B-2017-0527CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-0527
10160 PARK CIRCLE E CUPERTINO, CA 95014-1953 (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: 408-729-4818
PHONE NO: (408) 3134408
LICENSED ONT A TOR' DECLARATION
BUILDING PERMIT INFO:
License Class f,--32 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 (1) PIPE JACK
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.
-I
,1 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 NT RTIFI CATION
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 "
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.
.Signature Ur�" /� Date 4/3/2017
Issued by: AbbyAyende
OWNER -BUILDER D . RATION
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
m. 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 Business &Professions Code)
_
��
owner of
z. I, as owner of the property, am exclusively contracting with licensed i
u
Signature of Applicant: � t
contractors to construct the project (Scc.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
m. 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
z. 1 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
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
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
I 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.
Licensed
Signature Date 4/3/2017
Professional
CUPERTINO
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(uD_cupertino.org
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USE OF SFD or Duplex ❑ Multi -Family
STRUCTURE: ❑ Commercial
ROOF AREA:
VALUATION:
ASPHALT SHGLES ElWOOD SHAKES 11 WOOD WOOD SHINGLES ❑ HER (SPECIFY)
EXISTING ROOF TYPE: [t-gUILT-UP ROOF ElIN
REMOVE/REPLACE El YES
0
IF NO,
# LAYERS:
PLYWOOD ❑ w, ❑,
THICKNESS: El 51—
PLYWD ❑ OSB
TYPE: ElCDX
PITCH:
12
ROOF
CLASS: A
.�, //
ElElElEl0
PROPOSED ROOF TYPE: BUILT-UP ROOF ASPHALT SHINGLES WOOD SHAKES WOOD SHINGLES /0THER
ICC -ES REPORT #
DESCRIPTION OF WORK: } k� �^
U—
VA*1 r 11f
By my signature below, I certify to each of the following: I an 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 bylMconstraction. I auth ' tives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INFORMATTON 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 TYPE
ROUTING SLIP
❑ OVER-THE-COUNTER
❑ EXPRESS
Li STANDARD
❑ BUILDING PLAN REVIEW
❑ PLANNING PLAN REVIEW
❑ , FIRE DEPT
OTHER,
ReroofApp_2011.doc revised 03116111
f\ SMOKE / CARBON MONOXIDE ALARM
__UWN_ER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT - BUI.L.DING DIVISION
TVT��4FV
Cup -El 1ko 4TJ,_C;,V&5 I Zt6
(408) 777-3228 - FAX (408) 777-3333 -
PLW(),SLI
This affidavit is aself-certification for the installation of all required Smoke and Carbon Monowide Alarr�s for
compliance with, 2016 CRC section JZY14; R315,2016 CBC Sections 4220.6 and 9072JLZwhere no interfor iaccess
for inspectionSL are required.
GENERAL INFORMATION
Existing single-farnfly and multi -family dwellings shall be provided with Smoke alarms and Carbon
Monoxide alarms. We the valuation of additions, alterations, or repairs to existing divelling units ex+ds
$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 instOed in the following locations -
AREA
SMOKE ALARMCO A M
Outside of ead, separate sleeping arca in the inlm*ediate v of the X X
bedroom(s) — (Smoke alarms shall not belo
�cated�within3 feet of bathroom door)
On everV level of a dwelling unit indu d v X 1
-R-t a U'VVI�11111 basement-, and habitable attics X
X
Carbon.Monoxide alarms are not required in dwellings which do not contain fuel-bundng,appliancesan4 that
do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply�?th
CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal.
Power Supply- In dwelling units ivith ne, commercial poWer supply, alar (s) m ay be solely battery aper ted..
