B-2016-3020 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-3020
1047 WEST HILL CT CUPERTINO,CA 95014-5063(362 27 049) JIM HAGEMAN
ROOFING
SAN JOSE,CA 95131
OWNER'S NAME: YOUNG ELVAN S AND NANCY M DATE ISSUED:11/01/2016
OWNER'S PHONE:408-996-9020 PHONE NO:(408)910-9190
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-39 Lie.#685760
Contractor JIM HAGEMAN ROOFING Date 01/31/2017 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:
REROOF;TEAR OFF;INSTALL OSB;COMP SHINGLES-(32 SQ)
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
Compensation,as provided for by Section 3700 of the Labor Code,for the
„-;-performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance,as provided for by
Ion 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$17410.00
APPLICANT 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 APN Number: r Occupancy Type:
and state laws relating to building construction,and hereby authorize 362 27 049
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 Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
SignatuDate 11/1/2016 Issued by:AbbyAyende
Date: 11/01/2016
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&Professions Code)
2. I,as owner of the property,am exclusively contracting with licensed Signature of Applican `�`
contractors to construct the project(Sec.7044,Business&Professions Code). Date:11/1/2016' ii✓✓///
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
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
a 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,Sections 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized ag
APPLICANT CERTIFICATION Date:11/1/2016
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.
Licensed
Signature Date 11/1/2016 Professional
i
5-2010 a20
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
�,� 10300 TORRE AVENUE••CUPERTINO,CA 95014-3255
(408)777-3228• FAX(408)777-3333•buildinq�cupertino.orq
CUPIERTINt
PROJECT ADDRESS ' ' /4 (12 777 err
chiry
OWNER NAME /f+-^i Y A Ko v4.1.5
PHONEnt l®''a E-MAIL
STREET ADDRESS /0 T y `" eQ
l ezi� /etSo Q FAX
CONTACT NAME e w PH E-MAIL
STREETADIjR Sac. e pc id t
cidt .(;) j iTEZIy _ _e
`4 4 Ii 1 FAX
❑ OWNER,, <❑ OWNER-SIMMER 0 OWNER AGENT E CONTIRACTOR ❑CONTRACTOR/AGENT 0 ARCHrrECT 0 ENGINEER 0 DEVELOPER 0 TENANT
CONTRACTOR NAMF,�; am f 0444,0 jtpmr.,.A LICENNS NUMB too L E AYP BUS.LIid 2.6B
COMPANY NAME,.n 9 e 0444a�OO ,w EMAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
1335 ,� F"o�� Car sQ�te �sr3 _
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC.#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
Fe_
USE OF 0 SFD or Duplex ❑ Multi-Family ROOF AREA: ALUATION:
STRUCTURE: 0 Commercial 3 Z ?(1 s Ii� .rfj r/`d
EXISTING ROOF TYPE: ❑BUILT-UP ROOF ASPHALT SHINGLES IV
WOOD SHAKES ❑WOOD SHIN lS `t'❑OTH (SPECIFY)
REMOVE/REPLACE El YES IF NO, PLYWOOD ❑ '/:" ❑ PLYWD OSB PITCH:ER. ROOF
0NO #LAYERS: _THICKNESS: 5/8" TYPE: 0 CDX '1 Z CLASS: L1
PROPOSED ROOF TYPE: 0 BUILT-UP ROOF 0 ASPHALT SHINGLES 0 WOOD SHAKES 0 WOOD SHINGLES 0 OTHER ICC-ES REPORT
DESCRIPTION OF WORK: `
ifemottt gstaC' QSis. tic
yr. C.N F'
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 relay.a : . g cons• e'en. I authorize representatives of Cupertino to enter the abov iden led roperty for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLE �AL INFO• • ION REQUIRED I o;~iICE:u.sEONby �`'. ,,:'"
If building is associated With a Home Owner's Association,provide letter YhAI CHECK TYPE Itoz,TP G SLIP �:3
of approval from HOA.
:tiCOVER T�COIJIiTTER �ffCIlB"DLnir��LalvR�*w
Provide Planning approval to verify if there any restrictions.
