B-2016-2092 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2092
10145 SCENIC BLVD CUPERTINO,CA 95014-2724(357 09 076) CUPERTINO ROOFING
INC
SAN JOSE,CA 95129
OWNER'S NAME: HARJONO TIIINO AND ERNIE TRUSTEE DATE ISSUED:06/09/2016
OWNER'S PHONE:408-391-2204 PHONE NO:(408)973-9427
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-39 Lic.#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 COMP.SHINGLES(22 SQ'S)
I hereby affirm under penalty of perjury one of the following two declarations:
i. 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.
zl 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:$20000.00
APPLICANT CERTIFICATION
I certify that 1 have read this application and state that the above APN
information is correct.I agree to comply with all city and county ordinances Number: Occupancy Type:
357
and state laws relating to building construction,and hereby authorize 357 09 076
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 accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant understands and will comply with all non-point
source . n er the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAS CAL ED SPECTION.
Signature Date /6 9/2016 Issued by:Alex Vallelunea /
Date:06/09/2016
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS:
following two reasons: All roofs shall be ins 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 sole installed�q' out first obtain' 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) I
2. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Dat7::��
I hereby affirm under penalty ofperjury one of the following three declarations: ERINGS 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
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 sir-contaammnt fined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance he Cupertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Co Sections 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions 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 RUCTI 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.
Signature Date 6/9%2016 Licensed
9 Professional
w REROOF PERMIT APPLICATION
r4` n
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE- CUPERTINO, CA 95014-3255
CUPERT[NQ (408)7.77-3228 • FAX (4i8)777-3333• buildin-WaDcupertino.org
-2-01U`��(2
PROJECT ADDRESS 1614 S_ �C en l� �L V,?
APN u �� � O� O-.-jrLC
OVN`ERNAME I'_ ow 1�Q v16 Ki�> PHONE'L(p'�I �CI f � E-M.AIL
STREET ADDRESS I CITY, STATE,ZIPC v -�1 , FAX
CONTACT NAME PHONE �VVVL E-MAIL
STREET ADDRESS CITY,STATE, ZIP FAX «
❑ OWNER ❑ OWNER-BUILDER ❑ ORTIER AZ7 L7"CONTRACTOR 13CONTRACTOR AGENTElARCHITECT ❑ENGA'EER ❑ DEVELOPER ElTENANT
CONTRACTORNAME`� LICEN E�UJvtBEER LICENS$T E BUS.LIC.R
COMPANYNAME t )� i �e G -E-M TAIL, FAX l
n
STREET ADDRESS CITY,STATE,ZIP N (� �I I PHONE
(6�,� 2 -e
JMg r
ARCHITECT/ENGINEERNAME 1�✓ LICENSENRBER 'L BUS.LIC`Cm
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF SFD or Duplex Multi-Family ROOFAREA: VALUATION:
STRvcrURE: ❑ Commercial
EXISTING ROOF TYPE:, ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY)
REMOVE/REPLACE CI YES IF NO, PLYWOOD - ❑ %," ❑ PLYWD ElOSB PITCH: ROOF
11 NO 91, RS: THICKNESS: ❑ 5/B" __JTYPE: ❑ 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:
Class
_ f ,
r:
By my signature below,I certify to each of t.e following: I am the property owner or authorized aeent to act on the property owner's behalf I have read this
application and the infonnatior I have provid d 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 relati g to buildin-construct'on. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature ofAPPlicant/Ag_ent: Date;
SUPPLED AL INFORMATION REQUIRED ��__ oFFic�usEonzz
_If b ,is associated With a Home Owner's Association,provide letter PLan c> cxYPE-:' .. .- _: c�toLrrGSLr u
of approval from HOA., o�>ii THE coIJI1TER �rILlimcPiAn RE� �v
_Provide Planning approval to verify ifthere any restrictions.
EXPRESS flP� ,�INII�GPLAh RE�iE� Y
_Provide copy of Manufacturer's Installation Specifications. L7sTND�ARD r s`r ❑ REiiEPT �;�r
_Provide signed copy of Cupertino's Tear-Off Policy. =
I rv.
j Reroof.4pp_2011.doc revised 03/16/11
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
CUPERTFNO 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
1 (408)777-3228- FAX (408)777-3333-building ancuoertino.or4
PROJECT ADDRESS I ' 4 I APN R /,
OWNERNAME f3 h� PHOTS, K 2 2-2 4 E-MAIL
STREET ADDRESS � ®� `� � � L�^ ` ` �� ITY, STATE,ZIP C ` I I FAX
CONTRACTOR NA LICE?Is LICENSET BUS.LIC.
