B-2016-2563 j
CITY OF CUPERTINO BUILDING PERMIT
BUILDINGADDRES CONTRACTOR: PERMIT NO:B-2016-2563
21750 OLIVE AVE CUPERTINO,CA 95014-5915(357 19 083) KING STAR ROOFING
CO
SAN LEANDRO,CA
94577
OWNER'S NAME: K WON JAMES S AND GRACE M TRUSTEE DATE ISSUED:08/22/2016
OWNER'S PHONE:4 08-316-6333 PHONE NO:(510)853-1565
LICENSED CONTR�CTOAIS DECLARATIONBUILDING PERMIT INFO:
License Class 539 Lie.#905124
Contractor KING STAR..RQOFING CO Date 10/31/201 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 I livision 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
RE-ROOF;TEAR OFF;INSTALL OSB;COMP SHINGLES(16 SQ'S)
I hereby affirm under enalty of perjury one of the following two declarations:
1. I have and w'll 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 ve and ll maintain Worker's Compensation Insurance,as provided for by
Sec
2 �klfa
* 'on 370 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$10000.00
APPLICANT CERTIFICATION
certify that I have rez id this application and state that the above
information is correct.I agree to comply with all city and county ordinances APN Numbers Occupancy Type:
and state laws relatin to building construction,and hereby authorize 357 19 083
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.agai ist liabilities,judgments,costs,and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against s id 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 LA D INSPECTION.
Signature 1 ? 5 _Date 08/22/2016 Issued b I S
Date:062-1
OWNER-BUILDER 4CLARATI0
I hereby affirm that I g im 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
1. I,as owner o C 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;(See.70 14,Business&Professions Code)
2. I,as owner of the property,am exclusively contracting with licensed Signature ofApplicant y y
contractors to construct the project(Sec.7044,Business&Professions Code). Date:08/22/2016
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I hereby affirm under ppenalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1. I have and w 11 maintain a Certificate of Consent to self-insure for Worker's
Compensatio a,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 w 11 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 iss ed. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
3. I certify that h 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 em loy 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 Coi ripensation 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 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed r yoked. Owner or authorized agent:/,
APPLICANT CERTIFICATION Date:08/22/2016
I certify that I have read this application and state that the above information is CONSTRUCTION'LENDING GENCY
correct.I agree to con ply 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 costruction,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 e 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 at 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.
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Licensed
Signature Date 08/22/2016 Professional
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REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228 FAX(408)777-3333•building(c)cuoertino.org
CUPE,RTINP20`0 - 253
PROJECT ADDRESS z ° APN# IT
OWNER NAME � PH gh) ®� )" ���j EMAIL
STREET ADDRESS CI Y, FAX
If eE
CONTACT NAME a > PHONE E-MAIL
STREET ADDRESSAA1e eo CITY,STATE ZIP FAX
OWNER ❑ ow NER-BUII:DER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT '❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER El TENANT
R NAME LICENSE NUMB / y LICENSE TYPE�s BUS.LIC# O�/ n
CONTRACTQ (. V
COMPANY NAME a �8 eo E-MAIL FAX
STREET ADDRESS ! � CITY,STATE,� ®0 04
ARCHITECT/ENGINE ;TAME LICENSE NUMBER BUS,LIC.##a
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP - PHONE
USE OF ❑ SFDorDuplex ❑ Multi-Family ROOF AREA: ,v VALUATION: / f?�
STRUCTURE: ❑ Commercial '; G ? ` o" 2
EXISTING ROOF TYP : XBUILT-UP ROOF ASPHALT SHINGLES ❑WOOD SHAKES El WOOD SHINGLES ❑OTHER(SPECIFY)
REMOVE/REPLACE YES IF NO, PLYWOOD w, ❑ PLYWD OSB PITCH: ROOF
NO LAYERS: - THICKNESS: ❑ 5/8" TYPE: ❑ CDX 12 CLASS: E1
PROPOSED ROOF TYP�: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER ICC,ES REPORT#
DESCRIPTION OF WORK: n
f. % %•� tae Sq� � 'C3j
A) / ae) 5-14410
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 ffifonnation 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 construction. th e representatives of Cupertino to enter the above-identified property for spection purposes.
Signature of ApplicanUAgent: 1 Dater
SII PLEMENTAL INFORMA ON REQ RED
ZOFFICE USE`4NLy
if building is associated with a Home Owner's Association,provide letter cxEc`T rENT sz�
of approval ftom HOA.
