B-2017-1289CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-1289
940 PROVIDENCE CT CUPERTINO, CA 95014-4028 (356 11 057)
T D ROOFING INC
SAN JOSE, CA 95111
OWNER'S NAME: TSUCHIDA THEODORE H AND CYNTHIA BUYCO
DATE ISSUED: 08/04/2017
OWNER'S PHONE: 4087857-8205
PHONE NO: (408) 892-8872
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class C-39 Lie. #$45591
Contractor D ROOFING INC Date 08/31/2018
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 ofthe Business & Professions Code and that my
license is in full force and effect.
JOB DESCRIPTION:
REROOF; REPLACE OSB WITH 30# FELT AND NEW COMPOSITION
I hereby affirm under penalty of perjury one of the following two declarations:
ROOFING (2900 SQ FT).
t. I have and will maintain a certificate of consent to self -insure for Worker's
as provid4for by Section 3700 of the Labor Code, for the
Compensationofthe
performance f the work for which this permit is issued.
0-
I have and wimaintain Worker's Compensation Insurance, as provided for by
Section 3700 Labor Code, for the performance of the work for which this
Sq. Ft Floor Area:
Valuation: $14890.00
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
APN Number:
Occupancy Type:
and state laws relating to building •construction, and hereby authorize
356 11 057
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 regulations per he u ertirio Municipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
J
Signatu Date 8.4.17
Issued by: SEAN.HATCH
Date: 08/04/2017
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
r. I, as owner 6f 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;!Busmess &',Professions Code)
2. I, as owner;of the property, Am exclusively contracting with licensed
Signature of Applicant:
contractors to construct the project (Sec.7044, Business & Professions Code).
Date: 8.4.17
I hereby affirm under, penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
t. I have and will mainCertificate tificate of Consent to self -insure for Worker's
Compensation;las provided'forlby Section 3700 of the Labor Code, for the
performance of the work',foT which this permit is issued.
HAZARDOUS MATERIALS DISCLOSURE
2. I have and will maintain Wo`rker's Compensation Insurance, as provided for by
I have read the hazardous materials requirements under Chapter 6.95 of the
Secfron:3700 of the Labor Codefor the performance of the work for which this
California Health & Safe, ty Code, Sections' 25505, 25533, and 25534. I will
permit is issued. • 1. ;
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
:
3. I certify, that in'the perfor mance of the work for which this permit is issued, I
Health &Safety Code, Section 25532(a) should I store or handle hazardous
i
shall not employ any person m any manner so as to become subject to the
material. Additionally, should I use equipment or devices which emit hazardous
Worker's Compensation laws; of California. If, after making this certificate of
air contaminants as defined by the Bay Area Air Quality Management District I
'
will maintain compliance with the Cupertin Mu i al Code, Chapter 9.12 and
exemption, I becomesubject to; the Worker's Compensation provisions of the
the Health &Safety Code, Sectio 2 25533, and 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked,
Owner or authorized agent:
APPLICANT CERTCATION
IFI
Date: 8.4.17 4:;
I certify that I have read this application and state that the above information isLENDING
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 pr'o`perty 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,Pe�mit. 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.
Signature Date 8.4.17
Licensed
Professional
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 FX
(408) 777-3228 • FAX (408) 777-3333 • buildinaCdcupertino.org
PROJECT ADDRESS,� r o ��` r�
`�/�
Q'
\PN #
✓ :J (
OWNER NAME 1
P .6 �
ESL
STREET ADDRESS �` r per, �7�
� t� i7c+'1 ejl
CITY(�T I ZIP
v�
FAX
CONTACT NAME j L.,
VV P7 9,J
ARCHITECTIENGINEERNAME
�l�' 'p�Mp
p_ -tL
Vg � C� � � L&AIL
STREET E� T(i-A, &'j ='
S ��E, ZIJ-- . q Sal (f
FAX
'❑. OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT NICONfRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACT M'
f P
V
MCENS B .R_�_g__C
LICENSP
BUS. LIC; N
COMP. Y
STREET ADDRP55") _
C w!-
��
E-MAIL
Cl�'Y/STATE, [. P V ()
FAX
PHONE
ARCHITECTIENGINEERNAME
LICENSE NUMBER
BUS. LIC. #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF VJ SFD or Duplex
STRUCTURE: C'onlmercial
❑ Multi -Family
ROOF AREA:
VALUATION:
ReroofApp_2011.doc r'evise(l 03/16 °l T
R 1
IN I
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
10300 TORRE AVENUE - CUPERTINO, CA 95014-$255
(408) 777-3228 - FAX (408) 777-3333 building( cuoertino.org
PROJE�I�S ` ,� / �o
(J V
/1 �
vPHONE
APN
OWNER NAMES
N
E-MAIL
STREET ADD SS�� 0
Vw
CITY,&fIP
FAX
CONTRA /rPAM®
/
LICENSE . ER
LICENSE TY _ �
BUS. LIC. k
COMPAN Y NAME
E-MAIL
FAX
Star JJ
CSTATE, Zip,
&Cf
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 Pp to one business dad before the requested inspection date.
