B-2017-0528CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-0528
10193 PARK CIRCLE W CUPERTINO, CA 95014-1966 (326 32 014)
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
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:
UNITS 1 - 4; REROOF; INSTALL TPO; INSTALL (I) PIPE JACK'S
I hereby affirm under penalty of perjury one of the following two declarations:
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. 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
Sq. Ft Floor Area:
Valuation: $7750.00
permit is issued.
APPLICANT CERTIFT_CATION
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 32 014
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.
WITHIN 180 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.
Signakre Date 4/3/2017
Issued by: Abby Aygnde
OWNER-BUILDER DECLARATION
Date: 04/03/2017
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
RE-ROOFS:
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)
r' 7
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: 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. 1 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 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. Additionally, should I use equipment or devices which emit hazardous
shall not employ any person any manner so as to become subject tthe
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:
APPLICANT CERTIFICATION
Date: 4/3/2017
1 certify that I have read this application and state that the above information is
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance
correct. I agree to comply with all city and county ordinances and state laws
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,
Lender's Address
judgments, costs, and expenses which may accrue against said City in
consequence of the granting of this permit. Additionally, the applicant understands
A DECLARATION
and will comply with all non-point source regulations per the Cupertino Municipal
all be usedECT
a
I understand my plans shall be used as public records.
Code, Section 9.18.
Licensed
Signature Date 4/3/2017
Professional
CgIF11417H•
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE v CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(a.cupertino.ora
PROJECT ADDRESS � � APN # ✓ 21a01
OWNER NAME A
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PHO *, � � C� �
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E-MAIL
STREET ADDRESS
CITY STA ZIP
FAX
CONTACT NAMES i�
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PHONE
E-MAIL
STREET ADDRESS
CITY, STATE, ZIP
FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT 040NTRACTOR ❑ CONTRACTORAGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME --Z��
L C T� NUMBER
5P
LI ENS�TYPE
BUS C. #
COMPANY NAME 'n �
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E-MAIL
FAX
STREET ADDRESS, & c T
CITY,STATK jL &
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7 7 [ U
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC. #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF SFD or Duplex ❑ Multi -Family
STRUCTURE: ❑ Commercials
ROOF AREA:
VALUATION:
EXISTING ROOF TYPE: BUILT-UP ROOF ❑ ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER (SPECIFY)
REMOVE /REPLACE El YF
NO
IF NO,
# LAYERS:
PLYWOOD ❑ w, ❑
THICKNESS: ❑ 5/8"
PLYWD ❑ OSB
TS PE: ❑ CDX
PITCH:
12
ROOF
CLASS: A
PROPOSED ROOF TYPE: ❑ BUILT-UP ROOF ❑ ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER
PORT #
DESCRIPTION OF WORK:L �`t
C k+ J 2 ZnJ 0 1 (OC -Milt
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 andverify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to b ding construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: �% —�� Date:
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.
= , oFFscE IIsi `onLi
PLAN, CHECK TATE
RODTinc SLIP .
-flVEii-iHE-COUNTER
0REss.
❑ STANDARD
- -
❑ BUILDINGPLANREVIE�'4
i7. PLANlYt VG PL 4N xEi IEw _-
❑ ;FIRE DEPT;
oTHER <_..-
ReroofApp_2011.doc revised 03116111
WATER -CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408177-4224 * W (408) 777-3333 - builging&cyperfino,orn
Address
1. Is your real property a registered historical site?
13 Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of
,,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?
0 Yes Civil Code Sections 1101.1 through 1101.8 do not apply.
El The licensed plumber's certification has been provided to the Building Division.
Skip the rest of the form and sign bottom of form,
ET'No Go to Question 3.
3. Is water service permanently disconnected for your building?
rl Yes Civil. Code Sections 1101_ 1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of
0"No Go to Question 4,
4. Is your real property built and available for use or occupancy on or before January 1,1994?
5.
0 No My Teal property is built and available for use or occupancy a;fteT January 1, 1994.
Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of f0m
"Y 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.
Please check ONE of the following:
0 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 fiXW
to be replaced with water -conserving plumbing fixtures throughout the building. On or before January 1, 2017, all nj
compliant plumbing fixtures shall be replaced with water -conserving plumbing fixtures (regardless of whO
property undergoes alterations or improvements),
a My property is a muWwnily 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).
