B-2016-2217 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2217
22104 CLEARWOOD CT CUPERTINO,CA 95014-1102(326 18 03 1) DAN ELLIOTT'S
ROOFING COMPANY
SAN JOSE,CA 95159
OWNER'S NAME: VIOLA SHARON C DATE ISSUED:06/27/2016
OWNER'S PHONE:408-257-2580 ( PHONE NO:(408)559-7327
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class ROOFING Lic.#611338
Contractor DAN ELLIOTT'S ROOFING COMPANY Date 01/31/2017 X BLDG —ELECT —PLUMB
I hereby affirm that I am licensed under the provisions of Chapteij 9(commencing MECH X RESIDENTIAL_COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Co a and that my
license is in full force and effect. JOB DESCRIPTION:
TEAR OFF;INSTALL TILES(39 SQ'S)
I hereby affirm under penalty of perjury one of the following two declarations:
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
t 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:$19000.00
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 326 18 031
representatives of this city to enter upon the above mentioned property for
inspection purposes. (We)agree to save indemnify and keep h�rmless 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 ®R
Additionally,the applicant understands and will comply with all non-point
source regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature-p . Date 06/2 /2016 Issued by:Abby Ayende
Date.06/27/2016
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License L�w for one of the RF-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
r. I,as owner of the property,or my employees with wages as(tIheir 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 intehded or offered for inspection.
sale(Sec.7044,Business&Professions Code)
2. 1,as owner of the property,am exclusively contracting withwensed Signature of Applicani�
contractors to construct the project(Sec.7044,Business&P ofessions Code). Date:06/27/2016
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-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 ork 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 p rmit 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 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 rovisions of the the Health&Safety Code,Sections 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions of this permit shall
be deemed revoked. Owner or authorized agent: .P
APPLICANT CERTIFICATION
Date:06/27/2016 tri_
I certify that I have read this application and state that the above i formation 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 purpo0s. (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 ity 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 rtino Municipal ARCHITECT'S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Licensed
Signature Date 06/27(2016 Professional
1
J
i
REROOF PERMIT APPLICATION
K
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
f 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTINO (408)777-3228• FAX(408)777-3333•building cupertino.org -2
PROJECT ADDRESS �Z ) ®� 0iiti'c , ".� `'�'# 32t� 18031
OWNER NAME � 4` �1�•� P��� P NE r 1" Zt/Cx•J' E-MAb
STREET ADDRESS f `+ CITY,STATE ZIP FAX
CONTACT NAME / P NE r E-IVIAIL
STREET ADDRESS 4 I CrI Y,STATE.ZIP
( To%-96q-
13
OWNER 11OWNER-BUILDER 13OWNER AGENT1CONTRACTOR 13CONTRACTORArFNT 13ARCHrmcT 13ENGINEER ❑ DEVELOPER ❑/ TL•NANT
CONTRACTORNAME C ` ICENSE NUMBER I 1 LICENSETYP BUS.LIC-#
COMPANY NAME 42 n Off�S I lG� L r I e 101 1�0 ✓S Ma S•VIAIL FAX
STREET ADD %6.7 ,STATE,ZiP ONE
I Se A q1�5I z 55 3
ARCHRECT/ENGINEER NAME LICENSE NUMBER BUS.LIC.#
COMPANY NAME FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF V SFD or Duplex ❑ Multi-Family I ROOF AREA: VALUATION: `1�(/�� J�71'�J
STRUCTURE: El Commercial _
EXISTING ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES 129 OTHER(SPECIFY) �t)�nL ,
An
REMOVE/REPLACE 10 YES IF NO. PLYWOOD 121 '/s" ❑ PL ❑OSB PTTCH: t ROOF
13NO #LAYERS: THICKNESS: E35/8" TYPE: ❑CDX 12 CLASS:
p ICC-ES REPORT#
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SH[KGLES ®OTHER t
( I \
DESCRIPTION OF WORK:
