B-2016-3258CITY OF CUPERTINO BUILDING!PERMIT
BUILDINGADDRESS: .CONTRACTOR"
PERMIT NO: B-2016-3258
935 ROSE BLOSSOM DR CUPERTINO, CA 95014-4215 (359 06 035)
CUPERTINO ROOFING
INC
SAN JOSE, CA 9512
OWNER'S NAME: WON YONG B AND SUNG H
DATE ISSUED: 12/12/2016
OWNER'S PHONE: 858-775-0837
i
if
PHONE NO: (408) 973-9427
LICENSED CONTRACTOR'S DELL RATION
BUILDING PE
it
T INFO:
License Class C-39 Lic. #565437
Contractor CUPERTINO ROOFING INC Date 03/31/201.8
X BLDG — ELE
T _PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
MECH X RE5
ENTIAL _ 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 C
1FF; INSTALL COMP SHINGLES - (20 SQ)
I hereby affirm under penalty of perjury one of the following two declarations:
,
r. I have and will maintain a certificate of consent to self -insure for Worker's
Compensation, as provided for by Section 3700of 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.
Sq. FtFloor Area:
Valuation: $10000.00
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
359 06 035
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
PERAHTEXPIRES
IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting of this permit.
WITHIN1
0 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.
`Signature, _1- -.. Date 12/12/2016
Issued by: MEL I
ANAME
OWNER -BUILDER DECLARATION
Date: 12/12/2016
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 ins
peeled prior to any roofing material being installed. If a roof is
i. 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
G
-Signature ofApphc
Date:
contractors to construct the project (Sec.7044, Business & Professions Code).
12/12/2016
I hereby affirm under penalty of perjury one of the following three declarations:
ALL ROO
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.
1Y
ZARDOUS MATERIALS DISCLOSURE
2. I have and will maintain Worker's Compensation Insurance, as provided for by
I have read the ha iardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code, for the performance of the work for which this
California Healt
& Safety Code, Sections 25505, 25533, and 25534. I will
permit is issued.
maintain complian
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
material. Addition
y, 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, atter making this certificate of
will maintain coinpl lance 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.
.o wner or authoriz'd agent:
/
APPLICANT CERTIFICATION �
Date: 12/12/2016
I certify that I have read this application and state that the above information is
I ONSTRUCTION LENDING AGENCY
for
correct. I agree to comply with all city and county ordinances and state laws
1 hereby affirm That here is a construction lending agency the performance
of work's for which his permit is issued (Sec. 3097, Civ C.)
relating to building construction, and hereby authorize representatives of this city
Lenders Name,
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
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'SARCYHTECT'S DECLARATION
1 understand my ple ns shall be used as public records.
Code, Section 9,18.
Licensed
Signature Date 12/12/2016
Professional
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDIN
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
UFiaF i[t�lt (408) 777-3228 • FAX (408) 777-3333 • building(a�cupertim
(J -CA-) lu _,b253
ION
PROJECT ADDRESS ' APN
OVvrNER NAME ` _
STREET ADDRESS � � .�,j� (.� CITY, STATE, FAX.
J ) t S
CONTACT NAME / PHONE E-MAIL
STREET ADDRESS CITY, STATE, ZIP l
FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OVAINTERAGENT --L CONTRACTOR ❑ CONTRACTORAGENT 0 ARCHITECT ❑ ENGINEER 0. DEVELOPER ❑ TENANT
CONTRACTORNAME '°b LICENSENUMBER LI ENS TE BUS.LIC. ft' n
AI ICT 9
l —0
COMPANY NAME E-MAIL
IR? C-4:1
FAX
r
STREET ADDRESS p --> t d j CITY; STATE, ZIP PHONE
ARCHITECTIENGINEER NAME C i ! 1 LICENSE NUMBER BUS. LIC.
i
F �
COMPANY NAME E-M.AIL FAX
tl
STREET ADDRESS CITY, STATE, ZIP PHONE
USE OF ❑ SED or Duplex -"°21 Multi -Family
ROOF AREA:
VALUATION:
STRUCTURE: ❑ Commercial
^ �1
>
EXISTING ROOF TYPE: ❑ BUILT-UP ROOF i] ASPHALT SHINGLES
❑ WOOD SHAKES
❑ WOOD SHIN
r
LES
❑ OTHER (SPECIFY)
REMOVE /RERLACE- AYES
IF NO,
PLYWOOD
El %" ElPLYWD
El O
B
PITCH: ROOF
'❑ NO
n LAYERS:
THICKNESS:
❑ 518"
TYPE: ❑ C
X
a
' 12 CLASS:. _ EL
PROPOSED ROOF TYPE: ❑ BUILT-UP ROOF`"^4:il ASPHALT SHINGLES
❑ WOOD SHAKES
❑ WOOD SHIN
3LES
❑ OTHER
ICC -ES REPORT r
DESCRIPTION OF WORK: r
��
By my signature below, I cettify-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 haveYovided is correct. I have read the Description ofWork and verify iti accurate. I agree to comply with all applicable local
ordinances and state laws relating to buing construction. I authorize representatives of Cupertino to enter flie above -identified property for inspection purposes.
