B-2017-1241CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-1241
19359 GREENWOOD CIR CUPERTINO, CA 95014-3415 (375 43 018) CONRAD ROOFING
SERVICE INC
SAN JOSE, CA 95112
OWNER'S NAME: FUNG ELAINE M TRUSTEE I I DATE ISSUED: 07/28/2017 1
OWNER'S PHONE: 240-751-2846
LI_CENSED CONTRACTOR'S DECLARATION
License Class 0399 Lic. #211852
Contractor CONRAD ROOFING SERVICE INC Date 08/31/2017
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:
i. 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.
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., (VVe) agree to save indemnify and keep harmless the
City of Cupertino against liabilities, judgment's, 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 regul • ns p the Cu ertino Municipal Code, Section 9.18.
Signature Date 07-28-2017
OWNER -BUILDER DECLARATION
I hereby affirm that I'am exempt from the Contractor's License Law for one of the
following two reasons;
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)
I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project(Sec.7044, Business & Professions Code).
I Hereby affirm under, penalty of perjury one of the following three declarations:
i. 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,' 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
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. 1 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. -
NO: (408) 294-7615
BUILDING PERMIT INFO:
X BLDG —ELECT _PLUMB
MECH X RESIDENTIAL COMMERCIAL
JOB DESCRIPTION:
RE -ROOF; TEAR -OFF; INSTALL OSB; COMP SHINGLES - (5 SQ) -
ATTACH GARAGE ONLY
Sq. Ft Floor Area: I Valuation: $5000.00
APN Number: Occupancy Type:
375 43 018
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: Kim Dunbar
Date: 07/28/2017
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
inspection.
Signature ofAppli
Date: 07-28-2017
ALL ROOF COVERINGS TO BE CLASS "A" OR
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,,Sections 25505, 25533, and 25534.
Owner or authorized ageriff
Date: 07-28-2017 '-
CONS ' UCTION LENDING AGENCY
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
ARCHITECT'S DECLARATION
I understand my plans shall be used, as public records.
SiSignature Date 07-28-2017 Licensed
9 Professional
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
111 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
CUPERTINO (408) 777-3228 - FAX (408) 777-3333 - building(acupertino.om
PROJECT ADDRESS13,r
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armLICENSE
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PROPOSED ROOF TYPE: 11BUILT-UP ROOF
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Provide copy of Manufacturer's Installation Specifications.
PHONE
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STRUCTURE:
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EXISTING ROOF TYPE: ❑ BUILT-UP ROOF
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ICC -ES REPORT
DESCRIPTION OF WORK:
of
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of approval
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Provide Planning approval to verify if there any restrictions.
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Reroqf,1pp_,201 Ldoc revised 03116/11
By my signature below, I certify to each of the following: I am the property ow I mer 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 tocotruplywith all Applicable local
ordinances and state laws relating to bucKon, I authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of'Applicarit/A ent:
Date:
IT
SUPPLEMENTAL INFORMATION REQUIRED
IV
PLAIVCHECKTITE
If building is associated with a Home Owner's Association, provide letter
from FIOA.
of
,
5OPEP REWENW,A'
of approval
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Provide Planning approval to verify if there any restrictions.
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Provide copy of Manufacturer's Installation Specifications.
Provide signed copy of Cupertino'sTear-Off Policy.
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Reroqf,1pp_,201 Ldoc revised 03116/11
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(ftupertino.org l Z�f I
PROJECT ADDRESS
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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 re4uest can be scheduled up to one business day.before the requested inspection date.
To schedule inspections call (408) 777-3228 from,7:30-3:30.pm (Mon-Thurs) or 73,0-2:30pm (Friday) to
schedule inspection. For Tear -Off and Nailing Inspections, you must also call ori the day of,the
inspection only'after,that phase of the work is completed. The building inspector; will be out to the
job site within one'hour. The hours for this service are: 7:30-1030am and 12 30=3:30 (Mon-Thurs)
and 7:30-10:30am and 12:30-2:30 (.Friday). Final Inspections' will be given a IwOhour 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/fagteners 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 from 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 perfortned.
6. A Final Inspection and approval shall be obtained from the building inspector when ,the re=tooling is
completed. To te'.ceive a final sign -off, the following items will be verified:
a. Flat roofs shall have a minimum of 1/4" per foot of slope and demonstrate;there is no ponding.
b. Listings from approved testing agencies for all pre -manufactured productsused shall be
available ori -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 coimplete, you will be
charged a re -inspection fee. The re -inspection fee shall be paid,before another!mspectionl can be
scheduled.
By my signing below, I certify each of the following is true: l am the property owner or author ized'agent to act on the
property owner's behalf I understand and agree to comply with the re -roof policy stated above l- also understand that
I' is.R314 and R3'IS of
smoke detectors and carbon monoxide detectors are re uired to be Installed in,accordance ivitli Seetioi
the 20.16 California Residential Code. i , a
Signature of Applicant/Agent: Date � ZG Z 7
RerobjPoliey._201 4. doe revised 0610117
SMOKE/ CARBON MONOXIDE ALARMS FILE
OWNER CERTIFICATE OF COMPLIANCE
+gx COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
CUPERTINO 10300 TORRE AVENUE• CUPERTINO,CA 95014-3255
(408)777-3228• FAX(408)777-3333• building( cupertino.orq
Puma... ANNoT.BE;:FINALED UNTI ,THIS CERTIFICATEHAS BEEN
COMPLETED,WNW;AND RETUR ?ED TO THE BU D r DI I IUlhi:
....... ...
PURPOSE
This affidavit is a self-certification for the installation of all required Smoke and Carbon Monoxide Alarms
for compliance with 2016 CRC Section R314,2016 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 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 X X
the bedroom(s)
On every level of a dwelling unit including basements X X
Within each sleeping 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 907.2.114 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 / `y'� �
Address: / 3S---7 ( f1i&t,OOdCi'/ ��L 2 h0`-� 3 iRe/
rmit No. 6 ZOO -72y
Specify Number of Alarms: #Smoke Alanns: ! 5 I #Carbon Monoxide Detectors I 49-----1-
/have reed and agree to comg'y with..the ter nd conditions of this statement
Owner(or Owner Agent's)Name. , 7
Signature Date
Contractor Name:
Signature Lic.# Date:
Smoke and CO form.doc revised 12/15/16