I I ::6
U C
6 XIR W I'f 1 L—ire ��. z I 1 10 IA
2 U 9fJ- '0 l!
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 harovided is convet. I have read the Desen'ptign of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating burl on I uthoi a resenta- of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: I, Date: �Q 6
SUPPLEMENTAL INFORMATION REQUIRED oM[i USF DNLY
If building is associated with a Home Owner's Association,provide letter PLAN CHECKTYPE ROUT[NG SLAP
of approval from HOA. I ❑. OVER-TIW-COIJiMR - 0 sU>aIDnvGPLaivt vrEw
Provide Planning approval to verify if there any restrictioi s. p.ExPRW 0-PLANNING PLAN.REVIEW
Provide copy of Manufacturer's Installation Specifications. STANDARD .. .azlrenl rr
Provide signed copy of Cupertino's Tear-Off Policy. a arTILR:
ReroofApp_2011.doc revised 03/16/11
�C
N F4 REROOF TEAR-OFF POLICY
rA COMMUNITY DEVELOPMENT DEPARTMENT- BUILDING DIVISION
,J ALBERT SALVADOR, P�E., C.B.O., BUILDING OFFICIAL
CUPERT[ ' 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255
(408)777-3228 • FAX(4)8)777-3333•buildino(d)cuoertino.org
PROJECT I APN 2 '62(-p 1t O✓1
OWN AME `Y I PHOTS E-MAIL
STREET 7 r �r I CI ,STATE,ZIP _ IMAX
/(/ Lfl�ar 4 0 Q-5-14 141
CON G ORNAD—//to LICENSE ER E BUS.LIC.R��3 9
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COM NAME E-MAIL /V/l f FAX / I
i2 in
ST T ADDRESS c�Cl Y,STATE, /�'// IV`
G'o ! n a /2 elWaf—sf- 712 ,7
I UNDERSTAND AND AGREE TO THE FOLLOWING:
1. The re-roof project shall comply wit 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 7:30-
2:30pm (Friday) to schedule inspection. For Tear-Off and Nailing Inspections,you must also call on the
day of the inspection only after thafI 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. Almy 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 withoutfust obtaining all prior inspection and written approvals from the
building inspector. Any roofing whi l h is applied without first obtaining an approved inspection will
require the removal of all new mater'Ll
down to the sheathing so a proper inspection can be performed.
6. A Final Inspection and approval sbe 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 miniriium of I/4"per foot of slope and demonstrate there is no ponding.
b. Listings from approved testig 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
11
charged are-inspection fee. The re-i spection 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 withthe 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 Residentia Code.
S ignature of Applicant/Agent: Date:Z,
ReroojPo1icy_2014.doc revised 01/15/14
I
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION
CVP RT1t-40 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333 building(d)cupertino.orq
Permit ' /==
d�
Address a� e�'7,9"A-W e�b �T'. l �4�#of Alar s Smok : r arbors Monoxide:
PERMIT'CANNOT B' FINALEI3 ANH CpMPL TRD UNTIL THIS C RTII I
-
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 CPC Sedans 4?0 6:and 907.2 41:2rliere-no irater-rar agess far
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
$1'000.00,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 d
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
CBC 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 perinitted to be solely battery operated where repairs or alterations do
xrot result-in he removal of wall and ceiling f rtislles or Ehere is rio access by rliearis 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.
l have read and agree to comply with the terms and ppnditions of this statement
Owner(or Owner Agent's)Name: ,
DaterSi nature. .j.:. ..C�.
Contractor Name: ('
k'&O PYP Si natu Lic.#.. � .. .......Date: .. ../.�r..
Smoke and CO form.doc revised 03/18/14
i
WATER-CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING[I DIVISION
1JP3TIINlt1 10300 TORRE AVENUE<CUPERTINO,CA 95014-3255
(4 ) 77-3228 FAX(408)777-3333 building@cupertino.orct_e
Owner Name Permit No' CEJ
Address Aato
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.
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 1,101.8 do not apply_
❑—The hcense`l pl7umber'`s certification ha 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.
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).
❑ My property is a multifamily residential real property.. See Civil Code Section 1101.5.
On and after January 1,2014,specified building alterations yor 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- 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-conserving plumbing fixtures comply with the requirements as indicated in the
table on the following page. N -
Owner or Owner Agent's Signature: Date: V1,e
Upon completing and signing this Certificate,please return it to the Building Division in order to final your b lding ermit:
SB40 7 2015.doc revised 08126/15