B-2017-1295CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-1295
10313 RICHWOOD DR CUPERTINO, CA 95014-3374 (369 08 050)
WESTSHORE
ROOFING INC
SAN JOSE, CA 95131
OWNER'S NAME: IWATSUBO MELVIN M AND AKEMI TRUSTEE
DATE ISSUED: 08/07/2017
OWNER'S PHONE: 408-996-7603
PRONE NO: (408) 456-0200
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class CC39 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 COMP SHINGLES (28 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
40
Section 3700 of the Labor Code, for the performance of the work for which this
Sq. Ft Floor Area:
Valuation: $15579.00
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
369 08 050
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 the Cupertino Municipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
II a Date 8/7/2017
Issued by: Jasmine Archbold
OMM&BUILDER DECLARATION
Date: 08/07/2017
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 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 property, am exclusively contracting with licensed
S' ofApplican
contractors to construct the project (Sec.7044, Business & Professions Code),
e. /7/ 7
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 andwill 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 material's 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.
,/%
O uthorized age "
APPLICANT CERTIFICATION
' 8/7/2017
I certify that I have read this application and state that the above information is
CO TR LEA E Y
correct. I agree to comply with all city and county ordinances and state laws
I hereby affirm that there i struction 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 8/7/2017
Professional
REROOF PERMIT APPLiCATI.ON
'COMMUNITY DEVELOPMENT DEPARTMENT,. -
10300 TORRE
EPARTMENT.-10300-TORRE AVENUE • CUPERTINO,-CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 - buildlnt AcWrtino.orq
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PROJECT ADDRESS
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CONTACT NAME(
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�❑ OWNER I ,OWNIER-13u1LDER ❑ OWNTR.AGENr .O.'VTRACTOA ❑CO`TRACTORAGENT- n ARCHM& a ENGINSER ❑ DEVELOPER, ❑ TENANT ;
C ACrO N tE LICEN SN M EA LICEN. T'S' BUS. LIG, #
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D R SS • Cir,;em7 : P S� ) PHONE
ARCfuTECrr't;-YGtNEER\G1hiE LICENSE.NL"hJiBER.. ( BhS. LIC. k
COMPANYNAME E FAX
STREET ADDRESS CITY, STATE; LIP PHONE
USE OF ' ST -B or Duplex M41ti-Family ROOF AREA- VALt:ATION�
srRCCrURE% O Commercial
EXISTuNG.ROOF. TYPE: ❑BUILT-UP ROOF :SPHALT'SHINGL-ES 11 WOOD SHAKES ZWOOD.SHINGLES ❑0'i'HEk(SPEC}FY) ,
RERIOVE IREPLACE : YES IF NO, PLYWOOD � get �:i" -❑ PS Ii;W 'OSB PITCH ROOF '
NO # LAYERS THIM4ESS: -.5,1- TYPE. :CDX ' 1.2 CL&, S' '
PROPOSED KOOFTYPE: ❑
BUILT-UP ROOF ASPHALT SHINGLF_S ❑ 14'OOD SHAKES L� WOOD -SHINGLES.' ❑OTHER
ICC -ES RE[ ORT ft
DESCRiPTI01� OF. WQitt(' 1 o -•C/ ✓ ) Y K . `IY:/ fi1� - I O5 � l V l �/
By my signature belovr I eertifq to each afthe following i afn'the: property o�vtier or autForized agent to. act on the property oi4tter's:belzalf. I.have read this
application and the; I l ' p viMise . 1 have.read the Descciption of Work and uenij .it is accurate: 'I agree tocomply with all applicabte_tocal
ordinancesand state laws gelatin bui ititi lauthorize representatives ofGupettino tri+ nte'rihe ahoye-ide tifyied_' .ropert for inspection.purjroses..
Signature o' p antlAgc Dare:
[SU.PPLELIENTAL INFOR iON I2EQt1IRED' x '
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Ifbuildtng is.associated with allome Owner's Association provide lever P} tetterf[Tvee kG[rrlttiGSLtIy
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Provide.Planning approcal.to tidit'v ifthere any restrictions. Q` xaPaEss: a 43tNlRGPt 1 of H7 1Y;'
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.Provide -copy Of Manufacturers Installation Specifications. Q` STAN0.1xRD''°' +;s -J 'mak; £ ❑ P�t�j'DEP7P` { jt : � �
Pro tide signed copAg
y of.Cupertina s Tear -Off P.oIicy. i
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--- REROOF TEAR -OFF POLICY
COMMUNITY DEVELOPMENT DEPARTI`4ENT B, ILDIN,G DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL -
03 P F_RT044P
10300 TORRE AVENUE-.CUPERTINO, CA 95014 3255
(408) 777-3228 • FAX (408) 777-3333 • building@ciiDertino:org'
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OWNER NANIM �i ,'� ('y , „` PFIONE �j
TR ET ADp SVS `\/ �!/' CITY, STATE, �P a / (� (� (/ ` FAX
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1 UNDERSTAND AND AGREE TOT .FOLLOWING:
