15110075"' ! : '. ::''' '; ' •.. CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:.21.571 TERRACE DR
CONTRACTOR: R E ROOFING &
PERMIT NO: 15110075
CONSTRUCTION INC
OWNER'S NAME: WANG'XIANFENG AND LI WEI
i -
15230 CLYDELLE AVE
DATE ISSUED: 11/12/2015
OWNER'S PHONE:', 4083867325:
SAN JOSE, CA 95124
PHONE NO: (408)626-9320
❑ `:.':, "LICENSED CONTRACTOR' CONTRACTOR S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
Livens Class:(`�'l' f Lic. # L i f
REMOVE SHAKE ROOFING AND INSTALL NEW 1/2" CDX,
30#
Contract` ''f`i Date
FELT, AND COMPOSITION ROOFING (3500 SQ FT).
I he`reb aiiirm 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"infull force and effect.
1 hereby affirm under penalty of perjury one of the following two declarations:
I have and will:maigtain a`certificate of consent to self -insure for Worker's
Compensation'as;proVidcd for,by: Section 3700 of the Labor Code, for the
,performance bf.thework for which this permit is issued.
Sq. Ft Floor Area:
Valuation: $20000
I have and',will,`inaintain Worker's Compensation Insurance, as provided for by
APN Number: 35620015.00
Occupancy Type:
Section 3,700 'of the Labor Code, for the performance of the work for which this
'.
permit is issued.' ,' L" : ;'
'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
WITIHN 180 DAYS OF PERMIT ISSUANCE OR
to building construction, acid hereby authorize representatives of this city to enter
upon, the above;'meiiitioned property for inspection purposes. (We) agree to save
180 DAYS FROM LAST CALLED INSPECTION.
indemnify and keep' -harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in of the
Issued by: � '�t`�G Date:
granting of thisIperrnit: � Additionally, the applicant understands and will comply
with all non -point source regulations er the Cupertino Municipal Code, Section
'I8.'
Z
RE -ROOFS:
Signature d t Date I l
I -roofs hall be inspected priorto ar�y roofing material being installed. If a roof is
- /
installed wr out f SWIS in an inspectY n I agree to remove all new materials for
inspection.
.,
❑ 'OWNER -BUILDER DECLARATION
/
f
I hereby affirm thatI am exempt from the Contractor's License Law for one of
/ Date:
Signature of�1b 1i am-.., Z � .
the following two reasons • I "
ALL ROOF -COVERINGS TO BE CL "A" OR BETTER
I, as ownat of the'property;;or'my'employees with wages as their sole compensation,
will do tire work, 4nd 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
I hereby affirm under penalty of perjury one of the following three
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will
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
terra�.'��ditionally, should I use equipment or devices which emit hazardous
Compensation, as provided for by Section 3700 of the Labor Code, for the
air contaminal is as defined by the Bay Area Air Quality Management District I
performance'of the work for which this permit is issued.
will maintain co plianee-wi the C pert no Nt nicipal Code, Chapter .12 and
" k '.
1 have and.will maintain Worker's Compensation Insurance, as provided for by
for
the Health & Saf de, Sect 25505, 2553 an 25534.
; _
` 1 `
Section 37004the Labor Code,.for the performance of the work which this
p
Owner or an o edag �'� Dater`
permit is issued.:,„ ,, + .•
` ��
1 certify, that in the performance of the work for which this permit is issued, I shall
^__„ •-'
not employ;anyiperson. in any manner so as to become subject to the Worker's
Compensation laws of Califon ia. If, after making this certificate of exemption, 1
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
Lender's Address
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 construe6n,'and hereby authorize representatives of this city to enter
upon the above 'mentioned property for inspection purposes. (We) agree to save
I +
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 I' I!1l Date
CUPERTU40
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 o FAX (408) 777-3333 • buildingCcDcupertino.org /J t r 0 0 75
PROJECT ADDRESS
I q yj �p , ,
7APN #
Gs
OWNER NAME �. > I /
PHONE I 1 O _ _
E-MAIL
STREET ADDRESS
�y�
CITY, STATE, ZIP
1
FAX
CONTACT NAME 00ft ijq
E-MAIL
STREET ADDRESS nn 07
CITY, STATE, ZIP G� l �� 12
FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT ^ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME�M ( !
