B-2017-1415—
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-1415
21725 COLLINGSWORTH ST CUPERTINO, CA 95014-4708 (356 17 066)
R E ROOFING AND
CONSTRUCTION INC
SAN JOSE, CA 95124
OWNER'S NAME: MUHLSTEIN LADO JR AND ELEANOR TRUSTEE
DATE ISSUED: 08/23/2017
OWNER'S PHONE: 408-253-0945
PHONE NO: (408) 626-9320
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class C-39: B Lic. #Y27599
Contractor R E ROOFING AND CONSTRUCTION INC Date 09/30/2018
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:
REROOF; TEAR OFF; INSTALL CDX; COMP SHINGLES (30 SQ)
I hereby affirm under penalty of perjury one of the following two declarations:
m. I have and will maintain a certificate of conseni to self -insure for Worker's
ompensation, as provided for by Section 3700 of the Labor Code, for the
erformance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance, as provided for by
4
Section 3700 of the Labor Code, for the performance of the work for which this
Sq. Ft Floor Area:
Valuation: $22000.00
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 17 066
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.
Add)itionally the applicant understandsand- ill comply with all non -point
Ke
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
s regurtionss p -e -r -the Cn ertin'o N4luniciip I ode, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
nature.-_--" Date 8/23/2018 0 8
Issued by: Abby Ayende
OWNER -BUILDER DECLARATION
Date: 08/23/2017
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
m. I, as owner of the property, or my employees with wages as their sole
installedwithout t.obtahvng an ins`pectrton, I agree to remove all rie materials for
compensation, will do the work, and the structure is not intended or offered for1
inspec n.
sale (Sec.7044, Business &Professions Code)
�,'
k
z. I, as owner of the property, am exclusively contracting with licensed
e ofApplicant:contractors
to construct the project (Sec.7044, Business & Professions Code).
20..8 �.✓ _._
I hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
m. 1 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.
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
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 contam" as de ned by the Bay Area Air Quality Management District I
Worker's Compensation laws of California. If, after making this certificate of
exemption, I become subject to the Worker's Compensation provisions of the
wfll maintain compliance i hAi Cuperii Munici mol Code,-,- pter 9.12 and
lthe Health & Saf� Code Sections 505, 5533 ,and Z5� 4.
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed
\
\
revoked.10
caner or autho(Iized agent:, /
APPLICANT CERTIFICATION
Date: 8/23/2018 ---------- •.
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
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
Lenders 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
ARCHITECT2S DECLARATION
Code, Section 9.18.
1 understand my plans shall be used as public records.
Signature Date 8/23/2018
Licensed
Professional
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255`- �P � � J_
[a (408) 777-3228 • building@cupertino.or ; PEMIT #B - `-C
CUPERTINO REV # DEF #
n XTFW C'nMSTRTT('TT(lM ` n AT)T)mc)N n AT.TFRATTnm n T T n MP.P FI?VE-ROOF n SWIMMING POOL/SPA
PROJECT ADDRESS ^ 1 I -zi &% �� ` ^ `m^ _ ` �APNI
L 7 V V U'�/PH70,
Z� 7 1 �j C)
OWNER NAME
lug �ti6 I4�k�,
N E-MAILL'i
, �- z-oga5'
STREET ADDRESS 2-12S' &I - U V W
CITY, STATE, ZIP clw< M1I V l )
ONTRACTOR NAME ❑ OWNER -BUILDER CO')_
ANY NAME n , , �
� Jp NSE NUMBER LICE/N�SE
TYPE
STREET DS
1 �� +l A _ �
`4'
CI'T'Y, STATE, ZIP
\LIC
E-MAIL Y �(Vo d J h l V l p) ao 1..�
� ONI ' 1 (, ` 2-K 1 BUS. I7 V LU I
❑ ARCHITECT El OWNE_R OWNER AGENT NTRACTORAGENT❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTACT NAME�J�,U�-
EMAIL
o a
STREET ADDRESS /
i
CITY, STATE, ZIP f- q q I PHONV
J zc J ot _
DECRIPTON
eRow-, Ox�S-r J c' i dt- (1�yJ vCA)
IaTnL a,w �X 3.64 f—�TV',I�W1, 0,0M P,
❑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
I STORIES #
TOTAL NET SF
REMODEL
BATHROOM SF
REMODEL KITCHEN
SF
REMODELOTHR GARAGE
SF SF
❑ ATTACHED
❑ DETACHED
"
EXISING ❑ YES
FIRE SPRINKLERS ❑ NO
EICHLER ❑ YES
❑ NO
SECOND STORY ADDITION ❑ YES
❑ NO
DWELLING ISECONDDWELLING []YES ❑ ATTACHED ❑ DETACHED OTHER
UNITS # UNIT ADDITON: ❑ NO S F
POOLS ❑ FIBERGLASS ❑ VINYL -LINED ❑ GUNITE ❑ PREFABRICATED
POOL - SF SPA - SF SPA ATTACHED ❑ YES ® NO. TOTAL - SF
Commercial or.Mutti-Fanii[y Buildings wiEh Public Swimming Pools requires Department ofEnvir,�__�,onm,,,,e""""tt''''t''''aPHeath approval
RE I BY:
JT4A L VALUATION:
1 �1 IS�tR,
L �V V�J v
RE -ROOF
EXISTING ROOF TYPE: ❑ BUILT-UP'ROOF ❑ ASPHALT SHINGLE OOD SHAKES ❑
WOOD SHINGLES ❑ TI LE OTHER (SPECIFY)
REMOVE EPLACE 0 NO
YES
I IF NO
!! OF LAYERS
PLYWOOD 'h- ❑ 3/8" PLYWOOD
THICKNESS ❑ 5/8" OTHER
TYPE:
❑ OSB CDX OTHER
PITCH: Ci
, 2
ROOF CLASS
A
PROPOSED ROOF TYPE: BUILT-UP ROOF XASPHALT SHINGLES ❑ WOOD SHAKES ❑WOOD SHINGLES ❑ OTHER
*Provide a signed copy of the Cupeff n8's Tear -Off Policy SF #of SQUARE30 R �
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 thug ation I have provided is correct. I have read the Description of Work and verify itis accurate. I agree
to comply with all applicable local ordinal es arrd s a laws relating to uilding construction.. I authorize representatives of Cupertino to
enter the above -identified pro erty for inspe ', purpose -I clai le ' and authorize all informatiorf cont ined on this application form
to be made available for public .e`rd.
