B-2016-2730 i
CITY OF CUPERTINO BUILDING PERMIT
BUILDINGADDRESS: CONTRACTOR: PERMIT NO:B-2016-2730
20031 PACIFICA DR CUPERTINO,CA 95014-3110(369 28 031) SECURITY ROOFING
INC
SAN CARLOS,CA
94070
OWNER'S NAME: HANNING KENNETH J AND MARLENE J TRUSTEE BATE ISSUED:09/15/2016
OWNER'S PHONE:408-996-9385 PHONE NO:(650)591-7663
CONTRACTOR'SLICENSED BUILDING PERMIT INFO:
License Class C-39 Lia#306844
Contractor SECURITY RO FING ING Date 04/30/2018 X BLDG _ELECT _PLUMB
MECH X RESIDENTIAL_COMMERCIAL
I hereby affirm that I am licensed und er the provisions of Chapter 9(commencing
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;INSTALLING OSB;COMP SHINGLES-(26 SQ)
I hereby affirm under penalty ofperjt ry one of the following two declarations:
1. 1 have and will maintain a cer.tific4e of consent to self-insure for Worker's
Compensation,as provided f`r by Section 3700 of the Labor Code,for the
performance of the work for vhich this permit is issued.
Orb-
I have and will maintain Wor er's Compensation Insurance,as provided for by
Section 3700 of the Labor Q de,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$11500.00
certify that I have read this application and state that the above
information is correct.1 agree to comply with all city and county ordinances APN Number: Occupancy Type:
and state laws relating to building co istruption,and hereby authorize 369 28 031
representatives of this city to enter u on the above mentioned property for
inspection purposes, (We)agree to have 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 cons equence 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 Cupart[DQ Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
-Signature Date 9/15/2016 Issued by:Kim Dunbar
Date:09/1512016
I-hereby affirm that I am exempt froth the Contractor's License Law for one of the J RE-ROOFS
following two reasons: I 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 mspe
sale(Sec.7044,Business&I rofes'kions Code)
2. I,as owner of the property,am exclusively contracting with licensed -- Signature of Applicant: -
contractors to construct the oject(Sec.7044,Business&Professions Code). Date:9/15/2016
I hereby affirm under penalty of perj ry 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 f or 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 W4er'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
maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
permit is issued.
Health&Safety Code,Section 25532(a)should I store or handle hazardous
a. I certify that in the performance of the work for which this permit is issued,I
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 law 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 255qg,25533,and 25534.
Labor Code,I must forthwid 1 comply with such provisions or this permit shall f
be deemed revoked. -
Owner or authorized agent
Date:.9/15/2016
I certify that I have read this applica ion and state that the above information is CONSTRUCTION LENDING AGENCY
I hereby affirm
correct.I agree to comply with all ci and county ordinances and state laws firm that there is a construction lending agency for the performance
relating to building_ construction,anc 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 3roperty for inspection purposes. (We)agree Lender's Name
to save indemnify and keep harmles the City of Cupertino against liabilities,
judgments,costs,and expenses wh ch may accrue against said City in Lender's Address
consequence of the granting of this ermit. Additionally,the applicant understands ARCHITECT'S DECLARATION
and will comply with all non-point solurce regulations per the Cupertino Municipal I understand my plans shall be used as public records.
Code,Section 9.18.
Licensed
Signature Date 9/15/2016 professional
RE ROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTIN (408)777=3228 FAX(408)777-3333•building(�D_cupertino.org /20
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PROJECT ADDRESS ,� APN# Q,
OWNER!; '.efr
STREET ADDRESS CITY, el
TE,ZIP y FAX
CONTACT N / PH/0 E-MAIL
STREET ADDRESS CITY,STATE,ZIP FAX
❑OWNER ❑ OWNER-BuiLDER ;I] OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR IxME 9 ._ LICENSE NUMB LICENS YP BUS.LIC
e W"G�
COM AME '' E-MAIL FAX
STREET ADDRESS L.. / C 'STATE,ZIP y PHONE
e'er / a p3 / 6 J ✓`
,1 a6-
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC.#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF FD or Duplex ❑ Multi-Family ROOFAREA: VALUATION: y�
STRUCTURE: ❑ Commercial
EXISTING ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES IOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY)
IF NO,11 PLYWOOD I*eW, ❑ PLYWD SB PITCH: ROOF
REMOVE/REPLACEEl No I S #LAYERS: THICKNESS: 5/8" TYPE: ❑ CDX .12 CLASS: A
PROPOSED ROOF TYPE: ❑BUILT-UP' OOF 14ASPHALT SHINGLES IJ WOOD SHAKES ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT#
It
DESCRIPTION OF WORK:
r
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 rela' g to building con etion.d authorize representatives of Cupertino to enter the above-ids tified roperty for inspection purposes.
