B-2016-2373 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2373
1191 STAFFORD DR CUPERTINO,CA 950144951(362 11026) JIREH INC
LOS GATOS,CA 95031
OWNER'S NAME:.LOHMILLER KATHERINE A TRUSTEE DATE ISSUED:07/25/2016
OWNER'S PHONE:408-257-4232 PHONE NO:(408)298-9399
LICENSED CONTRACTOR'S DF LARA ION BUILDING PERMIT INFO:
License Class GENERAL BUILDING ONT TOR Lie.#800707
Contractor JIREH INC Date 10/31/2017 _X BLDG _ELECT _PLUMB
_MECH X RESIDENTIAL_COMMERCIAL
I hereby affirm that I am licensed under the provisions of Chapter9(commencing
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; RE-ROOF;TEAR OFF;INSTALL OSB;COMP SHINGLE(30 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
dl.
/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:$11250.00
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 362 11 026
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 Cup rtino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED-1SPECTION.
Signature %"/Ih'� __ Date 07/25/2016 Issued by:MEL SAN .S
Date:07/25/2016
OWNER-BOWNER-B ER 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 being installed.If a roof is
m. 1,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 intended or offered for inspection.
sale(Sec.7044,Business&Professions Code)
z. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec,7044,Business&Professions Code). Date:07/25/2016
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
m. 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 r
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 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 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 Cod ions 25505,25533,and 25534.
Labor Code,I must forthwith comply withsuch provisions or this permit shall
be deemed revoked. Owner or authorized agent
APPLICANT CERTIFICATIONDate:07/25/2016
I certify that I have read this application and state that the above information is ONS R TI N 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 07/25/2016 professional
REROOf= PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
Cl1P RTihiC) (408)777-3228• FAX(408)777-3333•building(c)cupertino.org
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PROJECT ADDRESS APN/ # /
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OWNERNAME / PHO
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STREET ADDRESS
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CONTACT NAME l`� PHONE E-MAIL
. STREET ADDRESS CITY,STATE,ZIP FAX
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENTCONTRACTOR 1:1CONTRACTORAGENT ❑. ARCHITECT El ENGINEER El DEVELOPER El TENANT
CONTRACTOR NAME LICENSEBER LIC NSE T BUS.LIC.#
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COMPANY NAME gAIL F !
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STREET D S CITY,STA ,ZIP
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ARCHITECT/ENGINEER NAME LICENSE NUMBER ` BUS.LIC.#
COMPANY NAME. E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF 2r SFD or Duplex ❑ Multi-Family ROOF AREA: VALUATION,
STRUCTURE: ❑ Commercial �,✓3 0 S' C-�r�
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EXISTING ROOF TYPE::. 11BUILT-UP ROOF El ASPHALT SHINGLES B WOOD SHAKES '�—IWOOD SHINGLES ❑-OTHER(SPECIFY)
REMOVE/REPLACE 1S4YES IF NO, PLYWOOD ❑ 'h" ❑ PLYWD OSB PITCH: ROOF
❑NO #LAYERS: ^� THICKNESS: ❑ vq8 TYPE: . - ❑ CDX 2 CLASS: A
PROPOSED ROOF TYPE: 11BUILT-UPROOF L2'ASPHALT SHINGLES ❑WOOD SHAKES ElWOOD SHINGLES ❑OTHER ICC-E5 REPORT
DESCRIPTION OF WORK�__
l Gce�-� -Lyt s V
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 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 bui din struct' I authorize repr sentatives of Cupertino to enter theabove-ide tified Iroperty for inspection purposes..
Signature of Applicant/Agent: Date: (�
SUPPLEMEN AL RdORMATION REQUIRED r '„ > cE usE olvi Y s `
r *' W r4ss t� g
_If building is associated with a Home Owner's Association,provide letter P c�cxYrExouTmlGszrr ¢s
of approval from HOA. ovEx T�coUrrrER ❑ BUIIDIPIGPLANREpIEyi
_Provide Planning approval to verify if there any restrictions. pEarxEss # ` �
r
Provide copy of Manufacturer's Installation Specifications. p STn, p ,rRFnEr�r :
_Provide signed copy of Cupertino's Tear-Off Policy. a® HE� ya x
`ReroofApp_2011.doc revised 03/16/11
........ ..........
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
ALBERT SALVADOR, P.E„ C.B.O., BUILDING OFFICIAL
CU.P EE P.TIN6 10300 TORRE AVENUE•CUPERTINO, CA 95014.3255
(408)777-3228- FAX(408)777-3333-buildingQcupertino.org
PROJECT ADDRESS p� e APN#3/
OWNERNAME ` PHO7/1w-
E-MAII
STREET ADDRESS P C ST E,ZIP FAX
CONTRACTOR NAME sem--_ LICENSE OB LICENSE TYPE BUS..LIC.
