B-2017-1422 •
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1422
22420 WALNUT CIR N APT A CUPERTINO,CA(357 03 043) M C ROOFING
SAN JOSE,CA 95127
OWNER'S NAME: BECCIA DORIS C TRUSTEE DATE ISSUED:08/24/2017
OWNER'S PHONE:408-253-0428 PHONE NO:(408)729-3436
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: '
License Class C-39 Lic.#736883
Contractor M C ROOFING Date 06/30/2019 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:
' RE-ROOF;TEAR OFF; INSTALL SHIELD TECH;ASPHALT
I hereby affirm under penalty of perjury one of the following two declarations: SHINGLES;-(22 SQ)
L 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
ierfonnance of the work for which this permit is issued.
. / . t" have and will maintain Worker's Compensation Insurance,as provided for by
41 Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$21000.00
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 357 03 043
•
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 PERMITISSUANCE OR
Additionally,the applicant understands and will Comply with all non-point
source regulations per the Cup rtinp Munici de,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
t
Ore ' �jJ ►' Date 8/24/2017 Issued by:Jasmine Archbold
1-, , /� Date:08/24/2017
OWNER-BUILDER CLARATION
IRE-ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons: I All roofs shall be inspected prior to any roofing material being installed.If a roof is
r. I,as owner of the property,'or my employees with wages as their sole installed without first obtaining an inspection I agree to rem. :11 new materials for
compensation,will do the woik and the structure is not intended or offered for insp-, ion. /
sale(Sec.7044,Business&Professions Code) /
2. I,as owner of the property;am exclusively contracting with licensed Si i. o'o fApplicant: .4;1
contractors to construct the project(Sec.7044,Business&Professions Code). r /24/2017
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 and wilUmaintainn 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
Section3700 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
Workerls Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Cha' 'r 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 25 5,25533,a:: 553•.
Labor Code,I must forthwith comply with such provisions or this permit shall ...in
be deemed revoked. Own E. :r orized agent: /".,,, '
' APPLICANT CERTIFICATION Da ear", 201
e read this application and state that the above information is CONSTRUCTION NDING AGENCY
I certify that I hav
correct.]agree to comply with all city and county ordinances and state laws .I"ereby 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 thelabove 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'SD . RATION
Code,Section 9.18. I understand my plans shall be used as public records.
Signature Date 8/24/2017 Licensed
Si
9 Professional
I
/ CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
, ..,
10300 TORRE AVENUE • CUPERTINO,CA 95014-3255
yt.tgf,
s (408) 777-3228 • building@cupertino.org PEMIT#B-. Za l Ii I LreZ
CUPRTINO REV# DEF#
❑ NEW
/CONSTRUCTION iiADDITION LI ALTERATION ❑T.I. ❑MEP RE--ROOF ❑SWIMMING
POOL/SPA
PROJE A'2 t OCL lk-, U)AN\A1� \ �I v c-k e APN# 3.5 L ". 03 � N
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GIAMR NAME, PHONE (�j E-MAIL
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STREET ADDRESS CITY,STATE,ZIP
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❑CONTRACTOR NAME 0 OWNER-BUILDER COMPANY NAME , tp f LICENSE NUMBER LICENSE
LICENSE TYPE �J
STREET T ADD' \5C k 'G VA Q�o$1,�V q -) 3 6!3 C1 �� C 3
LI ae \ic i P�� y Z '9:57,92 `7
E- PHONE BUS.LIC#
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0 ARCHITECT 0 OWNER 0 OW GENT C}' ONTRACTORAGENT❑ENGINEER
CO ACT NAME�� � 1 E-MAIL
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STREET ADDRUN CITY,STATE,ZIP PHONE
DECRIITONA
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3c LI cY �%.,r. ' t-esc AcNII• t l ahs k-c cow
❑SINGLE-FAMILY/DUPLEX 0 MULTI-FAMILY 0 INDUSTRIAL 0 COMMERCIAL I
EXISTING USE EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES It TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION($)
' REMODEL , REMODEL KITCHEN REMODEL OTHR GARAGE ❑ATTACHED
BATHROOM SF SF. SF SF 0 DETACHED
EXISING ❑YES EICHLER ❑YES SECOND STORY ADDITION ❑YES
, FIRE SPRINKLERS 0 NO 1 ' '' 0 NO 0 NO
DWELLING SECOND DWELLING, El YES 0 ATTACHED DETACHED OTHER .