0 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 improveirients) .
in
1, as the owner or owner's agent of this property, certify under malty of perjury that non-compliant Plumbing fiaures Evill be
replaced prior to date specified above with crater -conserving plumbing fixtures in accordance with Civil Code Sections l 101 . I
through 1101,8. the current California Plumbing, Code and California Green Building Standards Code, and manufactwet's
installation requirements, and that the water -conserving plumbing fixtures comply with the requirernents as indicated in I the
Owner or Owner Agent's Signature! J XkA)44,1-AYQ_ 14 jd -Date. Wkl( t,
Upon completing and signing this Certificate, please reUrn it to the Building Division in order to final your building p
S64072015.doc
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
CUPERTINO I U1jVV 1 VrV1kr_ AVENUE - UUPERTINO, CA 95014-3255
(408) 7773228 - FAX (4081777-3333 - t01dirlqQcuperUnoorcl
I vivrVaL
This affidavit is a self -certification for the installation of all required Smoke and Carbon Monoxide
compliance with 2016 CRC Section R314; R315,2016 CBC Sections 420.6 and 907.2.11.2. where no it
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
$1000-00, CRC Section 8314, R315, and CBC Sections 907-2.11.5 and 420.6 require that Smoke Alarms
Carbon Monoxide Alarms be installed in the following locations:
is for
access
AREA
SMOKE ALARM
CO AL4RSkl
�utde �of each separate sleeping area in the immediate vicinity of the
bedroom(s) — (Smoke alarms shall not be located within 3 feet of bathroom door)
X
X
On every level of a dwelling !n!dw.lin base eziits and habitable attics
X
Within each sleeping122sLj
X
_j
Carbon Monoxide alarms are not required in dwellings which do not contain fuel -burning appliances anti that
i
do not have an attached garage, Carbon monoxide alarms combined with smoke alarm shall comply v4th
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 4a
space. Refer to CRC Section R314 and CBC Sections 907.211.4 and, 420,6.2. An electrical permit is required for
alarms which must be connected to the buildL-ig wiring,
As owner of the above -referenced property, I hereby certify that the alarm(s) referenced above has/have I
installed in accordance with the manufacturer's instructions and in compliance with the California Build
and California Residential Codes. The alarms specified below have been tested and are operational, as of
date signed below. I
Address:
Specify Number of Alarms:
Permit
I ha ve read and t $
7 ?grQe X. qO,-nP]Y with the rims and condkians of this statement
Owner (or er Agent's) Name-,
t4�1
. . . . . . . . . . . - 4 .1 14 4 ....... . ., - . . . . . . . . . __ . . . . . . . . . . . U'C'# - .. - -
Smoke and COf6tin-flac rev 4sed
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE,
C OVIMUNITYPEVELOPMENT DEPARTNENT - BUILDING DIVISION
CUPERTINO 9f}ativ i CUPERTINO, CA 95014-3,>55.
(408),777-3228 - FAX (408) 777-333 s . buildinnnn nunpHnn nm
I'IIC tar
TI -ds affidavit is a.self-certification for the installation of all required Smoke and Carbon Monoxide Alarms for
compliance with 2016 CRC.Secti
on 8314; R315, 2016 CBC Sections 420.6 and 907.2.11.2 where no inte
riorlaccess
for insections are required.
p
GENEILU, INFORMAT -ION
Existing single-family and multi-fan-dly dwellins shall be provided with Smoke Alums and Carbon
Monoxide alarms, When the valuation of additions, alterations, or repairs to ekisting dwell1ing unit exceeds-
$100UQ, CRC Section R314, R315, and CBC Sections 907.2.1-1
..5 and 420.6 require that Smdke Alarms an�i/or
Carbon Monoxide Alarms be installed in the following locations:
AREA,
SMOKE ALAR
COAL
sleeping.areaX
Outside of each separate sleeping.area mi the iinmediate -vicinity of the
. .... ..
X
bed'roo=(s) — (Smoke alarzn!� shall not be located within 3 feet of bathroom door)
On every level of a dwellin- unit Includingbasernents and habitable attics
X
X
Within each slew
X
Carbon Mono)dde alarms are not require,.1 in dwellings which do not contain fuel:bu at
rnmg appliances M4 that
do not have an attached gaxage. Carbon m6noxide alarms combined writh smoke alarms shall comply vv5!h
CBC,Section 420.6 and shall be approved by the Office of the State Fire Marshal.
Power Supply- Indwelling units with no commercial power supply, alarm(s) may be solely battery opera 't
-d.
In existing dwelling, units, alarms are permitted Lo 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,basementorwl
cra
space. Refer to CRC Section R314 and CBC Sections 907.2.11.4 and 420.6.2- An electrical pern-itis require! for
alarms which must be connected. to the building wiring
As owner of the above -referenced property, I lLereby certify fhat the alarm(s) referenced above has/havebeen
installed -in accordame'vvith the manufacturerrs instructions and 1.1 compliance Nvith the Califon -iia Build rid,
and California Residential Codes. fine: alarms specified below have been tested and are operational, as of the
date signed, below,
Address -
_L00 -3
Specify lNumber of.klarnis:
Monoxide
0,anar (or Owner Aqotfs) Name:
coll7ad"rNama:
"All
8i nature.-- : I V_� Dale-
€gnaiur Lie............ ........
