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B-2016-3051 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-3051 18974 PENDERGAST AVE CUPERTINO,CA 95014-3623(375 34 041) CALIFORNIA RAINGUARD INCORPORATED SAN JOSE,CA 95112 OWNER'S NAME: MATTSSON CAROL E DATE ISSUED 11/07/2016 OWNER'S PHONE:408-255-3767 1 PHONE NO:(408)279-6116 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class C-39 Lie.#943125 Contractor CALIFORNIA RAINGUARD INCORPORATED Date 02/28/2018 X BLDG _,ELECT _PLUMB i MECH X RESIDENTIALCOMMERCIAL I hereby affirm that I am licensed under the provisions of Chapter 9(commencing 1 _ with Section 7000)of Division 3 of the Business&Professions Code and that my 1 license is in full force and effect. JOB DESCRIPTION: RE-ROOF;TEAR-OFF;INSTALL TPO (16 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 144 performance of the work for which this permit is issued. z. 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:$6300.00 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 375 34 041 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 regulat'• s per the Cupertino Municipal Code,Section 9.18. 180 DAYS.FROM LAST CALLED INSPECTION. 0, :) Signatut Date 11/7/2016 Issued by:Kim Dunbar 0 ' Date:11/07/2016 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 ' pection. sale(Sec.7044,Business&Professions Code) 'Air 2. I,as owner of therope p rty,am exclusively contracting with licensed Signature of Applicant; contractors to construct the project(Sec.7044,Business&Professions Code)_ Date:11/7/2016 I hereby affirm under penalty of perjury one of the following three declarations: ALL I 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,S .1,s 25505,25533,and 25534. Labor Code,I must forthwith comply with such provisions or this permit shall -, ; / be deemed revoked. Owner or authorized agen ' d /r" APPLICANT CERTIFICATION Date:11/7/2016 /jr�� I certify that I have read this application and state that the above information is - I CONSTRI9CTION 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 11/7/2016 Licensed Si 9 Professional 9k 1 REROOF PERMIT APPLICATION look COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 1PERT11tilt3 (408)777-3228•FAX(408)777-3333•buildings cui ertino.orq C ,16".-20/49 . 057 PROTECT ADDRESS 81 6 b � APN# / J L 7 OWNER NAME Cf,i, 61#=— (!/�'�fV iV®t... 3. PHONE( )5 37 7 E-MAIL STREET ADDRESS CITY,STATE,ZIP c I FAX v ` , � a1 JI • CONTACT NAME treC,`3eJ6eY J� r PHONE ,,,��y� 4 o. E-MAIL / f STREET ADDRESS r CITY,STATE,ZIP / FAX 11 )4" o OWNER El OWNER-BUILDER ❑ OA'NERAGEmr El CONTRACTOR 0 CONTRACTOR AGENT ❑ ARCHITECT El ENGLETEER El DEVELOPER 0 TENANT CONTRACTOR NAME t1t"vr LICENSE NUMBER9A. I' LICENSE TYPE BUS.TaI (49 COMPANY NAME. uo e 1u�cu... E-MAIL(�-� FAX STREET ADDRESS c„, a pT CITY,STATE,ZIP P • �g°1/ ` PHONF(44'1 Y I p 4 I ARCHITECT/ENGINEER NAME LICENSE NUMBER (T BUS.LIC.#u Ll +®1y.b COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF 'SFD or Duplex ❑ Multi-Family ROOF AREA:, r i VALUATION: STRUCTURE: 0 Commercial ‘4-.)®15© 3 EXISTING ROOF TYPE: 1KUILT-UP ROOF 0 ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES El OTHER(SPECIFY) REMOVE/REPLACE 0 YES IF NO, PLYWOOD lE '/" ❑ PLYWD 0 OSB PITCH: ROOF ©"1550 #L:AYERS: THICKNESS: El 5/8" TYPE:I ( DDX • 2-- .12 CLASS: A —TV PROPOSED ROOF TYPE: 0 BUILT-UP ROOF ❑ASPHALT SHINGLES ElWOOD SHAKES IDWOOD SHINGLES ❑OTHER b ICC-ES REPORT# DESCRIPTION OF WORK: 12.1etAryvie, Leg.st .1/;l 46 PA'ttv 4EVE4k(ISAN'SaN) 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 relating to `s' g anstruction. I authorize representatives of Cupertino to enter the abo -id ntified property for inspection purposes. Signature of Applicant/Agent: /t` Date: 7I1,4 SUPPLEMENTAL INFORMATION REQUIRED J If building is associated with a Home Owner's Association,provide letter ' PL,AI�,CHECK'TIPE T ;ROUTII\GSLIP` ��` of approval from HOA. ISP ❑` OWER THE-COU\TER ❑ BUH.DINGPLANI2EVIEw Provide Planning approval to verify if there any restrictions. � ExPREss � ❑ PiANIVII1c PLAn R���w r Provide copy of Manufacturer's Installation Specifications. ❑; s�Ar`D trtD (0 FIRE D>PT Provide signed copy of Cupertino's Tear-Off Policy. ❑ OrxER ReraofApp_2011.doc revised 03/16/11 { \, REROOF TEAR-OFF POLICY COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 4 .rp ALBERT SALVADOR, P.E.,C.B.O.,BUILDING OFFICIAL. 