UNIT3# UNIT ADDITON: ,0 NO S F
POOLS' '❑FIBERGLASS'❑VINYL-LINED 0 GUNITE ❑PREFABRICATED
POOL-SF SPA:SF I SPA ATTACHED ❑YES i.4 NO I TOTAL-SF
fikar.sTED BY: TOTAL VALUATION:
Commercial or Multi-Family Buildings with Public Swimming Pools requires Department of Environmental.Heath approval J 4J;q loon.I
RE-ROOF'EXISTING ROOF TYPE'- ❑ ®, ,BUILT-UP ROOF ASPHALT SHINGLES❑'WOOD SHAKES EI WOOD SHINGLES❑TILE OTHER(SPECIFY)
REMOVE/REPLACE�❑NO IF NO PLYWOOD ❑'" ❑3/8" PLYWOOD TYPE: ���Jj,_, PITCH' J ROOF CLASS
Lr YES #OF LAYERS_ THICKNESS❑5/8" OTHER 7/ ❑OSB, ❑CDX OTHER e5a /0 :12 A'
PROPOSED ROOF TYPE:❑BUILT-UP ROOF !lP SPHALT SHINGLES 0 WOOD SHAKES['WOOD SHINGLES 0 OTHER
*Provide a signed copy of the Cupertino's Tear-Off Policy sF 33eo #of SQUARES„
By my signature below 1 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 inspection urposes. I ackn e e and uthorize all information contained on this application form
to be made available for public record.
Signature of Applicant/Agent: , _, -ef Date: IeS�f/� 7
SUPPLEMENTAL INFORMATION REQUIR•
SFD/Second Dwelling Units/Multifamily Dwellings:A Demolition permit is required prior to issuance of a building permit for all new construction. •
*Commercial Buildings:.Prgvide 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 f approval from the Home Owner's Association
BldgApp_2017.doc revised 08/01/17
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,,,,k,N*, ,,•,,,- REROOF TEAR-OFF POLICY
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COMMUNITY DEVELOPMENT DEPARTMENT*BUILDING DIVISION
:.-.,01e•4,•;:
.iiie!P444.•' ALBERT SALVADOR, P.E.,C.B.O.,BUILDING OFFICIAL
CUPEritiN0 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408) 777-3228 4 FAX(408)777-3333.building(ftunertino;orpt $ _ ---1..__ I Lraz
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PROJECT ADDRESS t
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COr'RA-Tort NAMELICENSE NUM BE _. , LICENSE TY PP BUS.LIC.
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I UNDERSTAND AND AGREE TO THE FOLLOWING: .
I. The re-roof project shall comply with all applicable provisions of the 2016.California Codes.
2. An inspection request can be scheduled up to one business.daV.before the requestectinspection date.
, .,
To schedule inspections call (408) 777-3228 from 7:30 3OPtit:(MOn-Thurs):or 7:30-2:30pm(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 completed; The buildinginspector will be out to the
job site within one hour. The hours for this service are: 7:30-10:30am,and 12:30-3:3,0 (Mon-Thurs)
and 7;30-10:30am and 12:30-2:30 (Friday). Final Inspections will be given a two hour window.
3. Tear,Oiff 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. [f plywood 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 which is applied without first obtaining an approved inspection will
require the'removal of all new material down to the sheathing:so a proper inspection can be performed.
6. A Final Inspection and approval shall be obtained from the:building inspector when the re-roofing is
. ,
completed. To receiVe a final Sign-off.the following itettlayall beverified:
a. Flat roofs shall have a minimum of 1/4" per footof Slope and demonstrate there is no ponding.
b. Listings from approved testing agencies for all pre-manufactured products used shall 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 inspeetion and the work is not coinplete, you will be
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 on the
property owner's behalf, I understand and agree to comply with the re-roof policy stated above. I alsounderstand that
smoke.detectors and earbOn'monoxide detectors are required to be installed in accordance with SeetionSR314 and R315 of
the 20'16 California Residential Co.„1 .y . .,
..,// . .`,.
1 $ ,4ti
Ignr of ApplipOrppt: , _ ._. .,,,,„!7:_ 9 _ 'Sf, ....,„___ Date: V i
RerooPo1ic00:14.doe revised 06/01/7
, ” •
•
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
, T10 CU
10300 TORRE AVENUE• CUPERTINO, CA 95014-3255
(408)777-3228•FAX(408)777-3333• buildinq(T,cupertino.orq
ER1YI C ISTCT41 ALED: NIVE V S: ......... .......`. : __..
``� .• CERTIFI;CAT'R:;HAStBEEN
cO LIITEI?,SIC—1‘70'.1,/iNb-PETIEVIVEDItYTREMILOMPIAISTOX
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 I SMOKE ALARM CO ALARM
Outside of each separate sleeping area in the immediate vicinity of X
the bedroom(s) X
On every level of a dwelling unit including basements X
Within each sleeping room X
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
Add
-F i 1
l.k.k7 Permit No af1tk
Specify Number of Alarms: #Smoke Alarms MI #Carbon Monoxide Detectors.
I have read and agree to corply with the terms- d conditions of this statement
Owner(or Owner Agent's)Name: 3
. . '• . . Date: 7,
' ' //
Contractor Name:
SignatB /r Lic.# � 6. Date•
/ r
Smoke and CO fo7777.doc revised 12/15/16