B-2017-1502 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1502
10090 PASADENAAVE APT B3 CUPERTINO,CA 95014-5939(357 17 089)10090 BILL HAMILTON
PASADENAAVE STE B2 CUPERTINO,CA 95014-5939(357 17 088)110090 ROOFING INC
PASADENAAVE STE B1 CUPERTINO,CA 95014-5939(357 17 087)110090 CAMPBELL,CA 95008
PASADENA AVE APT B4 CUPERTINO,CA 95014-5939(357 17 090)
OWNER'S NAME: BROWN JOHN H AND BARBARA J.H.TRUSTEE DATE ISSUED:09/07/2017
OWNER'S PHONE.408-930-3016 PHONE NO:(408)379-1303
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO.
License Class C39 Lic.#644400
Contractor BILL HAMILTON ROOFING INC Date 04/30/2018 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
RE-ROOF,TEAR-OFF-INSTALLING COMP SHINGLES-(44 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
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. Sq.Ft Floor Area: Valuation:$31000.00
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 17 087
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
maAdditionally,
accrue againstsaidCity in stands and e of the hg othis 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
Signatures _ Date 09-7-2017 Issued by AbbyAyende
Date:09/07/2017
OWNER-BUILDER D"CLARATION
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 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 Signature of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:09-7-2017 P
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 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 contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 25 5,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent:,
APPLICANT CERTIFICATION Date:09-7-2017
I certify that I have read this application and state that the above information is CONSTRUCTION ENDIN GENCY
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 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 09-7-2017
Professional
. - �►
' juiL,
t E : ' PERMIT' APPLICATION -
COMMUNITY DEVELOPMENT DEPARTMENT m BUILDING DIVISION _
4.,-;,4,__
'"', 10300 TORRE AVENUE.C.UPER I INO,CA 95014-3255
CUPtft0. . (408)777-3228•FAX(408)777-3333 a buildings cupariino.orq
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PROJECT ADDRESS i ri I,. '+ t.�PN,
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OWNER NAME Ciio oitieuj is- t I PHONE - _ , E-MAIL
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STREETADDRESS - ' r ' CITY,STATE,ZIP , FAX 00t0r e.__ . � '
_ CONTACT NAME PHONE :
STREET ADDRESS - CITY,STATE.ZIP FAX
0 OWNER 0 OWNER-BUILDER 0 OWNER AGENT W!CONTRACTOR 0 CONTRACTOR AGENT' 0 ARCHITECT 0 ENGINEER 0 DEVELOPER 0 TENANTCGivTRACTORIvA,3'#E , _ v ._
LICENSE NUMBER . - LICENSEE TYPE/ 31 BUS.LIC# 60 r
COMPANY NAME .. `, F E-MAIL
/ 1 °I-i ie:), 1,-_, /vic FAX• �q 0 _ 77i—/30
STREET ADDRESS `� /� r
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CITY,STATE,ZL C,/ Abel/
€i,! t 5-00 PHONE/1.160-1-7-71.7_/....},2.,/��,'/
ARCIITECT/ENGINEERNAME IIMIIIIIIIIIIIIIMIIEIIIMIIIII
COMPANY NAH
STREET ADDRESS CITY,STATE,ZIP PHONE
' USE Or 0 SF])or Duplex 0 Multi-Family ROOF AREA: _ VALUATION
STRUCT IR E: ', Commercial /-1a4 Se, , o . Cf `
I. EXISTING ROOF TYPE: CI BI.IILTNJP ROOF 5 AS"PHAL'.SHINGLES O WOOD SHAKES lWOOD SHINGLES'-.... LI OT.I (SPECIFY)
REMOVE/REPLACE AI YES IF NO, PLYWOOD CI vi- 0 .„__,. PLYWD 0:OSB PITCH: r� I ROOF
0 NO P LAYERS. THICKNESS: 0 SIS” TYPE. 0 COX _ :12 CLASS: A ,
PROPOSED ROOF TYRE, 0 BUILT-UP ROOF ®ASPHALT SHINGLES 0 WOOD SHAKES 0 WOOD.SHINGLES 0 OTHER ICC-ES REPORT#
DESCRIPTION OF t-VORK: • '
r_•(tl ' ° : ° frig/ail 11e ;tcii , i
i #WEE &-r 1 A.
By=my signature below;I certify to each of the following: [am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information Chat have provid-.d is correct. I have read the Description of Work and verity it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to Bluld'4,-,.nstruction. I authorize representatives of Cupertino to enter the ab e id mtifie propertyfor inspection purposes.
t-
Signature of Applicant/Agent: '"Ni.. A Date: (-�
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SUPPLEMENTAL FNTAt ;<II WORM ION REQUIRED ' tt i o c.,
If building is associated with a..cine .per's Association,provide letter s reI CI.'TY Rt FiT E
of approval from HOA, t
RTS GTESs4Yc .04;t4
Pro�.�€de Planning approval to verify if there any restrictions. f" ° 1 PEA JG AS RE I,
I Provide copy of Manufacturer's Installation Specifications. 4-;STN '" T, ST F i,
signed copy of Cupertino's Tear-Off Policy,ProvideaI '
ReroofApp_201 Looe revised 03/16/1I
Monta Vista Woods HOA
10090 Pasadena Avenue #B-1
Cupertino, CA 95014
September 6, 2017
To whom it may concern at:
Bill Hamilton Roofing, Inc.