Signature of Applicant/Agent tg Date:
SUPPLEMENTAL INFORMATION REQUIRED „ or P cP IJSE o vLY
r
If building Is associated with a Home Owner's Association,provide letter PfAcT � tQUTINcsLn'
❑ OVER THE COUNTER ❑ $i}ILDING PLAN RE11E
of approval from HOA. W
�_:
Provide Planning approval t
g pp o verify if there any restrictions. kP""SS ❑ PLANNING PLAN REVIEW
Provide copy of Manufacturofs Installation Specifications. ❑ A At671
❑ r DST
Provide signed copy of Cupertino's Tear-Off Policy. `"oTxER
i
ReroofApp_2011.doc revised 03115/11
RERQOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
ALBERT SALVADOR,P.E.,C.B.O.,BUILDING OFFICIAL
Ci I P RTt Cp 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(40$)777-3228 FAX(408)777-3333•building(Mcupertino.org
PROJECT ADDRESS c APN#
OWNERNAME P o / j _1 - S &MAIL
STREET ADDRESS,- CITY STATE,ZIP FAX
CONTRACRGN LICEIyS�(�VIr �'
COM aNY�INAME [J i /f /,sem^ /E MAII FAX /
STREET AIjG� S ,/� 69,E C5SX_ ZIP PHO
I�
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 clan 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[ofll 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 shal�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-sine 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 dor 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 leach 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 det rs a quired to be installed in accordance with Sections R314 and R315 of
the 2013 California Reside Code,
Signature of Applicant/Agenti V Date:
ReroofPolicy_2014.doc revised 01115114
_ tL
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION
Ct,1Pt=R`rMO 90300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(408)777-3228,FAX(408)777-3333 o buildingCc upertino org
Permit No.,?
Address ,� Z'i�er� r #of Alarms Smoke: Carbon Monoxide:
P>�RMIT CANNOT SE F4NALEW ANI)COMPLETED,,UNTIiLTHIS CERfiIFICATE
/EIA $TEEN�j '` IRNE U THS$U
'DING, -DIV`ISI0 �
PURPOSE
This affidavit is a self--certification for the installation of all required Smoke and Carbon Monoxide Alarms for
compliance with 2013 CRC Section 8314,2013 CBC Sections 420.6 and 907.2.11.iwhere 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,dxceeds
$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 _.0 ALARM
Outside of each separate sleeping area in the immediate vicinity of the X X
bedroom(s) _
On e rery level of a dwelling unit including basements X X —
Withn 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, alarni(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 craw}
space.Refer to CRC Section 8314 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 cornp!2 with the terms and conditions of this statement
Ownerr(or Owne Agent's)Name:
�✓! t��3�1 r Si nature...... .. :.... ......... ............Date:
Contractor Name:
fi / _ .,i Signature Date:
....
..........Lic.#.:...................................
Smoke and CO form.doc revised 03118114
WATER-CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
�, �INO 10300 TORRE AVENUE-CUPERTINO,CA 95014-3255
�40 )777-3228-FAX(408)777-3333• building(a)cupertino.org
Owner Name �,• —i-r r' Permit No. � 73
Address 6 o -3 )
1. Is your real property a registered historical site?
❑ Yes Civil Code Sections 110 1.1 through 1101.8 do not apply.. Skip the rest of the form and sign bottom of form.
17�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 pennanentlydisconnected 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.
E4—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.
9-'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:
OL-gy 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 properly 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: Date: %L9-/ Z16
Upon completing and signing this Certificate,pleas return it to the BuNing Division in order to final your building permit.
SB40 7 2015.doc revised 08126115