15100237CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 1121 MILKY WAY
CONTRACTOR: R E ROOFING &
PERMIT NO: 15100237
CONSTRUCTION INC
OWNER'S NAME: KISHIMOTO ZENICHI AND YUKIKO
15230 CLYDELLE AVE
DATE ISSUED: 10/29/2015
OWNER'S PHONE: 4089969138
SAN JOSE, CA 95124
PHONE NO: (408)626-9320
LICENSED CONTRACTOR'S DECGLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
Lice Class C. Lie. # -72 t
Remove (E) roof; Install (1) plywood; 30# felt and (N) lifetime comp ashpalt
shingles - 24 Sq's
on acto Date 2 y
�amensed
1 her affirm un a 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: $11000
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
APN Number: 36219016.00
Occupancy Type:
permit 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 YS FROM LAST CALLED INSPEC IO .
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
rr '' ry
L (� C l.t(�� 10 vl
J
granting of this permit. Additionally, the applicant understands and will comply
Issued by: Date:
wi I non-point source regulations per the Cupertino Municipal Code, Section
RE-ROOFS:
.18.
ignature to I I
2
All hall be inspected prior to any roofing material being installed. If a roof is
stalled wt out first obtainin n-insp ction, I agree to remove all w materials for
i❑
OWNER-BUILDER DECLARATION
Linspection4.,
� OJT Z
re 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
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)
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(x) should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's
ly, should I use equipment or devices which emit hazardous
materieal
Compensation, as provided for by Section 3700 of the Labor Code, for the
air conaned by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued.
will man a with the Cupertir um 1 Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
1
the HeJJ, e, 33, and 534.Section
3700 of the Labor Code, for the performance of the work for which thisOwner
G ff Date:
la 7 C 1241!
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
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,
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 15i 0093
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building ancupertino.ora
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PROJECT ADDRESS I I � A L"
I APN 4
OWNER NAME � �1 C 1, I l I U-�l
PHONE � � Cj r„ G � Z G E-MAIL
STREET ADDRESS ' ` 2� ' ��/ \1v k�
CITY, STATE, 71PC , �(�/
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I FAX
CONTACT NAME �n `
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STREET ADDRESS 2 !, 1
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CITY, STATE, ZIP C�� fIi
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0 OWNER 13ORT'ER-BUILDE)R❑ 01AINTER AGENT NTRACTO 1-1 CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER 13DEVVELOP TENANT
COT?R4CTOR NAME =LICENSENTUMBER (�
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LIC i 'SE TYPE
BUS. LIC.
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COMPANY NAME nnV' (Vj n M
E-MAIL
FAX
STREET ADDRESS 1 \ ` �/
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CITY, STATE, ZIP /„ �� /
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PHONE
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC.
COMPANY NAME
E-MAIL
FAX
S'T'REET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF 1�1SFD Duplex 0 Multi -Family
ROOF AREA:
VALUATION:
UV,
STRUCTURE: ❑ o
fmmercial 4 UD
I Ua
EXISTING ROOF TYPE: ❑ BUILT-UP ROOF ❑ ASPHALT SHINGLES
OOD SHAKES R OD SHINGLES ❑ OTHER (SPECIFY)
REMOVE /REPLACE BS
IF NO,
PLYLV )OD ''/i' E]PLYbVD
-7
OSB
TPITCH:
ROOF
13 NO
L.Al'ERS:
THICKNESS: /
❑ 518"
TYPE DX
12
CLASS: A
PROPOSED ROOF TYPE: ❑ BUILT-UP ROOF AASPHALT SHINGLES
❑ WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER
ICC -ES REPORT 4
DESCRIPTION OF NVORK:
By my signature below erti each of the follo\vinz: I am the property owner or authorized agent to act on the property owners behalf. I have read this
application and the ' formation I hay provided is correct. I e reg
e Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and sta laws relating to b tructao u riz
r p sentatives of Cupertino to enter the above -i TiedgpTp for inspection purposes.
SignatureofAppli nUAgent: _
Date: t
SUPPLEMENTAL INTFORA REQUIRED'
oFFicE UsE biyia _
= PLAT` CHECK TYPE:`
ROVTINQ SLIP
_ If building is associated With a Home Owner's Association.
provide letter
-
`OVER THE -COUNTER r
77 7 -
❑ BUII,bI?�G PITA -N REVIEW
of approval from HOA.
PP
Provide Planning approval to verify if there any restrictions.
D , ELPRESs f� k x
, ❑ PL t.N�GrLAI� REQissv
Provide copy of Manufacturer's Installation Specifications.
❑ Sa.DARD
❑-IT TRRDEpj
6.
❑
_ Provide signed copy of Cupertino's Tear Off Policy.
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OTFIER
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XeroofApp_2011.doc revised 03/16/11
` u—
CITY OF CUPERTINO 15 too
1�/JI FEE ESTIMATOR -BUILDING DIVISION
1A,
ADDRESS: 1121 Milky Way
Plumb. flan Cheek
DATE: 10/29/2015
REVIEWED BY: Paul
Plumb. Pcrr, .
