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B-2016-1426 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1426 21465 HOLLY OAK DR CUPERTINO,CA 95014-4927(3 62 02 016) (A-JAY) SANTA CLARA,CA 95050 OWNER'S NAME: THIEM NGUYEN DATE ISSUED:02/24/2016 OWNER'S PHONE:408-202-6310 PHONE NO:408-661-4254 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B Lic.#936341 Contractor A-JAY Date 02/2412016 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: TEAR OFF OLD ROOF,REPLACE ALL DRY ROT,SHEET WITH 7/16 1 hereby affirm under penalty of perjury one of the following two declarations: OSB,PAPER&BAT,MONIER TILE ROOF(26 SQUARES) 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. ff 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 permit is issued. Sq.Ft Floor Area: Valuation:$21000.00 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 362 02 016 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 pity 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 CALLED INSPECTION. Code,Section 9.18. Issued by:ABBY AYENDE Signature Date 02/24/2016 Date:02/24/2016 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 inspection; compensation,will do the work,and the structure is not intended or offered for sale(Sec.7044,Business&Professions Code) /Signature of Applicant: 2. I,as owner of the property,am exclusively contracting with licensed Date:02/24/2016 contractors to construct the project(Sec.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 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 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(x)should I store or handle hazardous 3. 1 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 deFned 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,Sec Vons255Z255 d 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 �. be deemed revoked. Owner or authorized agent: Date:02/24!2016 APPLICANT CERTIFICATION S C ON LENDING AGENCY 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 Lender's Name to enter upon the above mentioned property for inspection purposes. (We)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 02/24/2016 N max'- REROOF PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE CUPERTINO, CA 95014-3255 CU P INO (408)777-3228• FAX(408)777-3333•building(D-cupertino.org PROJECT ADDRESS � l ®JAPN# ®"�lm OWNER NAME r �s , ( r•a,y PHDp C.O 6 Q O E-MAIL STREET ADDRESS Zj(r� CITY, STATE,ZIP ! FAX CONTACT NAME PHONE E AIL A. w F STREETADDRES C STATE,ZIP_ FAX Id �to ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ffrCONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CO CTOR NAME LICENSE NUMBER, LICENSE TYPE BUS.LIC.# COMPANY NAME E MA FAX STRE T ADDRESS CITY,STATE, , p� 1 `! AR CHITECT/ENGINEERNAME LICENSE NUMBER BUS.LIC.# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑ SFD or Duplex A6 Multi-Family ROOF AREA: VALUATION:�,�,,��cfyy��a,, STRUCTURE: ❑ Commercial .J& � V�✓ r EXISTING ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES WOOD SHAKES ❑WOOD SHINGLES FOTFMR(SPECIFY) REMOVE/REPLACE RYES IF NO. PLYWOOD ❑ %" P PLYWD .OSB PITCH: ,/s�f� ROOF ❑.NO #LAYERS: THICKNESS: ❑ 5/8" TYPE: ❑CDX —�E--:12 CLASS: A PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER %�* `!i ICC-ES REPORT# DESCRIPTION OF WORK: l qtr oL l Ad Aky IoT z ' `- . � i0 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 b ' mg construct n. uthorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLE NTAL INFORMATION REQUIRED i n 'il ` r 1.1%,__:4�t .r If building is associated with a Home Owner's Association,provide letter r>ANCHEEc , .k RosrP ' of approval from HOA. D-ov1•ax Tm�-cort�v�Eiz���`��' L� >3zI���IIr c i�AI�Ev[ � � � = _Provide Planning approval to verify ifthere any restrictions. ❑ + ss , � Provide copy of Manufacturer's Installation Specifications. _Provide signed copy of Cupertino's Tear-OffPolicy. � m ': frb - 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 CUIPEhTINO 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 (408)777-3228• FAX(408)777-3333 building cDcupertino.orc PROJECT ADDRESS APN# 5 ! '�f Q Z7 -01-6 0 1- OWNER NAME r PHONE v [� E-MAIL (� ?;_ 316 STREET ADDRESS CITY, STATE,ZIP FAX i CONTRACTOR LICENSE BER LICENSE TYPE BUS.LIC.