In -existing divelling units, alarms are permitted to be solely battery operated where repairs or al terationsdo
i
not result in the removal of wall and ceiling finishes or there is no access by means of attic, basement or c I awl
space. Refer to Sec R31id CBC Sections 907.2.11.4 and 420,6, 2, An electrical peritis required for
CRC 4 aA
alarms which must be connected to the buildirAg wiri
As owner of the above -referenced property, I hereby certify that the alarm(s) referenced above has/have. een
installed in accordance with the manufacturer's instructions and in compliance with the California Buildi'rg
and California Residential Codes. The alarms specified below have been tested -and are operational, as of iffie
date signed below.
Addrcss: —Permit
Ato—t
Specify Number of klarms: Striabe Alarms: bon Monoxide Detectors:
sand aaf as to complywfth theter ms and condidoiis of thiq
— .... . Lic.4
Smoke and Wfbrin.dac mWsed
WATER -CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
................. 10300 TORRE AVENut - cuPERTINO, CA 95014-3265
0
--4�408) 777-n28 (408) M, -3333 buildinagb-cuootin-mo
3
Owner Name t i rc Permit No.
Address 101t�gc roner+if\'C-�
1, Is your realpropertyaTegistered historical site?
0 Yes Civil itode Sections 1101.1 through 1101.8 donot apply. Skip the, rest of the forrn and sign bottom of
,a No Go to Question I
2. Does your real propertyliave a licensed plumlicr certitdng that, due to the age or configuration of the property or its
plumbing,instaUation. of water=conserving plumbing fixtums is not wohnically feasible?
0 Yes Civil Code Sections 1101,1 through 1101.8 do not apply.
0 The licensed plumber's certification has bemprovided to the Building Division -
Skip the rest of the form and sign bottom of form
Nti Go to Question 3,
3. Is wa service permuently disconnixted for your building?
0 Yes Ciyi].Q)deS=tion,.q.1101..IthrougbI101.9donot fipply.. Skip the rest of the form and sign bottom of fry
-0-go Go to Question 4,
4. Is your m -d property built and available for use or oom-@anqy on or before January 1, 1994?
n No My ml property is built a -ad available for use or occupancy jftM January 1, 1994
Civil Code Sections 1101.1 through 1101.8 do not apply. Slip the rest of the form and sign bottorn or ronui
la' -Yes My real property is built and available for use, or occupancygn rbp
_ o -kre Januai-y 1, 1994.
Civil Code Sections 11013 t1=ugh 1101.8 apply. Check one of the- three following state is and sign
bottom of -fbrm..
5, Please check ONE of the following. 1
El My property is asingle-family residenfial real property. See Chil Code Section 1101A I
On and after January 1, 2014, building alterations or impmvements. shall require all non-compliant plumbing fix"
to bo replaced with water -conserving plumbing fixture-,- throughout the building.. On or before January 1, 2017, all n0-
compliant plumbing fixtures shall be replaced with v-vater-conserving, plumbing fixtures (regardless of whether
.1proporty undergoes alterations or improvements).
-fl My property is a m0ifaWly residenfial real prnperty� See Civil Code Section 1101.5.
On and after January 1, 2014, specified building alterations or irnprovements shall require non- compliant
plumbing fixtures to be replaced with water-conservirig plumbing fixtures -
On or before January 1, 2019, A ron-compliant plumbing fixtures shaU be replaced with water-
cog plumbing Bxftm throughout -the building (regardless of whether proNny undergoes alterations or
improvements),
0 MypxWertyi-,acoin�nercialredpropert3i� See Civil Code Section 1101-5.
On and aftcr.Tanuary 1, 2014, specified building altera- tions orimprovements shall require non- compliant
plumbiag f . ixtum to be replacedwith- water-couserving, phunbing Extures.
On or before January 1, 2019, all non-compliant plumbing Extures shall be replaced with water- conservingi
plumbing fttm throughout the building (mgardless of whether property undergoes alterations or improvemetift). 1,
TJ�on comp1dinj and nm4g this Certificate, please retumit to the Building Division in order to final your buildbTg-]�ihrn
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