B-2017-0647CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0647
22674 VOSS AVE CUPERTINO, CA 95014-2665 (342 29 018) RA CONSTRUCTION
SAN JOSE, CA 95136
OWNER'S NAME: BUENO RONALD W AND ELIZABETH L TRUSTEE
OWNER'S PHONE: 408-353-9430
LICENSED CONTRACTOR'S DECLARATION
License Class S-38 Lie. #633438
Contractor R A CONSTRUCTION Date 12/3112017
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.
I hereby affirm under penalty of perjury one of the following two declarations:
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
pefformance 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 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
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
may accrue against said City in consequence of the granting of this permit.
Additionally, the applicant understands and will comply with all non -point
source regulations pe e Cupertinp Mur*ipal Code, Section 9.18.
Date 4/25/2017
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
1. I, as owner of the property; or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered for
sale (Sec.7044, Business & Professions Code)
2. I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec.7044, Business & Professions Code). C
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
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
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
I certify that in the performance of the work for which this permit is issued, I
shall not employ any person in any manner so as to become subject to the
Worker's Compensation laws of California. If, after making this certificate of
exemption, I become subject to the Worker's Compensation provisions of the
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
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 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 may accrue against said City in
consequence of the granting of this permit. Additionally, the applicant understands
and will comply with all non -point source regulations per the Cupertino Municipal
Code, Section 9.18.
Signature Date 4/2512017
ISSUED: 04/25/2017
NO: (408) 559-1877
PERMIT INFO:
X BLDG —ELECT —PLUMB
_ MECH X RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION:
REROOF; TEAR -OFF; COMP SHINGLES - (26 SQ)
Sq. Ft Floor Area: I Valuation: $11500.00
APN Number: Occupancy Type:
342 29 018
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: Abby A e
Date: 04/25/2017
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
His on.
Signature of Applicant:
Date: 4/25/2017
ALL ROOF COVERINGS TO BE CLASS "A"
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
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
the Health & Safety Code, Sec ' ns 25505, 25533, and 25534.
=a
Owner or authorized agent:
Date: 4 7
I hereby affirm that there is a construction lending agency for the performance
of work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
AR ,HIT . T' DF. RATION
I understand my plans shall be used as public records.
Licensed
Professional
iCUPERTINO
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildinana,cupertino.org
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USE OF (5. SFD or Duplex El Multi -Family
STRUCTURE:: ! II Commercial
ROOF AREA:
220 0
VALUATION:
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EXISTIIdG ROOF TYPE:13BUILT-UPROOF JASPHALT SHINGLES 11 WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER (SPECIFY)
REMOVB/fLEPLACE eY!pYES
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4LAYERS:
PLYWOOD ❑ %" ❑
THICKNESS: ❑ 5/8"
PLYWD ❑ OSB
TYPE: ❑ CDX
PITCH: 12
ROOF A
CLASS:
PROPOSED ROOF TAPE: ❑ BUILT-UP ROOF q?kSPH-ALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER
ICC -ES REPORT
DESCRIPTION OF WORK:
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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 b struction - orize r resentatives of Cupeitino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: _ Date:
SUPPLE14ENTA.L RGORMATION REQUIRED
If building is associated with a Home Owner's Association, provide letterPLA7�
of approval from HOA.
Provide Planning �proeal Lo verify if there any restrictions.�5�
Provide copy of manufacturer's Installation Specifications.
Provide signed copy of Cupertino's Tear -Off Policy.
OFFICEVSEONLY
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ReroofApp_2011.doc revised 03/16111
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COMMUNITY. DEVELOPMENT DEPARTMENT • BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
10300 TORRE AVENUE I • CUPERTINO, CA 95014-3255
(408) 777-3228 , FAX (408) 777-3333 • buildinga(7cupertino.ora
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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 7:30-3:30pin (Mon-Thurs) or 7:30-
2:30pm (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 (Kon-Thurs)
and 7:30-1.0:30am and 12:30-2:30 (Friday). Final Inspections will be given a two hour window.
3. 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.
5. 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 I/" per foot of slope and demonstrate there is no ponding.
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.
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.
yy Lily J16ill118 UCIU\N, 1 I.GlLIly GaWi Ul LIIG IUIIUV+ilig IJ Irue. I am Ine properly owner or autuonzea 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 requ' ed to be installed in accordance with Sections R314 and R315 of
the 2016 California Residential Code
Signature of Applicant/Agent: �Date: �?�/ �/
Re7-60fP0licj_2014.doc revised 12115/16
CUPERTINO
PURPOSE
SMOKE/ CARBON WONOCIQE ALARMS'
OWNER CERTIFICAtE OF {COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION _ 17
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 - FAX (408) 777-3333 - building(a.cupertino.oro
This affidavit is a self -certification for the installation of all required Smoke and Carbon Monoxie am fs1 or
compliance with 2016 CRC Section 8314; 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 Smoke Alarms and Carbon
Monoxide alarms. When the valuation of additions, alterations, or repairs to existing dwelling 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 installed in the following locations:
AREA
SMOKE ALARM
CO ALARM
Outside 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 unit including basements and habitable attics'
X
X
Within each slee mi g 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 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; "� �1° P-67'7"
No.,�� 0641
Specify Number of Alarms: r Smoke Alarms- ! Carbon Ylonoxide Detectors
I have read and agree to comply with the terms and conditions of this statement
Owner (or Owner Agent's) Name: >
—
`
Signature, ...... .
Contractor Name:
-_
Signature..
.................................................................. Li c. ......................................... Dat......%.....
Smoke and COform.doc revised GI/10/2017