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B-2017-1280CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-1280 10810 PENINSULAR AVE CUPERTINO, CA 95014-0100 (326 03 047) WESTSHORE ROOFING INC SAN JOSE, CA 95131 OWNER'S NAME: FARRER DAVID J DATE ISSUED: 08/03/2017 OWNER'S PHONE: 408-702-8448 PHONE NO: (408) 456-0200 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class 399 Lic. #787221 Contractor WESTSHORE ROOFING INC Date 11/30/2018 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: RE -ROOF; TEAR -OFF; INSTALL CDX; COMP SHINGLES - (20 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: $13000.00 permit is issued. APPLICANT CERTIFICATION I certify that I, have read this application and state that the above information is correct. [:a gr6e to comply with all city and county ordinances APN Number: Occupancy Type: and state laws relating to building construction, and hereby authorize 326 03 047 representatives of this city to enter upon the above mentioned property for inspection purpose's. (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. Additionally, the applicant understands and will comply with all non -point WITHIN 180 DAYS OF PERMIT ISSUANCE OR source regulations per the Cupertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signat Date 08/03/2017 Issued by: Kim Dunbar OWNER DECLARATION Date: 08/03/2017 -BUILDER I hereby affirm, that Ilam' exempt from the Contractor's License Lawlor one of the RE -ROOFS: following two reasons: I '' All roofs shall be inspected prior to any roofing material being installed. If a roof is t. 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) 2. I, as owner of the',propert}, am'exclusively contracting with licensed Signature ofApplicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: 08/03/2017 I hereby affirm under penalty of perjury one of the following three declarations: I have maintain Certificate'of Consent to self -insure for Worker's ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER . 1. and willa Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work fon 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 compliancewith the Cupertino Municipal Code, Chapter 9.12 and the s. 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, 113ecome subject,to the Worker's Compensation provisions of the the Health & Safety Co e, Section 05, 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: 08/03/2017 I certify that I have read this application and state that the above information is CONSTRUCTION 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 constrdction, 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 08/03/2017 g Professional t RER00F. PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT -.BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 • n (408) 77763228'• FAX (408) 777-3333 - bu1lding0—cupeitin6org lctipNo 13-V11- IZO PROIECrADI3RESS `oo/D Perur)5ular P-}Ve PPr �`� 0 ... OWNER NAME ., i,l 2 ucl� I PHONE p . 'tot 70Z- 8,f+b E -WAIL L12 _ ade a `yahoo. ew* f STREET; ADDRESS ,O o o(o Pentn5utar A-ve CITY, STATE„ ZIP FAX CONTACT NAME" av—L 1 v 1 . I t-er LICENSE NUMBER PHONE /1 O Q 4✓ /� Q 2Q V NV [Z,P E h1AIL" `%i- v✓l 4C.5t5ho e a r • `.. /� � / �' pI�O G (I/ y� STREET ADDRESS � �7 .d 1 o bu.Y le 6 i CITY, STATE._ 5 , A 0� e Ck "'1 EAh-40 8 ,1 5b — O %3 '0 6W?-0ER 13 OWNER -BUILDER OLVh'ERAGE.�vr jiG! CO?1TltAC76R OC ON'Fi2AC-rbR;AOENT- Q ARC'IL'TEC2' ❑-ET(, 'EE12 C�. tiLVfl.OPEit - 0 Z'HNAN7 COYTRACTORNAME _ esiskofe ?o© ut LICEN'SE�NUMBER LicE'VSETYPL 7872- 1 - . o -.4q _ ��2 ; - Co;vfPANr:NAME QQp �LL.0�� E -JAIL D�,,,��aD 11---'',,,�/�((��.Cc��,�c�lpp pp��Q l w`�"� WCJIJrC,<�/rlerCo F4X 0Z3 ". S7REETADDRESSZ24T.J ;1/�� _ IVI Vut•leC� V � STATE, CITY.. PHONE AIi6 iTECTIENdINFhKNA,kIE LICENSE NUMBER _. ... BUS. LIC.,' LOS2PAItY NA viE ' E-MAIL FAX STREET -ADDRESS CrrY,STATE,zIP- - PHONE . GSE OF "SFD or Duplex 0 -Multi-Family STRUCTURE _ . CilnlnierCkal ROOF AREA, � - ZV CJV VALUATION: EXtS11Nb R06F TYPE: 13 [itr[LT=I P ROQF ❑ASPHALT SHINGLES .CJ WOOD Ski 1KES tiVOOD SHitiOI ES. ❑OTHER (SPECIFY) REhIOVEIVEPLACE SES ' 0 NO IPNO;• 'tLAYER& PLYWOOD THICKNESS: .1�rli" 0 0518- PLYN'D ❑ :OSB -TYPE % IX.CDX � PITCH; � -12 ROOF CLAS: PROPOSED ROOF TYPE'. ,O BUILT-UP ROOF 21ASPHALT SHINGLES ❑ WOOD SHAKES GI, ❑FOTHER ICC ES. DESCRIV`rl()TS Of 540RI;: as l�lg fir; s 1�5 -I-. q Q=tjg S Provide copy of Dupe -tino's Tear -Off Policy, * ` 9TIiEk signed By my ,ignatuie below { rI rliCv to each,ot the folloivitrg; t am titcpropetty o%vner 6r` author iz6dl agent to F el onthe pcoperty'a)snL 's behalf. applicatioti:and.the information d' v provided is correct. I,have read the Description of Workan3 verify: t is aceirrafe. T agree to