B-2017-1447 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1447 .
20565 KIRWIN LN CUPERTINO,CA 95014-4316(359 18 047) CUPERTINO ROOFING
INC
SAN JOSE,CA 95129
OWNER'S NAME: HALL ROBERT B AND SHIRLEY A TRUSTEE DATE ISSUED:08/30/2017
OWNER'S PHONE:925-330-6707 PHONE NO:(408)973-9427
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class CC=39 Lic.#565437
Contractor CUPERTINO ROOFING INC Date 03/31/2018 X BLDG _ELECT _PLUMB
MECH X RESIDENTIAL_COMMERCIAL
I hereby affirm that I am licensed underthe 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;COMP SHINGLES(10 SQ)
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
` .formance of the work for which this permit is issued.
have and will maintain Worker's Compensation Insurance,as provided for by
eioor
Section 3700 of the Labor Codc,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$5000.00 .
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 359 18 047
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 PERMIT ISSUANCE OR
Additionally,the applicant understands and will comply with all non-point
sou -- -gu. ''ns per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Si. 'w°#e I '~ Date 8/30/2017 Issued by:Jasmine Archbold
It ' Date:08/30/2017 .
OWNER-BUILDER.DECLARATION
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
1. I,as owner of the property,or my employees with wages as their sole installed without first •• ' -an inspection,1 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) (102,..2,, I
6kAr...._...
2. I,as owner of the property,am exclusively contracting with licensed Signa•;r' 'Y"Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code). a 30 2017
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 ALL ROOF COVERINGS TO BE.CLASS"A"OR BETTER
Compensation,as provided for by Section 3700 of the Labor Code,for the •
performance,o£'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. 1 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 defi •: o •• Bay Area Air Quality Management District I
Worker's Compensation'laws of California. If,after making this certificate of will maintain compliance with the 'o ertino Municipal Code,Chapter 9.12 and
exemption.,1 bee onie'subject to the Worker's Compensation provisions of the the Health&Safety C i de,Se 'ons 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked] 0_=,2,5(., >`thorized agent: Aiiir L.
APPLICANT CERTIFICATION °' :3t 20 7
I certify that I have read this;application and state that the above information is I.ri- ' TI•►L DI • E►
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 construdtion,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 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'S DECLARATION
Code,Section 9.18. I understand my plans shall be used as public records.
Licensed
Signature Date 8/30/2017 Professional
. CONSTRUCTION PERMIT APPLICATION
/"t COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
(� 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 • B
y-4.l pf.
4. s (408) 777-3228 • building@cupertino.org PEMIT#B- La t 1 - 14`44---
CUPERTINO
`CCUPERTINO REV# DEF#
❑ NEW CONSTRUCTION ❑ADDITION ❑ALTERATION ❑T.I.- `❑MEP 131 RE-ROOF ❑SWIMMING POOL/SPA
PROJECT ADDRESS / 1 2 1' 1 L APN II
OWNER NAME 4 PHONE E-MAIL •,
STREET ADDRESS CITY, STATE,ZIP
2.oS—C, \�llekit,, Las) Lu p.co+-1 n
CONTRACT. ,,
OR NAME, IDO'WNNER-BUILDER COMPANY NAME LICENSE NUMBER LICENSE TYPE
,..,
STREET ADDRESS C STATE, ZIP I
i uWiz \ -1 y � 4
E-MAIL PHONE BUS.LIC#
C-0 Peefilno�.,0pi)i-,\ S13< G( 06 cAL.,r0e�- 1-4 CA 2..t'2-^8l 9
0 ARCHITECT 0 OWNER ❑OWNER AGENT 0 CONTRACTOR AGENT 0 ENGINEER 0 DEVELOPER❑TENANT
CONTACT NAME E-MAIL
STREET ADDRESS CITY,STATE,ZIP PHONE
.
