B-2017-0593SMOKE / CAR13ON MONOXIDE ALARMS
OWNER CERTIFICATE' OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(alcupertino.ora
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 907.2.11.2. where no interior access
for inspections are'required.
GENERAL INFORMATION
Existing single-family and multi -family dwellings shall be provided with 5MORe ,Alarms and Carbon
Monoxide alarms. When the valuation of additions, alterations, or repairs to existing dwelling units exceeds,
$1000.00, CRC Section R314, 8315, 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:
AREA
SMOKE ALARM
CO ALAIZM
Oukside of each separate sleeping area in the immediate vicinity of the
bedzoom(s) -' Smoke alarms shall ztot be located within 3 feet of bathroom door)
X
X
On ev level of a dt�ellin unit includizla basements and habitable attics
X
X ,
Within each slee ing roou-i
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. smolce 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 conanezcial 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 8314 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 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,
Address: ZI,q 66AR0'. 4 Permit No. t3-Zar} -0593
Specify Number of Alarms: -9 Smoke Alanzas: �� ;# Carbon Monoxide Detectors:
(or Owner Agent's) Name:
1 have read and agree to comply with the terms and conditions of this statement
Signature.. .........................................
Lica �KNDate: y'2D,1 i
Smoke and CO forntdoc revised 011.1012017
cvrOnNo
WATER -CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
tJ
(408) 777-3228 - FAX (408) 777-3333 - building@cuoertlno.org
Owner Name tv&, r&7 y AOT-/ Permit No 13 - 2°l_'-OS13
Address .0/4-43 S/i *_Q_W Cr CURYAW //{1O. C0 Z5"0
I. Is your real property a registered historical site?
Q Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the. form and sign bottom of form.
9?"No Go to Question 2. 1
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?
CJ Yes Civil Code Sections 1101.1 through 1101.8 do not apply.
❑ The licensed plumber's certification has been provided to the Building Division.
Slap the rest of the form and sign bottom of form.
E"*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, Skip the rest of the form and sign bottom of form.
LG0No 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 7anuary 1, 1994.
` Civil Code'Sections 1101.1. through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
19/yes My real property is built and available for use. or occupancy oz 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..
5. Please check ONE of the following-
[IY 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 plumbmi g fixtures
to be replaced with dater -conserving plumbing Mures 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 multifamily 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 neon -compliant plumbing fixtures shall be replaced with water -
conserving pluinbing fixtures throughout the building (regardless of whether property undergoes alterations or
improvements).
❑ My property is a eominercial real property. See Civil Code Section 1101.5.
On and after January 1, 2014, specified building alterations or improvements shall require nom- 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 properiy.undergoes alterations or impzovemcnts).
1, as the owner or owner's agent of this pzopert3: certify under penalty of perjury that non-compliant plumbing fix tures will be
replaced prior to date specified above with water-donserving plumbiing fixtures in accordance with Civil Code Sections 1101.1
through 1101.8, the current California Plumbing Code and California Green Building Standards Code, and manufacturer's
installation requiremments, and that the water -conserving pluinbing fixtures comply with the requirements as indicated in the
table on the followizu; Uaize.
I Owner or Owner Agent's Signature: i ll 4:512nr-Gt: Date. 4 j Z0 f /% I
T7pon completing and
it to the Building Division in order to final your building permit.
SR4072011doc revised 01/05/17
CITY OF CUPERTINO BUILDING PERMIT
BUILDINGADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-0593
21443 SHANNON CT CUPERTINO, CA 95014-4970 (362 01 005)
ROSSETTXS
ENTERPRISES INC
SAN JOSE, CA 95126
OWNER'S NAME: FOTI ANTHONY JOHN AND DOROTHY ANN TRUSTEE
DATE ISSUED: 04/14/2017
OWNER'S PHONE: 408-446-9631
PHONE NO: (408) 294-4400
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class _Q -M Lic. #743864
Contractor ROSSETTA'S ENTERPRISES INC Date 12/31/2017
X BLDG _ELECT —PLUMB
MECH X RESIDENTIAL COMMERCIAL
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business & Professions Code and that my
license is in full force and effect.
JOB DESCRIPTION:
REROOF; TEAR -OFF; INSTALL CDX; COMP SHINGLES - (33 SQ)
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 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: $28000.00
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above
APN Number:
Occupancy e:
anc
p y TSp
information is correct. I agree to comply with all city and county ordinances
362 01005
and state laws relating to building construction, and hereby authorize
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.
