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B-2017-0529v CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0529 10162 PARK CIRCLE E CUPERTINO, CA 95014-1954 (326 32 046) D & M QUALITY ROOFING SAN JOSE, CA 95112 OWNER'S NAME: PARK CIRCLE, LLC DATE ISSUED: 04/03/2017 OWNER'S PHONE: 408-729-4848 PHONE NO: (408) 313-4408 LICENSED CONTRACTOR'S DECLARATION ARATION BUILDING PERMIT INFO: License Class C 39 Lic. #646795 Contractor D & M QUALITY_ ROOFING Date 06/30/2018 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: RE-ROOF;(N) TPO & PIPE JACKS (20 SQ) I hereby affirm under penalty of perjury one of the following two declarations: CUPERTINO BUS LIC #403090 EXP - 4/2/2018 r. 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. 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: $7750.00 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 326 32 046 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. Additionally, the applicant understands and will comply with all non -point WITHIN 180 DAYS OF PERMIT ISSUANCE OR source regulations per the Cupertino Municipal Code, Section 9.18, 180 DAYS FROM LAST CALLED INSPECTION. Si nature - .� // Date 4/3/2017 g Issued by: Abb�Ayende OWNER -BUILDER DECLARATION Date: 04/03/2017 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. 1, 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. 1, as owner of the property, am exclusively contracting with licensed Signaturc of ApplicantA contractors to construct the project (Sec.7044, Business & Professions Code). Date: 4/3/2017 I hereby affirm under penalty of perjury one of the following three declarations: ALL 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 s. I certify that the performance of the work for which this permit is issued, I Health & Safety Code, Section 25532(a) should I store or handle hazardous -in 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, Sections 25505, 25533, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. ,Owner or authorized agent: L APPLICANT CERTIFICATION Date: 4/3/2017 I certify that 1 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 CONSTRUCTION LENDING AGENCY 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. Licensed Signature Date 4/3/2017 Si 9 Professional CUPERTINO COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building2cupertino.orr PROJECT ADDRESS ^I , A n /6 APN # _ % OWNER NAMEC41 4Z4PHONE �� Z .-. `��(g E-MAIL , l STREET ADDRESS % j� �� 'p��Ap__�CITY, � f ( V eZ � s�o I� S TE, FAX CONTACT NAME P Pj PHONE E-MAIL STREET ADDRESS CITY, STATE, ZIP FFAX ❑ OwNER ❑ OWNER.BUIIAER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME Le� LI E NI JM BSER LICENSE TYPE BUS fI IC� COMPANYNAME yp ro r E-MAIL FAX STREET ADDRESS Sc, Gf CITY TATE,'TP 0- Y 5"a B - Lc PH �� -{, /109 1 0`9 ! (j ARCHITECT/ENGINEERNAME LICENSE NUMBER BUS. LIC.# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF CG -<D or Duplex , ❑ Multi -Family STRUCTURE: ❑ Commercial ROOF AREA: �� ► V.,�W'ATION: 't EXISTING ROOF TYPE: E BUILT-UP ROOF ❑ ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER (SPECIFY) REMOVE /REPLACE 11 YES ❑ NO IF NO, # LAYERS: PLYWOOD ❑ w ❑ THICKNESS: ❑ 518 PL -wD ❑ OSB TYPE: ❑ CDX PITCH: -:12 ROOF CLASS: A PROPOSED ROOF TYPE: ❑ BUILT-UP ROOF ❑ ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER I C REPORT ;# �' DESCRIPTION OF WORK: * c. 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 bu' ding construction. I�authorize --representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of ApplicantiAgent: �/ Date: % ®l SUPPLEMENTAL INFORMATION 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 signed copy of Cupertino's Tear -Off Policy. OFFICE USE ONLY " PLAN -CHECK TI.TE ROUTING SLIP OVER-THE-COUNTER fl STAATDARD !BUILDINGPL.ANREVIEw - rLA1,nti5c PLAN REVIEW . ❑. FIRE DEPT �- OTHER: " RerOofAPP 2011.d0c7-evised 03116111 0 'SMOKE I CARBON OWNER CERTIFICATE OF COMPLIANCE COMM UNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 0tuflefLn qa,oupertino.orq PJAWKWIN11 This affidavit is a self -certification for to installation o all required Smoke aid Carboys Motimade Alarms for compliance with 2a!,6 CRC Section. R314; R31 , 2f116 CBC Sections 420,6 and 907.2.11.2. here no interior access for inspections are required. GENERAL INFORMATION TION Existing singleaf y and multi -fare dwellings shall be provided with Smoke Alarms and Carbon Monoxide alarms. when the valuation of additions, alterations, or repairs to e�dsting dwelling units exceeds 1000.00, CRC Section 131 R315, and CSC Sections 907.2.3 1.5 and 426.6 require