Signature of Applicant/Agent: ---' Date: U 111
SUPPLEMENTAL INFORMATION REQUIRED
*New SFD/Second Dwelling Units/Multifamily 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
B1dgApp_2017.doc revised 08101117
r
LM
•M 'R' .i .fit �. .,� i' .� `, i ;�, ..
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
ALBERT 5.ALVADOR, P.E., C.B.O., BUILDING OFFICIAL
10300 TORRE AVENUE • CUPERTINO, CA 85014-3255
(403) 777-3228 . FAX (408) 777-3333 a building tzcuperfin .org
PROJECT ADDRESS o ijj
AP's w
OWNER NAME
IU
h J � C:KII
Ll,(�1�c1YL %(Lt{�LS I yc�- zy;— 0JL ml�h(sqei � cC�Sfi,
S T F:UI TADDRESSI
2 11
- _...._.._
CITY, STATE. ZIP �(1 L1� (� FAX
CCR l J�,J nR_4 ( .
WiNtI*RA(:-I'OR NAME
��1
�IZc1L�k,
LICENSE NUMBERI'M S1, Typi_
271)— 1 �3� hj
aus. 1.1c.
�-e_ r noFAX
"} In U tx, Q_ 0..G (. C vr--�
(�
STREET rtDCucfi
iC
l i Lii(✓
A
CITY, ST. L(2,
PHONE q ()( �,2 b -
I LI�DERSTANTI) AND AGREE TO TI1.F FOLLOWING:
1. 'I'I-le re-roofpr(�lect shall comply with all applicable provisions of the 2016 California Codes.
2. An his'pection request can be scheduled tarp to (tragi lac€siness 1a laefot a the .rect€Iested inspection date.
ro schedule inspections call (408) 777-33228 from t.�(i� �t3pt�i 0,4on-Thttrs) car 7:30 ?.;3(ipm (Friday) to
schedule insp6ction. 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. Th.e building inspector will be out to the
job site within one hour. The hours for this service are: 7.3040:30am and 12:30.3:30 (l�� o-Thurs).
and 7:3€t-10:30an and 1.2:30-2:30 (Friday). Final: Inspections will be given a two hour window.
i.
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 plrvood 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 Nvhich is applied Nvi hoot first obtaining an approved inspection twill
require the removal (if all. new material down to the sheath.jpg so a proper inspection can be perfornied.
. A Final l:n Rection, and. approval shall be obta;it ed ftoiii the:.tbuild'i>ab inspector when the re -roofing is
completed. To receive a finial si&zn-off, the followrin' g i <erns will be verified:
a. Flat 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 pt'e.-manufactured. prod.ucts used. shall be
available on-site to review at the time of the inspection.
c. Proper spark: arrestor installation, vents paintecL gutter/downspouts installed, debris remov ed.
7. NIOTE: Ifvou call for a tear -cuff or plywood nailing inspection and the work is not complete, you will be
charged a re -inspection. fee. The re -inspection fee shalt_beF raid before another inspection can be
scheduled.
By rny signing below, I certify each of the following is true: I ani the property owiieT (?r autlioi-iz.ed agent to act on the
property owner's behalf. I understand and agree to comply with the re -roof policy stated above. 1. also understand that:
smoke detectors and carbon ntp. iT(?%I e . teetors a�reoequi.;ed,,,�e,i ts�btalled in accordance with Section ; R314 and R315 of
the X016 California Residenial Code! ; � % T
Hcant'
Date:
Rem Q17-lolkV.....2014.doc revise. d 06'0 1"
1 Cq
F1,[ "te"'"'n
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE ��'
: $ ;; COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
UPERTINO 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255
(408)777-3228•FAX(408)777-3333• buildinq(a�cuoertino.orq
?EOMIT cAisTisT T.BE:EENAI�ED J1\ 'I : ` I ... ......_._.,._.._._......... ...._..,....... . ..._ ._........
4 , . S CERTfFICAT�SAS BEEN
OM-At:14A SI GNED,z 'I3 RETURNED TO THE:BUILIfING D3I SION
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
eW;t 'p�as1?�sleoping.,xoom - 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 //I
Address. 2( b3LA-MIOW0tillA � Permit No. �"2.®I 1 ` H(1)
Specify Number of Alarms: ; S riSoke-.�Ala=nnrs 1 7 I f [��:a`r=.on M.or oxide cet fora1 /
I have read and agree to comply with the terms and conditions of this statement
Owner(or Owner Agent's)Name: -�
Signature . . . `
Contractor Name:
PJliCTOW(er
Signature . .. ... Lic.# 11.4 . Date:gla
Smoke and CO fonn.doc revised 12/15/16