B-2016-2675 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR PERMIT NO:B-2016-2675
19991 RODRIGUES AVE CUPERTINO,CA 95014-3151(369 04 010) STONERIDGE
ROOFING
SAN JOSE,CA 95151
OWNER'S NAME:. SUNDARAM SWAMINATHAN H AND RAMA DATE ISSUED:09/07/2016
OWNER'S PHONE:408-813-1099 PHONE NO:(408)729-5101
LICENSED CONT ACTORS DECLARATION BUILDING PERMIT INFO:
License Class Com9 Lic.#951530
Contractor STONERIDGE ROOFING Date 08/31/2018 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:
RE-ROOF;TEAR OFF SHAKE;INSTALL 30LB FELT;INSTALL COMP
I hereby affirm under penalty of perjury one of the following two declarations: (25 SQ).
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.
2, 1 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:$17800.00
APPLICANT CERTIFICATION
certify that 1 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 369 04 010 R-3
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 derstands and will comply with all non-point
source regulations p th upertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature' . 1 Date 9R/16 Issued by:SEAN HATCH
Date:09/07/2016
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 being 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 remove all new materials for
compensation,will do the work,and the structure is not intended or offered for inspection.
sale(Sec.7044,Business&c Professions Code)
2. 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: /9 7/16
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 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 Code,Secti ns 5505;25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent:
APPLICANT CERTIFICATION Date:9/7/16
I certify that I have read this application and state that the above information 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 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. I understand my plans shall be used as public records.
Signature Date 9/7116 Licensed
Professional
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTI NO
(408)777-3228 FAX(408)777-3333•buildingg-cupertino.org
PROJECT ADDRESS ' APN# j_/°4&
1 l
OWNERNAME PHONE E-MAIL
STREET ADDRESSCITY,STATE,ZIP PF
CONTACT NAME PHONE'' E-MAIL
STREET ADDRESS CITY,STATE,ZIP FAX
I
0 OWNER OWNER-BUILDER ❑ OWNERAGENT CONTRACTOR 11 CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC.#;
a
III
COMPANY NAME 4 E-MAIL' (i FAX
a
STREET ADDRESS XS bole CITY,NATE,ZIP PHONE
(1
ARCHITECT/ENGINEER NAME LICENSE NUMBER 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: ❑BUILT-UP ROOF t.k'ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY)
REMOVE/REPLACE ❑YES IF NO, PLYWOOD ❑%" ❑ PLYWD El PITCH: ROOF
❑NO #LAYERS: THICKNESS: ❑5/8" TYPE: ❑ CDX ""' '12 CLASS: - A
PROPOSED)?OOF TYPE: ❑BUILT-UP ROOF V PHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT#
DESCRIPTION OF WORKTL;
S
/
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 protide is c rrect. 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 buil g ns ction. I authorize representatives of Cupertino to enter the above-identified V_e
rty for inspection purposes.
f
Signature of Applicant/Age / Date:
SUPPLEMENTAL VIATION REQUIRED ' o>Fig ust ONLY:,
If building is associated with a Rome Owner's Association,provide letter PLACHECKIYPE 13°oxmlGsl
I
of approval from I3OA. '`""
OVgR77ECOIINTER i BUILDINOPLANRESYEW
Provide Planning approval to verify if there any restrictions. �Xp>tEss i] PLA 4NiNG PLAN REVIEW
Provide copy of Manufacturer's Installation Specifications. 0 ST, ARD, � � � 'FIRE DEPT,,
n,4HER ;
Provide signed copy of Cupertino's Tear-Off Policy.
RerogfApp_2011.doc revised 03116111
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION
ALBERT SALVADOR, P.E.,C.B.O., BUILDING OFFICIAL
CUPERTINO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333-building&cupertino.org
PROJECT ADDRESS , a APN#
OWNERNAME .. PHONE E-MAIL
STREET ADDRESS CITY,STATE,ZIP FAX
CONTRACTORNAM LICENSE NUMBER LICENSE TYPE BUS.LIC.#
COMPANY NAME EMAIL FAX
STREET ADDRESS C Y,STAT ZIP
PHO
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 Innspecton 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/"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 deitectors are required to be installed in accordance with Sections R314 and R315 of
the 2013 California Residential Cod
Signature of Applicant/Agent: Date: '
ReroofPolicy_2014.d6c revised 01115114
FILE-
SMOKE / CARBON MONOXIDE ALARMS _ �I
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CUPERTINO 10300TORREAVENUE•CUPERTINO,CA9501'4-3255
(408)777-3228•FAX(408)777-3333•buildingQcupertino.org
q c� Permit No.
Address , / I � A0. J #of Alarms Smoke: IT Carbon Monoxide:
PERMIT CANNOT BE FINALED AND COMPLETED UNTIL THIS CERTIFICATE.
HAS BEEN SIGNED AND RETURNED 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
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 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
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 stall 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 9,07.2.11.4 and 420.6.2.An electrical permit is requirVd for
alarms which must be connected to the building wirin
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 beenn tested and are operational,as of the date signed
below.
l have read and a ree to comply yvith the terms and Ponditions of this latement
Owner(or Owner Agents)Name: r p f
S'. H e S lJ KDA R AM Signature........ � .... Date:_ ...
...... ..............
Contractor Name:
Sinature...................................................................Lic.#......................................Date: ...................
Smoke and Co form.doc revised 03/18114
WATER-CONSERVING PLUMBING FIXTURES FILE
its OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CUPER`!'INO 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(408)777-3228•FAX(408)777-3333-building@cupertino.org
Owner Name S u ryJ>1A R A M Permit No.
Address O-K 0— Ct,, e_ h'," cA
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 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.
> No Go to Question 3.
3, is water service permanently disconnected for your building?
El 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 110 1.1 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 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).
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 110 1.1
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: 371 Date: f j
Upon completing and signing this Certificate,please return it to the Building Division in order to final your building permit.
SB407 2015.doc revised 08126115