B-2017-1272CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-1272
10510 DEODARA DR CUPERTINO, CA 95014-2431 (316 30 036)
WILLIAMS - TYLER
INC
SAN JOSE, CA 95118
OWNER'S NAME: HENDRIKSEN DAN E TRUSTEE
DATE ISSUED: 08/02/2017
OWNER'S PHONE: 401-272-3473
PHONE NO: (408) 277-0800
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class Q -M Lica#501852
Contractor WILLIAMS -TYLER INC Date 10/31/2018
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 OSB; COMP SHINGLES -(26 SQ)
I hereby affirm under penalty of perjury one of the following two declarations:
1. I have and will maintain a certificate ofconsent 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.
2Ihave and will maintain Worker's Compensation Insurance, as provided for by
ection 3700 of the Labor Code, for the performance of the work for which this
Sq. Ft Floor Area:
Valuation: $10785.00
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above
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
3
316 30 036
16
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 ap ant underst n s and will comply with all non -point
source regulati rfs C o Municipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
,' re Date 812/201.7
Issued by: Jasmine Archbold
Date: 08/02/2017
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the
RE, 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 t 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 t%G'
contractors to construct the project (Sec.7044, Business & Professions Code).
Date: 2 2
I hereby affirm under penalty of perjury one of the following three declarations:
for
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
t. 1 have and will maintain a Certificate of Consent to self -insure 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 tbeCcyertjno Municipal Co #, Chapter 9.12 and
exemption, I became subject to the Worker's Compensation provisions of the
the Hea!W Safety Ca e, ec ' ns 5505, 25 3 a 2 34.
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
Owner zed agent:/ L
APPLICANT CERTIFICATION
Date:
I certify that I have read this application and state that the above information is
CONSTRU TION 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.
I understand my plans shall be used as public records.
Licensed
Signature Date 8/2/2017
Professional
i
llsnzwtk
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
[1 1 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 K
CUPERtIINO (408) 777-3228 - FAX (408) 777-3333 - building(ftulperdno.orig
PROJECFADDRESS L)
LICENSEfNIBER
APN 9
BUS LIC P
OWNERNANIE (-),N
E-MAIL
7Z23
XZ
SrMA
E-MAIL
STREET ADDRESS C) (Cf erko� g.ZA I
Cjy4,g ZII�t
T T, V%&eO.,rL e
�cro
FAX
o?%l
CONTACT NAME
L
BUS, LIC 9
3j
Ar�gv
ST R BET ADDRESS
crry' ZIPC
CITY, STATE, ZIP
FAX
0 OWNER 0 OWNER -BUILDER. 0 OWNER AGENT 'CO RACTOR 11 CONTRACTOR AGENT 11 ARCHITECT 0 ENGINEER 11 DEVELOPER 0 TENANT
CONTRACT INkF"
LICENSEfNIBER
LICE�
BUS LIC P
COMPANY NAME
E-MAIL
FAX
SrMA
'rEStj e J
CITYSTJZ��
J
L
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS, LIC 9
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE or KsFD or Duplex El Multi -Family
STRUCTURE: C] Commercial
ROOF AREA:
a. (;:, 45CA,
VALUATION -
1 /0 , ri a)
ReMqfApp__M Ldoc revised 0311611
REROOF TEAR -OFF POLIO'
its COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
Ct`6PEt3'B 6N® 10300 TORRE AVENUE . CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buiIding cu ertino.org
PROJECT AUDRESS
AP\it
OWNER
G`
Ir
7
E-titA[L
STREET D 'SS
CONTRA C O Ai F
/, r
y �F, lP
LICF,NSE nU ' / yj
a
LICENS Y
FAX
BUS. LIC. N
COM _N NA,/
N '
E-MAIL
FAX
S rRj�E?JA
Weqmkdea
/
J -5L7.
�
CITY. STAT
e9i Y
P L
I UNDERSTAND AND AGREE TO THE FOLLOWING:
I . The re -roof project shall comply with all applicable provisions of the 2016 California; Codes.
2.An inspection request can be scheduled up to onebusiness day before the requested inspection date.
To schedule inspections call (408) 777-3228 from 7:30-3,30prim (Mon-Thurs) or 7:30 L30pm (Friday) to
schedule inspection. For Tear -Off and Nailing Inspections, you must also call 6n1the clay of the
inspection only after that phase of the work is completed. The building inspecior will be out to the
job site within one hour. The hours for this service are: 7:30-10:30am and 1'2:30-3:30 (Ilion-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 prier 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 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 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/a" 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.
By my signing below, I certify each a following is true: I am the property owner or authorized agent to act on the
property owner's behalf. I enders . nd d agree to 0-i"r
with the re -roof policy stated above. I also understand that
smoke detectors and carbon mo ox e detect rs areto be installed in accordance with Section 314 and 831:5 -of,
the 2016 California Residenti Cod .
