B-2017-0320CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
923 OLD TOWN CT CUPERTINO, CA 95014-4024 11 035)
CONTRACTOR:
'PERMIT NO: B-2017-0320
(356
EAST / WEST
BUILDERS
SAN JOSE, CA 95117
OWNER'S NAME: LEE BRIAN PAND TSO-HUEI
DATE ISSUED: 02/28/2017
OWNER'S PHONE: 408-373-5841
PHONE NO: (408) 561-2004
LICENSED CONTRACTOR'S DECLARATION ARATION
BUILDING PERMIT INFO:
License Class j_ Lie. #891264
Contractor EAST/ WEST BUILDERS Date 08/31/2018
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; OSB; COMP ROOF SYSTEM (24 SQ IS)
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.
.' 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.
APPLICANT
Sq. Ft Floor Area:
Valuation: $9500.00
CERTIFICATION
certify that I have read this application and state that the above
"N 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
356 11 035
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 against said City in consequence the granting this permit.
Additionally, the applicant understands nd willl comply with all ll non -point
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
source regulations per theperft nicip I Code, Section 9.18.
l 1
180 DAYS FROM LAST CALLED INSPECTION.
Signature , Date 2-28-2017
Issued by: Kim Dunbar
OWNER -B UDER DECLARATION
Date: 02/28/2017
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
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: 2-28-2017
I hereby affirm under penalty of perjury one of the following three declarations:
1. I have and will maintain a Certificate of Consent to self -insure for Worker's
ALL 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 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
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
exemption, I become subject to the Worker's Compensation the
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Co 0, Chapter 9.12 and
Md
provisions of
the Health & Safety Code, Sections 25505, 2 533,
Labor Code, I must forthwith comply with such provisions or this permit shall
be
12�53�4*
deemed revoked.
Owner or authorized agent.)
APPLICANT CERTIFICATION
Date: 2-28-2017
1 certify that I have read this application and state that the above information is
CONSTRUCTION LENDING A EN Y
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 2-28-2017
Licensed
Professional
P,
CUPERTINO
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(a)cupertino.orp
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❑ OWNER ❑ OWN-ER-BuiLDER ❑ OWNER AG CONTRACTOR ❑l CONTRACTORAGENT❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
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COMPANY NAME
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USE OF SFD or Duplex Multi-FamilyROOF
AREA:f
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VALUATION: 90
50
STRUCTURE: E]Commercial
, 21-1
EXISTING ROOF TYPE: ❑ BUILT-UP ROOF ❑ ASPHALT SHINGLES [I WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER (SPECIFY)
REMOVE /REPLACE AYES
IF NO,
PLYWOOD yv, ❑
PLYWD OSB
PITCH: 1)
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ROOF
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# LAYERS:
THICKNESS: ❑ s/8"
TYPE: ElCDX
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CLASS: A
PROPOSED ROOF TYPE: 13BUILT-UPROOF ASPHALT SHINGLES ElWOOD SHAKES ElWOOD SHINGLES ElOTHER
ICC -ES REPORT #
DESCRIPTION OF WORK: i
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By my signature below, I certify to each of the following: I Fn 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 re e Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to bug cons -tin. I autho re -id of Cupertino to enter the above til ntifiedp e for inspection purposes.
Signature of Applicant/Agent: Date: LQJ
SUPPLEMENTAL INFORMATION REQUIRED
OFFICE usE ONLY
PLANCHECKTYPE -
ROUTING SLIP
If building is associated with a Home Owner's Association, provide letter
AVER -THE -COULTER--
❑ BUILDINGPLA)\ REVIEW `
of approval from HOA.
Provide Planning approval to verify if there any restrictions.
❑ EXPRESS
❑ PLANNING PLAN REVIEW
i Provide copy of Manufacturer's Installation Specifications.
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Provide signed copy of Cupertino's Tear -Off Policy.
❑ pTHER:,
ReroofApp 2011.doC revised 03/16111
CUPERTINO
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 • build in-g(a)cugertino.ora
PROJECT ADDRESS
APN #
OWNERNAME
PHONE
E-MAIL
STREET ADDRESS
CITY, STATE, ZIP
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CONTRACTOR NAME
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LICEI TSE NUMBER l
LICENSE TYPE 1i1
BUS. LIC. #
COMPANY NAME
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I UNDERSTAND AND AGREE TO THE FOLLOWING:
1. The re -roof project shall comply with all applicable provisions of the 2016 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-
2:30pim (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: 7:3040:30am 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. 'Kear-Off Inspection is required. Any and all dry -rotted wood shall be replaced. prior to this inspection.
less 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..-1koofing 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.
I
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 t stalled in accordance with Sections R314 a R315 of
�. /� _
The 2016 -California Residential Code {w { -- I -7
Slanature of Avulicant/Aaent� a b Date: .
ReroojTo1icy_2014.doc revised 12/15/16
SMOKE / CARBON MONOXIDE ALARMS
ONER_CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CUPERTINO TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333•buiidino(ajcupertino.org
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ERMI T O _"TOT 3 LED I 'I ,EIS CERTIVICf1TE SEEN -
. COMPLETED,SIGN Dg `D ET ' TO THE B DIC .IVIION t
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PURPOSE
This affidavit is a self-certification for the installation of all required Smoke and Carbon Monoxide Alarms for
compliance with.2016 CRC Section R314,R315,2016 CBC Sections 420.6 and 9072.11.2 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 toexistingdwelling units exceeds
$1000.00, CRC Section R314,R315, and CBC Sections-907.2.11.5 and 420.6 require that Smoke Alarms and/or
Carbon Monoxide Alarms be installedin the following locations:
AREA + SMOKE ALARM CO ALARM
Outside of each separate sleeping area in the immediate vicinity of the X X
bedroom(s)-(Smoke alarms shall not be located within 3 feet of bathroom door) {
- - On every level of a dwelling unit including basements and habitable attics X I 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 wl-tich must be connected to the building wiring.
As owner of the above-referenced property,I hereby certify that the alarms) 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. l
Address: 2 3 OC.V Gtr/v £T Permit No."2-6/7 03 2.c)
Specify Number of Alarms: #Smoke Alarms: y Carbon Monoxide Detectors: L L- I
/have read and agree to comply with the terms and c nditions of this statement
Owner(or Owner Agents)Name:
Wry (4 Signature Date-• 7(...C.
Contractor Name: - • -
Signature - - Lic.# - Date:
Smoke and CO,orrrr.doc revised 01110/2017