B-2016-1503 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1503
10152 PENINSULA AVE CUPERTINO,CA 95014-1210(326 24 043) (WESTSHORE
ROOFING INC)
SAN JOSE,CA 95131
OWNER'S NAME: HSIAO YINGPO DATE ISSUED:03/11/2016
OWNER'S PHONE:408-680-4434 PHONE NO:408-456-0200
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class CC=39 Lic.#787221
Contractor(WESTSHORE ROOFING INC Date 03/11/2016 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(E)COMP,INSTALL(N)COOL ROOF,CLASS A ROOF
I hereby affirm under penalty of perjury one of the following two declarations: SYSTEM, 18 SQ'S
2. 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.
2' '' 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:$10080.00
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 ATN Number: Occupancy Type:
ordinances and state laws relating to building construction,and hereby 326 24 043
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. ddition the applicant understands and will
comply with all non-poi source reg lations per the Cupertino Municipal 180 DAYS FROM L INSPECTION.
Code,Section 9.18.
-ter Issued ISSA
Signature" Date 03/11/2016 Date:03/11/2016
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 prtorto_any roofing material being installed.If a roof is
following two reasons: installed without first obtaining a inspec to ,I agree to remove all new materials for
1. 1,as owner of the property,or my employees with wages as their sole ins ecti n.
compensation,will do the work,and the structure is not intended or offered r
for sale(Sec.7044,Business&Professions Code) Signature of Applicant:
2. 1,as owner of the property,am exclusively contracting with licensed Date:03/11/2016
contractors to construct the project(See.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 i&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 Cu rtino Mu ipal Code,Chapter 9.12 and
Worker's Compensation laws of California. If,after making this certificate of the Health&Safety Code, tions 505, 5533,and 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 fh
be deemed revolted. Owner 3/ authorized agent
Date:03/11/2016
APPLICANT CERTIFICATION CONSTRUCTION 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 t e 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 03/11/2016
4
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REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333•buildingQ)cupertino.org
PROJECT ADDRESS 1 ol :] � APN# — Ms
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OWNER NAME ® P E-MAIL
STREET ADDRESS T P ctol FAX
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CONTACT NAME
STREET ADDRESS CITY,STATE;ZIP AX, COAJ
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❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
S ��t LICCE� BUS.LIC.
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COMPANY NAME E-MAIL FAX
S REET ADDRES ��ryry CITY STATE,ZIP
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ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC.#
COMPANY NAME EMAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF �SFD or Duplex [I Multi-Family ROOF AREA: VALUATION: ///" //\J ((/��J
STRUCTURE: ❑ Commercial I s 5(27C -O 10, 'v o
EXISTING ROOF TYPE: 11BUILT-UP ROOF ICI ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES 11 OTHER(SPECIFY)
REMOVE/REPLACE 11 YES IFNO, PLYWOOD ❑ '/." ❑ PLYWD ❑OS,B PITCH: ROOF
❑NO #LAYERS: THICKNESS: ❑ 5/8" TYPE: ❑ C X :12 CLASS; A
PROPOSED ROOF TYPE: 11BUILT-UPROOF ASPHALT SHINGLES ElWOOD SHAKES 11WOOD SHINGLES ElOTHER ICC-ES REPORT#
DESCRIPTION OF WORK:
By my signature below,I certify to each of the follog, lthe rope owner or authorized agent to act,on the property owner's behalf I have Iapplication and the information I have provided is cve r the escription of Work and verify it is accurate. I agree t�.per-Z,�fbr�ins
comwiall i 1ordinances and state laws relating to building construth_ori rep sentatives of Cupertino to enter the a -id tified io u s
Signature of Applicant/Agent:
Date:,
SUPPLEMENTAL INFORMATION REQUIRED
If building is associated with a Home Owncr's Association,provide letter
t { r
of approval from HOA. I� BuuDuvcrr vii ��
n3'U'�THE-CO'I7L�TER �� �
Provide Planning approval to verify if there any restrictions. ❑ �xPx>s �4 PANuvLAI`tv>>w � r
ge
Provide copy of Manufacturer's Installation Specifications.
_Provide signed copy of Cupertino's Tear-Off Policy.
rc—
ReroofApp_201 L doe revised 03/16/11
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-buildinq(a�cupertino.oro (0 —
PROJECT ADDRESS I yez P/{ APN# ' 11
OWNER NAME PHO / GcQ � -M`4II' LA
STREET ADDRESS CI STA I (� FAX
COCTOR NAME , LIC LIC BUS.LIC.#
COMPANY NAMEE-MAIL FAX
MST F ADDRESS �+ (� TA IP CA HONE y per_
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:�0-3:30pm(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: 7:30-1030am 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 anel 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 c ply the re-roof policy stated above. I also understand that
smoke detectors and carbon monoxide detectors are e uire t b installed in accordance with Sections R314 and R315 of
the 2013 California Residential Code.
Signature of Applicant/Agent: Date:
ReroofPo1icy_2014.doe revised 01/15/14
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
FILE
10300 TORRE AVENUE CUPERTINO, CA 95014-3255
C U l�E,�,Tt i�Q
(408)777-3228•FAX(408)777-3333 building(d)cupertino.org
Permlt oi�i R-.2o16-'6`O3
', ddr-ess--10 162 E'EN_ ISuGI-1 Ave,, g a o ##ofAlarms Sm�o e� `CarbonMonoxideD 11
PERMIT CANNOT BE FTNALED.AND COMPLETED I7NTIL,THIS CERTIFICATE
HAS BEEN.SIGN D AND RFTUI?NED TO THE BUII.,DING DT�ISION
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
CSC 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.
1 have read and agree to comply with the terms and conditions of this statement
Qw/ner or Owger Agent's-Name j
`(Z �? -Signature......, ....... f ................................................................
-Cantractor Nam6: 7,R 72,
........:...........................Date
Smoke and CO forin.doc revised 03118/14
10 WATER-CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE FILE
COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION rS
CUPERTINQ 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
/�° 408 77-3228•FAX(408)777-3333•building atuperfino.org 3
Owner Name 1 /Vt / Permit Nor, D-o �"&6 7
Address 1016 27 PklltIiY. ULA J V Ctwe r6-ii o
/
1. Is your real property a registered historical site?
❑ Yes Civil Code Sections 110 1.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
2 No Go to Question 2.
2. Does your real property have a licensed plumber certifying that,due to the age or con figuration 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 forma
j ® 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.
Q No Go to Question 4.
4. Is your real property built and available for use or occupancy on or before January 1, 1994?
El 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.
C1 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. Please check ONE of the following:
Id 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 110-1.5..
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 whetherproperty 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).
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 Agent's Signature v Date: ?-16 -?±f G
Upon completing and signing this Certificate,please return it to the Building Division in order to final your building permit.
SB40'72015.doe revised 08/26/15
i