Signature of Applicant/Agent: Date:
Reroofl'o1icy_2014.doc revised 06101/7
F
R 4y ; SMOKE] CARBON MONOXIDE ALARW
1 . .. t. - OWNER CERTIFICATE OF COMPLIANCE
'COWL:tar/DEVELOPMENT'DEPARTMENt-BUILDIN DIVISION
01.1.1tre . , - . .
- 1030.0:TORM",..•'AVENUE.CUPERTINO CA 9$01.4:3746
CUPEATINO
taosy777,32234,FAX(4,1a)777-3331-bureno.f:;cusertin-0,,arG
'-•;.,: :•KI 'I :}1IiIc .•A-I .,Is! ::- ,N:;•iI•66.:?;:, ,,t'I.3iII-•':';'.,;?. ,' ..:::',,. .; ?I::1;;':',:,F,L , ::::;?-!t.AM:" .'i.1";Z:II.'..,;&:,';:::E.;.:,,,,nN,I[,;;;:; ,M;1•,::
0*,)40Z:SP*pt yWit E01', ...p.pxlitS.,,OxtilIPM:t H.\S
oogeo"A-ftl*kiiir4.-plif*' *tfiiiiiiiiiefilii#6401W§ToUnlit
PURPOSE .
This affidavit is a seli-certification for the inStallation of all requi red Smoke and Carbon Nfortoide Alarms .
foreorn ob.anee w i th.2016 CRC Secton R314.2016 CBCSections:420)5 and 907.2.112 where no interior access
for inspections are required,
GENERAL INFORMATION
xi$ting Siit'41q-fitnily and multi-family dwellings shall be provided with Smoke Alarms and Carbon:
Monoxide alarms. When-the valuation of additions,alteraidthls,or repairs to existing dwelling unit exceeds -
$11..X10,00„CRC Section'R3 Pe and CBC Sections 9072.11.5 and 420;6 require that Smoke Alarms and/or Carbon
.Monoxide AJarms'boinstaliea in the,following loc ations: .
AlEA. i SMOKE ALA,R1 '1 CO ALARM i
[Outch side of eaivatawsleeping arta in The itnraediatevitinity or 1
X
th bedrooin(S) ' ' I
Onevery leveloi a dwellii*upit.inch:din,-ba.:,4:,..tnents_ ----T— X , X j
• • - iirt.ead;slet02182/292±FL._ - X
I
' •
Cat:bow:Monoxide alarms are not requisedin dwellings which do not contain fuel.,huming appliances and that
do not ha .-i,e arattichedgarage. Carbon Monoxide:alarms combincombined with-smOke alarms shalt comply'With
CBC Section 4204 and'shall be approved by the Office of'the State Fire Marshal,
.Poer Supply:In dwelling units with no commercial power,supply alarms)may be solely battery operated.
in eXisting dwelling units,alarms are permitted to be.:solely batters operated where repairs or alterions do
not're'sultin the nernoval of wall and(tiling finishes or there 15 no access by means'ciattic„basement or'cra IA
spa6:..Refer to CRC Section R514.and CBC sections 907 2,1.2 A and 42062.An elecLical permit is required for
atairti5 which mustbe connected to the building wiring,
,
As-dikne..ripi the.above.teferencettproperty,I hereby eertify•that the _14.krti*)tei6ithced:zibovoliaslhaye,been
instailed'in accordance with the manufacturer's instructions and in coMpliance,with the CalifOrnia Building
and,Cal4tUaReSidentia/Codes,The alarms sivcified below have been tested-and are operatiortaLas-of the
aateSiNnebelow.
, & -.
- ,
Adclrtest : -/P.c/0- De6zA A.,, ;?--i:,,, D J--
,...A.,„_,., •—_,........_ Permit No 7)OP -M,
Speqy NtOber ot.Adarms #Smoke Alarms: e
. . . # arliOn Monoxide Detecom 1
IIM —
i have P•kael Valalgeo,'to corral,/ th The:6477t•;By 1 ton 4106,1-4 Of Mis Vpfermif
; !431§Inicit or aA6of A.Ortrs1Nrirtle. '
t '1, ,.....,
,_, t:: .1.)4AlAr4 ‘ 777-4 . A4i.
i ;to,, :s-,74.5
; Tir7;;;;GT i'qztrw,7 ---------' - - ''''''' – -I - " -,------:-------
i 1 ' I Safure .._...
•
!' 1
I , I SMOSki 1 47,14 TO Artr,d0C irl*Crd M 5'216
1 r
i : 1
,,... .
,
WATER-CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
,• .4
CON1141,1141P(DtVELOPrvlENT DEPARTMENT-BUILDING PiVISION .
