B-2017-0666CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-0666
21427 KRZICH PL CUPERTINO, CA 95014-4942 (362 05 039)
GREG JONES
ROOFING INC
HALF MOON BAY, CA
94019
OWNER'S NAME: LINDLEY DALE C AND CAROLINE N TRUSTEE
DATE ISSUED: 04/27/2017
OWNER'S PHONE: 408-482-4752
PHONE NO: (650) 726-1428
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class C-39 Lie. #669195
Contractor GREG JONES ROOFING INC Date 02/28/2019
X BLDG —ELECT _PLUME
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; TEAR -OFF; INSTALL OSB; COMP SHINGLES - (30 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
permit is issued.
Sq. Ft Floor Area:
Valuation: $20000.00
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
362 05 039
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 regul tions jor the Cupertino Municipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
g 0 27 20 7
Si natur Date
Dunbar
Issued by: Kim un
Date: 04/27/2017
OWNER -BUILDER DECLARATION
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. I, as owner of the property, or my employees with wages as their sole
installed without first obtaining ani pecticn, 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. I, as owner of the property, am exclusively contracting with licensed
Signature ofAppficant:
contractors to construct the project (Sec.7044, Business & Professions Code).
Date: 04/27/2017
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
3. 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
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: 04/27/2017
1 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
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 04/27/2017
Si 9
Professional
CUPEIRTINO
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildinci a.cupertino.org
PROTECT ADDRESSj
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CONTACT NAME
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FAX
❑ OWNER ❑ OWNER-BUII,DER ❑ OWNERAGENT ❑ CONTRACTOR ❑ C0X1TRACCTyORAGEh*r ❑ ARCHITECT ❑ ENGwEER ❑ DEVELOPER ❑ TENANT
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ARCHITECT/ENGBgEFRNAME LICENSE NTUA.SER
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COMPANY NAME
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STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF Q SFD or Duplex ❑ Multi -Family Y ROOF AREA:X
STRUCTURE: Q Commercial
VALUATION:
Q
EXISTING ROOF TYPE: ❑ BUILT-UP ROOF ❑ ASPHALT SHINGLES WOOD SHAKES ❑ WOOD SHINGL ❑ OTHER (SPECIFY) ^�
REMOVE/RL-PLACEES IF NO, % PLYWOOD %z" ❑ _. PLYWD OSB PITCH: ROOP
❑ r10 Y LL YERS. ( THICKNESS: ❑ S/S" Ti PE: ❑ CDX ' 12 CLAS : A
PROPOSED ROOF TYPE: ❑ BUILT' -UP ROOF ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES Q OTHER I ICC -ES RE - ORT r
DESCRIPTION OF WORK�r^
By my signature below, I certify to each of the fo owing: I aIn the property ow er or authorized agent to act on the property owner's behalf. 'I have read this
application and the information I have rovided is co ct. I have read the Des ription of Vdork and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to ilding cos on. I authorize representatives of Cupertino to enter the above -identified roperty for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL 1AVORAATIONREQUIRED
If building is associated with a Home Owns Association, provide letter
Of approval frolm HOA.
Provide Planning ae ro /al; to yerify if there any restrictions._ . _ _
Provide copy of Manufacturer's Installation Specifications.
Provide signed copy of Cupertino's Tear -Off Policy.:°
OFFICE'USEo>\Ly, '
Pim CHECK TYPE=
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ReroofApp_2011.doe revised 03/16/11
CUPERTINO
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 • building(d)cupertino.org
PROJECT ADDRESS
OWNERNAnfEz
LC� APN #!
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STREET ADDRESI,
CITYf TEm� Y `'
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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: 7:30-10:30am. 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.
3, Tear -Off Inspection is required. Any and all dry -rotted wood shall be replaced. prior to tlds 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 requiredY.
5. Roofing shall not be applied without first obtaining all prior inspection and written approvals fi-oin 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.
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.
property owner's behalf. I understand and agree to
smoke detectors and carbon monoxide det�c ors a
the 2016 California Residential Code. -
of .AUtulicant/.
I am -the property owner or- authorized agent to act on the -
with the re -roof policy stated above. I also understand that
i to be installed in accordance with Sections R314 and R315 of
Date:
Re7-oofPo1icy_2014.doc revised 12115116
tam I
onoxide
rn-'s for
PURPOSE the installation of all required Smoke and carbon Where no interior access
Trds affidavit is aself-certification for 8315, 2016 CBC Sections 420.6 and 907
compliance with 2016 CRC Section 8314,
for inspections are required.
GENERAL INFORMATION to existing dwelling units exceeds
inti -family dwellings shall be provided with Smoke Alarms and Car on
Existing single-family and m alterations, or repal
Monoxide alarms. When the valuation of additions,
$1000.00, CRC Section 8314, R315, and
CBC Sections 907.2.11.5 and X0.6 require that Smoke Alarms and/or
Carbon Monoxide Alarms be installed in the following locations: SMOKE ALARM CO ALARM
AREA X X
Outside of each sepazate sleeping area in the immediate vicinity of the
X X
room s) — (Smoke alarms shall not be lucatedrW ntsana habitable attics door X
bed ( g Unit including baz
On every level of a dwelling '
Within eacl, sleep ina room g' appliances and that
ot contain
Carbon Monoxide ala
rms are not required in dwellings WE, ch db ned with moke alarms shall comply with
ayage.Carbon monoxide alarms com
do not have a ��t6aWddhall be a
pproved by the Office of the State Fire Marsha .
CBC Section 4_ alarmO Y
ercial ower supply s may be solely battery operated.
