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B-2016-1354 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1354 21425 MILLARD LN CUPERTINO,CA 95014-1320(326 44 057) (T D ROOFING INC) SAN JOSE,CA 45111 OWNER'S NAME: YEE EDDIE LAND CHRISTINE,S TRUSTEE DATE ISSUED:02/12/2016 OWNER'S PHONE:408-733-4223 PHONE NO:408-849-0840 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class C-39 Lic.#BA5591. Contractor(T D ROOFING INC I Date 02/12/2016 X BLDG _ELECT _PLUMB _ MECH X RESIDENTIAL_COMMERCIAL 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. JOB DESCRIPTION'. TEAR OFF(E)WOOD SHAT-E,(NO PLY)INS TALL(I)30#FELT CLASS I hereby affirm under penalty of perjury one of the following two declarations: A COMP ROOF SYSTEM(28 SQ'S) 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 erfermance of the work for which this permit is issued. z ,f 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. Sq.Ft Floor Area: Valuation:$16000.00 { 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 APN Number: Occupancy Type: ordinances and state laws relating to building construction,and hereby 326 44 057 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 nonpoint ou ce regulations per the Cupertino Municipal 180 DAYS FRO ALLED INSPECTION. Code,Section 9.18. �� Issued by:MFLISS Signatures afe 02/12/2016 Date:02/12/2016 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 m§ ection,I agree to remove all nev`materials for 1. I,as owner of the property,or my employees with wages as their sole nspection. ^' compensation„will do the work,and the structure is not intended or offered for sale(Sce.7044,Business&Professions Code) Signature of Applicant 2. I,as owner of the property,am exclusively contracting with licensed Date:02/12/2016 contractors to construct the project(See.7044,Business&Professions Code). ALLROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: 3 1. 1 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,fer 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. 1 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 Health&Safety Code,Section 25532(a)should I store or handle hazardous this permit is issued. s. I certify that in the performance of the work for which this permit is issued,l material. Additionally,should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air uality Management District I shall not employ.any person in any manner so as to become subject to the will maintain compliance with the Cupe tino ', icipal Code,Chapter 9.12 and Worker's Compensation laws of California. If,after making this certificate of the Health&Safety Code,Se tro '-25 05,25 end 25534, 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 - p y p p Owner or authorized..agent:/-/ i be deemed revoked. Date:02/12/2016 APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENC I certify that I 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 Gender's Name to enter upon the above mentioned property for inspection purposes. (Vve)agree Lender's Address to save indemnify and keep harmless the City of Cupertino against liabilities, judgments,costs,and expenses which may accrue against said City in ARCHITECT'S DECLARATION consequence of the granting of this permit. Additionally,the applicant I understand my plans shall be used as public records. understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Licensed Professional Signature Date 02/12/2016 u REROOF PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT+BUILDING DIVISION is 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUPeR"i`mf} (408)777-3228• FAX(408)777-3333 building(o1cupertino.org G-W(6 - 13. PROJECT ADDRESS i Ss )l l a I �, iLXA APN# OWNERNAME gad�`� �e-q- '0- 3 S / 3 E-MAIL ( r FAX STREET ADDRESS' q /�l 1 Ci,V--C-,( CITY, ATE,ZJ$ CONTACT NAME'--D LL 14 ,�,to_ cc) C3 � 1 t3 E-MAIL STREET ADDRESS CITY,STATE,ZIP ! FAX ❑OWNER ❑ OWNER-BUILDERS ❑ OWNER AllCONTRACTOR 1:1CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER [3DEVELOPERS ❑TENANT CONTOR ,AME P LICENS �B9It°G-q { LICENSE TY BUS.LIC.# ''M I E-MAIL t FAX COMPANYNAME STREE JW S l r 'C 0 T2.,TTATE,� r1e e C-%�1 t I P(ss 9 `L -1 C)S `I 0 ARCHITECTIENGINEERNAME ry LICENSE NUMBER C� BUS.LIC.# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF SFD or Duplex ❑ Multi-Family ROOF AREA: ` VALUATION: �- Xk J_ c8 16 t (Sly STRUCTURE: ❑ Commercial EXISTING ROOF TYPE: BUILT-UP ROOF ❑ASPHALT SHINGLES WOOD SHAKES 13 WOOD SHINGLES 0-OTHER(SPECIFY) REMOVE/REPLACE YES IF NO, PLYWOOD ❑ '/:" ❑ PLYWD ❑ OSB PITCH: ROOF ❑NO #LAYERS: THICKNESS:. ❑ 5/8" TYPE: ❑ CDX '12 CLASS: A ICC-ES REPORT# PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER DESCRIPTION OF WORK: I� i 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 Is corn ct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local application and the information I have provided ordinances and state laws relating to building . ns c on. I authorize representatives of Cupertino to enter the abboove-pdenti�fie proY e for inspection purposes. I Date: // 1 Signature of Applicant/Agent: SUPPLEMENTAL INFORMATION REQ = i Q_- 06- oN�� PLAN CHECK"TYPE OUTING SLTP � _If building is associated with a Home Owner's Associa I provide letter ry of approval from HOA. IIzCOIIIVTIx �BIJILDINGFLANRE4ihw Provide Planning approval to verify if there any restrictions. 0 EXFx�ss _ F © LANNI�ILA1VxI vIW _Provide copy of Manufacturer's Installation Specifications. sTA�AIR�`DErr �`�-�-�- � x �- -� �t�`, ��0•r,r�S.R:,�'+. 'ire. ���`�,-w b Provide signed copy of Cupertino's Tear-Off Policy. 5 s 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 its 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CIllPEERT- 11140 (408)777-3228• FAX(408)777-3333-buildingQcupertino.org [ PROJECT ADDRES�g`t q � APN# � � �� OWNERNAME (''tJ( F STREET ADDRESS MY, STATE,ZIP FAX CONTRffITIiSME �/L LICENSE ET ��"i , LICENSE 0) BUS.LIC.# COMPANY N AME/ E-MAIL FAX STREET DESS_ a l C � C °ZIi � q , III Pqbg 1 9 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 behalf. I understand and agree to co, ply with the re-roof policy stated above. I also understand that smoke detectors and carbon monoxide detect�rsla e r -uired to be installed in accordance with Sections R314 and R315 of the 2013 California Residential Code. /r 2 ` G Signature of Applicant/Agent: / Date: ReroofPolicy_2014.doe revised 01/15/14 OWNER CERTIFICATE OF COMPUANCE COMMUNITY DEVELOPMENT DEPARTMENT►BUILDING DIVISION IL 10300 TORRE AVENUE►CUPERTINO,CA 95014-3255 CA1libER►�"1�IC3 (408)777-3228►FAX(408)777-3333•building(a cupertino.org AL PERMIT CANS N OT DF r'INA I,r!,D�yAN-D CaC'��MPJ�Q��'�'i ED UNTIff,T�( S CERT I FICA`E HASIBI:•�f F S S;l M Y �i�l l"y� +EJ .LY.1113UH D 1`Y b.1 .. 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 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 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 dwellingunits,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 CRTC 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 buildhag wiring. As owner of the above-referenced property,I hereby certify tl`zat the alarm(s)referenced above has/have been stalled in accordance with the manufacturers instructions and in compliance with the Califorrua BuiIdrrug and Callfonrdia,Residential Codes.The alarms havebeeirt,testedndl are operational, as of the date signed below.. 1 have read and a s ree=Yb corm I withi_,_thet berm,s,and1 conditions of this statement i i i�at3re Go�tracf6r Nene; }Igturew Lc >. Darr: Shwke,atrd CO foi;nt.doc vevised 0311,81,1,14,, WATER-CONSERVING PLUMBING FIXTURES r OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING•DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 GUPERT1hiO f {408 777-3228 FAX{408}777-3333 building(a�cupertino.org f.4 Owner Name ���C�i Q Permit No 6 Address your real property a registered historical site? es Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the foam 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. 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. NT0 Go to Question 4. 4. Is your real property built and available for use or occupancy on or before January 1, 1994? o 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 January1, 1994. Civil Code Sections 1101.1 through 1101.8 apply. Check one of the three following statements and sign bottom of form.. 5. P ease check ONE of the following: M property is a single-familyresidential real roe See Civil Code Section 1101.4. (((��� y p p t5'� property. 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'leal 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). 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 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 age. Owner or Owner Agent's SignaturFDater Upon completing and signi s Certificate,please retu� it to the Building Division in order to final your building permit. SB407 2015.doc revised 0812611'5