B-2017-0085CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
7480 HEATHERWOOD DR CUPERTINO, CA 95014-5824 (359 28 050)
CONTRACTOR:
JIREH INC
PERMIT NO: B-2017-0085
LOS GATOS, CA 95031
OWNER'S NAME: PLEBAN MICHAEL AND TENGAN TANIA M
DATE ISSUED: 01/17/2017
OWNER'S PHONE: 408-499-5867
PHONE NO: (408) 298-9399
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class Q Lic. #800707
Contractor JIREH INC Date 10/31/2017
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:
I hereby affirm under penalty of perjury one of the following two declarations:
RE -ROOF; TEAR OFF; INSTALL OSB; COMP ROOF SYSTEM (43
t. I have and will maintain a certificate of consent to self -insure -for Worker's
SQ'S)
Compensation, as provided for by Section 3700 of the Labor Code, for the
erformance of the work for which this permit is issued.
2., 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: $17000.00
APPLICANT ANT RTIFi ATION
I certify that I have read this application and state that the above
APN Number:
Occupancy Type:
information is correct. I agree to comply with all city and county ordinances
and state laws relating to building construction, and hereby authorize
359 28 050
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 the granting this permit.
Additionally, the applicant understands and willl comply with all ll non -point
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
source regulations per the upertino Municipal Code, Section 9.18.
180 DAYS FROM LAS ECTION.
Signature �Date.11.
Issued by: MELISSA NAMES -
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OWNER -B RTD R DECLARATION
Date: 01/17/2017
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)
2. I, as owner of the property, am exclusively contracting with licensed
Signature ofApplicant:.
contractors to construct the project (Sec.7044, Business & Professions Code).
Date: 01/17/2017
I hereby affirm under penalty of perjury one of the following three declarations:
t. I have and will maintain a Certificate of Consent to self -insure for Worker's
ATL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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 Cade, 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
s. 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
Worker's Compensation laws of California. If, after making this certificate of
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
exemption, I become subject to the Worker's Compensation provisions of the
Labor Code, I must forthwith comply with such provisions or this permit shall
the Health & Safety Code, Sec y 25505, 25533 and 25534.
j
be deemed revoked.
Owner or authorized agent.
APPLICANT CERTIFICATION
,
Date: 01/17/2017
1 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.
1 understand my plans shall be used as public records.
Signature Date 01/17/2017
Licensed
Professional
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildingQcupertino ora
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USE OF I� SFD or Duplex ❑ Multi -Family
ROOF AREA:
VALUATION:
STRUCTURE: ❑ Commercial,
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EXISTING ROOF TYPE: 11BUILT-UPROOF 11 ASPHALT SHINGLES 11 WOOD SHAKES ❑ WOOD SHINGLES u'OTHER (SPECIFY) ale
REMOVE/REPLACE ® YES
IF NO,
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PLYWOOD ❑
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PITCH:
ROOF
❑ NO
# LAYERS:
THICKNESS:
TYPE: ❑ CDX
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CLASS: A
PROPOSED ROOF TYPE: ❑ BUILT-UP ROOF MAIZPHA LT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER
ICC -ES REPORT #
DESCRIPTION OF WORK.
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 bui din struct' �i. I authorize repr sentatives of Cupertino to enter the above -identified p operty for inspection purposes.
Signature of Applicant/Agent: Date: //
SUPPLEMEN AL INORMATION REQUIRED
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If buildingis associated with a Home Owner's Association, provide letter
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ReroofApp 2011. doe revised 03/16111
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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 - building(cDcuperfino.org
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I UNDERSTAND AND AGREE TO THE FOLLOWING:
1. The re -roof project shall comply with all applicable provisions of the 2013 California Codes.
1
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 7:30-3:3.0pm (Mon-Thurs) or 7:30-
2:30pm (Friday) to schedule inspection. For Tear -Off and Nailing Inspections, you must also call on the
dayof the inspection only after that phase of the work is completed. The building inspector will be
available
ilable 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 1/4" 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/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 detector are required to e installed in accordance with Sections 8.314 and R315 of
the 2013 California Residential
I Signature of Applicant/Agent: -7- Date- ///z
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CUPERTINO
Address - A ",9
SMOKE / CARBON MOtiOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
nrn
PERMIT CANNOT BE FINALED AND COMPLETED UNTIL TRIS CERTIFICATE
HAS BEEN ST(T AND RETURNED TO THE BUILDING 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 no interior access for
inspections are required.
GENERAL INFORMATION
Existing single-family and multi-fan-ily dwellings shall beprovided 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:
M4
AREA SMOKE ALARM CO ALARM,.
Outside of each separate sleeping area in the immediate vicinity of the X X
bedroom(s) ' X
On ever level of a dwelling unit including basements X
Within each sleeping room I X
Carbon Monoxide alarms are not required. in dwellings which do not contain fuel -burning appliances and that'
monoxide alarms combined with smoke alaxms shall comply with
do not have an attached garage. Carbon
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 ? ,zs/have been
installed in accordance with the manufacturer's instructions and in compliance with thy, California Building
and California Residential Codes. The alarms have been tested and are operational, as of the date signed
below.
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: '
Lica#
Signature ........................................ .....................
....._. Date :.................
'CQ%rin.dr revised 03/18114
i
WATER -CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
I COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
IUOtAtINO 10300 TORRE AVENUE' • CUPERTINO,. CA 95014-3255
(408) 777-3228 • FAX (408).777-3333 • building agcupertino orq
Owner Name 1 C V 1 Cl 4� J l C� �Vt ��
- � Permit No.
Address it/SC/) X-ti0/i f�l� 101-/e 1/111i l \n
pA'.RMiT. f' A XTXTrim
Please refer to the attached California Civil Code Sections 1101.1— 110 1. 8 which are part of this Certification form. rte.
1. Is your real property a registered historical site?
❑ Yes 'Civil Code Sections 1101.1 through 1101.8 do not apply. Sign below and skip the rest of the form.
Owner' Signature:
No Go to Question 2.
Date:
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.
Sign below and skip the rest of the form.
Owner' Signature: Date:
No 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. 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?
❑ 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.
�.T Owner' Signature: Date:
La,`Y 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. Refer to the attached.
Myproperty 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 naultfamily 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.. "
SB4072014.doc remised 03/18114