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408)777-3228• FAX(408)777-3333•buildinq(a7cupertino_orq PROJECT ADDRESS ` �Yy�. y 0. � G t o°h ,�C'11�` V APN 5-1c- -3tt --o OWNER NAME ( s/9 6m"v PHON4/(cp 3741 E-MAIL STREET ADDRESS C CITY,STATE,ZIP , .61,44_,A•q� � Fy CONTRACTOR NAME.---' 6 LICENSE NUMBERTjciSy LICENSE TYPIC BUS.LIC.#5.6A.qL i COMPANY NAME CA 4411.sctar E-MAIL FAX STREET ADDRESS 13s- . CITY,STATE,ZIP ) +1 y PHON j(_�✓) 7 d/ 11 I UNDERSTAND AND AGREE TOS THE FOLLOWING: ING: �V ` !, jE(41)W 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 7:30-3:30pin(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 Cil- ,A4)Signature of Applicant/Agent: �/ _i Date: �r ti/ l ReroofPolicy_2014.doc revised 01/15/14 WATER-CONSERVING PLUMBING 7:2, F il OWNER RTI T OF L , COMMUNITY Uf I M N T DE BUILDING DIY1SION CUPERTtN0 10300 TORE AVENUE-CUPERTINO,CA S5014-3255 1405)7774228 .A 4408)7774333 ',A41110Naina Nd�r f F, IS ytllir real ro registered ftfa f after Yon Ord Code Sections 1101.1 through 1101 do notm i . Skip the rear tit the form -, sign bottom of Petit,, too to Question 2, . Does join real pr:;# y have a licensed plumber 'Tying that,one to the age or configuration of the pry f : 3 ter its plumbing,installation of wareeconseriing plumbing fixtures as mit technically featthlrt • 'es Civil Code Sectionsf l a through f.f 01,13,S do riol °. ` hThc licensed plumber's c- ftcatf n has been provided to the Building tavasir, Skip the test ofth and sign bonoin - loon.. gNo Go to Question 3. , Ir eater service permanently tl t tin c t for yourbuilding? O Yes Chil Code Sections 1101,1 through 1101.8 o not arty Skip the rmt of the limn ad sign bottom of forth, No 00t0 f ues on x . 4. is your real property buftt and mailable for use or oeiman.on or betide Januar) 3,944? O f real poverty is built and availablefor use or occupancy rtu, 1, 1094.. Civil Code Snetione 1101,1 through 1101.8 do not apply Skip the tow arise tfte arra d sipbotrion of form. Yes, ty real pro tt t is built anti mailable tsar use or o cttp tt: *r y....; antro fatWM, i ff Code: tins /1011 through 1101S apply. h c one to three f iffkr f ,,anithinents. and Stott bottom 0f 1011'1. 3. Elyase chock ONE of the ftitfo itt , My properly is a tingferust.tf t--remdential real property, See Cod Cope Beetion Gni On and after January 1.2014, building alterations or unproxemana shah requite all n n : milt plumbing fixtures to he replaced ortft water e pg plumbing ft es throughout t h building. On r beforr carr 1,2017,all non- compliant n-ompli nt f rbin . fixtures shell be replaced with waterseenserving plumbing ftrtar a treeardleas of whether proper'ty undergoes alterations of improvementsf a My property Xx a multitiomir residenual:r al propel. Seeivil Code Seetfop f t :t ,5, Op and after January f 2014,stiffed buff i g alterations or imprommennt shag require m tt compliant plumbing a fixtures to be replaced with narerthonsen gig thumbing fi tt r ... On or before January 1.2010,ail nooe mpfaatrtt plumbing fixtures shall he replaced wt tea ex-- consorting p r-;got ertin l mbin ours throughout the building(regardless of libeller ether pro, rty'k.. .to pea eft t ffon r ttttpra omelets I. t My property is a earinnterr rid real property. See Cis it Cock Section 11(11, ,, On and after, t caro f,2014,specified bunging alterations r i.t rr ernerell Miall require Os ct t tpff t t plumbing fi, t Cres t fr he-placed with