B-2016-3268CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:"
PERMIT NO: B-2016-3268
19515 GREENWOOD CT CUPERTINO, CA 95014-3346 (369 14 024)
JIREH INC
LOS GATOS, CA 950 1
OWNER'S NAME: SETO SAM AND CHENG WINNIE
DATE ISSUED: 12/14/2016
OWNER'S PHONE: 408-417-0948
PHONE NO: (408) 298-9399
LICENSED CONTRACTOR'S DECLARATION
BUILDING PER1M IT INFO:
License Class ja Lie. #800707
Contractor JIREH INC Date 10/31/2017
X BLDG _ELEC _PLUMB
I hereby affirm. that I am licensed under the provisions. of Chapter 9 (commencing
MECH X RESENTIAL _ COMMERCIAL
_
with Section 7000) of Division 3 of the Business & Professions Code and that my
license is in full force and effect.
JOB DESCRIPTI N:
DUPLEX/APT 1 & ; TEAR OFF 1 LAYER COMP (NO PLY); INSTALL
I hereby affirm under penalty of perjury one of the following two declarations:
COMP ROOF SYS M (26 SQ'S)
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.
2`0 I have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700ofthe Labor Code, for the performance of the work for which this
permit is issued.
Sq. Ft Floor Area:
Valuation: $7600.00
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
APN Number:
Occupancy Type:
and state laws relating to building construction, and hereby authorize
369 14 024
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 E IBES IF WORK IS NOT .STARTED
may accrue against said City in consequence of the granting of this permit.
WITHIN 18 DAYS OF PERMIT ISSUANCE OR
Additionally, the applicant understands and will comply with all non -point
,
source regulation upertino Municipal Code, Section 9.18,
180 DAYS F OM ED SPECTION.
Signature Date 12/14/2016
Issue y: NfELIS A NAME
Date: 12/14/2016
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 insj oected prior to any roofing material being installed. If a roof is
1. 1, as owner of the property, or my employees with wages as their sole
installed without first btaining 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)
z. I, as owner of the property, am exclusively contracting with licensed
Signature ofApplicant "
contractors to construct the project (Sec.7044, Business & Professions Code),
Date: 12/14/2016 -
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.
HAZARDOUS MATERIALS DISCLOSURE
2. I have and will maintain Worker's Compensation Insurance, as provided for by
I have read the ha2 ardous 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 complianct with the Cupertino Municipal Code, Chapter 9.12 and the
3. 1 certify that in the performance of the work for which this permit is issued, I
Health &Safety ode, 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 i lefined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California. If, after making this certificate of
will maintain compli ince with the Cupertino Municipal Code, hapter 9.12 and
exemption, I become subject to the Worker's Compensation provisions of the
the Health & Safety Code, Se , and 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
Owner or authoria agent:
APPLICANT CERTIFICATION
Date: 12/14/2016
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
!L ONSTRUCTION LENDING AGENCY
9 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
AR AIT m' D L. RATION
and will comply with all non -point source regulations per the Cupertino Municipal
. .
I understand my plai is shall be used as public records.
Code, Section 9.18.
Licensed
Signature Date 12/14/2016
Professional
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • B61LDING IVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-255
(408) 777-3228 • FAX (408) 777-3333 • building(cDcuperting.ora
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PROJECT ADDRESS/
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❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
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COMPANY NAME
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ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC. #
COMPANY NAME
E-MAIL
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STREET ADDRESS
CITY, STATE, ZIP
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USE OF eSFD Or Duplex ❑ Multi -Family
ROOF AREA:
V LUATION:
❑ Commercial
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STRUCTURE:.
7
EXISTING ROOF TYPE: ❑ BUILT-UP ROOF ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SEEN GLFS ❑-OTHER (SPECIFY)
REMOVE/REPLACE aYEs
IF NO,
PLYWOOD ❑ %.: ❑
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PITCH:
ROOF
❑ NO
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# LAYERS: A
THICKNESS: El5/8"
TYPEd`� u C X
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CLASS: `,
PROPOSED ROOF TYPE: ❑ BUILT-UP ROOF ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHB, GLES ❑ OTHER
ICC -ES REPORT
DESCRIPTION OF WORK:
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By my signature below, I certify to each of the following: I am the property owner or authorized agent to ac 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 s accurate. I agree to comply with all applicable local
. I authorize repentatives of Cupertino to enter tie above -identify prop rty for inspection purposes.
ordinances and state laws relating to bui di strucf r s
Signature of Applicant/Agent: Date:
SUPPLEMEN AL IN ORMATION REQUIRED
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If building is associated with a Home Owner's Association; provide letter
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of approval from HOA.
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—Provide Planning approval to verify if there any restrictions.
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Provide copy of Manufacturer's Installation Specifications.
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Provide signed copy of Cu ertino's Tear -Off Polic .