COUNTE B GP �N RE\IEW
Provide Plan inQ
approval to verify If there an restrictions.
a ILII fY y EMPRESS NN PI AN j2EYIEW
Provide copy of Manufacturer's Installation Specifications. sTANDAxD ❑ DEPT;
y
Provide signed copy of Cupertino's Tear-Off Policy. oTxEx
f
ReroofARp=011.doc revised 03/16/11
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-; REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
ALBERT SALVADOR, P.E.,C.B.O.,BUILDING OFFICIAL
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUPERTIr
(408)777-3228•FAX(408)777-3333• buildinana cupertino.ora
_I
PROJECT ADDRESS ! f Gf 11 !0 c /T- [APN#,
OWNER NAME1 'Tf "e-'5 � Z4PHON �``� E-MAIL
STREET ADDRESS Z CITY, ST E;Z a �@ FAX
Qw
CONTRACTOR NAMELICENSE NUMBER LICENSE TYPE 2, BUS.LIC.
COMPANY NAME v E-MAIL FAX
STREET ADDRESS ` CI Y,STATE � /E ds
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 thT inspection only after that phase of the work is completed. Tlie 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 7:301710:30am and 12:30-2:30 (Friday). Final Inspections will be given a two Hour window.
3. 'Dear-Of Inspection is required. Any and all dry-rotted wood shall be replaced prior to this inspection.
Unless n w 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 'hall 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 toe removal of all new material down to the sheathing so a proper inspection can be,perfonned.
b. A Final lInspection and approval shall be obtained from the building inspector when the re-roofing is
complete. To receive a final sign-off,the following items will be verified:
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a. flat roofs shall have a minimum of I/"per foot of slope and demonstrate there is no ponding.
b. listings from approved testing agencies for all pre-manufactured products used shall be
I�vailable 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
propertyoWne 's behalf. I understand and agree to comply with the re-roof policy stated above. I also understand that
smoke de'tector3 and carbon monoxide detectors are required to be installed in accordance with Sections R314 and R315 of
the 2013 Calif mia Residential Code. 1
Signature of Applicant/Agent: Date: 2 2
ReroofPohey_2014:doe revised 01115114
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SMOKE f CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
CU.. ERTI 0 10300 TORRE AVENUE o CUPERTINO,CA 95014-3255
(408)777-3228• FAX(408)777-3333•buildingQcupertino.om
Permit No.
Address �1 (d y � + #of Alarms-Smoke: Carbon Monoxide:
PERMIT CANI�YQT BE FINALED'AND COMPLETED UNTIL THIS CEKTIF'ICA.TE
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 CSC 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, C C Section R314 and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and/or Carbon
MonoxideAlarms larms be installed:in the following locations:
AREA SMOKE ALARM CO ALARM
Outside!!I of each separate sleeping area in the immediate vicinity of the X X
bedrooin(s) '
On eveky 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 Sup ly: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.Refers 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
l have read and agree to comply with the terms and conditions of this statement
Owner(or,Owner Agent's)Name:
Id
Signature ......... :. :..... ... ........ `......... ...............Date `!.. . .....
Contractor Name:
Signature'.................................................................Lic.#......................................Date: ...................
,Smoke and CC foiryn.doc revised 03118114
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WATER-CONSERVING PLUMBING FIXTURES.
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE• CUPERTINO,CA 95014-3255
CUPERTINO
_ (408)777-3228•FAX(408)777-3333•buildingcupertino.org
Owner Name l ,W, C Y t f��n Peng�nit N'o 3 p 6 �6
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.
VNo Go to Question 2. ,
2. Does your i eal property have a licensed plumber certifying that,due to the age or configuration of the property or its
t plumbing,installation of water-conserving plumbing fixtures is not technically feasible?
❑ Yes. Civil Code Sections 11.01.1 through 1101..8 do not apply.
10 The licensed plumber's certification has been provided to the Building Division.
kip the rest of the form and sign bottom of form.
IV No i o to Question 3.
3. Is water service permanently-disconnected for your building?'
❑ Yes Civil Code Sections 110i.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
No jo to Question 4.
4. Is your.,real propel ty built and available for use or occupancy on or before January 1, 1994?
❑ No n1y 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 fora and sign bottom of form,
M 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
ottonn of form..
5. Please check ONE of the following;
9 My prop rt3'is a single fancily 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 rep aced with water-conserving plumbing fixtures throughout the building. On or before January 1,2017,all non-
compli t plumbing fixtures shall be replaced with. water-conserving plumbing fixtures (regardless of whether
property undergoes alterations or improvements).
❑ MypropipVis a nmltifannily 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-conseiving plumbing fixtures.
On or before January 1,2019,all non-compliant phunbing fixtures.shall be replaced with water-
conservilig plumbing fixtures throughout the building(regardless of whether property undergoes alterations or
improve ents).
0 My property is a conimercial 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 innprovements).
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 equirements, and that the water-conserving plumbing fixtures comply with the requirements as indicated in the
table on the following page.
Owner or,Ow ier Agent's Signature: Date:
Upon completing and signing this Certificate,please return it to the Building Division in order to final your building permit. a
SB407 2015.doc revised 08/26115
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