B-2017-1527 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1527
21341 MILFORD DR CUPERTINO,CA 95014-1327(326 41 100) JIREH INC
LOS GATOS,CA 95031
OWNER'S NAME: LEE JOAN T TRUSTEE DATE ISSUED:09/11/2017
OWNER'S PHONE:408-621-2971 PHONE NO:(408)298-9399
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C=39 Lic.#800707
Contractor JIREH INC Date 10/31/2017 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 OSB;COMP SHINGLES(32 SQ)
I hereby affirm under penalty of perjury one of the following two declarations:
i. 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
rformance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance,as provided for by
0010000
GSection 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$11145.00
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 326 41 100
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
source regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
':'ature Date 9/11/2017 Issued by:Abby Avende
do . - Date:09/11/2017
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
i.,.-.I,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,I agree to remov all new materials for
`�✓ compensation,will do the work,and the structure is not intended or offered for inspe
sale(Sec.7044,Business&Professions Code)
2. I,as owner of the property,am exclusively contracting with licensed saigerre of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code).` Date: H 19 /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 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 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. 4 Owner or authorized agen.t.:a50‘C.° 2",.........017--'''"'"------
APPLICANT CERTIFICATION Date:9/11/2017
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 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.
Signature Date 9/11/2017 Licensed
Professional
torF, 1�2�
\ f REROOF PERMIT APPLICATION •
1�' COMMUNITY'DEVELOPMENT DEPARTMENT•BUILDING DIVISION
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10300 TORRE AVENUE••CUPERTINO,CA 95014-3255
CUP1=F;;i"1NC5 (408)777.3228• FAX(408)777-3333•building cupertino.orq
PRODRESS 3 i// dnu grd/ APN# 3 pn o ./�/! • /oil
OWNER NAME Orli / PHONE/g /_g/ 029//j E-MAIL
STREET ADDRESS ^/J, // f,nl��1 CITY /T" IP L — • FAX
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CONTACT NAME ' PHONE E-MAIL
STREET ADDRESS I CITY,STATE,ZIP FAX
El OWNER 0 OWNER-BUILDER 0 OWNER AGENT I CONTRACTOR El CONTRACTOR AGENT 0 ARCHITECT 0 ENGINEER 0 DEVELOPER 0 TENANT
• CONTRACTOR NAME LICENSE BER LIC SE T BUS.LIC.#
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COMPANY NAME E- I FAX
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ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.'LIC.#
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COMPANY NAME--`----- - --- ---- - ------ --------- --
• STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF 0 SFD or Duplex 0 Multi-Family ROOF AREA: VALUATION:
STRUCTURE: ❑ Commercial'
//) / * '
EXISTING ROOF TYPE: 0 BUILT-UP ROOF El ASPHALT SHINGLES 0 WOOD SHAKES 0 WOOD SHINGLES ❑'OTHER(SPECIFY)
REMOVE/REPLACE 0 YES IF NO, PLYWOOD ❑ 'v" 0 PLYWD 0 OSB PITCH: ROOF
El NO #LAYERS: THICKNESS: ❑sirTYPE: 0 CDX .12 CLASS: A
ICC-ES REPORT#
PROPOSED ROOF TYPE: 0 BUILT-UP ROOF ❑ASPHALT SHINGLES 0 WOOD SHAKES 0 WOOD SHINGLES El OTHER /
DESCRIPTION OF WORK� /i r kaki–• ..111 c y/ ,„ 0615 ,1 �vG 4 `
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66,1140() ("7,0---thii4t(k..c a( A . a .
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 bui din• _• struct'99li. I authorize repr sentatives of Cupertino to enter the above iiidde /tide r roperty for inspection purposes.
' Signature of ApplicanUAgent: 7'",22�%, sZG Date: d W / '
N.
SUPPLEMEN AL IN ORMATION REQUIRED w "i " qmt,)11E i Ezz.,-;; i3ks>4 -•
a i4 �OFFICUSEO,NLYst t k, x tt
_ ',t"d r ma.,,I i:,ti YScrwcx z ,ax,'. Iq lel '{ ,.�,,� .N.r y T"'
If building is associated with a Home Owner's Association,provide letter 4.PLAN LHRC'KTYPE` ,4:441. -a." vk ..rT ROUTING SLIP ,,,,,,,,,,,i,
'' na1i,t. 5 ,," „M„':'7" 'S 3-' ', 'A'r.,,'-Wres �'"#Y�" ri f ,41:1,=11
of approval from HOA. .❑ OVER TH7<COUNTER ❑ BIJILDINGPLAN
PP - •RF P -� 'Sl"}, '�R.P`t � A:.3 h €t^`S REVIEW-� L��E '
Provide Plannin approval to verifyif there anyrestrictions, ,. x PF, W T'"n;y `� y 1 ` #rix,..t,. ^EE4' .1
g PP *❑ EXPREss I xa s ,x ❑ PLANNINGPLANR* -P 1 is a �{
trF :1,''i "' .*'i t2( ,SLIKI' 2 i;a-,�+-F,X ,r i r
Provide copfr of Manufacturer's Installation Specifications. 0::'T2I4±ARn µ 4ti ®,_}FII2EDEPT•�w3 1 x�rr ,4i. '
Provide signed copy of Cupertino's Tear-Off Policy. - rs> 4; oT4H, ,c,-�.. 1f '.
