B-2017-1361CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-1361
10360 WALNUT CIR CUPERTINO, CA 95014-2738 (357 03 039) T D ROOFING INC
SAN JOSE, CA 95111
OWNER'S NAME: HSU FREEMAN AND CHEN MING MING
OWNER'S PHONE: 408-398-0699
LICENSED CONTRACTOR'S DECLARATION
License Class= Lic. #845591
Contractor T D ROOFING INC Date 08/31/2018
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:
t. 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
r 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. (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 pey th910,, pertino'Municipal Code, Section 9.18.
Date 08/16/2017
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
1. 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)
2. I, as owner, of the property, am exclusively coniracting 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:
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.
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.
s. 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. l 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,
judoments,-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.
Signature . Date 08/16/2017
DATE ISSUED: 08/16/2017
PHONE NO: (408) 892-8872
BUILDING PERMIT INFO:
x BLDG —ELECT —PLUMB
_ MECH 3X RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION:
RE -ROOF; TEAR -OFF- COMP SHINGLE (30 SQ)
Sq. Ft Floor Area: Valuation: $13000.00
APN Number: Occupancy Type:
357 03 039
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: Kim Dunbar
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an ins ectjon I agree to remove all new materials for
s c, on.
Signature ofAppliggt:
Date: 08/16/20171 1
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 Munici a Code, Chapter 9.12 and
the Health & Safety Code, Sections 2 505 2 533, and 25534.
Owner or authorized agenr "
Date: 08/16/2017
CONSTRUCTION LENDING A
hereby affirm that there is a construction lending agency�heperfor ance
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.
Licensed
Professional
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 ✓�� p
(408) 777-3228 • building@cupertino.org PEMIT #B -
CUPERTINO
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SINGLE-FAMI /DUPLE ❑ MULTI -FAMILY [:]INDUSTRIAL ❑ COMMERCIAL
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NEW FLOOR SF
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TOTAL NET SF
REMODEL
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GARAGE ❑ ATTACHED
BATHROOM SF
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EXISISPRINKLERS [I NO
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SECOND STORY ADDITION ❑ YES
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DWELLING SECOND DWELLING ❑ YES ❑ ATTACHED❑ DETACHED OTHER
UNITS # UNITADDITON: ❑ NO S F
POOLS ❑ FIBERGLASS ❑ VINYL -LINED ❑ GUNITE ❑ PREFABRICATED
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POOL - SF SPA - SF SPA ATTACHED ❑ YES ❑ NO TOTAL - SF
Commercial or Multi -Family Buildin s with Public Swimmine Pool a hires Devartment o Environrneutal Heath approval
RECEI BY: O4 VAI v C/
RE -ROOF
EXISTING ROOF TYPE: F]BUILT-UP RO PHALT SHINGLES ❑ WOOD SHAKES ❑
WOOD SHINGLES ❑TILE OTHER (SPECIFY)
REMOVE /REPLACE ❑ NO
IF NO
PLYWOOD E'h" ❑ 3/8"
PLYWOOD TYPE:
PITCH:
ROOF CLASS
YES
I # OF LAYE
THICKNESS ❑ 5/8" OTHER
❑ OSB ❑ CDX OTHER
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PROPOSED ROOF E: ❑BUILT-UP ROOF ASPHALT SHINGLES ❑ WOOD SHAKES ❑WOOD SHINGLES ❑ OTHER
*Provide a signed copy of the Cup rtin 's Tear -Off Policy SF #of SQUARES
By my signature below I certify to each of the following: I am the property owner 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
to comply with all applicable local ordinances and state law relating to building construction. I authorize representatives of Cupertino to
enter the above -identified property for inspection pur ses. cknowledge and authorize all information contained on this plication form
to be made available for public record.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INFORMATION REQUIRED
*New SFD/Second Dwelling Units/Multifamily Dwellings: A Demolition permi is required prior to issuance of a building permit for all new construction.
*Commercial Buildings: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project.
*Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application.
*HOA -Provide a letter of approval from the Home Owner's Association
BldgApp_2017.doe revised 08101117
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COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION
ALBERT "SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
10300 TORRE AVENUE • CUPERTINO, CA 95.014-32 55
(408) 777-3228 - FAX (408) 777-3333 • buiiding�Dcuoertino org
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T UNDERSTAND.AINTD AGREF TO T14F FOLLC}VgNG
1. 'Ilse re -roof project shall comply with all appli.cabl:e provisions. of the 2016 -California Codes.
2. An inspection request can be scheduled un to one business da before the.recluested inspection €sate,
f o schedule inspections call (4.03) 777-322'8 from 7 30 30pIn (, on-TlYurs or `7 30 .3t}pm (Ft Ida}r); 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 7:30-10:30ama and'i 1,1:30-3:30 (iltlo-Thurs):
and 7:30-1.0:30am and 12:30-2:30 (Friday). Final Inspections will be given a,two hour window.
3. 'rear -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 'ial be either
completely knocked -down or removed prior to this inspection. r
4. If pl nvood is installed, a, plywood Nailing htspection is :regalred..
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 anopproved inspection will.
.require the removal of all now material down to the sheath,Iio ;so a proper inspection. can.. b6 performed.
6. A Finai nspection and approval shall be obtained'frc rn the building inspector when theire= oof ng is
completed. tlo receive a final sign -off, the following tte rls willbe verified:
a. Flat roofs shall have a minimum of.'/a" per foot of slope and, dem onstraw there.!is no ponding.
b. Listings from approved testing agencies for all pre. manufactured troduc s used ;sliall 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 com�rlete, you will be
charged a re -inspection. fee. The re -inspection fee shall be paid before another inspection can be
scheduled. I'' "
By niy signing below, l certify each of the follov
property owner's behalf. 1 understand and agree
srhoke i detectors and carbon. monoxide detectors:
the 2016 CaliforniA :Residential Code.
true: 1 a)n• the property owner or authorized agept;to act on the
ly Witt) the re -roof policy stated above. Lalso uriderstand that
)e in tolled in accordance -with Seetions"R314. and RM 5 of
<9_ l' (k
Rerog1Po1ic.v_-2014-[IOC revised 06/0R7
2
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION _
CUPERTINO10300 TORRE AVENUE• CUPERTINO, CA 95014-3255
(408)777-3228•FAX(408)777-3333• buildino cupertino.orq
r, ups z'S sa z o ti l' d, - ''°`tt'^ v? t 5 a r` v, £ x''* N q
h 3PERMIT C,ANNOT-BE FIN.A'LED UNTILTH S ERTIFICATE=HA�S.�BEEN� i,
iZtE � eRvpLETE D,SIGNED RETURNEDg 'HE BU1I DING DIVISION .AK
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 907.2.11.4.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. r
Address: /0 3 6 0 W . 1'V1.�t t( Permit No. ��'�I 3 I
Specify Number of Alarms: #Smoke Alarms: I 10 I #Carbon Monoxide Detectors: I 2 I
I have read and agree to comply with the terms and conditions of this statement -
Owner • +wnerAgent's)Nam/e:�,
n r t7l i�ni e'1 WQI�/Yl Signature... f.. ,,... :. ...:� Date: /
114/
Contractor game: <0-02
Signature Lic.# Date:
Smoke and CO fonn.doc revised 12/15/16