❑ oTxER {
ReroofApp_2011.doc Devised 03/16/11
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 • buildin cu ertino.o 0
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PROJECT ADDRESS 19
APN #
OWNER NAME
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I UNDERSTAND AND AGREE TO THE OLLOWING:
1. The re -roof project shall comply with all applicable provisions of he 2013 California Codes.
2. An inspection request can be scheduled up to one business day b
Please schedule inspections online or call (408) 777-3228 from 7
2:30pm (Friday) to schedule inspection. For Tear -Off and Nailing
day of the inspection only after that phase of the work is compl
available within one hour. The hours for this service are: 7:30-10
and 7:30-10:30am and 12:30-2:30 (Friday). Final Inspections N
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 s all be replaced prior to this inspection.
Unless new plywood roof sheathing is proposed throughout, all t e 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 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 b verified:
a. Flat roofs shall have a minimum of I/4" 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/d wnspouts 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 3wner 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 detector are required to e installed in accordance with Sections R314 and R315 of
the 2013 California Residential /
Signature of Applicant/Agent: X_J� _ I , Date: / -112,11&
ReroofPolicy_2014.doc revised 01115114
Address
PURPOSE
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(Dcupertino.org
PERMIT CANNOT BE FINALED AND COMPLETED UNTIL THIS CERTIFI
HAS BEENCST TNFD AND RETURNED TO THE BUILDING DIVISION
This affidavit is a self -certification for the installation of all required Smoke and Carbon M1
compliance with 2013 CRC Section R314,2613 CBC Sections 420.6 and 907.2.11.2 where no
inspections are required.
GENERAL INFORMATION
Existing single-family and multi -family dwellings shall be provided with Smoke Alarms
Monoxide alarms. When the valuation of additions, alterations, or repairs to existing d7A
$1000.00, CRC Section R314 and CBC Sections 907.2.11.5 and 420.6 require that Smoke X
Monoxide Alarms be installed in the following locations:
t
Alarms for
access for
Carbon
g units exceeds
and/or Carbon
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 including basements
X
X
Within each sleeping room
X
Carbon Monoxide alarms are not required. in dwellings which do not contain fuel -burning
do not have an attached garage. Carbon monoxide alarms combined with smoke alarms s
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
In existing dwelling units, alarms are permitted to be solely battery operated where repairs
not result in the removal of wall and ceiling finishes or there,is no access by means of attic, l
space. Refer to CRC Section R314 and CBC'Sections 907.2.11.4 and 420.6.2.. An electrical peri
alarms which must be connected to the building wiring.
As owner of the above -referenced property, I hereby certify that the alarm(s) referenced
installed in accordance with the manufacturer's instructions and in compliance with the
and California Residential Codes. The alarms have been tested and are operational, as of
below.
I have read and agree to comoly with the terms and conditions of this
dances and that
comply with
ttery operated.
alterations do -
,ement or crawl
: is required for
Te has/have been
forma Building
date signed
Owner (or Owner Agents) Name:
Rt/1�'Cr�
Signatuse_•��•••``'••— .............................
Date:..?!.
Contractor Name:
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Signature .............................. ...Lic.# ..60!.�� a..�...........
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Date:G.,.'�Cir
Smoke and C0 fonn. doe revised 03118114
17
CUOtikfINO
Owner Name (I Rq,®Lj
WATER -CONSERVING PLUMBING FIXTU
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DI
10300 ,TORRE AVENUE - CUPERTINO, CA 95014-3255
(4081),7177-3228 • FAX (408).777-3333 • buildhq(a)cupertinomq
Address "z_ om
FI
-2d/4 , 3
rEds. CERT1F1_C.ATE--*_'-,.!
Please refer to the attached' California Civil Code Sections 1101.1 — 1101.8 whicharepart of this Certification form.
1. Is your real property a registered historical site? I
171 yes Civil Code Sections 1101.1 through 1101.8 do not apply. Sign below and skip th' rest of the form.
i
J� Owner" Signature: Date:
FAI No Go to Question 2.
2. Does your real property have a licensed plumber certifying that,. due to the age or configuration nfigu ti of the property or its
plumbing, installation of Water -conserving plumbing fixtures is not technically feasible?
0 Yes Civil Code Sections 110 1. 1 through 1101.8 do not apply.
0 The licensed plumber's certification has been provided to the Building Division.
Sign below and skip the rest of the form.
Owner' Signature: Date:
Of No 06 to Question 3.
3. Is water service permanently disconnected for your building?
El Yes, Civil Code Sections 1101.1 through 1101.8 do not apply. Sign below and skip the, rest of the form.
Owner' Signature: Date:
No Go to Question 4.
4. Is your real property built and available for use or occupancy on or before January 1, 1994?
171 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. Sign below and skip the 'rest of the form.
Owner' Signature: Date:
I 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. Refer to the attached.
• My property is a single-family residential real property. See Civil Code Section 1101.4.
On and after January 1, 2014, building alteration's 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-conservmgplu ing, fixtures (regardless
of whether propel ty -undergoes alterations or improvements),
• My property is a inultifamily residential real property. See Civil Code Section 1101.5.
On and after January 1, 2014, specified building alterations or improvements shall require ion- 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 aterplumbing fixtures throughout the building (regardless of whether property undergoes alterations or
improvements).
0 My property is a cominercidl 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.
B4072014.doc revised 03118114