Power Supply: In dwelling units With no comm p of attic, basement or crawl
are ermitted to be solely battery operated repairs or alterations o
In existing dwelling units, alarms por there is ermit is required for
not
result in the removal of wall and ceiling rig es 907 11.4 and 420 6.2 An electrical p
space. Refer to CR the coion R.7DI4 and CBC nnected to the building wiring.
alarms which mus
d property, I hereby certify that the alarms) referenced above has/have been
nl
As ojveT of the above -reference pro p
compliance Nvi$h the California Building
installed in accordance �'Nrith the manufacturer's instructions and in been tested and are operational, as of the
com iu
and California Residential Codes. The arms specified below have � P �
Permit N t t2
date signed below.
n /r —,
1 f I ")'1 !� -/?A
Address:
Specify Number of Alarms: _
I have read and a
Carbon Monoxide Detectors:
Smoke_ Alm
with the terms and conditions of this statement
e to co
Owner (or Owner Agent's) Name:
Signature ...
/C/o�nt�ra/c�tor �P Pn//
Signature
/ -1 t --'Or' ,I lY)e ] ..
.............................
�Qlt�.:.l� 1 ........... Date ...•
............. LIC..+
Smoke and CO form.doc revised 01/101'201;
CUPERTINO
Owner Name
Address ;Z/ �n2
WATER -CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-322§r FAX (408) 777-3333 • building(dcupertino.ong
Permit No,;
1. Is your real property a registered historical site?
❑ Yes Civil Code Sections 1101.1 through 1.101.8 do not apply. Skip the rest of the form and sign bottom of form.
ANo 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?
❑ Yes Civil Code Sections 1101.1 through 110 1. 8 do not apply.
❑ The licensed plurmber's certification has been provided to the Building Division.
Skip the rest of the form and sign bottom of fonn.
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 fonn and sign bottom of fonn.
)91 No 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 January 1, 1994.
Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the fonn and sign bottom of fonn.
Yes 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:
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 fixtures
to be replaced with water -conserving plumbing fixtures 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-conseiving 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).
❑ 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 improvements).
I, as the owner or owner's agent of this property, certify under penalty of perjury that non-compliant plumbing fixtures will be
replaced prior to date specified above with water -conserving plumbing fixtures in accordance with Civil Code Sections 110 1. 1
through 1101.8, the current California Plumbing Code and California Green Building Standards Code, and manufacturer's
installation requirements, and that the water -conserving plumbing fixtures comply with the requirements as indicated in the
table on the following nage.
Owner or Owner Agent's Signature: ., �� , :�j Date: 7
Upon completing and signing this Certi Cate, please return it to the Buil _., Division in order to final vour building uermit.
SB407 2015. doe revised 01/05117
1. If the existing plumbing fixture water usage/flod7 rate is equal to or lower than the figure shown, it is not required to be upgraded.
SB407 2015.doc remised 08/26/15
Non -Compliant
Water -Conserving Plumbing Fixture
Plumbing Fixture
(Fixture Complying with Current Code Applicable to New Construction)
Maximum Water Usage/Flow Rate
Fixture Type
Water Usage
2013 CPC Ch. 4
2013 CPC Ch. 4
2013 CPC Ch. 4
(Flow Rafe
2013 CALGreen Div. 4.3
2013 CALGreen Div, 4.3
2013 CALGreen Div. 5.3
Single -Family
Multi -Family
Commercial
Residential
Residential
Water Closets
Exceed 1.6
Single flush toilets: 1.28 gallons/flush
(Toilets)
Gallons/flush
Dual flush toilets: 1.28 gallons/flush effective flush volume (the composite,
average flush volume of two reduced flushes and one full flush
Urinals
Exceed 1.0
0.5 gallons/flush
Gallons/flush
Showerheads
Exceed 2.5
2.0 gallons per minute @ 80 psi. Also certified to the performance criteria of
gallons per minute
U.S. EPA WaterSense Specification for Showerheads
(A hand-held shower is considered a showerhead.)
For multiple showerheads serving one shower, the combined flow rate of all
showerheads and/or other shower outlets controlled by a single valve shall not
exceed 2.0 gallons per minute @ 80 psi, or the shower shall be designed to
allow only one shower outlet to be in operation at a time.
Faucets —
Exceed 2.2 gallons
Maximum 1.5 gallons per Within units: 0.5 gallons per minute @ 60
Lavatory
per minute
minute @ 60 psi; minimum Maximum 1.5 gallons psi
Faucets
0.8 gallons per minute @ per minute @ 60 psi;
20 psi minimum 0.8 gallons
per minute @ 20 psi
In common and public
use areas: 0.5 gallons
per minute @ 60 psi
1.8 gallons per minute
60 psi
Faucets —
Exceed 2.2 gallons
1.8 gallons per minute @
1.8 gallons per minute
1.8 gallons per minute @ 60
Kitchen
per minute
60 psi
@ 60 psi
psi
Faucets
May temporarily increase
May temporarily
up to 2.2 gallons per
increase up to 2.2
minute @ 60 psi, and must
gallons per minute @
default to maximum
60 psi, and must
1.8 gallons per minute @
default to maximum
60 psi
1.8 gallons per minute
Where faucets meeting
@ 60 psi
the above are unavailable,
Where faucets meeting
aerators or other means
the above are
may be used to achieve
unavailable, aerators or
reduction.
other means may be
used to achieve
reduction.
1. If the existing plumbing fixture water usage/flod7 rate is equal to or lower than the figure shown, it is not required to be upgraded.
SB407 2015.doc remised 08/26/15