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15100184CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 11840 UPLAND WAY I CONTRACTOR: PETERSEN-DEAN INC PERMIT NO: 15100184 OWNER'S NAME: YOW JOSE R AND PEI -PEI L TRUSTEE 17980 ENTERPRISE DR I DATE ISSUED: 10/22/2015 OWNER'S PHONE: 4082577501 1 NEWARK, CA 94560 1 PHONE NO: (510)494-9982 A LICENSED CONTRACTOR'S DECLARATION C 3 � Lic. # " 66 License Class Date l d 1221 15 Contractor? leteRseN beE}N 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 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. 2. I have and will maintain Worker's Compensation Insurance, as provided for by Tx;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. 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 s 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.ditionally, the applicant understands and will comply with all non-point'?,p}wlreg�tions per the CupertA Municipal Code, Section 9.18. Signature (J4U 1 6r a( S ❑ ER -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. 1, as owner of the 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. 2. 1 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 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 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. APPLICANT CERTIFICATION 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, 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 JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ TEAR OFF (E) WOOD SHAKE, INSTALL (N) OSB, 30 # FELT, CLASS A COMP ROOF SYSTEM (31 SQ'S) Sq. Ft Floor Area: I Valuation: $14003 APN Number: 36603048.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYSX'VOM LAST CALLED INSPECTION. Date: ld! ZZ RE -ROOFS: All roofs shall be i4 rcted 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. r +l r Signature of Applicant:4".eDate:10 !/1 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 devices which 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 the Health & Safety Code, Sections 25505, 25533, and 25534. (l�te thorized age dd Date• 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 GUPERTlh10 (408) 777-3228 • FAX (408) 777-3333 - building(51-cupertino.orq 5 /0 PROJECT ADDRESS l t C6-1 a V P LA Pn `NAV) I APN 1 3 4' C a -3 OWNER NAME PHONE 50 Se- / O W I �-4 2s% 7 1;O �`� SL y 0 (Ili AI0 M SillADDRES V * v v`l r ST.p C�14 Q QTI I!'' �I C 0 � ! I FAX COI\?ACT NAl`4E • TI JEAN S,m 0 P ONE �S1 0 2 — Z0k4 E -MAI M,,��CA PerePgeNbQ,1N.e IM STREET ADDRESSa Ila TOvf-4 H(Ne Dx. I C�I� lY,, 41y tl re_ FAX I13 Owx:ER El OWNTER-BUILDER ❑ 0\\?ITER AGENT ❑ CONI ACTOR OI�TTRACTOR AGENT❑ ARCHITECT 13ENGINEERElDEVELOPER 13TENAI.TT C�Oe-NTRACTQR NAME e t ` LICENSENTJMBER � M l 7 LICENSE TY r So% BUS. LIC. COMP `N ' M i'� Sl d E-MAIL�C/��l-a''/�.SQH+/N• CCiM �" FAX STREET ADDRESS CITY, STAT , ZIP 0 t P R i SP D (t. ci,4 (Avc r 4 OIC{ S 6 0 P �, .ZcI eti ON 9� ARCHITECT/ENGINEER NAME LICENSE NUMBER I BUS. LIC. n COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF > -RFD or Duplex ❑ Multi -Family ROOF AREA: VALUATI/ON: i ( 3 F-1Commercial-3 S< / `%,j ` V 0 STRUCTURE: DESCRIPTION OF WORK: l S (`� A titS EXISTING ROOF TYPE: OOD SHAKES ❑ BUILT-UP ROOF ❑ ASPHALT SHINGLES1—I! ❑ WOOD SHINGLES ❑ OTHER (SPECIFY) REMOVE /REPLACE YES IF NO, PLYWOOD ❑ '/:" ❑ PLYWD ❑ OSB , :, ... ,. OFFICE usE oNt _.O PITCH: ROOF 13 NO R LAYERS: THICKNESS: ❑ 5/8" TYPE: ❑ CDX i fl I3UILDIIVG PI,A1�rREVIE�i'� ' 12 CLASS: A PROPOSED ROOF TYPE: ❑ BUILT-UP ROOF ❑ ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SPUNGLES ❑ OTHER ICC -ES REPORT R DESCRIPTION OF WORK: l S (`� A titS t e 14 (L0 a p S1 -4 N s� A L L i r,-- c owt v s� .?o 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 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 build'nA onstruction. I authorize re resent`tives of Cupertino to enter the aboveproperty for inspection purposes. S i -nature of Applicant/Agent: /identified Date: U 1 22 S SUPPLEMENTAL INFORMATION REQUIRED , :, ... ,. OFFICE usE oNt _.O � If buildin- is associated With a Home O\vner's Association;provide letter �PI;AR'CHECKT�'PE .: _. _; ' ROUTING.SLIP .. of approval from HOA. ❑_ OVER THE-COTJI3TER �. i fl I3UILDIIVG PI,A1�rREVIE�i'� Provide Planning approval to verify if there any restrictions. �' E�� �`�' y st',�3T L7 E�.P, S ❑ PL _ h k=° 9 NItTL'� G PLAN REViE�i! } t , _ 41A:j_y# Provide copy of Manufacturer's Installation Specifications.F.:DEPT`� x ._ �'r. � 5 i� 1 _ Provide si-ned copy of Cupertino's Tear -Off Policy. 