LICENSE NUMBER
LICENSE T/n
BUS. L)IC�. #
COMPANY NAME
M
E-MAIL
e—(06'�(1) co
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
L4 () v Za
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC. #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OFSFD or Duplex ❑ Multi -Family
STRUCTURE: ❑ Commercial
ROOF AREA: / -
VALUATION: �j,, ll
�{{
D I V U V
EXISTING ROOF TYPE: ❑ BUILT-UP ROOF ❑ ASPHALT SHINGLES ROOD SHAKES El WOOD SHINGLES El OTHER (SPECIFY)
,,
MOV /REPLACE ES
El NO
IF NO,
# LAYERS:
PLYWOOD %: ❑
THICKNESS: 115/8"
PLYWD ❑ OSB
TYPE: DX
PITCH:
2
ROOF
CLASS:
PROPOSED ROOF TYPE: ❑ BUILT-UP ROOF ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER
ICC -ES REPORT #
DESCRIPTION OF WORK:
f ,� / ' 1 n ,
}f'j'' j'�
3,C j
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 info tion a provided is correct. I have read't�ie cription of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state 1 s relating to b ildm !str��on.pres atives of Cupertino to enter the above -idle tified rope ty for inspection purposes.
Signature of Applican gent: 1 —......... Date: \ ��
SUPPLE AL INFORMATION REQUIRED
_ If building is associated with a Home Owner's Association, 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.
OVER-THE-COUNTER
EXPRESS'
❑ . STANDARD
N/IBUILDING PLAN REVIEW
][ PLANNING PLAN REVIEW
❑ FIRE DEPT
O OTHER:
ReroofApp_2011.doc revised 03/16/11
I
CITY OF CUPERTINO
FF.F. FIRTIMATOR - BUILDING DIVISION
Af(?ci,,. , Man Cbt?ck
Other _,,�,Ieeh.'Pqp,
Heel), fr.131).
FEE ID ROOF AREA
(S.f)
IREROOFFRES 3,500
/.)I I Jqdfdtl (--p,
Fee:
Plant ., ieck I I
IElec. perinif Fee:
Oiber b1ec. Ins.o.
Ir'sp. Fee:
NOTE:. This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District; Thesefees are based on the prelimina information available and are only an estimate. Contact the Dept -for addnl info,
ADDRESS: 21571 Terrace Dr
DATE: 11112/2015
REVIEWED BY: Sean
MISC ITEMS
APN:
BP#:
*VALUATION:
1$20,000
*PERMIT TYPE: Minor Building Permit
PLAN CHECK TYPE: Re -roof
PRIMARY
SFD. or Duplex
USE:
PENTAMATION
PERMIT TYPE: 1SFDWLR00F
WORK
Remove shake roofin-q and install new 1/2" CDX, 30# felt, and composition roofing (3500 sq ft).
SCOPE
_T71
Af(?ci,,. , Man Cbt?ck
Other _,,�,Ieeh.'Pqp,
Heel), fr.131).
FEE ID ROOF AREA
(S.f)
IREROOFFRES 3,500
/.)I I Jqdfdtl (--p,
Fee:
Plant ., ieck I I
IElec. perinif Fee:
Oiber b1ec. Ins.o.
Ir'sp. Fee:
NOTE:. This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District; Thesefees are based on the prelimina information available and are only an estimate. Contact the Dept -for addnl info,
El . tlT'EMS'07ee Resolution] 1-053 gff. 7/1/132
FEE
FEE
QTY/FEE
MISC ITEMS
PICIn. Cheek 176,e:
0 PC.Fee
Permit Fee:,
_T71
Work Without Permit? 0 Yes (D No
$0.00
ocuinentguo n Feclls:
Strong Motion Fee:',- IBSEISMICR
$2.60
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
V
_,.SUBTOTALS
'59efo $0.00 T
Revised: 10/01/2015
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 - building(a.cupertino.org
PROJECT ADDRESS' '• � � �] � 7�� � � m I��
APN #
OWNER NAME.