t r7,-. x,y ^" r,'.
' ,ReroofApp_2011.doc revised 03/16/11
\ / REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
•
•
•
slap,-
ALBERT ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL '
CUpEiT INO 10300 TORRE AVENUE••CUPERTINO, CA 95014-3255
(408)777-3228• FAX(408)777-3333•buildincl cupertino.orq
PROJECT ADDRESS cvs Ch / n/grej I Q APN#S=1 6 /y/-D
OWNERNAMEjb l J � PHONEE4g ‘� e�/, E-MAIL
STREET ADDRESS CITY, STATE,ZIP FAX
CONTRACTOR NAME _ I ? f C UCEN NUMBE
ODg7 ,n LIC ST�PE, •
BUS.LIA3 4 /
Co NAME '�J l J (n�� E-MAIL f( V �'/� FAX I/
� s G w- c� �0�"1 n ±Ifla q_ SDs gioslr"e0�in .ccs-, 7O S�1�i'-937J
STRE����_TT,,. RFSS� 1 /�J CITY TATE,ue�— � � PHONE/04,243 O
rSS r).fis�/C'fi n. Qin` 35 .l e sll 243 9
I UNDERSTAND AND AGREE TO THE FOLLOWING:
•
1. The re-roof project shall!comply with all applicable provisions of the 2013 California Codes.
2. An inspection request can be scheduled up to one business day before the requested inspection date.
Please schedule inspections online or call (408) 777-3228 from 7:30-3:30pm (Mon-Thurs) or 7:30-
2:30pm(Friday)to schedule inspection. For Tear-Off and Nailing Inspections,you must also call on the
- __-.-da .of the ins ectiori only after tliat -hase df the work is com leted—The builin ins ector will be
Y p Y i� p - p -- g • p
available within one hour: The hours for this service are: 7:30-10:30am and;12:30-3:30 (Mon-Thurs)
and 7:30-10:30am and.12:30-2:30 (Friday). Final Inspections will be given a two'hour window.
•3. • °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 plywood is;installed, a'plywood Nailing Inspection is required.
5. `;Rong;shall not be applied withou
'ofit first obtaining all prior inspection and written approvals.from the
building inspector. Any roofing wl1ich 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 andiiapproval shall be obtained from the building inspector'when the re-roofing is
completed. To receive a'final sign-off,the following items will be verified:
a. Flat roofs 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 reviewj,at the time of the inspection. •
1,
c. Proper spark arrestor installation, vents painted, gutter/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 refinspection 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 also understand that
smoke detectors and carbon monoxide detector are required to ee installed in accordance with Sectio s R3141.and R315 of
the 2013 California Residential ea- 3�
Signature of Applicant/Agent: A ,/,i_I/ _ Date:
i'
• ReroofPolicy_2014.doc revised 01/15/14
SMOKE / CARBON MALARMS LONOXIDE
OWNER CERTIFICATE OF COMPLIANCE
g .-< COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE• CUPERTINO,CA 95014-3255
CUPER,TINO •
(408)777-3228•FAX(408)777-3333•building( cuoertino.orq
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, w i �,i N a y 4a;,;. f"� 1 t,t ,, L.,a 4 gft,.. ''^ <k- -t '-a
m tedSTIVORIARE rED TJNI I TE IS CERTIFICATE HAS BEEN *�, "
�-'.. �r«r`i�..�s� {� j��c.7-',€...�.k--2Sc.-"`ter 7�zF.��,+ ���+._+s, �"T �^+� �rFsx�.YT�`�
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•
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&ttached 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 finishesor 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.
Address: o2/,3 c/ prol &J,, Permit No.&O/7•(9 2
Specify Number of Alarms-: #Smoke Alarms: #Carbon Monoxide Detectors:
I have read and agree to comply with the terms and conditions of this statement
Owner(or Owner Agent's)Name:
Signature Date:
Contracto Name:
tetea
Ca) Signature. ,..� Lic.# 4530 71-7 Date:f
/119
Smoke and CO fonn.doc revised 12/15/16