B-2016-2229 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2229
10393 COLBY AVE CUPERTINO,CA 95014-2421(316 29 020) JIREH INC
LOS GATOS,CA 95031
OWNER'S NAME: ROMANKEWICZ MARC AND PORCIUNCULAAUREA DATE ISSUED:06/29/2016
OWNER'S PHONE:408-8064584 PHONE NO:(408)298-9399
LICENSED ONTRACTOR'S DECLARATION ATION BUILDING PERMIT INFO:
License Class GENERAL BUILDING DONT A TOR Lic.#800707
Contractor JIREH INC Date 10/31/2017 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:
I hereby affirm under penalty of perjury one of the following two declarations: TEAR OFF;INSTALL CLASS B SHAKE(25 SQ'S)
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.
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:$11858.00
APPLICANT CERTIFICATION
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 316 29 020
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 regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
r
Signature Date 6/29/216 Issued by:Abby Ayende
Date:06/29/2016
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 inspected prior to any roofing material bei ng installed.If a roof is
1. I,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,I agree to rem we 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(Sec.7044,Business&Professions Code). ``-Date:6/29/216
I hereby affirm under penalty of perjury one of the following three declarationsALL ROOF COVERINGS TO BE CLASS"A" R 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 D SOLO RE
2. 1 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 25505,255 3,and 25534. I will
permit is issued. maintain compliance with the Cupertino Municipal Cod(,Chapter 9.12 and the
3. 1 certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should I store r handle hazardous
shall not employ any person in any manner so as to become subject to the material. Additionally,should I use equipment or device which emit hazardous
air contaminants as defined by the Bay Area Air Quality Wanagement 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&Safety Code,Sections 25505,2 3 ,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. -Owner or authorizedagent:
APPLICANT CERTIFICATION Date: /6 29/216
1 certify that I have read this application and state that the above information is CGN TION LENDING AGE CY
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 .)
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 6/29/216
Professional
r ow
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CLIP RT[NC3 (408)777-3228• FAX(408)777-3333 buildingg-cupertino.org
PROJECT ADDRESS APN# _
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OWNERNAME p//
PHONE ! E-MAIL
STREET ADDRESS CITY, STATE,ZIP �j FFAX
CONTACT NAME PHONE (� �l MAIL
STREET ADDRESS 7'
CITY,STATE,ZIP FAX
❑OWNER ❑ OWNER-BUII,DER ❑OWNER AGENTCONTRACTOR I—]CONTRACTOR AGENT ElARCHITECT ElENGINEER ElDEVELOPER ❑-TENANr
CONTRACTOR NAME LICENSE MR LIC NSE. BUS.LIC.#-
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COMPANY NAME I F
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STREET MkS CITY,STA ZIP PHO
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ARCHITECT/ENGINEERNAME LICENSENUMBER BUS.LIC.#
COMPANY NAME E-MAIL
FAX
STREET ADDRESS CITY,STATE,ZIP PHONE - -
USE OF SFD or Duplex ❑ Multi-Family ROOF AREA: VALUATION:
STRUCTURE: ❑ Commercial
EXISTING ROOF TYPE: 0 BUILT-UP ROOF ❑ASPHALT SHINGLES ' SOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY)
REMOVE/REPLACE I�d,YES IF NO, PLYWOOD ❑ %" ❑ PLYWI(78Wn�(fSY PITCH: 12 ROO A.
❑NO #LAYERS: THICKNESS: ❑ 5/8 TYPE. ❑'c v� CLA S
PROPOSED ROOF TYPE: ❑.BUILT-UP ROOF `ASPHALT SHINGLES AOOD SHAKES ❑.WOOD SHINGLES ❑OTHER ICC-ES REPORT#
DESCRIPTION OF WORK
4�/M/L_11_11 c
9
By my signature below,I certify to each of the following:- I am the property owner or authorized agent to act on the properly owner's behalf. I have red 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 buildirlg trucf?r. I aut orize repr sentative's of Cupertino to enter the above-identifprope for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMEN AL INKORMATION REQUIRED
Q -x..v�.. u�.c,..�...a.,...� ,3. OFFICE,LISE_ON_LYr, .?�:�:s.:t?sn....t, 5:�A;•,:
If building is associated with a Home Owner's Association,provide letter PLAN,ci�cxTYrE � x. xoTrr�G sLiP, ,.,
of approval from HOA. ❑g" a "t � .