= � � WA-
PHONE
E-MAIL
STREET ADDRESS ..,, ^
CITY, STATE, ZIP Q
FAX
CONTRACTOR NAME _ ') ]
/ I//\
LICENSE NUMBER —1 Z I (J�/�,
( "I
LICENSE�1
(
BUS. LIC. #
COMPANY NAME,', ',,'•
E-MAIL
FAX
tU
STREET ADDRESS' : ���� O 1
�� - A n I
CITY, STATE, ZIP I � I
PHONE q r. r A ry
i
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 (Mon-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/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 beha understand and agree to comply with the re -roof policy stated above. I also understand that
smoke detectors - d carbon m oxide detectors are require a installed in accordance with Sections R314 and R315 of
the 2013 Calif is Residential de.
Signature of App icant/Agent:
ReroofPolicy_2014.doc revised 01/15/14
Vii• '
I
CUPERTlIrNIO
Owner Name
Address
WATER -CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMP LL ANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 9501473255
(408) 777-3228 , FAX (408) 777-3333 ^ buildingP-cupertino.om
0 FILE
0151a015.
i co-�,J
1. Is your real property a registered historical site?
❑l /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 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 form and sign bottom of form.
Io 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.
Vo 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.
Ves 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. a
e check ONE of the following:
y 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 110 1.8, 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. (""l-
Owner or Owner Agent's Signatu���y � ��, —__�� Date..--
Upon completing and signing this Certificate, please return it to the Building Division in order to final your building permi t.
SB407 2015.doc revised 08/26/15
iSll �%�+ IL�TG PEI UT _CzMNINOT 1$E_ FP =f D IND �C 3111P ::ETE, D U'�SI . 'Ii MS
R RT �r� r Eli �! . F S�"D RJT .�P '�: � BU � ��jlID
1. If the existing plumbing tixture water usage/now rate is equal to or LuwGL LLLan LLLG L16LLL1+ AL1V W,1, 1L 10 11V I-li 111 Vl1 -JI,5- .. ---
SB407 2015.doc revised 08/26/15
Non -Compliant
Water -Conserving Plumbing Fixture
'
Plumbing Fixturel
(Fixture Complying with Current Code Applicable to New Construction)
Maximum
Water Usage/Flow Rate '
Fixture Type
2013 CPC Ch. 4
2013 CPC Ch. 4
2013 CPC Ch. 4
Water Usage
2013 CALGreen Div. 4.3
2013 CALGreen Div. 4.3
2013 CALGreen Div. 5.3
/Flow Rate
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 tixture water usage/now rate is equal to or LuwGL LLLan LLLG L16LLL1+ AL1V W,1, 1L 10 11V I-li 111 Vl1 -JI,5- .. ---
SB407 2015.doc revised 08/26/15
Dec 12 15 09:28a
CUPERTINO
Address
PURPOSE
SMOKE f 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 • building(&cupertino.org
21 I 4 I�UiiJ�� ��• 9 of Alarms Smoke:
PERIMIT CANNOT BE FINALED AND COMPLETED UNTII, THIS CERTIFICATE
HAS BEEN SIGN D AN[) REi'URNE:D TO TIME BUILDING DIVISION
This affidavit is a self -certification for the installation of all required Smoke and Carbon Monoxide AIarms for
compliance with 2013 CRC Section R0314,2013 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 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 :
J
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 8314 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 plarmab2tve been tested and are operational, as of the date signed
below. �✓'�
UJa4& have read and agree to comply vilth the terms and conditions of this sratemen(
ow mr (or O�vrtvr Agenrsl Mame:
Sicna`.ure. .... - . Dale:
Conitacf& Name:
Signature...................................................................0 c.# ...................................:.. Date:
Smoke and CO form.doc revised 63/18/14