: "VALUATION: 1$2,500 'PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof PRIMARY SFD or Duplex PENTAMATION 1 SFDWLROOF USE: PERMIT TYPE: WORK Roof repair- remove appox. 4 coarses of clay tiles. Inspect for dryrot and repair. Replace with 1 layer SCOPE of ice buster shield and 1 layer of 90 1 rolled roofing; Class A(6sq) FEE ID ROOF AREA s.f. 1REROOFFRES 600 Afech.Plan Check Plumb.Plan Check I.Jee. Plarl Check T-1 11ech. I'ormir J,, Plunib.,Pei mit i`e [EleC,Permit Fe( Other.Mi?c h.Insp. Other-Plumb hasp, Other Elee..hap. Ifech,Insp.Fee: Plumb.Insp. Fee: lec.hup.Fec NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . Thesefees are based on the prelinWna information available and are only an estimate. Contact the De t or addn'l info, FEE ITEMS (Fee Resolution 11-053 E . 7/1/132 FEE QTY/FEE MISC ITEMS Plan Check 1ee: Suppl. .PC.Fie Phtmh.,%fech./Elee Permit Fee: $102.00 SuppL Insp Fee Plumh.%Mech./Elec Plumh.lMech.IElec Permit hee: ("Onstruction Tux: ,,,hi inisirtrlive I7ee_ Work Without Permit? O Yes No $0.00 4.c1�'[znGe'cl T'lcty2nu7�.1'c'i'. TrL,wel Docuinentt:tioi-?I ees: Stroniz Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $103.50 $0.00 TOTAL FEE: $103.50 Revised: 10/01/2015 ;4 R-4, 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 CUPERTlNO (408)777-3228 - FAX(408)777-3333- buildino d)cupertino.oro PROJECT ADDRESS �/Qt_)� � G)� /� � � � .APN# OWNER NAME PHO ,_ E-MAIL IZay-`z., STREET ADDRESS CITY, STATE,ZIP9 FAX CONTRACTOR NAME - LICENSE I`4BER LICr T BUS.LIC.R COMPA7\ AA4E� E-MAIL ` _ AX STREET ADDRES Jl r CITY,S ,ZIP �✓ ,{I �J PH9NE J b'43 0, 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 7:30-3:30pin (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 (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 de..ectors are required to be installed in accordance with Sections R314 and R3 15 of the 2013 California Residential Code. Signature of Applicant/Agent: ' Date:., ReroofPolicy_2014.doc revised 01/1.5/14 SMOKE 6 CARBON MONOX0E ALARMS OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT o BUILDING DIVISION CUPERTINO 10300 TORRE AVENUE e CUPERTINO, CA 95014-3255 ��f (408)777-3228 a FAX(408)777-3333 o buildinaCd)cupertino.org qp, : I�1�y-:> 5 rio-s-s V$05 Rv%-fo)y Dr T aCa1ib ,9noxide: PERMIT CANNOT BE FINALED AND COMPLETED UNTIL THIS CERTIFICATE HAS BEEN fi QN , AND RF.,TURNF,D TO THE BUILDING 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 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 CSC 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) 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. I have read and a ree to complL with the terms and conditions of this statement 9wner4'ior, wnerAge_nt's).Name: Tac-Vnature............ ...... ... ... . J //�0l 1 ..... .......... ... ..... .... tjjDaf_e.� .Qf.. . ConfraclorName: Si•q-Aw e.................................................................. Q ....................................D`ate: ................... Smoke and CO fornz.doc revised 03/18/14 WATER-CONSERVING PLUMBING FIXTURES FILIE OWNER CERTIFICATE OF COMPLIANCE91 COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION TSCg-1. CUPERTINO 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255 (408)777-3228•FAX(408)777-3333• buiIdinq(!_)CUperHno.orq i Owner Name � c�.��©l "1 Permit N o. ,1 l 000 ���—GD Address 12- 1. 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. 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 110 1.1 through 110 1.8 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. �l 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. 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 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 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 following page. Owner or Owner Agent's Signature: Date: IV/.20/­` V 0 S Upon completing and signing this Celli cate,please return it to the Building Division in order to final your building permit. SB4072015.doc7-evised 08/26/15