B-2016-2188 ,.7
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2188
10812 WILKINSON AVE CUPERTINO,CA 95014-4732(356 13 038) LUNNEBORG
ROOFING INC
CAMPBELL,CA 95008
OWNER'S NAME: CAMILLERI NATALINO AND SUSAN DATE ISSUED:06/22/2016
OWNER'S PHONE:408-504-1664 PHONE NO:(408)402-1465
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-35 Lie.#679725
Contractor LUNNEBORG ROOFING INC Date 04/30/2018 X BLDG —ELECT —PLUMB
I hereby affirm that I am licensed under the provisions of Chapter (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 CLASS A ROOFLINE UNDERLAYMENT AND
I hereby affirm under penalty of perjury one of the following two dleIclarations: INSTALL STONE COATED METAL ROOF SYSTEM(29 SQ'S)
t. I have and will maintain a certificate of consent to self-'nsute 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.
41_z. 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:$19500.00
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 ordinances APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 356 13 038
representatives of this city to enter upon the above mentioned propperty for
inspection purposes. (We)agree to save indemnify and keep haFmless the
City of Cupertino against liabilities,judgments,costs,and expenes which PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting oft iis permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionall he applicant understands and will comply with,all n'n-point
source r uN tions per the Cuperti u icipal Code,Section 9.18. 180 DAYS FROM LAS AL E SPECTION.
Si Date /22 20116 Issued by:Alex Vallelunga
Date:06/22/2016
-BUILDERWN
T hereby affirm that I am exem4kom the Contractor's License Law for one of the RE-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofmg material being installed.If a roof is
t. I,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for
compensation,will do the work,and the structure is not inte ded or offered for inspection.
sale(Sec.7044,Business&Professions Code)
z. 1,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Scc.7044,Business&P ofessions Code). Date:6/22/2016
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-insL re for Worker's
Compensation,as provided for by Section 3700 of the Labo Code,for the
performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
z. Lhave 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 any person 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 in 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&Safety ode,Sections 2550 55 ,and 25534.
Labor Code,I must forthwith comply with such provisions r this permit shall
be deemed revoked. Owner or authorized ag t:
APPLICANT CERTIFICATION Date:6/22/2016
1 certify that I have read this application and state that the above information is C CTIO LENDING Y
correct.I agree to comply with all city and county ordinances an state laws I hereby affirm that ere I a construction len ' g age cy for the performance
relating.to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Se .3097,Ci C.)
to enter upon the above mentioned property for inspection purpo 3es. (We)agree Lender's Name
to save indemnify and keep harmless the City of Cupertino agair�st 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 Cup,Brtino Municipal
ARCHITECT'S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Licensed
Signature Date BL212016 Professional
1..
REROOF PERMIT APPLICATION
n of
1c COMMUNITY DEVELOPMENT DEPARTMENT' BUILDING DIVISION low
10300 TORRE AVENUE�CUPERTINO, CA 95014-3255
CUPERTIPtQ (408)777-3228 ' FAX(408)777-3333• building a(_cupertino.org
PROJECT ADDRESSI D 11 r ' 1(I_,NS APN
OVNER NAME n`a..( A(,a /' ' I PII I.PHONE E-MAIL
r y C-1{
STREET ADDRESS I C.L r I (NS CITY, S]•ATE,ZIP 76
r,—/ I FAX
CONTACT NAA4E (A C U� q - y . .. E-MAIL
STREET ADDRESS •'T GSW CITY,STATE, ZIP FAX
❑ OWNER ❑ OWNER-BUILDER ❑ ON;WERAGEN7 ❑ OON7RACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGIN'EER ❑ DEVELOPER ❑ TENANT
CONTRACTORNA74E M a 1 ^ ( s LICENSE NUM
R Z LICENSECT P BUS.LIC.R
EC
� �
COMPANY NAMEE:MAIL FAX
e c�-ea.,� (t�n�u: S c�-Pn• r�a 1--�w•�•�a �.o��
STREET ADDRESS I l { a` /q /J CITY,STLE,ZIP "`( l `��V PHONE
j� v y r Y L r
ARCHITECT/ENGINEERNAME F.^� lJ �— LICENSENTJMBER L BUS.LIC:R
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF �SFD or Duplex ❑ Multi-Family ROOF AREA: VALUATION:
STRUCTURE: ❑ Commercial 27lo /#/
EXISTING ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHIN'6LESOD SHAKES E3WOOD SHINGLES ElOTHER(SPECIFY)
REMOVE/REPLACE Wy1 s IFNO, PLYWOOD- El Y.- ElPLYWD El PITCH: ROOF
E3NO m LAYERS: THICKNESS. Elsx, TYPE: ❑ CDX 12 CLASS: L1
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF 13HI
ASPHALT SNGLES 11HI
WOOD SHAKES ❑WOOD SNGLES ElOTHM
ER '"M( ICC-ES REPORT
DESCRIPTION OF WORK: /
772Af v f{ w j-c� r� — �'.�( t`i el47ti11- r ^4ee 1,4,L �w.f�� f a lArr
G vo,(— s o4, . .f2 II3 0 9 �
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property ow'ner'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 const io . I authorize representatives of Cupertino to enter thea veJidentified property for inspection purposes.
SignatureofApplicant/AE t• Date:
SUPP CENTAL rNTFO ON REQUIREDZy
_If building is associated with a Home nv. is Association,provide letter' PLST• E
s r
of approval from HOA. OVER THE COiJITERx � $tJILITGPT�AI�REVIE�i �x 's
Provide Planning approval to verify if there any restrictions.