compiy.tivi ordinances And state laws relating o rld" g construction. I authorize representatives of Cupertino to enter• the abode-identified"property for Signature of Applicant/Agent�� �L SUPPLEMENTAL INFORMATION REQUWRED oFFrccusEooLs 7 IuIN CH$Ckr T�T1 " If building is associated with a home Owner s Association, provide -.letter i3 o�EIrrRFuL��rER,3 k 4 t C3 B�Itla�i of a royal ftnnT' FlOt1 Ph Provide I'lanninl; approt°alto verify if there any restriefions. � �� � fi ,� t Pira rl+r Provide copy of. Manufacturer's Installation Specifications. Provide copy of Dupe -tino's Tear -Off Policy, * ` 9TIiEk signed Et t id.thPs icable l'oct purposes.. ReaonfAp 2(i/r,orrevFrer�Oa/1 I CcIrA -OFF POLICY REROOFTEAR .01 COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION ALBERT SALVADOR, D.E., C.B.O., BUILDING OFFICIAL i 0300 TORRE AVENUE - CUPERTINO, CA 95014-31255 08) 777--n28 - FAX (408) 777-3333 - building&werfino,r o ,4 _q ) _' PROJM'ADDRESS K\j PIN� r� J STREFT ADDRES _N \j ]c FAX LIC W S LIC Or 00 EIL Ck FA X STRE%:" ADIREr PHONF, 1TUNDERSTANDAND AGREETO THE FOLL OWING:' he .re -roof project shall coirriply -,m),th all applicable provision -s of the 2016 California Codes. i. LA inspecton request can be scheduled uD to- one basdnessdmv, before, the requested insDectibrt damfp. To schedul-einspe Qtions 6a11 (,) 777-3228'f;ori'7*--'3-Oi3:-'P"m WM fs)or 3:-23 OP.h0l*to schedule inspection. For Tear -Off and Nilin A 2 Ins-pectionsyou must also call on th6 day offthe inspection only after that phase of the work, is coxnplet�d-. The building inspector will, be outito the site within one hour. The hours for this service are: 7- 3,0'. '0:3am ' d 12- 0 an i30-3:30 (Mon-Thurs). and 7:3040:30am and 12:30-2:30,(Friday). Final Inspections will be given a two hour Nviindbw. reauired. Any and all dr, Iprior to ihisiii-Ispection. Tear -0 1.nm,ectior,.J& y-,rott �,�;ood shall be rep'deed Unless- new- pbjmmod roof s16 is proposed thfou ghput'.; I I the nails/fasteners 'shall b Bit er e Com plfet£'-� knGO.K.4-d-own q.-remomved prior to t1iis jo*etion If plywood is installed, a plyNvood Natuna Insvection iv-re4aired, , Roof= shall not be applied without first obtaining all.-priorinspection, and written approvals 66'm the ' t�obtg g an approve inspe , ctioii win blUilding Amy roofing i ch is " lied with d app out 1.h,� n ,iuire the removal of all new material do-;vm to the sheat , 'S -formed. , a f er inspection. be Pei' P prop 6. A Final Inspe&timn and,apvroval shall be obtained- t1ai�--...bqi'1d1.r1Dr hnspector V�hlemtherte-rpoung is ffia sign -*of , the following iterp'.s will be verified: completed. To receive a final ff, a. Flat roofs shall have a minimum of per food of slope and demonstrate there is no P,6idinlg. b. Listings from approved testingagenciesfor all .Pre,qanufacture-d-,.r,--ducts'used shall 6e , available on-site to review at the time of the nspec_m. c. Proper spark arrestor installation, vents painted, gutterldo.xnsvouts install eck, de ris removedi. NOTE: If yTou call for a tear -off or plywood nailing inspection and the -work- is not complete,. vou will be charged a re -inspection fee. The re -inspection fee shall_aid before anotherins�e&i6n Iaii be scheduled. j! By my sigiiingluelow,1cartfify each of the followipp, is trine: .11 am the property o1- erora t o edkeiit to;acv6n the S p"t, o,,vner's behalf. .1,understand and agree to comply \mith the, re roof policy stated above. 1 al'o undo stl 3d trim n� -e ui re o ie Installed d t E sial e e q q in accord ditectoi§an 't. W ance tvit Sections k3 14;"d 8315of end. bid the 201 6 Califbi MI:6: H I PeroqlPolicv 2014,'dqc revised 06 01`7 o33 SMOKE / CARBON MONOXIDE ALARMStoILI , OWNER CERTIFICATE OF COMPLIANCE h! int COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE• CUPERTINO,CA 95014-3255 CUPERTIi,' O (408)777-3228.FAX(408)777-3333•buildinoCo?cuoertino.orq TS .EIt"_' I -l = l1Ei2Tii+`i1iS':B�i r��-r:��,_.x •:u::�'?s ':, ��i- '�e:•�����;�,:���.fax=;��?� �" " -��i�'' .._ 'S�.-�^'>''"��'{>`= tF3^- _ igzC� �aa�- "" - - -i?v'�:t. - i�°y*�� :.:',���„, 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 8314 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 unitincluding 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_S_ection R314 and CBC Sections 907.2.11.4 and 4206.2.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 j Address: I U b 10 Pie. 11( ri ut l Lil."i{ Are.1 Permit No.2-0 Specify Number of Alarms: #Smoke Alarms: ! (p ! #Carbon Monoxide Detectors: 5— I I have read end agree om ly with the terms and conditions of this statement Owner(or Owner Agent's)Name: Signature ..... Fte: Contractor Name: Signature Licit Date: Smoke and CO form.doc revised 12/15/16