1. The re -roof project shall comply with all applicable pro`Tisons of the 2016 California Codes.
?. An _inspection request can be scheduled up to one business day:before,'the requested inspection,:date
To schedule,inspections call (408) 777-3228 from' 7:30 3 3Opm (Vlori-Thurs) iii 7:30-2:3"Oprn (Fridao'to
schedule inspection. For Tear -Off and: Nailing Inspections, �o must.also call. on; the day of the
inspection only after that phase of the work is coinpWe d Tl e: building inspector will be out to the
job site within one hour. The hours for thisservice are 730 10.30aan and 112::30-3:30 (Ion--Thtars)'
and 7:30-t0:`30am and 12:30-2:30 .(Friday). Final Inspeetians - i11 e given :a two hour window,
3. Tear-Clff llnspeo-tion.ia .required. Any and all dry -rotted �vood';shall be replaced prior to this inspection.
t1iilss new plywood root sheathing is proposed throughout, all tiae Heals/fasteners shall..lbe either
cowpletely.knocked-down or.'regnoved Drior to,this inspectioir:
4. If plywood is installed, a plywood Nailing Inspection ts. regiaired
5. Roofing shall not be applied without -first obtaining all prier inspecti - 'and written approvals from the
building inspector. Any roofing which is applied without :fist obtaining an approved "inspection will,
require the removal of all new material down to the sheatizng so. a proper inspection can be performed.
6. A ?Final iaasection and agnroval shall be.obtained Born the building inspector when the re roofrig;is
completed. To teeeivea f"uial sign -off, the fallowing items vs5i11 "be , ti d:
a. .Flat roofs shall have a minim in of 1/41' perfoot of slope,<and demonstrate there is no ponding.
b. Listings from approved testing agencies foi all pre niariufactured products used shall tie
available on-site to review at the time of the inspection.
c. Proper spark arrestor installation, vents painted,.gutter/downspouts installed, debris temoved:
i. NOTE: If you call for a tear -off or plywood nailing inspection. and the work is not complete; you will lie
charged a re=inspection fee. The re -inspection fee shall -be paid .before another insnectiori can -'be
sehedufecl:
By my sighing below, I certify each of the following is true: 1 atr t. p -property owner or authorized agent to act on ilia
pI cperty ournei's iehalf -, I underst d and as ee to comply with fihe ra-i onfpollcy staled above I also understand that
srrioke detectors and carrion no i e det to a raga;red to"oe installed in accordance with Secttans 314 and R315 of
the2015 Calrforn'a Reside tial od ;
Sxgnatur,"of`AppiicantfAgerit Date
ReroaJPolicy_Z014.doc revised 06`0117
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\ 1/ SMOKE / CARBON MONOXIDE ALARMS QF I E
4 �3IPr
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CUPERTINO fltilO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333•building a(�,cuoertino.orq
T-01, ITT CANNOT iNOT t FINAli4D U TM THI$CgRI t 1CATT IFAS$ lit
CO 1 TR;I}-;g1C NEDe 4ND,RL+``I URNED TO RIII 0 G I SION
PURPOSE a_
This affidavit is a self-certification for the installation of all required Smoke and Carbon Monoxide Alarms for
compliance with 2016 CRC Section R314,R315,2016 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,R315,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 I
Outside of each separate sleeping area in the immediate vicinity of the X X
bedroom(s)—(Smoke alarms shall not be located within 3 feet of bathroom door)
On every level of a dwelling unit including basements and habitable attics 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,alarms)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 907.2.11.4 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
Address: dG,313 r,Mteoa1 �✓/ £ -/w A/t D ij•2 0t7/ Z,q J
Permit No.
Specify Number of Alarms #Smoke Alarms. 116111
#Carbon Monoxide Detectors. M'
I have read and agree to comply with the terms and conditions of this statement
Owner(or Owner Agent's)Name:
Signature Date:
Contractor Name:
Signature../7°.
Lic.# /7:7 Z . Date:
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Smoke and CO form.doc revised 01/10/2017