B-2016-1319 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1319
10574 FELTON WAY CUPERTINO,CA 95014-4313(359 18 024) (ROOFING DOCTOR)
UNION CITY,CA 94587
OWNER'S NAME CHEN HSN SHENG DATE ISSUED:02/08/2016
OWNER'S PHONE: PHONE NO:510-552-1575
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class c39 Lic.#767843
Contractor(ROOFING DOCTOR)Date 2/8/20.16 X BLDG —ELECT -PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing MECH X RESIDENTIAL,_COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION-
REMOVE(E)ROOF AND INSTALL(N)PLWOOD;30#PAPER AND
I hereby affirm under penalty of perjury one of the following two declarations: LIFETIME COMP ASPHALT SHINGLES-22 SQ'S
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 whichthispermit is issued.
I have and will maintain Worker's Compensation Insurance,as provided for
ti by Section 3700 of the Labor Code,for the performance of the work for which
this permit is issued. Sq.Ft Floor Area: Valuation:$13000.00
APPLICANT CERTIFICATION
1 certify that I have read this application and state that the above
information is correct.I agree to comply with all city and county APN Number: Occupancy Type:
ordinances and state laws relating to building construction,and hereby 359 18 024
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 PERMIT EXPIRES IF WORK IS NOT STARTED
expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally,the applicant understands and,will
comply with all non-point source regulations per the Cupertino Municipal 180 DAYS FROM LAST CALLEDINSPECTION.
Code Section 9.18. /�a
J r e
Issued by: 1981 ,(
Signature Date 2/8/2016 Date•2/8/2016
OWNER-BUILDER DECLARATION RE-ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of the All roofs shall be inspected prior to any roofing material being installed.If a roof is
following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for
1. I,as owner of the property,or my employees with wages as their sole r' f inspection.
compensation,will do the work,and the structure is not intended or offered ,
for sale(Sec.7044,Business&Professions Code) Signature of Applicant:
z. I,as owner of the property,am exclusively contracting with licensed Date:2/8/2016
contractors to construct the project(Scc.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
r. 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 HAZARDOUS MATERIALS DISCLOSURE
performance of the work for which this permit is.issued. I have read the hazardous materials requirements under Chapter 6.95 of the
2. I have and will maintain Worker's Compensation Insurance,as provided for California health&Safety Code,Sections 25505,25533,and 25534. I will
by Section 3700 of the Labor Code,for the performance of the work for which maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
this permit is issued. Health&Safety Code,Section 25532(a)should I store or handle hazardous
3. I certify that in the performance of the work for which this permit is issued,I material. Additionally,should I use'equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the 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
Worker's Compensation laws of California. If,after making this certificate of the Health&Safety Code,Sections 25505,25533,and 25534.
exemption,I become subject to the Worker's Compensation provisions of the f ,
Labor Code,I must forthwith comply with such provisions or this permit shall Owner or authorized agent:
be deemed revoked. Date: /2 8/2016
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
I certify that t have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance
correct.I agree to comply with all city and county ordinances and state laws of work's for which this permit is issued(Sec.3097,Civ C.)
relating to building construction,and hereby authorize representatives of this city Lender's Name
to enter upon the above mentioned property for inspection purposes. (W6)'agree
to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Address
judgments,costs,and expenses which may accrue against said City in
consequence of the granting of this permit. Additionally,the applicant ARCHITECT'S DECLARATION
understands and will comply with all non-point source regulations per the I understand my plans shall be used as public records.
Cupertino Municipal Code,Section 9.18.
Licensed
Professional
Signature Date /8/2 2016
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPIcEtT l+ C3 (408)777-3228• FAX(408)777-3333•building(a-cupertino.org
PROJECT ADDRESS /P
/� p1 APN# [
I-/- L-1
OWNER NAME (S�) (;,�►/� �J PHONE E-MAILSTREET ADDRESS 0- CITY, STATE,ZIP a o I P FF
CONTACT NAME ® `�.� - PHONE �(yr(/`�r' P !t E-MAIL
STREET ADDRESS VosY(! W v CITY,STATE,ZIP l •,�i0 0(roJ 1 yJ AX
❑OWNER ❑ OWNER-BUILDER WY❑t OWNER AGENT VC.ONTRACTOR ❑CONTRACTOR AGENT ❑ ARCFIITECT 11 ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAMEs, �0® ! LICENSE NUMBER -g FLICEN7SETYPE� e BUS.LIC,#.
COMPANY NAMEt E-MAIL FAX
-1»
STREET ADDRESStf CITY,STATE,ZIP PHONE_ ®�
ARCHITECTIENGINEERNAME fly wLICENSE NUMBER BUS.LIC.#
COMPANY NAME _ - E-MAIL - FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF V/SFD Or Duplex ___ 2q lti-Family ROOF AREA: VALUATION: 99
STRUCTURE: ❑ Commercial ^ (/
EXISTING ROOF TYPE: ❑BUILT-UP ROOF ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES El-OTHER(SPECIFY)
REMOVE/REPLACB. YES; IF NO, PLYWOOD W%" ❑ PLYWD ❑ OSB PITCH: ROOF
❑.NO. #LAYERS: THICKNESS: ❑ 5/8" TYPE: _ ❑ CDX :12 CLASS: `�
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ASPHALT SHINGLES ❑WOOD SHAKES ❑'WOOD SHINGLES ❑OTHER ICC-ES REPORT#
DESCRIPTION OF WORK: e'„_A e?,g� F Id ,a
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 Iding construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: / Date:
SUPPLEMENTAL INFORMATION RE UIItED
_If building is associated with a Home Owner's Association,provide letter MIND—.`
of approval from HOA.