# COMPANY N P. n j E- AIL FAX STREET ADDRESS �&&L CITY,S ATE,ZIPS^ PHONE - 31 14-2-4 � T' 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 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 Co . Signature of Applicant/Agent: Date: ReroofPo1icy_2014.doc revised 01/15/14 CITY OF CUPERTINO JjFEE ESTIMATOR-BUILDING DIVISION TAPN: DRESS: 21465 HOLLY OAK DR DATE: 02/24/2016 REVIEWED BY: ABBY 362 02 016 BP#: "VALUATION: 1$21,000 -� *PERMIT TYPE: Building 'Permit PLAN CHECK TYPE: Alteration/Repair PRIMARY SFD or Duplex PENTAMATION USE: p PERMIT TYPE: 1 SFDWLROOF WORK TEAR OFF OLD ROOF REPLACE ALL DRY ROT SHEET WITH 7/16 OSB PAPER & BAT MONIER SCOPE TILE ROOF(26 SQUARES) El Ins'?" 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 on1v an estimate. Contact the Detor addn'l info, FEE ITEMS O1'ee Resolution 11-053 Eff I11113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 F2,6001 s.£ Re-roof Suppl.PC Fee: 0 Reg. Q OTJ 0.0 hrs $0.00 $442.00 IREROOFRES PME Plan Check: $0.00 Permit Fee: $0.00 Suppl.Insp.Fee-.(j) Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Work Without Permit? 0 Yes 0 No $0.00 G Advanced Planning Fee: $0.00 Select a Non-Residential IT Building or Structure Strong Motion Fee: IBSEISMICR $2.73 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 sIUBTOT ;S $3.73 $442.00 ToTA :FEES $445.73 Revised: 01/01/2016 Jt 'WWUftrZ:'P N±[. !".�[ •�sd W�® M`�mY+Pa.9Air;� laa.raw--> OWMER CERTIFICATE OF COMPLIANCE s 4 ` COMMUNITY DEVELOPMENT DEPARTMENT.BUILDING DIVISION rl F uz _-` 10300 TORRE AVENUE e CUPERTINO,CA 95014-3255 i (408)777-3228-FAX(408)777-3333,buildinCa cupert no.orq c PE) TMIT C NOT BE I+IN I,�b AKD CO1MPILMD UNTIL THIS Cri'MVICA'T HAS 161 K,r .I.. l<E ,�, TWT, �3 rim-wo mmo PURPOSE This affidavit is a self-certification for the installation of all required Smoke and Carbon Monoxide Alarms for compliance with 2013 CRC Section 8314,2013 CBC Sections 420.6 and 907.2.11.2 where no interior access for inspections are required. GIENMAL INVOR A,TIO 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 aid CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and/or Carbon Monoxide Alarms be installed MZ the following locations: AIRF-A SMOKE ALAR Vi CC ALARM Outside of each separate sleeping area in the immediate vicinity of the XX bedroom(s). On every level of a dwelling unit including basements X X Within each slee 'in room X E I Carbon.Monoxide alarms ar.e no re uired.in dwellings which do not contain fuel-burning appliances and that do riot have an attached garage. Carbon monoxide-alar'ms cornbxned 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 dwel+l'.Ing units witli no commercial power supply,alarrn(s may be solely battery operated. In existing dwell"hag utlIts; alarins are perimitted toT be solely battery operated where repairs or alterations do. not restfl%n< the removal of wall and ceiling.firdslles;or there is no.access by meads of attic,basement or cratwl: space.Refer to CRC Section 8314 and(C0C Sections 907.2.11.4 and 42©t.6..2.Anti eTeetr cal perriuf is required far ala�rms which mwmt b e connected to the bnrlding,wiring. As owner,o=f the above-referenced proper,y,I hereby cerfify tha+t the alar,�)(ts)refere iced ab�ave has�ave beeLz insta�lll''ed'=ins accordance:vri}th:fhe rmannfacturer's inns {�ct,o�n�s•avl�cl1 2n coz�vp}li�aulce with the.Cajlifrarr�a Butrld�Yg, i � anclt Ca ifow as Resi3dlen[raal Codes.The alanrtms have been tested,and acre � €erational,as ofithe date sig e-di b-Olow- 1!hada}re•adp, . Zee,to camni,wct�i�h teems_aridtronditii nsoftthi statement 4 1- ! L_ ...... 