3 i �pSL 0Ti3EI{ 0.S: sv✓Ss $ -"' 8..z } i.' . 'F't`E`�1 t Ste^ ReroofApp_201 1. doc revised 03/16/11 CITY OF CUPERTINO Iml FEE ESTIMATOR -BUILDING DIVISION igADDRESS: 11840 UPLAND WAY DATE: 10/22/2015 REVIEWED BY: MELISSA Mech. perririt Fee: APN: 366 03 048 FBP#-. *VALUATION: 1$14,003 PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re -roof PRIMARY USE: SFD or Duplex "/umb. hasp. Fee: PENTAMATION PERMIT TYPE: 1 SFDWLROO WORK TEAR OFF E WOOD SHAKE INSTALL N OSB 30 # FELT CLASS A COMP ROOF SYSTEM SCOPE �S'upp[ Insp Fee FEE ID ROOF AREA s.f. 1 REROOFFRES 3,100 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 tnreliminary information available and are only an estimate. Contact the Dept for addn'1 info. FEE ITEMS (Fee Resolution 11-053 a.'711/13) , :Meeh. flan Check Plrcrtrb. Plan Check Elec..Plan Check Mech. perririt Fee: F'lumh. hlec. Peril l,et,. Other Hech. Insp. s"Im"r� Ph+rnh Insrr. OtherI h-�c. Insp. Ifech. Insp. Fee: "/umb. hasp. Fee: Llec. Insp. 1,'ve: 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 tnreliminary information available and are only an estimate. Contact the Dept for addn'1 info. FEE ITEMS (Fee Resolution 11-053 a.'711/13) , FEE QTY/FEE MISC ITEMS Plan Check 14ee: 'A Supt>l..P(.,♦ 1"Ce F Ph1mh. ,Vfeclz.!E1eC Permit Fee: $5,2 -KO �S'upp[ Insp Fee Lf00 o Plumh.111ech. - Elec Phtnrh.;/Mech.%E'lec Permit Fee: Construction Tax: ldministrative Fee: Work Without Permit? Q Yes No $0.00 -4dvanced Planning Fees: � 7'r avel Documentaiion Fees. Strong Motion Fee: IBSEISMICR $1.82 Select an Administrative Item 5-07- S Bldg Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $529.82 $0.00 TOTAL FEE: $529.82 Revised: 10/01/2015 A REROOF TEAR -OFF POLICY COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 - FAX (408) 777-3333 - buildino(a�cupertino.org PROJECT ADDRESS(� 4 C) L A 1 � h V/ 6 1)� 4PI`' # OWNER NAME r1�` p , _ ! PHU1� 0� 257 - s a E-MAIL�Q a yo w "'If STREET ADDRE$S� LN U P LAN ^ l , 11 p /� `� eE�ZI�` � C,� � O' I CCu pe FAX CONTRACT R N 4E Q. Ap,,Y S �� U LICENSE NUM ER L( 6 17 LICENSE TYPE C3°l BL'S. LI . i 4 l COMPANY peFye�SQN 1beA N NIS i c^� PPToRtp►� APj9 N coj�t FAX STREET DRESSrE ry a pal, &P— tJ (Z . C IT �J QAw I/ T 1 " V C R b1 S 6 Q ( PHO ( G) t(q y I [JNDERSTAND 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 detectors are required to be installed in accordance with Sections R314 and R315 of the 2013 California Residential Code- (Q Signature of Applicant/Agent:eTn� Date: ReroofPolicy_2014.doc revised 01/1.5/14 SMOKE 1 CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE ICOMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION CUPE RCTINO 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 FAX (408) 777-3333 •'building aDcupertino.ong dd s PERMIT C NNNOT BL, FINAI.ED AND COMPLETED UNTIL THIS CERTIFICATE E 13F, N =5, �� 1 AI\ID RFTtTR IFD TO THE B LT.ILDING DIN _. - 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 CSC 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 907.2.11.4 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. f have read and agree to comp) with the jer- ondifons of this statement iVJI� C 6[`OG�lFtE'�F/�gert s�Na[PtE: ria i e ......... li ......................... .. �.of Contractor -Name: Si n f eLic ... Da e- Smoke and CO form.doc revised 03118114 Owner Name Address WATER -CONSERVING PLUMBING FIXTURES - OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE CUPERTINO, CA 95014-3255 ,,(49,8) 777-3228 - FAX (408) 777=3333 - buildingP-cupertino.org 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 fonn. 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. Skip the rest of the fonn and sign bottom of form. J 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, i No Go to Question 4. Skip the rest of the form and sign bottom of form. 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 properly. 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). 1, 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 110 1.8, the current California Plumbing Code and California Green Building Standards Code, and manufacturer's installation requirements, and that the water -cons ervin l� fixtures comply with the requirements as indicated in the table on the following page. , Owner or Owner Agent's Upon completing and signing this Certificate, pleasz�'eturn it to the Building Division in order to final your building permit. SB407 2015. doe revised 08/26/15