.❑ EXPRESS '�-�� �c,❑r-P3•�'IQII�GPLAi\REViE�3' ,� �r "'
z :
_Provide copy of Manufacturer's Installation Specifica ions. p $asD,mn y'
v F3REDEPT � r ,,
Provide signed copy of Cupertino's Tear-Off Policy. — ❑ oxR ,
4 _ .OER
r Reroofilpp_�011.d0c revised 03/16/11
I
r� REROOF TEAK-TOFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION
ALBERT SALVADOR, P.E, C.B.O., BUILDING OFFICIAL
CUPERTFNO 10300 TORRE AVENUE-�CUPERTINO, CA 95014-3255
(408)777-3228 - FAX (40i)777-3333-building a0cugertino.org
PROJECT ADDRESS I ,^VF�� N S 0,-/ �N 4
OWNER NAME /1i e.V(Vt Iry%) l l� ,^ PHOT E-MAIL
STREET ADDRESS / 6r J % I./fid!J CITY, �A� z- 9 ry I
CONTRACTOR NAMFAX
E �5 � 6� LICENSE LICIT E TYPE BUS.LIC.R
� t �(h� 4i IBEER. f 3 S
COMPANY NAME a n E-MAIL J FAX�0,S / J
STREET ADD7J Zr ` CITY,STP�7�HIP �r ^rVu r/ PROD J f 4102'Wer
7-q. (fes. f L/- Y
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 hoursifor 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. Aly 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 remoed prior to this inspection.
4. If plywood is installed, a plywood Nalinz Inspection is required.
5. Roofing shall not be.applied without first obtaining all prior inspection and written approvals from the
building inspector. Any roofing whi+, is applied without first obtaining an approved inspection will
require the removal of all new materi Ilal down to the sheathing so a proper inspection can be performed.
6. A Final Inspection and approval sh�all be obtained from the building 'inspector when the re-roofmg is
completed. To receive a final sign-o , the following items will be verified:
a. Flat roofs shall have a mininLum of I/4"per foot of slope and demonstrate there is no ponding.
b. Listings from approved testi'' g 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
ID
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 agre�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 d .
Signature of Applicant/Agent: Date ^�Z
ReroofPolicy_201 4.doc revised 01/1 5114
SMOKE CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE-CUPEEb7`INO,GA 0-5014-3255CUPERTINO
(408)777-3228 r FAX(408)777--3333•building atcupertino_orcl
Address � kvt, .fSn�dke: �' arm mclmi&
? �
CANNOT NOT 10A1*0 A', [) OMP 1'� .
HAS AFEN MM AND IiLBMDJED Tt)SHE UII;I7iI VI It3N
PURPOSE
'Ibis affidavit is a.self-wcerffkaticn for the ins-stamation of all required Smoke and Carboy Monoxide lams for
Comphance with. 013 CRs'Section CBC Sections 4-70 6 and <:2.11-2 e no an for access for
inspectims are required-
GENERAL ERAL I F K TION
Existing single-family and mule fare dwellings shall be provided with Smoke ke Alars and Carb on
Mo €-Ade-alarms- 'Why the valuatimuof ad d , rtms,�or exceeds
$1000.00,CRC Section,R314 an Sections 907.2.11.5 and 420.6 require that Smoke Alarms an cr Carbon
Monoxide Alam be installed in the following locations
AREA SMOKE ALARM WALAR1'+
Outside of each separate sleeping area in the immediate-vicinity of the X X
bedroom(s)
ilili tldin�each slee in rootaz X
Carbon Monoxide alarms are not required in dw sa d-i do not contain fuel-burning apphar Lces and that
do not have an attached garage. Carbon monoxide alarms combined with smoke alarms sb ill c ply with
CBC Section 420 6 and shall be approved by 1he Office of the Stag Fare Marshal.
Power Supply:In dwelling-units with no commercial power supply,alarm(s)may be solely batter r operated.
In existing€Iwellingun ls,alarms are permitted to be solely battery operated where repairs car alta cations do
not xesult m tlhe reinnoval-of w0 and:ceil g finisbes 4or flxve as ne mess by meas of arc,baswenient or crawl
space. Refer to CRC Section 8514 and CBC Sections 997 2.11.4 and 42(1:6.2. An electrical pest is r equired for
alarms which must be connected to the building wiring.
As owner of the above-referenced properly,I hereby certify that the alarm(s)referenced above ,Have been
installed in accordance with the m mar's instructims and in compliance-with the Califo Building:
and California Residential odes.The alamns,have been tested and are operational,as of the date i ;ed
below.
1 have raad and agree to ELmplt with tine rerms and conditions of this statement
owner for ow r enfs), ame: J f
i
on s NW
¢ L Si nut r .._.... r -----Ln- ........Date Q._
All
Smoke and CO form—dorevised 03118114
F I I
WATER-CONSERVING PLUMBING FIXTURES U�E--
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CUPERTINO 10300 TORRE AVENUE-CUPERTINO,,CA 85614-3255
(4 8)777-3228 (408)77 , 333•building@21peTfino.org 1pertino.org P
Owner Name` ,,` Yermit No'-` �1
Address Qua L .'44,P
1. Is your real property a registered historical site?
D" Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of firm.
o Go to Question 2.
1. Does your real property have a licensed plumber certifying that,due to the age or configuration of the property ori s
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.
0� o Go to Question 3.
3. Is water service permanently disconnected for your building?
L7 Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of f im.
r 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.
es My real property is built and available for use or occupancy on or before January 1, 1994.
,4 _. .Civil Code Sectiones 110.1.1 throw 1101.8 app ,=Check one of the three_following statements and s' n
bottom of form..
5. ,Fjease 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).
II 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 orbefore 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).
❑ 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).
1,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'- on ruin bitig comply with the requirements as indicated in the
table on the following page.
Owner or Owner Agent's Signature Date:
Upon completing and signing this Certificate,please return it to the Building Division in order to final your building permit.
SB4072015.doe r wised 08126115