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B-2016-3022 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-3022 22051 REGNART RD CUPERTINO,CA 95014-4842(366 02 035) BUCK'S ROOFING SAN JOSE,CA 95129 OWNER'S NAME: LEE GORDON AAND ANNE MARIE L DATE ISSUED:11/02/2016 OWNER'S PHONE:408-668-5638 PRONE NO:(408)313-3429 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class C-39 Lic.#739593 Contractor BUCK'S ROOFING Date 08/31/2017 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: RE-ROOF;TEAR-OFF;INSTALL TPO;COMP SHINGLES-(22 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. y 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. Sq.Ft Floor Area: Valuation:$12000.00 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: Occupancy Type: and state laws relating to building construction,and hereby authorize 366 02 035 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 againstsaidCity in stands and e of the hg o this 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. Signat e Date 11/2/2016 Issued by:Kim Dunbar / Date: 11/02/2016 OWNER-BUILDER DECLARATIOPI 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 Applicant: contractors to construct the project(Sec.7044,Business&Professions Code). Date:11/2/2016 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER i. 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 pem't'is issued,I Health&Safety Code,Section 25532(a)should I store or handle hazardous material. Additionally,should I use equipment or devices which emit hazardous shall not employ any person in any manner so as to become subject to the 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 agent: APPLICANT CERTIFICATION Date:11/2/2016 I certify that I have read this application and state that the above information is CONSTR I TIO ', 1 G AGENCY correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a constfuction 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 11/2/2016 LicenseProfessionald `+ n REROOF PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION " • 10300 TORRE,AVENUE•CUPERTINO,CA 95014-3255 (408)777-3228•FAX(408)777-3333•buildincl cupertino:orq CUPERTINO -ic/& -30 2 PROJECT ADDRESS /0 r 12_03 tP 1 isck APN# 344, 0 J� OWNER NAME J �� PHONE 9-((_ �U 38 E-MAIL STREET ADDRES 1T �� CITY, STATE,ZIP ® e FAX °S cir �� p2 ( c am CONTACT NAME �-•-...Io( /? PHO E-MAIL STREET ADDRESS CITY,STA ,2I - • FAX ❑ OWNER 0 OWNER-BUILDER 0 OWNERAGENT ❑ CONTRACTOR 0 CONTRACTOR AGENT 0 ARCHITECT 0 ENGINEER 0 DEVELOPER 0 TENANT CONTRACTOR NAM , 1.(,`� ]� - / '� LICENSE NUMBER7 J/$_;J LICENSE TYPF�`73e' BUS.LIC.#,` )0 COMPANY NAME `d C [ f'ie� f�+ E-MAIL J f FAX FAX STREET ADDRESS/( `A/t v I„ 9.�ry(r^i r6 P CITY,STATE,ZIP c j,""2„,re c7,77.2.4/HONE I/d 43 3 ARCHITECT/ENGINEEEERNAME �I( !1 L9� li LICENSE NUMBER yBUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF 0 SFD or Duplex ❑ Multi-Family ROOF AREA: VALUATION: STRUCTURE: 0 Commercial ` EXISTING ROOF TYPE:/�❑BUILT-UP ROOF ASPHALT SHINGLES 0 WOOD SHAKES 0 WOOD SHINGLES 0 OTHER(SPECIFY) REMOVE/REPLACE ErcES IF NO, PLYWOOD 1=1' " 0 PLYWD 0 OSB PITCH: ROOF • 0 NOO/ #LAYERS: THICKNESS: 0 5/8". TYPE: 0 CDX •12 CLASS: A PROPOSED ROOF TYPE: UILT-UP ROOF ASPHALT SHINGLES 0 WOOD SHAKES 0 WOOD SHINGLES 0 OTHER ICC-ES REPORT# I�B DESCRIPTION OF WORK: 11-- 0 e8e f2o /1 SA7�\t1,5\ C( 4-\C roni a(5 ,- yt6 Z<c 5 (.