R r coTzt BtranzNr ArtR
�v a, ..`
—Provide Planning approval to verify if there any restrictions. p fi [ ��ArcLATxu v��i
Provide copy of Manufacturer's Installation Specifications. L� STANarib CIS°FlxuEr1
—Provide signed copy ofCupertino's Tear-Off Policy. "
ReroofApp_2011.doc revised 03/16/11
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
ALBERT SALVADOR, P.E.,C.B.O., BUILDING OFFICIAL
CJpERTlNiC3 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(408)777-3228- FAX(408)777-3333 building(a.cupertino.org
-PROJECT ADDRESSy @ APN#
OWNER NAME fl.� , 1A
PHONE / C3 E-MAIL.
STREET ADDRESS CITY, STATE,ZIP ' o FAX
gai
CONTRACTOR NAME !' ICENSE NUMBER J� LICENSE TYP BUS.LIC.#
COMPANY NAME f�A y ®� n E-MAIL FAX
STREET ADDRESS ? JC✓� Y •� CITY,STATE;ZIP L i PHONE
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 roofin 'which is applied without firstobtaining 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 beobtainedfrom 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. r�
Signature of Applicant/Agent: h Date: t3'
ReroofPolicy 2014.doc revised 01/15/14
CITY OF CUPERTINO -. I& 13 ILI ,
FEE ESTIMATOR BUILDING DIVISION
ADDRESS: 10574 FELTON WAY DATE: 02/08/2016 REVIEWED BY: PAUL
APN: 359 18 024 BP#: 'VALUATION: 1$13,000
°PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY PENTAMATION
USE: SFD or Duplex PERMIT TYPE: 1 SFDWLROOF
WORK REMOVE E ROOF AND INSTALL N PLWOOD; 30# PAPER AND LIFETIME COMP SHINGLES
SCOPE 22 SQ'S
FEE ID ROOF AREA
(S.L)
1 REROOFFRES 2,200
.{<..t«. r.Y,`2»:10<.. zr W Fee: .fsr£.. P-cri.," Pei",
OAi,r -.e 's`i. h:,jT7. c, Z,.,t...
El
NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc. . These ees are based on the prelimina information available and are only an estimate. Contact the De t for addn'l in o.
FEE ITEMS ffee Resolution 1.1-053 h'f: 7/11.13) FEE QTY/FEE MISC ITEMS
s
Plan rhe Fel-1:
_i :t
Permit Fee: $374.00
, s
`.
OHS,,`t'l,a1If e 3 2
1Fee:
Work Without Permit? 0 Yes Q No $0.00
i
Strong Motion Fee: 1BSEISMICR $1.69Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $376.69 $0.00 TOTAL FEE: $376.69
Revise ,. 01/01/2016
1FILEISR CERTIFICATE OF COMPLIANCE-
1
-0 411 COMMUNITY DEVELOPMENT DEPARTMENT o BUILDING DIVISION ��C
C P `NO 10300TORRE AVENUE m,CUPERTINO,CA 95014-3255
(408)777-3228 m FAX(408)777-3333 building(a)cupertino.org
PFItMIT CXNN0T DF z IN2kLFD AND CDgPLETED UNTIL TMS CERTIFICATE
g I�'ED T T3iC �D DI77
T Cl
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 8314 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 COALARM
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-burrung 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,da
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 4 ice with the Califorzua Building
and Cal=ifonr-a Residential Codes.The alarms have been tested and are operational, as of the date signed
below..
l ha:ue read and agfe to cqmpk vvoG the termt, and'conns aft StA menf
(�StUSH&Aq CIf97V _i l:jffi,r'et. �
Go�tracfor4lam�e; ,
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Srnnke mrd:`C`O=form;docrersed.03/1.'8/114
e
WATER-CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE F L R
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION Z ZZ 6
t~61PftTtht lt}-5 1 RRE AVENUE-CUPERTINO,CA 95014-3255
j408)77Z-3228 FAX 4408)777-3333 building a&uperdno.oro
Owner Name Permit N o.
Address i D 5'74
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.
t K 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.
El The licensed plumber's certification has been provided to the Building Division.
Skip the rest of the form and sign bottom of form.
KNo 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.
-J
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.
L] Yes My real property is built and available for use or occupancy on or before January.l,.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 propertyis asingle-familyresidential real roe See Civil Code Section 1101.4.
On and after January
1 2014 buiklin afterat ons o
ry , g r 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 whethez
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).
El 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
installationn 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- 1
Upon completing and signing this Certificate,please return it to the Building Division in order to final your building permit.'
SB4072015.doc revised 08126115