B-2016-2093 CITY OF ICUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2093
10209 WESTERN DR CUPERTINO,CA 95014-2944(359 11 006) CUPERTINO ROOFING
INC
SAN JOSE,CA 95129
OWNER'S NAME: LIANG CHAO-YU AND HSN-LING TRUSTEE DATE ISSUED:06/09/2016
OWNER'S PHONE:408-768-3526 PHONE NO:(408)973-9427
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class 0399 Lie.#565437
Contractor CUPERTINO ROOFING INC Date 03/31/2018 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;INSTALL OSB AND LIFETIME COMP.SHINGLES(30
I hereby affirm under penalty of perjury one of the following two declarations: 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
ormance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance,as provided for by
ction 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area:3000 Valuation:$21000.00
APPLICANT NT RTIFICATION
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 ordinances 59 Number: Occupancy Type:
3
and state laws relating to building construction,and hereby authorize 359 11 006
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 expenses which PERMIT EXPIRES IF WORK IS NOT STARTED
may acct ainst said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the ap 'cant understands and will comply with all non-point
source regulations pe he Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAS tt E , INSPECTION.
I
Signature Date 619/2016 Issued by:Alex Vallelunea j
Date:06/09/2016
D TI
hereby affirm that I am exempt from the Contractor's License Law for one of the RF ROOFS:
following two reasons: All roofs shall e' ected prior to any roofing material being installed.If a roof is
1. I,as owner of the property,or my employees with wages as their.sofe installed without first obta'.' g an inspection,I agree to remove all new materials for
compensation,will do the work,and the structure is not intended or offered for inspection.
sale(Sec.7044,Business&Professions Code)
2. I,as owner of the property,am exclusively contracting with licensed Signature ofApplicant:
contractors to construct the project(Scc.7044,Business&'Professions Code). Dater 6/9/:106OF
I hereby affirm under penalty of perjury one of the following three declarations: COVERINGS TO BE CLASS"A"OR BETTER
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,for the
performance of the work for which this permit is issued. ' HAZARDOUS MATERIALS DISCLOSURE
2. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
3. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should I store or handle hazardous
shall not employ anyperson in any manner so as to become subject to the material. Additionally,should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&'Saf de,Sections 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provision or this permit shall
be deemed revoked. Owner or authorized agent:
APPLICANT CERTIFICATION Date:6/9/2016
I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,Civ C.)
to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments,costs,and expenses which may accrue against said City in Lender's Address
consequence of the granting of this permit. Additionally,the applicant understands
and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Licensed
Signature Date 6/9/2016 Professional
I
REROOF PERMIT APPLICATION
v _ COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE• CUPERTINO, CA 95014-3255
(408)777-3228 • FAX(4
CUPERTIC�IO 08)777-3333• building(a-)cupertino.orci
So q
PROJECT ADDRESSc-y ` J rj S• Y APN R 111�CI-A i /'l0 r A
OVR'ERNAMEC o p I a 1 PHON) —7 S E-MAIL
STREET ADDRESSf O-a U e g D� I CITY, STATE,ZIPS ��� I V� FAX
CONTACT NAME 1,� U r c^J V` PHONE E-MAIL
STREET ADDRESS ® c2r d Q1�� D� CITY,STATE, ZIP (� FAX
❑ OWNER ❑ OWNER-BUILDER ❑ OIVNERAGEN'r ❑ ICoNTRACTOR ❑CONTRACTORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENAN'T
I
CONTRACTOR NAME T LICENSE NUMBS / / LICENSE TYPE BUS.LIC.R U
COMPANY NAME E MAIL (7 / FAX
STREET ADDRESS Z 1 1 1 CITY,STATE,ZIP C,1 r'L 1 PHONE t cr� —2
ARCHITECT/ENGrNEERNAME l LICENSENTMIBER t BUS.LIC:4
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF SFD or Duplex ❑ Multi-Family ROOF AREA: VALUATION:
STRUCTURE: ❑ Commercial CA
EXISTING ROOF TYPE: ❑BUILT-UP ROO - SPHALT SH(INGLES COD SHAKES ❑NVOOD SHINGLES ❑OTHER(SPECIFY)
REMOVE/REPLAC--ff"�YES IF NO, I PLYWOOD - ❑ %i' ❑ PLYWDOSB PITCH: ROOF
❑NO 1 9 LAYERS' THICKNESS: ❑ 5/8" TYPE: ❑ CDX 12 CLASS: A
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER I ICC-ES REPORT R
DESCRIPTION OF WORK:
�•-2 ct c�- S
By my signature below h of the following: I am the property ov mer or authorized agent to act on the pro Arty o-wn6's behalf. I have read this
application and the information I have pr ided 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 t buildin dMit, I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of ApplicariUAgent: Date:
SUPPLEMENTAL INFORMATION REQUIRED i t
_ If building is associated with a Home O-wner's Association,provide letter k .??L�CBECx�YPE; 7 a Rohr G sLTr ' ,