(N `(0((( ` ° l4 n 1 . ^. U Q-tr( y By my signature below,I certify to each of the folloyiing: 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 relating to building construction. I authorize representatives of Cupertino to enter the above-I ntifi property for inspection purposes. Signature of Applicant/Agent -:a�j Date: /r. 1s// (: � SUPPLEMEN °v 1N e' ATION REQUIRED C _. OFFICE'[JSiOIILY _.: If building is associated with a Home Owner's Association,provide letter - x PI,ANCxECKTYPE m ROUTInG SLIP t of approval from HOA. I•JLER THE COULTER -,BIJILDINGPLAN REVIEW Provide Planning approval to verify if there any restrictions. EXPRESS O ` PLANNINGPLArtRE�'IESi' Provide copy of Manufacturer's Installation Specifications. © ST�,ATD IiD .FIRE DEPT. —Provide signed copy of Cupertino's Tear-Off Policy. ❑ oTI(ER ReroofApp_2011.doc revised 03/16/11 • fi 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• buildino cuaertino.orq PROJECT ADDRESS `-1 I 1`R9 1 ri(A �t✓ + Q "+- APN OWNER NAME yI d/e cJ PHO I✓I _MOP Com' (94>0 E-MAIL STREET ADDRE l r -( - CITY,STATE,ZIP FAX CONTRACTOR NAME y'vl _/ /�t LICENSE NUMBER?7 5 Q LICENSE'Pt' J BUS.LIC.# (// COMPANY NAME/J1V C ly`j ,6,( E-MAIL / FAX STREET ADDRESS 6c) / ,' I ( CITY,STATE,CP` ^'a ,fes f �"/ PHONE Q z/"7 J / I UNDERSTAND AND AGREE TO THE FOLLOWINr 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 Residential Code. Signature of Applicant/Agen• Date: //! i--/ 6 ReroofPolicy 2014.doe revised 01/15/14 WATER-CONSERVING PLUMBING FIXTURES We OWNER CERTIFICATE OF COMPLIANCE -c,, COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUPERTINO (408)777-3228•FAX(408)777-3333•buildinqacupertino.org Owner Name _ 4F1 me Mew Lee_ Permit No. -'2-0t ` `''L (dAddress m)"4) / e fGL-� 1. Is your real property a registered historical site? I 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? LI Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of faun. No Go to Question 4. 4. Is your real property built and available for use or occupancy on or before January 1, 1994? 0 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. C1 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: Arl 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 plumbing fixtures comply with the requirements as indicated in the table on the following page. /7 Owner or Owner Agent's Signature: / Date: ite,f �� f Upon completing and signing this Certificate,please return it to the Building Division in order to final your building permit. SB4072015.doc revised 08/26/15 SMOKE / CARBON MONOXIDE ALARMS riti/4:* OWNER CERTIFICATE OF COMPLIANCE ey1.F'sm COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228•FAX(408)777-3333•buildinq(a cupertino.orq PERMIT CA OT�BE I WII �L)NTIT-THIS CE411ENATT2IAS BEEN ',� .. '.,.-�' - e0 E-?;1I`GNED,AICD RETI IINTOTO 11 MU1LDIlvCG'DI SIQN r ' 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 Ala.tnts 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 X X the bedrooms) 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 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 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: it6i3 EA-To `- t 't,6 -e. PermitI No. rj�� r�3 Specify Number of Alarms: 3_ # Smoke Alarms: I #Carbon Monoxide Detectors: I have read and agree to comply with the terms ans.c'. ditions of this statement Owner Owner Agent's)Name:. _ i I,p 0 : Signatur —it Contractor Name: Signature Lic.# Date: Smoke and CO form.doc revised 09,27/16 SMOKE / CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE ,T.f'rm COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION CUPERTINO 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 (408)777-3228•FAX(408)777-3333•buildinq(ci)cuoertino.orq f ; f p11: ✓1 ILO 0-4,It73E tialiED TJNTII,THIiC SERTIFIC 1°TT3HASlFIEN ,�r'� yid -.A5 QOM FETED;STGNT� ICANDZItETTTRNFTJ`TO laMSEII D LA IVISTON , 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 X X the 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 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 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. ^^ ('D 5�7 R No./--�– 6 Address: Rey) 6,r1—r6,r1— jr?-6-4C Permit Specify Number of Alarms: #Smoke Alarms: ) 4 f #Carbon Monoxide Detectors: / I have read and agree to comply with the terms and conditions of this statement Owner(or Owner Agent's)Name: Signature Date: Contractor Name: ' / Signature Lic.#�/ �. ..........Date:/ `16_16, Smoke and CO form.doc revised 09/?7/16