Signature _.�� Date 411.4/2017
Issued by: AbbyAyende
DECLARATION
Date: 04/14/2017
OWNER -BUILDER
I hereby affirm that I am exempt from the Contractor's License Law for one of the
RF ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
following two reasons:
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)
''
z. 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: 4/14/2017
I hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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.
z. I have and will maintain Worker's Compensation Insurance, as provided for by
He7nRnAus MATERIALS DISCLOSURE
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
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
permit is issued.
a. 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 in any manner so as to become subject to the
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
r
be deemed revoked.k
CDate:
- �? 9
Owner or authorized agent: �-- -�-�
APPI ICANT CERTIFICATION
4/14/2017
I 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
of work's for which permit is issued (Sec. 3097, Civ C.)
relating to building construction, and hereby authorize representatives of this city
.this
Lender's Name
to enter upon the above mentioned property for inspection purposes. (We) agree
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
ARCHITECT'S DECLARATION
and will comply with all non -point source regulations per the Cupertino Municipal
I understand my plans shall be used as public records.
Code, Section 9.18.
Licensed
Signature Date 4/14/2017
Professional
4
CUPERTIN
osb
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 . FAX (408) 777-3333 • building 2cupertino.org
PROJECT ADD§S
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APN -- 3Q2_
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OWNER NAME�1� � PeNF � Y - r 1a
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E-MAIL
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STREET ADDRESS
CITY, STATE, ZIP,`,
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CONTACT NAME 1MC ac �� �
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PHONE E-MAIL
STREET ADDRESS
CITY, STATE, ZIP
FAX
❑ OWA'ER ❑ OWNER -BUILDER ❑ OWNERAGEI\'T I CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRA NAMEId NSE NUMBER
LICENSE TYPE
BUS. LIC.
COMPANY NAME
E-MAIL
FAX
STREET ADDRESSH,) I L,
CI STATE, ZIP I
P O E%'a01L1 —,l ^ (40b
ARCHITECT/ENGLNEFR NAME LICENSE NUMBER
BUS. LIC. --
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF Q SFD or Duplex ❑ Multi -Family
ROOF AREA:
VALUATION:
STRUCTURE: ❑ CommercialC1
L
EXISTING ROOF TYPE: ❑ BUILT-UP ROOF ❑ ASPI-LALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES hDTHER (SPECIFY)
l✓�
R.EMOVE/RFPLACE NYES IFNO, PLYWOOD Ln w, ❑
PLYWD ❑ OSB
PITCH:
ROOF
❑ NO --LAYERS: THICKNESS: ❑ 5/8"
TYPE: El CDX
.12
CLASS: A
PROPOSED ROOF TYPE: ❑ BUILT-UP ROOF N ASPHALT 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 «rork and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: t . Date:
SUPPLEMENTAL INFORMATION REQUIRED
oFICE iisE oniY "`
cHEcx;ftPl -,
Rot�rli\c:silP
If building is associated With a Home Owner's Association, provide letter.PLAN
"ov> R-rHE coU. rER
_:BT3ILDINGPlAN REVIEW,
of approval from HOA.
Provide Planning approval to verify if there any restrictions.M
_.
fl-
Provide copy of Manufacturer's Installation Specifications.
El STANDARD
i] -`FIRE DEPT
Provide signed copy of Cupertino's Tear -Off Policy.
oTxEx
ReroofApp 2011.doc revised 0.3/16/11
_�I
CUPERTINO
REROOF TEAR -CUFF POLICY
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 • buildino(a.cupertino.ong
PROJECT ADDRESS
, 5�0,,n t +r , `D
t� 9
APN #
OWNERNAME
, PHONE E-MAIL,
k-� LA (A 14, -Au 01 Ta,
STREET ADDRESS
CITY, STATE, ZIP
FAX
CONTTOR NAME
Ma—V l l LICENSE NUMBER
LICENSE TI'PE
BUS. LIC. #
COMPANY NAME
E-MAIL
FAX
--
iio1 b
STREET ADD S
0 � V1 (.a L N'!
CITY, STATE, ZIP /� r
A,-, ` IJ� ✓J 1p
PRONE
�-iE0 Cell -1
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-
2:30pn1(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: 7:30-10:30am. 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.
3n 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.
Roofing shall not be applied without first obtaining all prior inspection and written approvals fi-om 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 L/" per foot of slope and demonstrate there is no ponding.
b. Listings fiom 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 sign z:'
l; 1 oeinty each ot-the tofl"owing-Is true. -I ainthe property owner or aumorizea 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 to be installed in accordance with Sections R314 and R315 of
the 2016 California Residential Cod 99j
Signature of Applicant/Agent: (/_� Date:
ReroofPo1icy_2014.doc revised 12115/16