LLTe: alitss LTLANNIG3LA1 RE«w
Provide copy of Manufacturer's Installation Specifications. a=1 STANDKRD 1=l;FIRE DEFT' -
Provide signed copy of Cupertino's Tear-Off Policy. ❑ oTtrER
ReroofApp_2011.doc revised 03/16/11
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
�,�p ALBERT SALVADOR, P.E.,C.B.O.,BUILDING OFFICIAL
CUPERTINO
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228• FAX(408)777-3333• buildinq(Wcupertinoorq
PROJECT ADDRESS /'y +•� W 1 I C A O u APN
OWNER NAME al 1/0460
v1/4114,Vol/0 PHONE Q/S‘ 90Z/0 E-MAIL
i
STREET ADDRESS o 7 i( �})Q COY, STA ,ZIP, setioe, FAX
CONTRACTORNAM0101 dint?N LICE4:eile 74 0 . + CENSE TS BUStily s
COMPANY NAMEZI fit tigtesettleto I R•®m4�� E-MAIL FAX
STREET ADDRES i 4!(�Edaps a A A71 Q 13( PHONE
` �J
13 42
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/"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 detectors are required to be installed in accordance with Sections R314 and R315 of
the 2013 California Reside de. l
Signature of Applicant/Agen'. i Date: if /
/ (
ReroofPolicy_12014.doc revised 01/15/14
....._......._,......,
WATER-CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
IA, COMMUNITY DEVELOPMENT DEPARTMENTS BUILDING DIVISION
•," P„,,
10300 TORRE AVENUE-CUPERTINO,CA 95014-3255
CUPERTINO
Owner Name
(408)J/7-3228-FAX(408)777-3333• buildincacupettirio.orq , ,,1 giva 0
,...?
,.., fi NI e,
-it Address 16 ta (Ai ,41 i il l.1 / Citi),Liih' ki C4 96-ny
_
1. Is your real property a registered historical site?
O Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of fonn.
N."1" o 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
pluAing,installation of water-conserving plumbing fixates is not technically feasible?
1 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 funi and-sign bottorn of form: - . - . --- - ---------
O No Go to Question 3.
3. Is water service permanently disconnected for your building?
O Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
,,,Z--No Go to Question 4.
4. Is your real property built and available for use or occupancy on or before January 1, 1994?
O No *real property is built and available for use or occupancy after January 1, 1994.
e., Civil Code Sections 1101,1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
.. _ . .1
Yes My real property is built and available for use or occupancy on or before January 1, 1994.
.
1
-
Civil Code Sections 1101.1 through 1101.8 apply. Check one of the three following statements and sign
bottom of form.. : . -
5, N se check ONE of the following:
My property is a'single-faingy residential real property. See Civil Code Section 1101.4.
/i 1 .
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).
CI 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-T-- - - — - -
• conserving plumbing fixtures throughout the building(regardless of whether property undergoes alterations or
improvements).
El My property is a commercial real property. See Civil Code Section 1101.5.
1
On and after January 1,2014,specified building alterations or improvements shall require non-c mpliant
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
4,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 ftiewater-conserving plumbinfixtures comply with the requirements as°indicated,in the
table on the followin..sage.-o ' _,,,,,'. . ' i " -- -
Owner or Owner Agent's Signature: AVATIMPA .- V Atki '. Date: --
............
Upon completing and signing this Certificate,please return it • • Building Divisi• in order to final your building permit.
SB4072015.doc revised 08/26/15
----- -
B ILDING PERMIT CANNOT BE FINALED ND CQ P.LETED:UNTI i HI
A- ,mac •
r,�\ .J.R, Ili I ATE,HIS B,EEN SIGNED.AND RETIT EDT ' E Bla LDI TG-DIVISION
Non-Compliant Water-Conserving Plumbing Fixture
Plumbing Fixturel (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
Residential Residential
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)
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 combi I ed 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. 1
Faucets— Exceed 2.2 gallons Maximum 1.5 gallons per Within units: 015 gallons per minute @ 60
Lavatory per minute minute @ 60 psi; minimum Maximum 1.5 gallons psi
Faucets 0.8 gallons per minute @ per minute @ 60 psi;
20 psi minimum 0.8 gallons
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 118 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 lower than the figure shown,it is not required to be upgraded.
•
SB407 2015.doc revised 08/26/15
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
.,� COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTINO
(408)777-3228•FAX(408)777-3333•buildinq aa..cupertino.orq
I'EIII IT CANNOTRE 1JNALED IINTI 7THIS CER1ll+`KATE 7A ER
CONEEtp i A RFTLTRIT 1�T • � 1 �
( THEA•Etta G MLYISZOI
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 Wigle-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 uiuts exceeds -
$1000.00, CRC Section R314 and CBC Sections 907.2.11.5 and 420.6 require that Smok Alarms and/or Carbon
Monoxide Alarms be installed in the following locations:
AREA SMOKE ALARM COALARM
Outside of each separate sleeping area in the immediate vicinity of X X
the bedroom(s)
On every level of a dwelling unit including basements X 1' 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: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 r�pairs 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 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 to California Building
and California Residential Codes.The alarms specified below have been tested and ar operational, as of the
date signed below.
i›..Address: 47)1'Permit No.
Specify Number of Alarms: #Smoke Alarms: I I #Carbon Monoxide Detectors: L I
I have read and agree to comply with the ter s and conditions of this statement
D
Owner(or Owner Agent's)Name:
1 i Signature.... :.. . .4..r. r�. ate:i fEl//l
Contractor Name:
Signature Lic.# Date:
Smoke and CO form.doc revised 09/27/16