watorthensen mg niumtfing fixtures. On or before innuary 1, 2019, all notheompffatttplumbing datums s huff be replaced .,fila aata,. coraterving plumbing fixtures.throughout the building f regardless orwhether property undergoes:fheratt.its tar improvements.: L.as the utter or owner ner"r>agent ofthis property,certify under penalty of"perjury that nomeomp taut phmth fixtures esti be replaced prior to date specified ff ed bt s .lilt °atereonseningt tttf t fi tt =es tit aceOldarree ith Chit Code Sixtions1101 through h f1014 ,the'current California Plumbing Cole an ,` .fr.l . tfa Green Badding g Stmt d Code.and mi ntringt ter"r. ata'sLatlJtiOf requirements..and that the watereonserring plumbing bi g fixtu es comply with the req,,`entonus as indicated in the table tura die fhff . `aaa r >we Ale Owner or Owner Agent's Situ t `: .. Date. t tf -t m tuti g and signing dos Cern O aRnRipe please return itto the fluildim DivisionBuilds an order t final your building gamin. . � e SMOKE CARSON MONOXIDE _ CERTIFICATEOWNER 3COMMUNITY DEVELOPMENTDEPARTMENT--BUILDING dansiON t0000 TORRE AVENUE CUPERTESO,CA 9 CUPERTINO OM) -32X8 FAX MOSI 777- - ,114t ,.: �i , art P uT cougoT BE I AILED UNTIL "TIFICATE HAS COMPLY 'Ef4'SOTorvis PURPOSE This affidavit is a seit-certification for the installation of all required Smoke and Carbon lonoxide Alarmstor compliance with 2013 CRC Section R.31.4,2013 CDC Sections 420.6 and 007.111.2 where o interior access for inspections are required. GENERAL INEGRMATION Existing single-family and multi-family dwellings shall be provided with Smoke Alarm and Carbon Monoxidealarms. When the valuation of additions,alterations,or repairs to existing d wetting units exceeds 1000,00,CRC Section R314 and 03C Sections 907.2215 and 420„6 require that Smoke it terms and/or Carbon Monoxide Alarms be installed in the following lort n AREA SMOKE ALA& CO ALARM Outride"team separate sleeping area in the immediate vicinity of the ber rt t t . On y r level rpt dwell t= nit in l ithi basements X I Withineach �" *in roorn C rbon Monoxide alarms are not required in dwellings which do not contain fuel-burni g appliancesfuel-burnand that do not have an attached garage, ,a r t monovide alarmscombined with smoke alar shall comply with CRC Section $2116 and shell be approved by the Office of the State Fire Xiansbal. Power Supply:In dwelling units with no . uteri power supply,alp may he so elybattery operated. to existing wetting units,alarms are e it~t to be solely battery operated where rep its or alterations not result in the removal of wall and ceiling finishes or there is no access by e s.of a 9r,basement or crawl space.Refer to CRC Section R314 and CBC Sections 9072 I IA and 0 2.An t is t i al ennit 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 ivith the manufacturer's instructions at d in 1:01110.1311Ce With di California Building and CaliforniaResidential Codes.The alarm ,specified below have been tested and are sperationali as of the date signed helonw. Address: u der it No. Sped Number of Alar . Smoke Alarms: r43 b Carbon-‘4011 d Det r ham row and a• 'ee eR * with the terms and cOndiVons of INS usT hurt tortlAman Agent's')Name, Cepvitre 4 hitt t Int CynTattof Name_ \\II ,/,;,' SMOKE I CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION CUPERTI10300 TORRE AVENUE.CUPERTINO,CA 950t4-3255 NO (408)777-3228'FAX(408)777-3333,i,buildirioAcuoartinooro , PERMIT CANNOT BE EINALED UNTIL THIS CERTIFICATE ANS BEEN COMPLETED,SIGNED,AND RETURNED TO TIIE WILDING 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 inn 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 9072.11.5 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 bases X Within each sleeping rooraX 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,basernent or crawl space.Refer to CRC Section R314 and CBC Sections 9072.11.4 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: . 