230 Harrison Avenue
Campbell, CA 95008
The Monta Vista Woods Home Owners Association has approved
CertainTeed Landmark Series shingle roof system in the
Georgetown Gray color.
John H. Brown
President, Monta Vista Woods HOA
fl
WATEr.-CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
44,1,1 COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
CUPERTINO 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
�®/1 (4087777-32 (408)777-3333• buildinq(c�cupertinrq o / / / 5/-
Owner Name Permit No.
Address l oO'YD p,S'cde f1L,A Are, eer-HnOl, 95 /
Is your real property a registered historical site?
❑ yes Civil Code Sections 1101 1 through 1101.8 do not apply Skip the rest of the form and sign bottom of form.
No Go to Question 2.
2. Does your real property have a licensed plumber certifying that,due to the age or configuration of the property or its
plumbmg,installation of water-conservmg plumbing fixtures is not technically feasible?
❑ Yes Civil Code Sections 1101 1 through 1101.8 do not apply
❑ The licensed plumber's certification has been provided to the Building Division.
—Skip the rest-of the foam-and-sign bottom-of form.—-- _�
12/No Go to Question 3
3 Is water service permanently disconnected for your building?
❑ Yes Civil Code Sections 1101 1 through 1101.8 do not apply Skip the rest of the form and sign bottom of form.
IE-No Go to Question 4
4 Is your real property built and available for use or occupancy on or before January 1, 1994?
❑ No My real property is built and available for use or occupancy after January 1, 1994
Civil Code Sections 1101 1 through 1101.8 do not apply Skip the rest of the form and sign bottom of form.
1 /Yes My real property is built and available for use or occupancy on or before January 1, 1994
Civil Code Sections 1101 1 through 1101.8 apply Check one of the three following statements and sign
bottom of form.
,5 Please check ONE of the following:
❑ My property is a single-family residential real property See Civil Code Section 1101 4
On and after January 1, 2014,building alterations or improvements shall require all non-compliant plumbing fixtures
to be replaced with water-conserving plumbing fixtures throughout the building.On or before January 1,2017,all non-
compliant plumbing fixtures shall be replaced with water-conserving plumbing fixtures (regardless of whether
property undergoes alterations or improvements).
❑ My property is a multifamily residential real property See Civil Code Section 1101.5
On and after January 1,2014,specified building alterations or improvements shall require non-compliant
ffi f es to *a're aced"`wiili waTer-conservm `lumtim T tires:
p g p g p______.-_g-
On or before January 1,2019,all non-compliant plumbing fixtures shall be replaced with water-
conserving plumbing fixtures throughout the building(regardless of whether property undergoes alterations or
improvements).
le My property is a commercial real property See Civil Code Section 1101.5
On and after January 1,2014,specified building alterations or improvements shall require non-compliant
plumbing fixtures to be replaced with water-conserving plumbmg fixtures.
On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water- conserving
plumbing fixtures throughout the building(regardless of whether property undergoes alterations or improvements).
I,as the owner or owner's agent of this property,certify under penalty of perjury that non-compliant plumbing fixtures will be
replaced prior to date specified above with water-conserving plumbing fixtures in accordance with Civil Code Sections 1101 1
through 1101.8,the current California Plumbmg Code and California Green Building Standards Code,and manufacturer's
installation requirements,and that the water-conserving plumbing fixtures comply with the requirements as indicated in the
table on the following page.
Owner or Owner Agents Signature � '� ;r`, , a – _ Date 9/b//7
Upon completing and signing this erti.'cate,please' rn it to the Building Division in order to fmal your building permit.
SB4072015.doc revised 08/26/15
\ SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
wyc.,ss COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CUPERTINO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333•buildinq(c_cupertino,orq
Permit No. /9,-/3
Address � #of Alarms Smoke: �, Carbon- Monoxide:
PERMIT CANNOT BE FINALED AND COMPI
HAS BEEN SIGNED AND RETURNED T
PURPOSE �
This affidavit is a self-certification for the installation of all reg1 Jy/72. 9i 6,4 r
compliance with 2013 CRC Section R314,2013 CBC Sections 42
inspections are required. ,�._.
GENERAL INFORMATION j
Existing single-family and multi-family dwellings shall be prof'
Monoxide alarms. When the valuation of additions, alteration 9.--,C %r/tO /37
/
$1000.00,CRC Section R314 and CBC Sections 907.2.11.5 and,C G �?
Monoxide Alarms be installed in the following locations: '1 � �% 't�d
AREA 4-1-e'"
Outside of each separate sleeping area in the immediate vicinity ,. A
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 finishesorthere is oaccess; g-m_ of=attie;haserr nnorcrawl- -
ap e;Rele-r e= eetron- -and-CBC`Sectior-ns 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 have been tested and are operational, as of the date signed
below.
I have read and agree to comply with the terms and conditions of this statement
Owner(or Owner Agent's)Name:
a �dr'i,C'( jZ.i/}it, Signature 3.34A Q �..�,a�r.'i<i'�°'�' Date:��/�, J'
Contractor Name:
Signature Lic.# Date:
Smoke and CO form.doc revised 03/18/14