OVER THE COIINTER ❑ BUII DING PIAN VLEW�
Provide Planning approval to verify if there any restrictions.
❑ tEXPRESs:{ ❑ePLANNINGPLAN vlEw nI
N'
&'T i? a ?L�.. a
Provide copy of Manufacturer's Installation Specifications. ❑ 'sTNDaRv _ qtr �
e-. FIRE DEPT rr �
_Provide signed copy of Cupertino's Tear-Off Policy.
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ReroofApp 2011.doc rev'sed 03/16/11
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O,, BUILDING OFFICIAL
ClI'ICT1E�tt3 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(408)777-3228• FAX(408)777-3333-buiidina a cupertino.org
PROJECT ADDRESS ) APN
OWNERNAME
1 L la— / PHONE jl l3 yej6 G� E-MAIL
STREET ADDRESS CITY, STATE,ZIP U FAX
CONTRACTOR NAME 1- I r LICENSE E LICENSE TYP� BUS.LIC.#
CO NAME r ® E-MAIL
®1t % '137)
SIRE DSS Us CITY TATE, PHONE
' `
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 hours for this service are: 7:30-10:30am and 12:30-3:30 (M 'n-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 tither
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%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 r moved.
7. NOTE: If you call for a tear-off or plywood nailing inspection and the work is not complete,,Tou will be
charged a re-inspection fee. The re-inspection fee shall be vaid before another inspection c n be z
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 detector4 are required to e installed in accordance with Sections R314 and R315 of
the 2013 California Residential Co }}
Signature of Applicant/Agent: Date: C f Z
RerogfPbliey_2014.doe revised 01/15/14
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE F LE
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISIONe- f
CtJPERTINO 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(408)777-3228•FAX(408)777-3333•building(aDcupertino.org g
Q3 Permit No. 13 azolb`;0J /
Address l Dl b #of Alarms Smoke: Carbon Monoxide: Z
PERMITCANNOT BE FINALEA AND COMPLETED UNTIL THIS GERTIFIIATE
�j�s �A BEENy' � �'I�FT_iTFt��D�'TO TFIE��TI`�L GDI''C�SII��T
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
$1000.00, CRC Section 8314 and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and/or Carbon
Monoxide Alarms be installed in the following locations:
AREA SMOKE ALARM CO ALARM
Outside of each separate sleeping area in the immediate vicinity of the X X
bedroom(s)
On every level of a dwelling unit including basements X X
Within each sleeping room X
Carbon Monoxide alarms are not required in dwellings which do not contain fuel-burning appliances and that
do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with
CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal.
Power Supply:In dwelling units with no commercial power supply, alarm(s)may be solely battery operated.
In existing dwelling units, alarms are permitted to be solely battery operated where repairs or alterations do
not result in the removal of wall and ceiling finishes or there is no access by means of attic,basement or crawl
space.Refer to CRC Section R314 and CBC Sections 907.2.11.4 and 420.6.2.An electrical permit is required for
alarms which must be connected to the building wiring.
As owner of the above-referenced property,I hereby certify that the alarm(s)referenced above has/have been
installed in accordance with the manufacturer's instructions and in compliance with the California Building
and California Residential Codes.The alarms have been tested and are operational, as of the date signed
below.
I have read and agree to comply with the terms and conditions of this statement
Owner(or Owner Agent's)Name: (J�$
Signature ........� ......... ............................... .............Date: ��
F
Contractor Name:
Signature...................................................................Lia.#......................................Date: ...I................
Smoke and CO fofm.doc revised 03118114
WATER-CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE I L wN:_
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION C �
CUPERTINO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
( 08)777-3228•FAX 408)777=3333 ouilding(alcupertino.org.
Owner Name Permit No a'J6l �a
Address ( 3
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.
`Rr 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 Sectons.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.
H 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?
0 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.
Rr Yes My real property is built and available for use or occupancy on or before January`l, 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:
01 My properly 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 f,'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).
❑ 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: / Date:
Upon completing and signing this Certificate,please return it to the Building Division in order to final your building permit.
SB407 2015.doe revised 08126115