9, e, _.e e , , Vt, il 7 rY, (V- N 9( 6---„949,40-3054 ...._.., . Permit No Specify Number of Alarms: #Smoke Alarms: 1111M #Carbon Monoxide Detectors: 1111M I have read and agree to comply with the terms and conditions of This afaternent Over or Owner Agents)Name: signature CortAte 92 ..)j,5,,...„.„ Dateitiltia-N516 Contractor Name: ,.....---...,—,.....,-- .........-,...,..--,..—..,..._, Smoke aizd COform.doc revised 09427116 AT CONS VIN PLUMBING FIXTURES 1,Ok' OWNER CERTIFICATE OF COMPLIANCE COMMuNrrY DEVELOPMENTDEPARTMENT. IILI ING DIVISION 10300 TORRE AVENUEP .R `I O,CA 950143255 Ca ry f 777-3228 FAX 1408)777-3333 r *ui1din. . art n r! j .ddrs _ 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 sin.bottom f 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,,i .stallati n of water-conserving plumbing fixtures s not technically feasible? Yes Civil Code Sections 1101.1 through 1101,8do not apply. The licensed plumber's certification has been provided to the Building Skip the rest of the form and sign bottom f form, No Go to Question 3. , is water service permanently disconnected for your building? 0. Yes Civil Code Sections 1101.1 through 1101.8 do not apply, Skip the rest of the formand sign bottom f loon. X No Go to Question Off 4. Is your real property built and available for use or occupancy on or before January 1, 1994.E Cl No My real property.Is built and available for use or occupancy after an y 1, 1094, Civil Code Sections 1101..1 through through1/01.8 do not apply. Skip the rest of the form and sign bottom f form, Yes My real property is built and available for use or occupancy on orbeide January 1, 1994. Civil Code Sections 1101.1 through 1101.8 apply. Cheek one of the three following statements and sit: bottom of form.. S. Pl ase check ONE ofthe following: My property is a ingl amily residential real property. See Civil Cede Section 1114. On and after January 1, 2014, building alterations or improvements shall require all non-compliam plumbing fixtures to be replaced with water-conserving plumbing.fixtures throughout the uil in .On or before January 1,2017,all non- compliant onc t pliant plumbing fixtures shall be replaced with water-conserving plumbing .t . s (regardless of whether r property undergoes alterations or improvements). 0 My property is a multifamily residential real property. See Civil Code Section 1101.5. On and after January 1.2014.specified building altr-atii ns or improvements ents shall require non-compliant plumbing fixtures to be replaced with water-conserving plumbing lixtur . On or before January 1,2019,at noncompliant plumbing xtures shall be replaced with Water- conserving ater-c nservAingg plumbing fixtures throughout the building(regardless of whether prpey undergoes alterations or improvements). 0 My property is a corrrrrrer°c£i l real property. See Civil Code Section 1101.5. On after January 1,2014,specified building alterations or improvements vements 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 replacedwith water- conserving plumbing fixtures thr u h ut the building=lre ardless of whether property undergoes alterations or improvements). 1,as the owner r owner`s agent oft1 this property,certify under penaly of perjury that it -cot ipliantplumbing fixtures wid be replaced prior to date specified above with water-conserving plumbing fixtures in accordance With Civil it Code Sections 1101.1 tr'ou h 11.111. .the current California Plumbing Code and California Green Building Standards Code,and manufacturer's installation requirements,ents,and that the water-conserving plumbing 'fixtures comply with.the requirements as indicated in the table on the 11 wimp age- Owner or Owner Agent's Signature; alwrri4 Date: Upon conipleting and signing this Certificate.please return it to the Buddinn Division in order id final your building permit .., _...._. 3 110, t 3e