Signature of Applicant/Agem: (1 i- Date: '
SUPPLEM�FNTAL WFORMATION REQUIRED
— If building is associated with a Home Owner's Association, provide letter
of approval from HOA.
Provide Planning approval to verify if there any restrictions,
Provide copy of Manufacturer's Installation Specifications.
Provide si.-ned copy of Cupertino's Tear -Off Policy.
ReroofApp_2011.doc revised 03/16111
a°
REROOF TEAR -OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDII`
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • build ing(a)cugertin
PROJECT ADDRESSL� TS � C� a j
0 j -S O ' v \
APN a
OWNTER NAMES ; �¢ k
j G��J
`-'
PHONE (^y _
S �-
E-M:AIL
STREET ADDRESS fi
CITY, STATE, ZIP-
FAX
CONTRACTORNAME �g
LICE TSEATUMB /� -y
LI
ENSE 1'
BUS. LIC,
COMPANY NAME x �_
Y
E-MAIL
FAX
STREET ADDRESS I^ Z /
CITY, STATE, ZIPIs s u
PHONEtAyM4
I UNDERSTAND AND AGREE TO THF
1. The re -roof project shall comply with all applicable provisions c
2. An inspection request can be scheduled up to one business day
Please schedule inspections online or call (408) 777-3228 from
2:30pm (Friday) to schedule inspection. For Tear -Off and Naili
day of the inspection only after that phase of the work is coma
available within one hour. The hours for this service are: 7:30-1
and 7:30-10:30am and 12:30-2:30 (Friday). Final Inspections
2013 California Codes.
fore the requested inspection date.
0-3:30pm (Mon-Thurs) or 7:30 -
Inspections, you must also call on the
ted. The building inspector will be
30am and 12:30-3:30 (Mon-Thurs)
ill be given a two hour window.
3. Tear -Off Inspection is required. Any and all dry -rotted wood sl all be replaced prior to this inspection.
Unless new plywood roof sheathing is proposed throughout, all th nails/fasteners shall be either
completely knocked -down or removed prior to this inspection.
4. If plywood is installed, a plywood
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 performed.
6. A Final Inspection and approval shall be obtained from the b,ui ding inspector when the re -roofing is
completed. To receive a'final sign -off, the following items will bel verified:
a. Flat roofs shall have a. minimum of 1/" per foot of slope aid demonstrate there is no ponding.
b. Listings from approved testing agencies for all pre-maiactured 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 aid before another inspection can be
scheduled.
By my signing below, I certify each of the following is true: I ani the property caner or authorized agent to act on the
property owner's beha-lf:"'I uiiderstand`- nd agree to comply with- the re -roof polity stated above. I also understand that
smoke detectors and carbon monoxide detectNs are required to be installed in ac cordance with Sections R314 and R315 of
the 2013 California Residential ode.
Signature of ADDlicant/A2ent: ®--� Y �M Date:
Re7-00fP0hcy_2014.doc7-evised 01115114
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
t;UPER,"6mo 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408)777-3333 > building(a)cui2ertino.org
PERMIT CANNOT BE FINALED. UNTIL TI118 CERTIFICATE HAS BEEN
COMPLETED, SIFz=_ AND RTTLHNED TO THE'BUILDING DIVISION "
.PURPOSE
f1?.is 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 Alarms and Carbon
Monoxide alarms. When the valuation of additions, alterations, or repairs to existing dwelling units exceeds
$1000.00,i_RC Section R314 and CSC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and/or Carbon
Monoxide b0arms be installed in the following locations: _
AREA
SMOKE AIARM
CO ALARM_�
_
�Outside of each separate sleeping area in the immediate vicinity of
X
the Ir. edroorn(s)
Signature.................................................................. Lic.# ......................................Date:
s _
leve_1 of a dt-velling unit including basements
X
X Y
1 -Within each sleep in room _ -
X
arbon Monoxide alarms,are not required in dwellings which do not contain fuel -burning appliances and that.
d.o not haye,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.
Supply: In dwelling units with no commercial power supply, alarm(s) may be solely batferyoperated.
1T- exisiing ctwelling units, alarms are permitted to be solely battery operated where repairs or alterations do
zv 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 grid 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 hasihave 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 --thee
:late signed below. n N
Address:
No. ,� Ot� — -32-rd'
Specify Number of Alarms: # Smoke Alarms: # Carbon Monoxide Detectors: ED
hog rc 1 -4 -m fr --hl e.ith fhe fnrmc nnA rnn icl9i nne of thic zfgtPmPr)f
Owner (or Owner Agent's) Name:
' --
Signature...........................:............
.... .s
..:............... ............. :............... ....:..............................................................................
Contractor Name:
Signature.................................................................. Lic.# ......................................Date:
Smoke and CO form.doe revised 0.9/27116
0
WATER -CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
GUP�RT1Nt? 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
\(408) 777-3228 - FAX (408) 777-3333 - buildingocupertino.org
Owner Name P Creir W& Permit No -P c)
Address q 3.5— A05r 9/00r5OWL Or
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.
,a 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.
.J�10 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.
�Mo 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.
;e es 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..
Pleadcheck 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).
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 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.
Owner or Owner Agent's Signature: Date:
I Tnnn cnm»letina and signing this Certificate, please return it to a Building Division in order to final your building permit.
SB4072015.doc revised 01105117