that Srn6ke Alarms and/or Carbon Monoxide Alarms be installed in the following locations - ARES. ALARM CO ALARM Outside of each separate Slee ii ig area:6 the mediate v cinity of e bedroom s) - (Sm rs e alaz s sbi not be located i this 3 feet of ba�thr m door) X X On every level of a: dwelling unifincludirfg basements ana habitable attics X X Witfcin each sle . i room ... Carbon Monoxide alarms are not required in dwellings which do not contain fuel -burning appliances and ibat do not have an attached garage, Carbon r onoxide alarms combined with smokealarms shall co-anply with CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal. Power Supply. In dwelling its with no commercial power supply, alarm(s) may be solely battery operated. In e)cisftg dwellirig iimits, alarms are permitted fo be solely battery operated Nvhere 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 crawi space, Leser to CRC Section.R.314 and CBC Sections 907.2,11A and 420.6.2.. An electrical permitis req iced for alarms which must be connected to the building wiring, As owner of the above -referenced property, I hereby certify that the alar (s) referenced above bass/ ave been installed in accordance withthe manufactmees 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, I I I"+rut o, i Specify Number of Alarms: M #Sir s Alarnis:Carhop 1 onoxidc Detectors: I have react and agree tp comply with the terms and conditions of this statement owner {rpt Owner a?saeaiz Nara ia- Srv7ke and CO fora€.doc reWxu€ 10111&'� 017 WATER -CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY.DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE # CUPERTINO, CA,95014-3255 (40�8),777-P428,- FAX*�408) 777-3333, Ownne L.11�1 l? j4 No erNarL_U_ Address 1. Is your real propertya registered historical site? 0 'Yes Civil Co& Sections 11 1,1 through 1101.8 donDtapply. Skip the -test of the form and sign bottom of foam Ja No Cie to Question 2. I Does your real property have a licensed plwnb�r certifyin gnof thepry oopertr its � g that, due to the age or conflmatio plumbing, installation of waW-conserving,plumbing 5c tum is not technicali y feasible? 0 Yes Civil Code..Sections 1101.1 tbrm_eh 1101A do not apply. 0 The licemed pluiribei certification has been provided to the Building Division. Skip the rest of the fbim and sign bottom of form. ET No Go to Question 3. 3- Is water -service pearianently discomeated for your building? 0 yes, Civil Cc& Sections 3.101.1 through 21 1.8 do, not apply, Skip the rest of the form and sign bottom of fbnn, ,4t No Go to Question 4. 4, Is your Teal property built and avaiilable for use or occupancy on or before January 1,1994? 0 No My real property i . s built and available for use or occupancygfig,: January 1, 1994 Civil code sections ljoij through 110t.9 kip texestof tbr, form and sign bottom of form. Z -Yes Myrealproperty is built and available fat use or occupancy,gn or bgforq January 1, 1994. Civil CodeSections 1101A ftough 1.101.8 apply. Check one of the three following statements and sign bottom of forni, 5Please chedic QNIE of the fbRowinr. property is a single-family yesidenlialTeal property- Cj-vil(�QdeSectionil0l,4 [3 my Sec On and after January 1, Z014, buildihg, alterations or improvements shall require all nan-comPliant plumbing, fixtures to be replaced with water -=serving plumbing fatures tbroughout the buMng. On or before January 1, ZOM all non- compliant plumbing fixtures siall be: replaccd with water-wriscrving plumbing fixtures (regardless of wheth6r 'propzrty undergoes alterations or improvements). L*? Mypropertyis, a mulfifamilyresidended =]property, See Civil Code Section 1101-5. On. and after January 1, 2014,specified buildir6g alterations or improvements shall require. non- compliatt plumbing fixtures to be replaced vnth water-consenving plumbing fixtures. On or beforejanuary 1, 2o1g, an non-compliar;tplumbing-fixtures shall be Teplaced with water- com-ervaig Plimlinng fixtures throughour the building (regardless ofwhotherpr9perty undergoes ahorations or iFr provements)- 0 My property is a conanercial real prnperty� SeoCivil Code Section 1101.5. On and after January 1, 2014, specified building alterations or improvements shall require non- compfiant plumbing.fixtures to be replacedwith water -conserving plumbing fixtures. On or before January 1, 2019, all non-compliant plutnbing fixtures shall be rqplacedvvith water- conserving plumbing fhares throughout thebuilding (regardless ofurhether property undergoes altairtion.sor impiovpments). SB407 2015, nr- nwiwd 0110SZ1 7