To schedule inspections call (408) 777-3228 from 7:30-3.:30pm (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 out to the
job site within one hour. The hours for this service are: 7:30-10:30am and 12:30-3:30 (Mon -Tours)
and 7:3040:30am 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 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/4" 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/teay-off or plywood nailing inspection and the work is not complete, you will be
charged a re-inspectioie re-inspec ' e shall be paid before another inspection can be
scheduled.
J
'By my signing below, I certify eac of the (lowing is true: I am the property owner or authorized agent to act on the
property owner's behalf. I under and a ee t comply with the re -roof policy stated above. I also understand that
smoke detectors and carbon monoxide detec its infrequired to be installed in accordance with Sectio s R314 and 8315 of,
the 20.1 .6 California Residential Code.
Signature of Apolicant/Aeent: /'---
Date:
Rer00%Policy_2014.doc revised 061111✓7
SMOKE / CARBON MONOXIDE ALARMS ILE
( OWNER CERTIFICATE OF COMPLIANCE d
4r.tts. ;< COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
4.
SUP RTI Ct 10300 TORRE AVENUE• CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333• buildinq(a cuoertino.orq
PERlYiIT CANNOT BE FI ALED-UNTIL=THIS CERTIFICATE;F AS.BEEl
X11 Ptati)l SIGNED :AND
... PETURNET3 TO TIE;BUIIX4l\TG DIVISION
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 yi
Address• ctO f'roo,{ YtL L4 L i f/1 ` M4,1f- 'S O!1 Permit N41 1121
Specify Number of Alarms: #Smoke Alarms. I 1 I #Carbon Monoxide Detectors I 2
I have read and agree to f',rnply with tlae terms and conditions of this statement
Owner(or Owner Agent's)Name:
too ' N= � �(d � Signature. ... . . .. . . fit
••, Date:11/42017
Contractor Name:
Signature Lic.# Date:
Smoke and CO fonn.doc revised 12/15/16
WATER-CONSERVING PLUMBING FIXTURES '.� 1LIE
0 OWNER CERTIFICATE OF COMPLIANCE
4, g COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
CUPERTINO 10300 TORRE AVENUE• CUPERTINO,CA 95014-3255
(4077
)7 -3,228• (40f)777-3333•buildincq(a�cuoertino.orq.
Owner Name I 1 0 - cal vt ‘Gt. ( S U c4A, " Permit N o. �1 7� I"2
Address LID p(pvi amce, C Co'peg-h.-A' A , C i 1 q 5Q
1.- Is your real property a registered historical site?
❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
No 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 1101.8 do not apply.
❑ The licensed pinmber's certification has been provided to the Building Division.
Skip the rest of the form and sign bottom of form.
XN0 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 form and sign bottom of form.
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 form and sign bottom of form.
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..
5. 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 hnprovements).
❑ 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-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).
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 1101.1
through 1101.8,the current.California Plumbing Code and California Green Building Standards Code,and manufacturer's
installation requirements,and that the w ter-conserving plumbing fixtures comply with the requirements as indicated in the
table on the following page.
Owner or Owner Agent's Signature: 1. /X — Date: 911)101,7
Upon completing and signing this 6,dlicate,ulease return it to the Building Division in order to final your building permit.
SB407 2015.doc revised 01/05/17