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//� �J ry
CO NAME ®- E MAI, O_ d! FAX'
STRE_ SS CITY TATE,S' PHONE
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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 (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 detector .are required to e installed in accordance with Sections R314 and R315 of
the 2013 California Residential o
Signature of Applicant/Agent: Date: l
ReroofPoliccy 2014.doc revised 01/15/14
IL
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CUPE�RTINO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333•building(a.cupertlno.org
-23
Permit No. 6201(o—
Address
1(o23
Address L t' / ,Q - . 0 of Alarms Smoke: Carbon Monoxide:
PERMIT CANNOT BE FINALED AND COMPLETED UNTIL THIS CERTIFICATE
HAS BEEN SfQNED AND REI R_NND TO THE BUILDING DIVISION
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
Existingsingle-family gle-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,CR(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
bedrooms) P
On ever level of a dwelling unit including basements X X ' .
within e eh sleeping room X
Carbon Mondxide alarms are not required in dwellings which do not contain fuel-burning appliances-and that G
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 hasihave been
installed in accordance with the manufacturer's instructions and in compliance with the California Building
and Cal forni;�.Residential Codes.The alarms have been tested and are operational,a.s of the date signed
below. Z—
I have read and agree to comply with the terms arA conditions of this statement
Owner(orOwn Agent's)Name
Signature... .... ..... .... ..... Date:¢
Cont r oMarne:
Signature...................................................................Lic.#......................................Date: ....................
Smoke and CO fonn.doc revised 03118114
F1
WATER-CONSERVING PLUMBING FIXTURES Q
OWNER CERTIFICATE OF COMPLIANCE �f
COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION
CUPEP�TiNO 1030 TORRE AVENUE•CUPERTINO,CA 95014-3255
(4 �777- 28•f 408)777-3333•buildingacupertino.org
Owner Name Permit No. Jo 44 r ",
Address _
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.
Nolo 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.
0 The licensed plumber's certification has been provided to the Building Division.
Skip the rest of the form and sign bottom of form.
o Go to Question 3.
3. Is water service permanently disconnected for your building?
❑ Yes ivil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
3kNo oto 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 oil 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 properly is a single-family residential real properly. 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-
complianx plumbing fixtures shall be replaced. with water-conserving plumbing fixtures (regardless of whether
property pndergoes alterations or improvements).
0 Myproperty 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
improveml ents).
My property is a commercial real property. See Civil Code Section 1101.5.
Onn and and a er January 1,2014,specified building alterations or irnprovernents shall require non-compliant
p 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 110.8,the current California Plumbing Code and California Green Building Standards Code,and manufacturer's
installation requirements,and that the water-conserving p bing 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 Certificat , lease return it to the Building Division in order to final your building permit.
SB4072015.doc revised 08/26/15
BiII�DING P omr CA OT 13E--)F NAEDA1VD COMPLETED i7NTIL THIS
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j Non-Compliant Water-Conserving Plumbing Fixture
Plumbing Fixture1 (Fixture Complying with Current Code Applicable to New Construction)
Maximum Water Usage/Flow Rate
Fixture Type 2013 CPC Ch.4 2013 CPC Ch.4 2013 CPC Ch.4
Water Usage 2013 CALGreen Div.4.3 2013 CALGreen Div.4.3 2013 CALGreen Div. 5.3
/Flow Rate Single-Family Multi-Family Commercial
ResidentialResidential
Water Closets', Exceed 1.6 Single flush toilets: 1.28 gallons/flush
(Toilets) Gallons/flush Dual flush toilets: 1.28 gallons/flush effective flush volume(the composite,
average flush volume of two reduced flushes and one full flush
C Urinals Exceed 1.0
Gallons/flush 0.5 gallons/flush
Showerheads Exceed 2,5 2.0 gallons per minute @ 80 psi. Also certified to the performance criteria of
gallons per minute U.S. EPA WaterSense Specification for Showerheads
(A hand-held shower is considered a showerhead.)
For multiple showerheads serving one shower,the combined flow rate of all
showerheads and/or other shower outlets controlled by a single valve shall not
exceed 2.0 gallons per minute @ 80 psi,or the shower shall be designed to
allow only one shower outlet to be in operation at a time.
Faucets— Exceed 2.2 gallons Maximum 1.5 gallons per Within units: 0.5 gallons per minute @ 60
Lavatory per minute minute @ 60 psi;minimum Maximum 1,.5 gallons psi
Faucets 0.8 gallons per minute @ per minute @ 60psi;
20 psi minimum 0.8 gallons
i
per minute @ 20 psi
In common and public
use areas: 0.5 gallons
per minute @ 60 psi
1.8 gallons per minute
60 psi _
Faucets— Exceed 2.2 gallons 1.8 gallons per minute @ 1.8 gallons per minute 1.8 gallons per minute @ 60
Kitchen per minute 60 psi @ 60 psi psi
Faucets May temporarily increase May temporarily
up to 2.2 gallons per increase up to 2.2
minute @ 60 psi, and must gallons per minute @
default to maximum 60 psi, and must .
1.8 gallons per minute @ default to maximum
60 psi 1.8 gallons per minute
Where faucets meeting @ 60 psi
the above are unavailable, Where faucets meeting
aerators or other means the above are
may be used to achieve unavailable,aerators or
reduction. other means may be
used to achieve
reduction.
1. If the existing plumbing fixture water usage/flow rate is equal to or Iower than the figure shown,it is,not required to be upgraded.
SB40 7 2015.doc revised 08126115