10500 7-00,,RE AVENUE-CUPERTKO,CA 95014- 55CUPERTINO : (408)777.3228.FAx fACE)777-3333•p.,,..!„.2iliaser.imeni no.or-,t, 0 -)...„ (7 1 ?_73
Owntr Noma lik„.4, .0: ,iy.e h.t1).-iiiJ-41-. Permit No. /4>
Addres3 i f..'";;t7-It> I) el.,-il rt.4-_-_,.., 9 - ., • .
. .
1, IR your rolproperly a regi,$tered,historical site:,
L. Yes Civil Code See-tiorig..11.01-.31.1-irouch 1101,8 do not apply, S leirl the TCS14;of the-form and silt hot ore of form.
Go to!Question'2.,
, .
2,. Does your fan]propenyhdve, a lieer.sed plumber certifying that;t.'=to the age or cord.ig,,aration ofthe property or its
plumbing,installation of water,consereingplumbing atures.i.S not It:chine-ally feasibles?
O Yes CivitCodo,Sections 1101„I throvsh.1101,S do not apply.. ,
• CI The'lltrensedplumbees:eertificanonlias.bei:a pmvidc-d to the Building Division. •
Skip the rest of fcrin iii)d sign bottom of form.
1X,No Go toQuestion ..
• 1. Is water service pertuaintly diseonuectedfor your building'?
0, Yes Civil Code Sedtions 1101 1 through 1101.S--do not apply. Skip the re-14t of the fain tnd ii2n bottom.of form.
PI o Go toQuestion 4.
„,
4. Js',lour real pilaperty built and 4.N:satiable:for use or Ocenpancy on or betorc January 1. 1994?
O No My real property is bait end available for lase or.occupancy after in:teary-1, 1994.. . .
_ . civil Code Stencils 1101,1 through 11011.g do not apply, Skip the reitt of the form and•sign bottom of form,
Yes my tv...ii pr6perty is built and available for use or oc.c.up- yon es bcfort.:.ram tary I.,1404,
Civil Code Sections 1101.1 through 1101„S apply. Check one of the three following_statementS and sign
bOtiont of form._
5. Please cheek ONE of thc following;
pk's
M property is 3 singie-lamily resdeptial real.prpperty. Sea Ciyii Cock Section 1101,4,
• Ott and:after January 1,S 2014,building alterations or',improveirienis shall require all non-compliantplumbing fixtures
to be replaced with water-conserving plumbing fixtures throughout thu building.On Orbefbminnuary I,2017,all non.
compliant plumbing fixtures shall be rvIaced with water7conse.rvii1,3 plumbing fiXtures (recardless of whether
property undergoes alterations or improvements):
0- My property is apattritarniftreildentiol real pmperty, Stru Civil Code Section:1101.5:
Oa and-after January 1,2014.specified building alterations or Itztoreve=nts shall require non-c•(=pliant-
plumbing atui-es to be replaced with Irater-cf.laserving plumbitw fixtures,
OR or before Jitialli TY 1,2019.alfriOn-comp1i•aut•ph:intimg tiNtures sball be replaced with water-
,
oonservir4,!.plumbing fix-noes throughout the buil dir;(regardless*of whether property undergoes ahertitions or
itrocovetrierns), . ,
0My property is-a covunertiol real property,, See CMI Code Section 1.10:1,5,
•
On and after:January I,20/4„.,speelfle.d building alterations or impro -cipaiitS.shall require r-on cormliaot
plumbing ftxtires to be replaced witb,waver-eonserving plumbing fixtures_
On, or 1:efore, latIttil IV ,.I, 2019. all non-compliant plumbing fixa11?-s ' 11411 he n7Placed 1.villl IA'mer, conservin
Piurribing fortunes throttgllout the building(rezarclress of whether property undergoes alterations or improvements).
. , . .
I;-c!....s,the owner or crtync2.,S agent of property,certify under penalty of peritar:,,,-that non-compliant plumbing fotture,s will.be
rep/heed prtor 1.0 date,specifi,ed above.4.itirli',Vateri-ccuservine phrrnbilie-fixtures in accordance with Civil,Code.Scetions 1101,1
through 1101./:1,.the current California Plumbing-Corii.--.and California Green I4t.ilding Standards Code,and tirrititufacturer's
iurx,llatiOn recuironicznis,and that the water-c or:se:nine plumbing fixtures comply with the requirdiuent, as Lidice led in the
table an-the following.page. , , , ,,„-‘7,,,,,,,,..,,,_ , ... ,.....,„,. „
Owner or Owfier Alonfs Sign:elute', /,-,7t . ' ' -1,4,--,:j4,4-a,- , 7:77e.: .Date-•,. fLiii/L-L__ .
. , .
- . ,
iipct.1 e.9.2.r.,,itetinl,..;aed si.t.,,rarrg this C. ticatc,proas return it to the BuiiclinttDivision in order to fntal yeiur btiiidib.i.pyarnirt,
S45407 2.D154oc,ftvi..war OHO-51.77
. . . , . ., :, •