DECRIPTON )�I
C--71.1)
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I ,
,
❑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# TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION($)
REMODEL REMODEL',KITCHEN REMODEL OTHR GARAGE 0 ATTACHED •
BATHROOM SF SF I' I SF SF 0 DETACHED
EXISING 0 YES EICHLER''❑YES SECOND STORY ADDITION DYES
FIRE SPRINKLERS❑NO y :
' r' i 1 ' -:12,NO ❑NO
SECOND DWELLING
DWELLING SECOND YES ❑ATTACHED 0 DETACHED OTHER
UNITS# UNIT ADDITON:i 11',,❑'NO , ^S F i Li
POOLSI 0 FIBERGLASS I❑iVINY -LINED 0 GUNITE 0 PREFABRICATED
POOL-SF SPA-SF I I!,SPA'ATTACHED ❑YES o! NO I TOTAL-SF _
I CETVED BY: 0 I
TOTALVALUATION:
Commercial or Multi-Family Buildings with Public Swimming Pools requires Department.of Environmental Heath approval I I,�_ t. 5 ,2, b,0 •
RE-ROOF',EXISTING ROOF TYPE i I0 BUILT-UP ROO ASPHALT SHINGLES❑WOOD SHAKES❑WOOD SHINGLES❑TILE OTHER(SPE IFY)
REMOVE',REP ACE NO I IF NOS'Ii i i I� PLYWOOD ❑'h ❑3/8" PLYWOOD TYPE: PITCH:(� 12 ROOF CLASS
YES II#OF `AY , THICKNESS❑5/8" OTHER ❑OSB ❑CDX OTHER T A
PROPOSED ROOF TYPE:❑BUILT-UP,ROOF;I ASPHALT SHINGLES 0 WOOD SHAKES O WOOD SHINGLES 0 OTHER
'Provide a signed copy of the Cupertino's Tear-Off Policy SF I d Sof SQUARES I°'G C)
•
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,To ' spection purposes. I acknowledge and authorize all information contained on this application form
to be made available for:public record _ a,,
Signature of Applicant/Agelit: I. ; ' ` 1 [ C_J b Date:
SUPPLEMENTAL INFORMATION REQUIRED .
*New SFD/Second Dwelling Units/Nlultifamily 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 I.etter or Meeting with Planning prior to submittal of Building Permit application.
*HOA-Provide a letter of approvalfroin the Home Owner's Association
' II , IsI.
'' i�iI' I
BldgApp_2017.doc revised 08/01/17
h ,
•
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
ALBERT SALVADOR, P.E.,C.B.O.,BUILDING OFFICIAL
Ar-Vt
C Ci 0 I 19300 TORRE AVENUE•CUPERTINO,CA 95014-3265 f2-L-e-D\.'l 4-
(408)777-3228• FAX(408)777-3333 0 buiiding@cupertimarg
pROJECT ADDRESS Uri
owNER.NA mE
irsik 4Ck • PHONE
— I
LS MEET ADDRESS „z, 6 s_ te. CITY, STATE,ZIP c FAX
‘N,D
CONFRACTOR NAMELICENSE BUS.LIC.
Irdk NUMBER I UCENSE
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
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 busirtess'Iday before the requested inspection date.
To schedule:inspections call(408) 777-3228 from'7:364:30Pin(MOn7thurs) or 7:30-2:30pm (Friday)to
schedule inspection. For Tear-Off andNailing Inspectionou 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: 7:3040:30arn and 12:30-3:30 (Mon-Thurs)
and 7:30-10:30ain and 12:30-2:30 (Friday). Final Inspections will be given a two hour window.
3. Tear-Off InSpekiion.is,required. Any and all dry-rotted wood.shall be replaced prior to this inspection.
Unless new lAyWbod roof sheathing is proposed throughout, all the nails/fasteners shall be either
completely knocked-down or removed prior to this inspection.
4. If plywood is installed, a plywood Nailing In ,pection is reguired
5. Roofing Shall not be applied without first obtaining all priorinspection and written approvals from the
building inspector. Any roofing which is applied without first obtaining an approved inspection will
require the:reinciVal of all new material down to the sheathing,so a prOper inspection can be performed.
6. A Finalinspectionand approval shall be obtained from the building inspector when the re-roofing is
completed: To!teceive a final sign-Off,the followingitems:will be verified:
a. Pigi-oofs shall have a minimum of'A" per foot of 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 inspeetion.
c. Proper'spark arrestor installation, vents painted, 2-Ater/downspouts installed, 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 shallbe aid before another ins ection can be
scheduled.
By my signing below, 1 certify each of the following is true: lam 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 also understand that
smoke detectors and Car oxide detectors:are required to be inqalled in accordance with Sections R314 and R315 of
the 2016 California Residenti I Co.
sian.4tur ofAppli,c4WAcielt: Date: V —3
Rerog/Policy 2014.doe revised 064)1/7
SMOKE / CARBON MONOXIDE ALARMS it I
OWNER CERTIFICATE OF COMPLIANCE �' . 1�
Tagg COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
CUPERTINO 10300 TORRE AVENUE• CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333• buildincc(a�cupertino.orq
PERMIT CANNOT BE FINALED UNTIL THIS CERTIFICATE FIAS BEEN
COMPLETED,SIGNED:AND RETURNED TO THE BUILDING DIVISION,
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 907.2.114 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
cAddreiii_-_� 57,5- (.1Qcc-o-c rP_ermit_Nii J ()1^
Specify Number_of Alarms: #Smoke Ala�ilis: I ti ! ;#Carbon Monoxide Detectors:
I have read and agree to.comply h the terms and conditions of this statement
--Owner(or Owner Agent's)Name: -
_ 1A
C Y`Urt �r\ .Signature .d o �./ Da
Contractor Name: G/�
Signature Lic.# Date:
Smoke and COfonn.doc revised 12/15/16