B-2016-2964CITY OF CUPERTINO BUILDING PERMIT I
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016 2964
22440 WALNUT CIR N CUPERTINO, CA 95014-2740 (357 03 050) T D ROOFING INC
SAN JOSE, CA 95111
OWNER'S NAME: LOH JOY HWEI L AND YU CHIAHUA G DATE ISSUED: 10/21/2016
OWNER'S PHONE: 408-507-6114 PHONE NO: (408) 892-8872
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class _Q_Q Lic. #845591
Contractor T D ROOFING INC Date 08/31/2018
I hereby affirm that I am licensed under 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.
I hereby affirm under penalty of perjury one of the following two declarations:
1, I have and will maintain a certificate of consent to self -insure for Worker's
BLDG —ELECT _ PLUMB
MECH X RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION:
RE -ROOF; TEAR -OFF; INSTALL OSB; COMP SINGLES - (40 SQ)
Compensation, as provided for by Section 3700 of the Labor Code, for the
a performance of the work for which this permit is issued.
1sP2. 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: $16500.00
APPPLICANT CERTIFICATION
I 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
and state laws relating to building construction, and hereby authorize
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
may accrue against said City in consequence of the granting of this permit.
Additionally, the applicant understands and will comply with all non -point
source regulations per the C plkino Municipal Code, Section 9.18.
Signature �f Date 10 21-
2016
E
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
I, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered for
sale (Sec.7044, Business & Professions Code)
I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project(Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three declarations:
n. 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. 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.
3. 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
Worker's Compensation laws of California. If, after making this certificate of
exemption, I become subject to the Worker's Compensation provisions of the
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
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 and state laws
relating to building construction, and hereby authorize 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 may accrue against said City in
consequence of the granting of this permit. Additionally, the applicant understands
and will comply with all non -point source regulations per the Cupertino Municipal
Code, Section 9.18.
Signature Date 10-21-2016
"N Number: Occupancy Type:
357 03 050
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: Kim Dunbar
RE -ROOFS:
All roofs shall be inspected prior toauy oofmg material being installed. If a roof is
installed without first obtaining a ins4e tion, I agree to remove all new materials for
S ectio .
Signature of Applicant: -4;1
'
Date: 10-21-2016
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505,'25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino M 'ci al Code, Chapter 9.12 and
the Health & Safety Code, Sections`255 5533, and 25534.
Owner or authorized agent:
Date: 10-21-2016
CONSTRUCTION LENDINGA ,NCV
I hereby affirm that there is a construction lending agency for the -p rformance
of work's for which this permit is issued (Sec. 3097; Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed
f
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(a)cupertino.om
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USE OF 11 SED Or Duplex
A .Multi -Family
ROOF AREA:
VALUATION:
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STRUCTURE: ❑ Commercial
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EXISTING ROOF TYPE: ❑ BUILT-UP ROOF
❑ ASPHALT SHINGLES, WOOD SHAKES
El WOOD SHINGLES ❑ OTHER (SPECIFY)
REMOVE JREPLACE YES
IF NO,
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PLYWOOD ❑`%"
PLYWD OSB. -
PITCH:
ROOF
❑ NO
# LAYERS:
THICKNESS: ❑ 518"
TYPE: ❑ COX
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CLASS: A
PROPOSED ROOF TYPE: ❑ BUILT-UP ROOF
KASPHALT SHINGLES ❑ WOOD SHAKES
❑ WOOD SHINGLES ❑ OTHER
ICC -ES REPORT #
DESCRIPTION OF WORK
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By my signature below, I certify to each of the fg11lowM. 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 providelic�tt. I have read the Description ofRork and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to buildingn V thorize representatives of Cupertino to enter the above -identified propirty for inspection purposes.
Signature of Applicant/Agent: lf/ Date:
SUPPLEMENTAL INFORMATION REQUIRED
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If building is associated With a Home Owner's Association, provide letter PLAnYcxEcx iPE IiotiTznc: si Ph
of approval from HOA. "I-7 LIVER Tx1•i-couN1,zER l�uILDINcriANREVII'+w "�
_ Provide Planning approval to verify if there any restrictions. l] E�PIiEss Cl pl nni\II`c PLANRE zEw
Provide copy of Manufa6turer's Installation Specifications, I sT�ND.gRD ❑ "FIRE DEIPT111
Provide signed copy of Cupertino's Tear -Off Policy. I] oTIIEx
Re7-oofApp_2011.doc revised 03/16/11
CUPERTWO
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
(408) 777-3228 • FAX (408) 777-3333 • building(alcupertino.ora
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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 fiom 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 perforined.
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/" 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 o coni, ly with the re -roof policy stated above. I also understand that
smoke detectors and carbon monoxide detectors are erire -tI be installed in accordance with Sections R314 and R') 15 of
the 2013 California Residential Code.
Sianature of AUvlicant/Anent: i r £ Date: tC> ' y
ReroofPol cy_2014.doc revised 01115114
M
CUPERTINO
SMOKE / CARBON MONOXIDE ALARMS
OWNE . CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildinq�cupertino.ora
FUKFU6
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 bedroom(s)
X
X
On every level of a dwelling unit includui 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: Ir: 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 specified below have been tested and are .operational, as of the
date signed below. (
Address: �-:.2 <( `1 ` k) tlOir t L'i a A C -k Permit No._..9. 0 ( 1� q y
Specify Number of Alarms: # Smoke Alarms: # Carbon Monoxide Detectors:
l have read and agree to comply with the terms and conditions of this statement
ner (or Owner Age 's)/Name: .,.�����
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Signature ........... Date:
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Contractor me: '
Signature.................................................................. Lie.# .....................................Date:
Smoke and CO fo)-imdoc revised 09%17116
Owner Name
WATER -CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT a BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 JAX (408) 777-3333 • building(a)cupertino.org
� II�
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.
No Go to Question 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?
❑ 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.
119cYes My real property is built and available for use or occupancy on or before January 1, 1994.
p Civil Code Sections 1101.1 through 1101.8 apply. Check one of the three following statements and sign
bottom of form..
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).
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 1 bing fixtures comply with the requirements as indicated in the
�- tab�ln the following
nage. the
Owner o Owner Agent's Signature: _ Date: 1'0 / z-�Wib I
w d
pon completing and signing this Certificate, please return it to the Bigftng Division in order to final your building permit.
SB4072015.doc revised 08126/15