COMPANY NAME(f-Li —I w J Ld E-MAIL FAX
STREET ADDRESS /,0 4a -2- 1 (�� CITY,STATE,ZIP �.�U PHONE
J 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 7:30-3:30pin (Mon-Thurs) or 7:M-
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 Code.
Signature of Applicant/Agent: Date:
Reroo)Tolicy 2014.doc revised 01/15/14
ens 'OWNER CERTIFICATE° E CoM,I9 LI,po:N
COMMUNITY'DEVELOPMENT DEPARTMENT•BUILDING DIVISION
TC�PlIM11No 10300 TORRE AVENUE-CUPERTINO,ICA 95014-3255
(408)777-322,8* FAX(408)777-3333►building6ac oupertino.org
r
PURPOSE
This affidavit is a self-certification for the installatioz1 of all required Smoke and Carbon Monoxide Ala ms for
compliance with 2013 CRC Section R314,2013 CBC Sections 420.6 and 907.2.11.2 where no interior accE ss.for
inspections are required.
G-P-N RAL INVORMATIONT
Existing single-family and multi-family dwellings shall be provided with Smoke Alarms and Carbon
Monoxide alarms. W-hen the valuation of additions,alterations,or repairs to existing dwelling units e ceeds
$1000.00;CRC Section R3,14 and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and/or Garbon
Monoxide Alarms be installed in the following locations:
AREA: SMOKE ACO A 'R—M
Outside of each separate sleeping area in the immediate vicinity of the
bedrooms
On eyeTy level:of a dwelling,unit includiri...basements
within each sleeping,root X
Carbon Monoxide alarms are not required in dwellings which do not contain fuel-burning appliances md that
do not have ar attached gar--age. Carbon ritonoxide alarms combined with smoke alarms shiall comply with
CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal.
Power Supply:In dwelling,units with n a coinn�ercial power supply,alarm(s),may be solely battery op-rated.
rated.
In existing dwelling units alarms are permitted to be solely battery operated where repairs or alterati,ns do
not result in the removal of wall and ce lirtf`.��islles or there is no access by means of attic,basement c r crawl
space.Refer to CRC Section 8314 ani s CBC Sectiorns 9`0.7.2.11.4 and 420,.6.2.An electrical perrnrt is re ied:for
alanni s:which must be com ected tcr the building wirh-tg.
As owner of the above-referenced pioperty,Thereby certify that fhe alarm(s)referenced above has/ha.e been
installe.d in accordaizce with the <<tanufacturer s instructions and in compliance with the California,Bu l'cliltig
and Califon--iia Residential Codes.The alarmashave been tested and are operational,as of the date signed
below.
P have read,and agg.ree to com;.G,with:the terms and conditions of this,statement;'
L #t x -
01'LD
— si-nature'. /2
�-2 lv,v cr Si tature.. ........ ... ............... La.c. -' L I to=�-7
Dat '.
WATER-CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CUPERTINO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)7778•FAX(408)777-3333•buildingP-cupertino.org_ s , r
r O`v-Vnci�Nanx--) IL 10\- `` 141R)-�b� c7 i I'et nit No B—2 C> 6 0 12
1 _
{�&e_s�l D I s S c.e r 1
1. Is your real property a registered historical site?
�E❑� Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
IJ 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?
ED Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of forrii.
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 3ign
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).
❑' 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).
El 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- cons rving
plumbing fixtures throughout the building(regardless of whether property undergoes alterations or improveme ats).
I,as the owner or owner's agent of this property,certify under penalty of perjury that non-compliant plumbing frK tures will be
replaced prior to date specified above with water-conserving plumbing fixtures in accordance with Civil Code Se tions 1101.1
through 1101.8,the current California Plumbing Code and California Green Building Standards Code, and manuf icturer's
installation requirements,and that the water-conserving pl robing fixtures comply with the requirements as indicz ted in the
table on the following page.
Owner or Owner Agent's Signature: j Date —1 /1--?-
Upon completing and signing this Certificate,please return it to the Building Division in order to final your building permit.
SB4072015.doc -evised 08126115