APN: 362 19 016
BP#:
*VALUATION: Isi1,000
'PERMIT TYPE: Minor Building Permit
Mech. Insp. Fee:
PLAN CHECK TYPE: Re -roof
PRIMARY
USE: SFD or Duplex
PENTAMATION
PERMIT TYPE: 1 SFDWLROO ;
WORK
Remove E roof; Install N plywood; 30# felt and N lifetime comp ash alt shingles - 24 S 's
SCOPE
FEE ID ROOF AREA
s.f.
1 REROOFFRES 2,400
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 addn'1 info.
FEE ITEMS (Fee Resolution 11-053 Eff. 711113
:11ech. Plan Check
Plumb. flan Cheek
E7ec. Plan Check
F1175, 1'ermrt Fec:
Plumb. Pcrr, .
Pcrrrri! ,
Other Mcch. Insp.
Other Plumb lrUp.
Other Hee. Insp.
Mech. Insp. Fee:
Plumb. Insp. Fec
Flec. Insp. Fee'
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 addn'1 info.
FEE ITEMS (Fee Resolution 11-053 Eff. 711113
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
Suppl. PC Fee
Plumb. /Illech./Elec
Permit Fee:
$40 .
Suppl. Insp Fee
Plumb./Mech./Elec
1'lumb.IMech.SElec Permit Fee:
C'Onstruction Tax:
.-hllninislrative Fere:
Work Without Permit? Yes (F) No
$0.00
.4th,( need Planning Fees:
l fWvel Documewalion Fees:
Strong Motion Fee: IBSEISMICR
$1.43
Select an Administrative Item cc��
�(J�
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$410.43
$0.00 TOTAL FEE:
$41 .
Revised:if 0/01 /2015
M
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 • buildino(5).cupertino.org
PROJECT ADDRESS (� (
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•'CPN 4 *�2[.-�'
O\\ NER NAME Il
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PHONE [ f \�/ '
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E-MAIL
STREET ADDRESS f
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CITY, STATE, ZIP %
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FAX
CONTRACTOR NAM GVj' !
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LICENSE NUMBER__ �
LICENSE T1TEC �q
BUS. LIC. 9 2(A
NAME �
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E-MAIL Y- .1 O ci I n
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FAX q4 -
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EET ADDRESS Z
STREET
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CITY, STATE, ZIP i
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PHONE
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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 7:30-1.0:30am 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,4nunaxide detectors are requiTe N be installed in accordance with Sections R314 and R31 of
the 2O1 ; C'.alifnrnia Residential Co . ,—. /_'-\ ^�
Signature of Applicant/Agent:
Date: Z l' (�
ReroofPolicy_2014.doc revised 01/1.5/14
CUPERTI(N O
WATER -CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLDANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 o building(a)-cupertino.org
Owner Name &Zt-4.' Cha ro ki,le- a k-;, {A i n Permit No /s- i 0 tl 2.37
Address /12 ! n1 ` I6 10,x_ C�� �' %,' 61 D , r A 5 c me
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.
9 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 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.
1 No Go to Question 3.
3. Is water service permanently disconnected for your building?
El Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
"" V 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.
1 Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
JW LI 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. "lease check ONE of the following:
Cdj 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 a ra ' till IF -
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 followine uaae. r -11- _ . .
Owner or Owner Agent's Signature=l l -- -�� plc;, ft/ f r�_77 Dater.._.,.! it A / 22 yA
UPUII UU111Picu11g d11U signing uus l,eilrircatC, please return rt to the buiictrng Division in order to tinal your building permit.
SB407 2015.doc revised 08/26/15
112-)
PURPOSE
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT o BUILDING DIVISION
10300 TORRE AVENUE o CUPERTINO, CA 95014-3255
(408) 777-3228 o FAX (408) 777-3333 o building(a.cupertino.org
/5 /0 0237
PERMIT CANNOT BE FINALED AND COMPLETED (UNTIL THIS CERTIFICATE
HAS BEEN S dYNE AND RETI.iRNI D TO TIDE BUILDING DIVISION
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, ,F s 1rw.�xisting dwelling units exceeds
$1000.00, CRC Section R314 and CBC Sections 907.2.11.5 and 420 t S ok Alarms and/or Carbon
Monoxide Alarms be installed in the following locations: (
AREA
SMOKE kLAAM
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.
i have read and agree to comply with the terms and conditions of this statement
OvvAgent si Name:
pp f_ -f
int [h� �f�� � F� Ki'S� 'lm 01,
�7 .
�Si "nature .. r �: �_, I/�5�2.c
..............�.............. .: ;:: lr.�..................... Date.j
C5'rifractor� Nam e:
-�'•� •'�
Si'"nature...................................................................'4.- fF;'.................................... D'alea
Smoke and CO form.doc revised 03118/14