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B-2017-1398CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-1398 21601 FITZGERALD DR CUPERTINO, CA 95014-1227 (326 47 041) M D C ROOFING SAN JOSE, CA 95151 OWNER'S NAME: CHUNG CHING-WEN AND CHEN HUI-CHUAN OWNER'S PHONE: -- LICENSED CONTRACTOR'S DECLARATION License Class ROOFING Lic. #807881 Contractor M D C ROOFING Date 02/28/2018 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: 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 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 buildingconstruction, 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 inconsequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per a Cupertino Municip de, Section 9.18. Signature . Date 08/22/2017 Alf I F-9 OWN R'B&DER DECLARO I I hereby affirm that am exempt from the Contractor's License Law for one of the following two reasons: t. 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.7044i Business & Professions Code) 2. I, as owner of the propeity, am exclusively contracting 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: 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. z. 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. 3. 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. 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 mention4property for inspection purposes. (We) agree to save indemnify andi 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 per the Cupertino Municipal Code, Section 9.18.. Signature Date 08/22/2017 ISSUED: 08/22/2017 PHONE NO: (408) 8584377 BUILDING PERMIT INFO: X BLDG —ELECT _ PLUMB _ MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: RE -ROOF; TEAR -OFF; INSTALL OSB; COMP SHINGLES - (35 SQ) Sq. Ft Floor Area: I Valuation: $22000.00 APN Number: Occupancy Type: 326 47 041 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Kim Dunbar Date: 08/22/2017 RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to re a all new materials for mspecti Af Signature ofApplican Date: 08/22/2017 ALL ROOF COVERINGS TO BE CLASS "A" OR -BETTER 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 Municipal Code, Chapter 9.12 and the Health & Safety Code, Secti s 25505, 2553 an i Owner or authorized agerr Date: 08/22/2017 CONSTRUC ON LEND C I hereby affirm that there is a construction lending agency for the performance 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 (408) 777-3228 • building@cupertino.org PEMIT #B - 11 - CL)PERTINO I REV# DEF# F-1 NF.W CONSTRUCTTON n ADDITION n ALTERATION n T _ n MF.P 1�i kE-ROOF n SWIMMING POOL/SPA In] PROJECT ADDRESS --K N 3 2 & OWNERNAME PH E E-MAIL 1C -141 STREET ADDRESS Cri7, TATE, ZIP CONTRACTOR NAME ❑ OWNER -BUILDER COMPANY NAME LICENSE NUMBER LICENSE TYPE r 8® 4 STREETADDRESS C TATE, ZIP I I E-MAIL tNE BUS. LIC #' ❑ ARCHITECT' ❑ OWNER ❑ OWNER AGENT ❑ CO ACTOR AGE ❑ENGINEER [I DEVELOPER [I TENANT CONTACT NAME E-MAIL STREET ADDRESS CrIY, STATE, ZIP PHONE DECRIPTON � lin ® S - 5 -SO tL ) G. 4©-D T V i 'SINGLE-FAMILY/DUPLEX , .❑ MULTI -FAMILY ❑ INDUSTRIAL ❑ COMMERCIAL USE TYPE OCC SQ.FT. VALUATION ($) EXISTING USE. EXISTING IF NEW FLOOR SF1 PORCH IF DECK IF I DEMO IFTOTAL NET IF REMODEL REMODEL KITCHEN REMODEL OTHR ❑ ATTACHED BATHROOM SF SF SF ❑ DETACHED EXISING ' [I YES EICHLER ❑ 'YES SECOND STORY ADDITION FIRE SPRINKLERS E] NO ; ❑ ; NO ODYES NO DWELLING SECOND DWELLING, 0 YES ❑ ATTACHED ❑ DETACHED OTHER UNITS # UNIT ADDITON: ❑ NO; i IF I POOLS ❑ FIBERGLASS ❑ VINYL=,LIIJED ❑ GUN= ❑ PREFABRICATED POOL - IF SPA - IF SFA1 ATTACHED []YES N NO TOTAL - IF RE D B L jZALUAI I©N: Commercial or Multi-FamilyBuildings B�ildinQs vrith.PuhliaSToimmitte Pools requires Department of Environmental Henthayproval �G RE -ROOF EXISTING ROOF TYPE: ❑ BUILT-UP ROOF ❑ ASPHALT SHINGLESfc 'WOOD SHAKES ❑ WOOD SHINGLES ❑ TILE OTHER (SPECIFY) REMOVE /REPLACE ❑ NO F NO IIF PLYWOOD Kh" ElPITC 3/8" PLYWOOD TYPE: H-. ROOF CLASS YES I # OPLAYERS' THICKNESS ❑ 5/8" OTHER OSB ❑ CDX OTHER A PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER *Provide a signed copy of the Cupertino'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 laws relating to building construction. I authorize representatives of Cupertino to enter the above -identified property for inspeAon purpos ac a ge and authorize all information c ntame on this application form to be made available for public req J Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION' R QUIRED *New SFD/Second Dwelling Units/M I1 •family 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 08101/17 COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDINGOFFJQIAL 10300 TORRE AVENUE - CUPERTINO, CA 950.14-3265 (408) 777-3228 - FAX (408) 777-3333 - building.CcDcuperting.o[g b, PROjECTADDRIESS APN` 01ANfER NAME L . . . .... . .. . .... ZIP FAX CONTRACTOR NNAMELICENSE NUMBER BUS. LIC. 0 41 V.N J�ie (y _79 COMP. VY NAME &IMAI FAX Vf Ck kol". STRELFT 1DDRFS9 CITY, STATE, ZIP I UNDERSTAND AND AGREF TO; THE FOLLOWING: I. The re -roof projject shall 1 comply with all applicable provisions of the 2016 California Codes. 2. An inspection request can be scheduled ug,. to one business ;,day ,before the-reguested juspection.d.ate.. 'Thw,-�) or 7. 30pm to I ro schedule inspections call (408) 717-3228 from 7:3073", nzi -10-2:D (Friday schedule inspection. For T ear -Off and, Nailing, Inspectipo§`,.Boit must also call on, the day of the inspection. only after that phase of the work is comet -The building inspector. will. be oa to the job site withinone hour. The hours -for this service are: 7:3044:30ani. and 1,2:30-3:30 (Mon-Thurs), and 1:30-1.0:30ani and 12:30-2:30 (Friday). Final Inspections will. be given a two hour window. 3. Teair-Off Inspegtion is required. Any and all dry -rotted wood shall be replaced prior to this inspection. U"nless new plywood roof sheathing is proposed throughout, all the nails/fasteners shall be either c6nipl6tely knocked -down or removed prior to this inspection. 4. If plywood is installed, a. plywood Nailing Insnection-is regaired., 5. Roofing shall not be applied without first obtaining all.prior-inspection and written approvals from the building inspector. Any roofing which is applied writhotit first; obtaining -an approved inspection will reqLiire the removal of all new material down to'the, sheath . ing so a proper inspection. can be performed. 6. A Final Inspectionondapproval shall be obtained .*ftorii;.the_-,buildit rr inspector when. the re-Toof Ing is d: rece nat �i off, th6 fbltowing.ije�.1 b v ifie coi-ap cidd. T,'o ive a fi Ign,,�� - a.. Flat roofs shall have a minimum of 114." per foot.of slope and-demonstiate there is no ponding. b. Li..sting$ from*approved testing agencies -for all pre-manufacturodproducts used. shall be available on-site to review at the time of the inspection.. c. Proper spark arrestor installation, vents painteo., gutter/downspouts: installed, debris removed. 7. NIOTE: If you call for a tear -off or plywood nailing inspection. and the work is snot complete, you willbe charged a re -inspection. fee. The re -inspection fee -shall-be paid before another inspection can be scheduled. By my signing below, I certify each of the following is true: I am the property, owner or authorized agent to act oil tile ,p -1 derstand that propertyowner's behalf. I understand and agree to comply with the re -roof policy st, ted above., I also tin 'C o -,e snP6 ke deter and cabon-Mono,x1de, d teeters are i dt b installed in,accordanee witli Sections R314.and R315 -of . the 20 1 6'C'a`1 if6miaR, - 90e* z /)70-/177 I. esidentiaWA ReroqlPolicIv. 2014,doc revised 06'01/7