B-2017-1382CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2017=1382
1334 S STELLING RD CUP-ERTINO, CA 95014-5204 (366 11 102)
JIM HAGEMAN
ROOFING
SAN JOSE, CA 95131
OWNER'S NAME: LUIZ LAWRENCE J TRUSTEE
DATE ISSUED: 08/18/2017
OWNER'S PHONE: 408-252-7028
PHONE NO: (408) 910-9190
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERNHT INFO:
License Class CC=39 Lic. #685760
Contractor JIM HAGEMAN ROOFING Date 01 /31/2019
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; COMP SHINGLES (31 SQ
I hereby affirm under penalty of perjury one of the following two declarations:
m. 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
p rformance of the work for which this permit is issued.
I liave 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: $17750.00
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 Iaws, relating to building construction, and hereby authorize
366 11 102
representatives of this, city to enter upon the above mentioned property for
inspection,'purposes. (We) agree tosave 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.
gnaure Date 8/18/2017
Issued' by: Abby Ayende
OWNER DECLARATION.
Date: 08/18/2017
-BUILDER
I hereby affirm that I am exempt from the Contractor's License Law for one of the
RE -ROOFS:
roofs shall be inspected prior to any roofing material being installed. If a roof is
following two reasons:All
t. 1, 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
i lic ature ofApp_
cont . contractors to construct the project (Sec.7044, Business & Professions Cod
i
Date: 8/18/2017 '�
I hereby affirm under penalty of perjury one of the following three declarations:
1have will maintain Certificate of Consent to self -insure for Worker's
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
1. and a
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
permitis issued.
maintain compliance with 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
Worket's'Compensation laws of California. If,, after making this certificate of
air contaminants as defined by the Bay Area Air Quality Management District I
Chapter 9.12
will maintain compliance with the Cupertino Municipal Code, and
exemption, I'become subject to the Worker's Compensation provisions of the
the Health &SafetyCode, Sections 25505, 25533, and 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked. d,
a wn r or authorized agent
APPLICANT CERTIFICATION
Date:, 8/18/2017
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
o building ;construction, and hereby authorize representatives of this city
relating to,,
of work's for which this permit is issued (Sec. 3097, Civ C.)
to enter uponithel 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
consequenceof !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 8/18/2017
Professional
PIZ 0.YKT ADDRESS
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
ALBERT SALVADOR,. P.E,, C.B.O., BUILDING OFFICIAL
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255.
(408) 777-3228 - FAX (408) 777-3333 - buiIdin_q0_cuDerfino-.oLg
OWNER NAIAE
PHONE
A ?NNi 64 , Ili l�2
STRIECT ADDRESS
Y 3_3 L/
CIT) TATE, ZIP
FAX
CON I R WR NAV�V
114 AMIm
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' NI WER LICINSETYPE
LACE"N M, N
BUS. LIC. 0
COMI)AA ' INAME
E-MAIL
FAX
STREET ADDRE
C I T� Y STATE �MIP L
I LNIDERSTANID AND AGREE TO: TI -IF, FOLLONVING:
I The re -roof prQject shall comply with all applicable provisions of the 2:016 California Codes.
2. An inspection request can be scheduled up, to one ,busineg.day befqrgther�quested inspection. date'.
To schedule inspections call (408)- 777-3228 6orn. 7310-3`30,pip. or. 71 :50-2-30pm (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 comp feted..'The building inspector will be out to the
job site within one hour. The hours for this service are: 17 0-.1,0:30am and 12:30-3:30 (Mon-Thurs),
and 7:30-1.0:30am and 12:30-2:30 (Friday). Final Inspections will. be given a two hour window.
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 thioucgrhout, all the nails/fasteners shall be either
completely knocked -down or 'removed prior to this. inspection.
4. If plywood is installed, a.. pJvwood Nailing Inspection is EtqLdred-
5. Roofing shall not be applied w-ithout first obtaining all.prior- inspection and writt&n 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 inspectioncan be perfornied.
6. A Final-Insy ! )ection,and-approval, shall be obtained *'froiii...tlie:.b.uildi.ii,.g inspector when the re -roofing is
completed. J'o receive a'eln' a4sig-n--off, 6.6 following 4terins4ill be verified.
a. Fiat roofs shall have a minimum of 1/4" per foot of slope and demonstrate. there is no ponding.
b. Listings from approved. testing agencies for all. pre;rniawfactured products used.'shall be
available on-site to review at the time of the inspection.
c. Proper spark. arrestor installation, vents painted, ,c:,,titter/doNNii.spouts-iiis-tall:ed., 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 e paid before'another inspection can be
Scheduled.
