B-2016-1432 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1432
1039 COLONY HILLS IN CUPERTINO,CA 95014-5801(359 30 002) (LUNNEBORG
ROOFING INC)
CAMPBELL,CA 95008
OWNER'S NAME: GIARRETTO SHIRLEY B TRUSTEE DATE ISSUED:02/25/2016
OWNER'S PHONE:4088072438 PHONE NO:4083699175
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C39 Lic.#679725
Contractor(LUNNEBORG ROOFING INC)Date 2/25/2016 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:
REMOVE(E)WOOD SHAKES;INSTALL(I)UNDERLAYMENT AND
I hereby affirm under penalty of perjury one of the following two declarations: (N)METAL SHAKE ROOF SYSTEM-42 SQ'S
t. 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.
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:$23000.00
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 359 Number: Occupancy Type:
ordinances and state laws relating to building construction,and hereby 359 30 002
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 CALLED INSPECTION.
Code,Section' .18.
Issued by:PAUL O'SULLIVANL
Signature Date 2/25/2016 Date:2/25/2016 T_)v
OWN/R-BUILDER DECLARATION RE-ROOFS:
I hereby affirm that I am exempt fro thContractor'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. 1,as owner of the property,or my employees with wages as their soleinspection.
r-'-
compensation,will do the work,and the structure is not intended or offered
for sale(See.7044,Business&Professions Code) Signature ofApplican.
2. I,as owner of the property,am exclusively contracting with licensed Date:2/25/2016
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 �CSS"A"OR BETTER
t. I have and will maintain a Certificate of Consent to self-insure for Worker's
Compensation,as provided dor 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
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,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 nte wefined 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,Sectio 55 5,25533,a 5534.
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 Owner or authorized a t:
be deemed revoked. Date:2/25/20'16
APPLICANT CERTIFICATION NS R i N ENDIN A EN
certify that I have read this application and state that the above information is I hereby affirm that ere is a construction lending ageo 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, iv 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 ARCHITECT'S DECLARATION
consequence of the granting of this permit. Additionally,the applicant
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 2/25/2016
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CIIPECtT Nt3 (408)777-3228• FAX(408)777-3333•buildinp(Qcupertino.org
PROJECT ADDRESSr (1"7 a � DM�` l APN#
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OWNER NAME 1! V •3 1 PHO E-MAIL
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STREET ADDRESS e CC) CITY, STATE,ZIP FAX
CONTACT NAME ( 1 4 PHONE E-MAIL
STREET ADDRESS CITY,STATE,ZIP FAX
❑OWNER ❑ OWNER BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME/ ®QS_(_QN ovr+ LICENSE NUMBER 2� LICEI�,SETIPE. BUS.LIC.#
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COMPANYNAME (� �J T E-MAIL (- j FAX
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ARCHIPECT/ENGINEERNAME LICENSE NUMBER BUS.LIIC.#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF -Vg-SFD or Duplex ❑ Multi-Family ROOF AREA: VALUATION:
STRUCTURE: ❑ Commercial Z,�1
EXISTING ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES WOOD SHAKES ❑WOOD SHINGLES ❑'OTHER(SPECIFY)
REMOVE/REPLACE;5kns IF NO, PLYWOOD ❑ w, ❑ PLYWD ❑ OSB PITCH. ROOF
❑NO 1 #LAYERS: THICKNESS: ❑ 5/8" TYPE: ❑ CDX :12 CLASS: A
PROPOSED ROOF TYPE: ElBUILT-UPROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES }OTHER C-ES REPORT#�
DESCRIPTION OF WORK: _ �J V
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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 building ction au orize representatives of Cupertino to enter the above-identified/property for inspection purposes.
Signature of Applicant/Agent: /
Date: ! 1p
SUPPLEM/'ENT4 INFORMATV12REQUIRED r,,,. oFrcrJsolv�xw -- .
If building is associated with a Home Ownssociatiorr provide letter
of approval from HOA. ovER THI<corllvTR x �BUIivTNG�P��NREVIE4V Y
Provide Planning approval to verify if there any restrictions.
ExeR3s Ell
Ex�TxLAxsrz
Provide copy of Manufacturers Installation Specifications. p sT s 1
Provide signed copy of Cupertino's Tear-OffPolicy. oT a
�iN Lb w E
ReroofApp_2011.doc revised 03/16/11
-x REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
CuptltTIN0 10300 TORRE AVENUE CUPERTINO, CA 95014-3255
(408)777-3228• FAX(408)777-3333•building ancupertino.orp
PROJECT ADDRESS ) �y C I ; / APN# �0
OLD
OWNERNAME / V PHONE E-MAIL
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STREET ADDRESS C C �t➢�J� .$ `r S 4 CITY, STATE,ZIP,r FAX
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CONTRACTOR NAM4,_j _® I'e - i� ®• d LIC EN N�MB�E,R�(r• LICENSEE TYPE BUS.LIC.#
)�(� :J[-�Lf ) -y/�� t. _( �s ry 2 may.
COMPANY NAME ` / we,l� E-MAIL� � � •7 I�`J J
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STREET ADDRESS13 0 I(Vk/ N CITY,ST ,ZIP O� q-swu y
PHONEXfJ Z'%r-
p� I UNDERSTAND AND AGREE TO THE FOLILOWING:
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 ode `
Signature of Applicant/Agent: / / Date:
ReroofPo1icy_2014.doc revised 01/15/14
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 1039 COLONY HILLS DATE: 02/25/2016 REVIEWED BY: PAUL
,APN: 359 30 002 BP#: "VALUATION: 1$23,000
*PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY SFD or Duplex PENTAMATION 1SFDWLR00F
USE: PERMIT TYPE:
WORK REMOVE E WOOD SHAKES' INSTALL N UNDERLAYMENT AND N METAL SHAKE ROOF
SCOPE SYSTEM 42 SQ'S
FEE ID ROOF AREA
S.f.
1REROOFFRES 4,200
El
NOTE.This estimate does not include fees clue to other Departments(4e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc. . These ees are based on therelimina information available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution 11-053 E(f. 71/13) FEE QTY/FEE MISC ITEMS
sr
Permit Fee: $7
Work Without Permit? 0 Yes (DNo $0.00
)
Strong Motion Fee: IBSEISMICR $2.99 Select an Administrativ t
Bldg Stds Commission Fee: IBCBSC $1,00 -1
SUBTQTALS: $717.99 $0.00 TOTAL FEE: $7 9
Revised: 16
P;\.
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2 NIT
WATER-CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE -
COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION
CUPERTINO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)77 -3228•FAX(408)777-3333•buildinaCu)_cunertino.org
OwnerNameQ' �/a'�L a2 tv Permit Nod` ' '" !
Address Fi d ` on�4-oPi 7 � ,�Le_T �/L� C' �� a�;—i r`+I � C
1--i f
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.
1N,,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.
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.
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.
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 January 1,1994.
J
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 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).
El 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).
D 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 following page.
Owner or Owner A ent's Si nature' Dafe:
9 9 Lf
Upon completing and signing thi Certificate,pi se return it to the Building Division in order to final your buil in permit.
SB407 2015.doc revised 08126115
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