4 �bnCr�#ot�lar�e:< ate I Snroke mid'=CO Ern,dbc re,,ised 0311WW OWNERCERTIRCAM OF COMP-LMCF. F1 ; GMM'tlNITY'Q: L'" C-,WT;�,,PART.ME-NT-:BUILDINGiDIVIVOltit tt~l.91°EWITNO 1+0300 TORRE:AVEW,1 •Gf 1 RTf3�O,GA 9 x71 3255 (4[I 777-32"28•sFAX x40 7 77-3333 #tiifdina cup inci.Grq Owner Nam Permit No - � mG/ �• .. Address . /�a l ; (fc3 17` , ✓ , ��`n© f 1. Is your real property a Tegistered historical site? ❑ Yes Civil Bode Sections 1101.1 through 1101.8 do not apply. Skip the rest of the forth and sign bottom of form. 17�No Go to Question 2. 2. Does your real proper=ty have a licensed plumber certifying that,due to the.age or configuration of the property or its plumbing,installation of water-conserving plumbing futures is not technically feasible? El Yes Civil Code Sections 1101.1 through 11'0.1:8 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_. � WNo Go to.Question 3. 3. Is water service perrnarently 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. 5(No Go to Question 4. ---- 4. -_4. Is your real property built and available for use or occupancy on or before January 1,1994? ❑ No Ivry real property is built and available for use or occupancy after January 1, 1494. Civil Code Sections 1101.1 thro-ugh 1101.8 do not apply. Skip the rest of the form and sign bottom of form. i 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 farm.. 5. Please check ONE of the following: l-Yproperty is a,sing eesidenHirt Teal property. See Civil Code Section 110IA. On and after January 1, 20`14,building alterations oF-improvements shall require all'!rton cornpliant pltambing fixtures to be,replaced wifh.water=conserving plumbing fixtures throughout the buildir%g.On or before January 1,2017,all non- compliant'p'i'umbing, fixtures shall be replaced with dater-conservitg plurnil iang fixtures (regardless of whether property undergoes alterations or.improvements). Myproperf yis a nudE family eesideniial real property. See Civil Code Section Orn and affer January 1,2014,specified building altera-Pions or impiroVeinents sha11 regwire non-compliant plumbing fixtures to be replaced with water conserving.plumbing fixtures, Ori or,before January 1, 20.19, all non-compliantptumbing fixtures shall.b-e replaced with water- consewinng p}luinbirig fixtures throughout the building(regardless of whetherp'rop lmt''ergoes alterations or im.proveiments). ❑ My property is a coxnmerciat real property. See civil Code Section 1IQ1.5. On.and atter January 1,,2414,specifiedbuilding alterations or improvements skall mgmilre non compliant plumbing;fikfu=to be replaced with water-conserving:plumbing fixtures. OR or before Jaau:ary, 1, 2019, all non-compliant pluinbrrig fixtures shall be replaced( with water conserving plumbihmg,fiilhr".es tibxoughunt 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 wi�llbe . replaced prior tot date:speeiFfi°edt above,with water-conserving plurnbing Fixtures in accordance with Civil'Code Sections 1101.1 through,1101.a,,thw current California Plumbing Code and Cali�fortira GreenBuilding Standards Code,and manufacturer's installation requirements„and that the.water-conserving plumbing fixtures comply with the requireinents as:indicated.in the table on the f611bw-in page: Owner orr 0W v _.._...w.. W, her/ gnf s.Signature. s G1at l �°f Upon compi'etitig,and signing this,Certificate,please return it to the.Buil ding l7ivisian,in.order to,finall y.,our buirdin.g peri,?t. \ SB407 2015.doc rev sed£o&126/1+5