By niy signing below, I certify each of the following is true: I ain'the prol.iert3towner cirautJioj,ized Agent to act on the
propertyowner's behalf. I understand ud agree to comply with the re -roof policy stated above. I also understand that
sinoke detectors and carbon monoxide detectors are required . ired to be installed in accordance with Sections 8314, and R3 :� 15 of
the 2016 California.Residential Code.
Date: X
RaroqiPolicY...2014'. doc revised. 06/01 -7
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • building@cupertino.or PEMIT #B -
CUPERTINO REV # DEF #
❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION ❑ T.I. ❑'MEP MME -ROOF ❑ SWIMMING POOL/SPA
PROJECTADDRESS
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OWNERN/PHONE
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CONTRACTOR NAME []OWNERY-fJMDER, COMPANY
NAME
LICENSE NUMBER LICENSE
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STREET ADDRESS
CITY, S ZIP %
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❑ARCHITECT ❑ OWNER ❑ OWNER AGENT ❑ CONTRACTOR AGENT El ENGINEER ❑ DEVELOPER ❑ TENANT
CONTACT NAME
E-MAIL
STREET ADDRESS
CITY, STATE, ZIP PHONE
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SINGLE-FAMILY/DUPLEX ❑ MULTI -FAMILY []INDUSTRIAL ❑ COMMERCIAL
USE
TYPE
OCC
SQ. FT.
VALUATION ($)
EXISTING USE
I EXISTING SF
NEW FLOOR SF
PORCH
SF DECK SF
DEMO SF
STORIES #
TOTAL NET SF
REMODEL `
REMODEL KITCHEN
REMODEL OTHR GARAGE
❑ ATTACHED
BATHROOM SF
SF i
SF SF
❑ DETACHED
EXISING YES
SECOND STORY ADDITION
FIRE SPRINKLERS ❑ NO
EICHLER No
OYES
NO
DWELLING SECOND DWELLING ❑ YES ❑ ATTACHED [I DETACHED` OTHER
UNITS # UNrr ADDrrON: ❑ NO SP
POOLS ❑ FIBERGLASS ❑ VINYL -LINED ❑ GUNITE ❑ PREFABRICATED
POOL - SF SPA - SF SPA ATTACHED ❑ YES N NO TOTAL - SF
Commercial ar Mu1N-Familu Buildings with Public 5¢vimminn Pools requires Department o(Enviranmental Heath approval
RECUJVED BY:
TOTALLUATTON:
CS �v
J
RE -ROOF
TINGEXLSROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLESWOOD SHAKES ❑
WOOD SHINGL S ❑ T[LE OTHER (SPECIFY)
REMOVE /REPLACE Q NO
IF NO
/
I
PLYWOOD ❑'h" E13/8- PLYWOOD
TYPE:
PITCH:
12
ROOF CLASS
YES
# OF LAYERS
THICKNESS ❑ 5/8" OTHER
❑ OSB ❑ CDX OTHER
•
A
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF AASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER
*Provide a signed copy of the Cupertino's Tear -Off Policy SF 31 #of SQUARES 3
By my signature below I certify to each iof 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 laws relating to building construction. I authorize representatives of Cupertino 'to
enter the above -identified property; for inspection purposes. I acknowledge and authorize all information contained on this application form
to be made available for public record.
1 -7
�y!
Signature of Applicant/Agent: Date:
-
SUPPLEMENTAL INFORMATION REQUIRED
*New SFD/Second Dwelling Units/Muliifamily Dwellings: A Demolition permit 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.doc revised 08101117
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
4�9 COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE• CUPERTINO,CA 95014-3255
CUPERTINO
(408)777-3228•FAX(408)777-3333• buildino cupertino.orq
,,
i &PERMIT CANNOT BE FINALED UNTIL�THIS CERTIFICATE BAS BEEN ��
tel, �
r • °�sCOMPLEETED,*SIGNED d ',�.RETURNEDTTO THE`B�UILDID
NG Iy ION
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 v_ icinity 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 alarin(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. Sip
Address: 3 31� S, 1 e-1. I!✓l- Q,1 } cLiPekt y)d Permit No. . ZCj 302
Specify Number of Alarms: #Smoke Alarms: 3 I #Carbon Monoxide Detectors: (9 , I
I have read and agree to co p with the terms and c`ofiditions of this statement
Owner(or Owner Agent's)Name:
Date9 4'
aGo •cQ 2_1)1)2- Signatu -.
Contractor Name:
Signature Lic.# Date:
Smoke and CO fonn.doc revised 12/15/16