0
Smoke and COfionn-dric rovisedO1167017
WATERCONSERVING PLUMBING FIXTURES
OWNER C ERTIFICATEOF COMPLIANCE
�PQMM- UNITY DEVELOPMENT DEPARTMENT, BIALDINO DIV1816N
-2- 'RE AVENUE'- CUPE R*nNO, CA 95014-3265
CUP IKO
�(4081777-fj I W (408) 777-;§�33 - buj1djW(&`cu4rtin
Owner Natno- e permit
M - &o.
-Address
1- Is yotil Ity a registered historical sale?
is:
Ol
-Ya- Civil Code -Sections 110,1.1 throtigh 1101.8 do not apply. Skip of the -,form and sign bp#qm
o Goo to Question 2.
2. Does your real proper lyhave alicemed plumber certifying that, due to the age or OnfigUratiOn, Of the PrOpOrty Or its
plumbin-,,installitionofw-ater-conspiVingplvtnbingjU=esis-nottechWmUy'fear,ible'?
C1 Yes Civil Code Sections 110-1,A through 1101.84qnot apply.
'Ci The licensedpIgmbet's certification has bjeaptovided to the Building,Division.
Skip the mst of the form, and tip,bottoni of form-
E3''Na Co to 'Quegtiqu:� .
3, Is water service porp'Oritly disconnected for your building?
M*Ye& civil bode sections 1101.1 through 1101,8 do rot apply- dip the rest afthefacet. andsigbottom
m
ErTaGo to Question 4.
4. is ywreal propertybuili and available for use or occupancy tin orbefora January 1,1994?
C1 X6 My real -prq erty is built and available for use or occupancy 4ftr7 januatyl, 1094.
Civsl Code: Sections: l 1171.1 through _] 101;8 da- tiot apply slap the test.of the, form and sign bottom of forin
"Y My real propertyis. built and available for use or occupancy on or before January 1,1994_
Civri`l
,1994-
Civil Code Sections I i0l.j through 3.101,8 apply. Check- one of the three following statements 494 sign
b6ttoft ofform..
Please check 014B of thefollowing:
,11 Myproperty- is, a single- See Civil Code Section, 110 IA.
Qrc family residenfidl real property�
and fa6r,January 1, 2.014, building alteratioils' or imprbvements-shall, require 4 Aon-cOmpliant plumbing &b
to be replaced w=ith: mer -conserving plumbing fixtures throughout the building, On or before January l, 20-17, all r
compliant, plumbing fixtures shall -be. replaced with water-oartserving phinabigg, axtures (regardless of -,,vhe
property undergoes alterations or improvements):
0' Myproper - tyisa mulfifamily resikndal real property, See, Civil Code Section 1101,:S..
Litt. anal after January 1, 2014, specified building alterations or improvements shall requki e non- compliant
plumbing &turm, to be replaced. with water -conserving plui0ing ft -tures.
0 a -hall be re
, tLor bcfo= January 1,2019 allmon-oomph nt plumbing fixtures s eplacedwith. water=
wrism-ving plunkiing fixtures throughout the building (regardless of whether property undergoes alterations or
ijtriprovements)-
Ell Myptopery $deC1viICodC-$ectlon I10I .S.
On and after January 1,2014, specified building alterations
orimprovements shall require non- compliant
planibing fixtures -tobe replaced with water: cojiseryiag plunibing fixtures -
oil or before. January 1, 2019; all nopconn'mplumbing fixtures shall 'be replaced with` water vdaervin,
11111111Wn fixtures throughout the building (regardleo of whether property -undergoes alteratiqmorjaprovements).
Zo- ow ger or owners agent of thispropetV, e e ffy underpenaltyof per ury that non-c6mPliarit*004 AXtOtO$
ill be
replacprforta date, §pwifed above with iwatir-,conceiving plumbing fbetutesinaccordamewittiCivil Cade Secti'orts
10
through 11014, the cunvatCalfforniaPlumbing Code and California Green Building Standards Code, and =nufll ture'l
insWatioar,-quiremenNand that the -,vato-conservit�,-,plumbIi fixtures comply with the,*quiM44A$�a$1ndjca2 in
ng
tine
table on the Lollowink pajc
Owner or OwnerAgent's Signature:
Uppnc* S t: -
niplet-ug anti signing tbiS Certificate, please reef M i to U rlluu L'.
ri
SBAO 2015.doo rn,&ed,,
j/0/1 7