of approval from HOA. M. r z 3
O�ER THE COUNTER s $TIbII�GII AI�,�2E�0i �
(
—Provide Planning approval to verify if there any restrictions. AQ ExREsS` 5flPF 4I�I�II�GPLA1\REVIEW z
—Provide copy of Manufacturer's Installation Specifications. ❑ sr .nnRn �#F7RF TfEPTaf
� y ,
-s3
_Provide signed copy of Cupertino's Tear-Off Policy. ❑ 'oaxER �, ` ��
e
Reroof.4pp_2011.doc revised 03/16/11
Y
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
ALBERT SALVADOR, Fi.E., C.B.O., BUILDING OFFICIAL
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUPERTENO
(408)777-3228 • FAX (4 08)777-3333•building aC)cupertino.org
PROJECT ADDRESS `., 9 � � APN I f 0 c)(
OWNER NAME C IA (yp� c j A� I PH-OIxE� b Ek I -MAIL
STREET ADDRESS \O ® � f - `n�7 \� CITY, STjATE,ZIP t�(� I FAX
CONTRACTOR NAME �1��� LICENSE SEER LIC!�f P EUS.LIC.R
COMPANY NAME c u�� ,`J�� 'T�� E-MAIL FAX
STREET ADDRESS 0 S Z `\ CITY,,S� 1 [ 1 2 / P
/ 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 un 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 Nailinz Inspection is required.
5. Roofing shall not beapplied 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-roofmg 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 are-inspection fee. The re inspection fee shall be paid before another inspection can be
scheduled.
By my signing bel0 1, each of the following is true: I am the property owner or authorized agent to act on the
property owner' behalf. I unders d and agree to comply with the re-roof policy stated above. I also understand that
smoke detectors a d carbon monoxide detectors are required to be installed in accordance with Sections RR314 and R315 of
the 2013 California Residential 'ode. l
Signature of Applicant/Agent: Date:
ReroolPolicy_2014.doc revised 01/1.5/14
J
Fli
OMERCE"FICATEOF COMPLIANCE L E
COMMUNITY DEVEL,'OP'MENT:DEPARTMENT-BUILDING•DIVISION
ICU VV .T01410
10300 TORRE AVENUE Cl1`PERTINO,CA 95094-3255
'(408)777-322,8 FAX(408)777-8333*-buildhg(cQcupertino.org
T 3-o 1
m ..
M5 ,
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 acce s for
inspections are required.
GEMRI E WORMATIONl
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 ex eels
VIGM-00, CRC Section 8314 and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and/or CEltbon
Monoxide Alarms be installed in the following locations:
AAEAS1Vi1010E AILARTA CO AL R1
Outside of each separate sleeping area in the immediate vicinity of the X X
bedroorn(s}
On every level of a dwellingunit including basements X
Within each sleeping room jf
Carbon Monoxide alarms are not required in dwellings which do i,Lot contain fuel-bursting app}Tianees d that
do not lta}ve azo attacl-ied garage. Carbon viortoxide 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:ha dwelling units with no curranercial power supply,alarms)may be solely battery op rated.
In existing.dwelling units, alarrms are permitted to be solely battery operated where repairs or alterations,do
not result,in,,the removal of wall mad ceiling finishes or there is no access by means of att-tc,basement o r. crawl
space,..Refer to CRC Section 8314 and CBC Sections 90.7.2.11.4 and 420.6,2.An electrical per,mrt is requi ed for
alarins whiclil must be connected to the budding wirh g.
As owner of the above-referenced pioperty,lhereby, certify that the alarrn(s)referenced above has/have been
installed In accordance with themanufacturer's instructions and in compliance with.thee Californla.Ru 1'duz00:
and Califomra Residential.Codes.The alarms have been tested a a,,d are operational, as of the date s g.n d
below.
i,tZave read.and a Pee to;com;,f with: . terms and conditions of his statement
_ _ G J" �V t/ �(':(l3tUr� ... ......... CfcltL' :; ,,1.�.,
......Date :_. ..._..
WATER-CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE i'
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CUPERTINO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
08)777- 228•FAX(408)777-3333•buildino(aD-cupertino.org_ s,
o, zo 9 ��- o '15
O�v��`r NGtme`� � � Permit No.
(Adcdress
1. Is your real property a registered historical site?
r � ❑ 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 2.
2. Does your real property have a licensed plumber certifying that,due to the age or configuration of the property oi 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.
'i` 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.
1 )1 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.
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 plumbinj 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 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 o
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-cone ing plumbing fixtures comply with the requirements as indicated in the
table on the following age.
[Owner or Owner Agent's Signature Da E
Upon completing and signing this Certificate,pl s return it to the Buildi 'sion in order to final your buildin a permit.
SB407 2015.doe revised 08126115