B-2017-1576 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1576
19160 LOREE AVE CUPERTINO,CA 95014-3539(375 08 001) SHADOWFAX
ROOFING INC
CAMPBELL,CA 95008 '
OWNER'S NAME: LING CHEN AND KUO JERRY CHUO-LIN DATE ISSUED:09/13/2017
OWNER'S PHONE:408-913-5498 PHONE NO:(408)628-0065
. LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-39 Lic.#894247
Contractor SHADOWFAX ROOFING INC Date 04/30/2019 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 OSB;INSTALL ASPHALT SHINGLES
I hereby affirm under penalty of perjury one of the following two declarations: -(31 S.Q.)
1. I have and will maintain a certificate of consent to self-insure for Worker's
C a.pensation,as provided for by Section 3700 of the Labor Code,for the
- ' erformance of the work for which this permit is issued.
e� 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:$22000.00
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 375 08 001
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 Cupertinoagainst 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
sourc-,aregulat'•ns per the C ertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
..rte
ignat y ` Date 9/13/2017 Issued by:,Abby Ayende
Date:09/13/2017
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 obta' g 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 ownerof the property,am exclusively contracting with licensed 'gnature of Applic•,
contractors to construct the project(Sec.7044,Business&Professions Code). Date:9/13/2017
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 Califomia. If,after making this certificate of will maintain compliance with the Cupertino Munici 1 Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Sections 25505 5533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall ^"`
be deemed revoked. i wner or authorized agen
•
APPLICANT CERTIFICATION Date:9/13/2017
I certify that I have read this application and state that the above information is CO_ S y'UC J O E.r G •GE C
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.
SiSignature Date 9/13/2017 Licensed
g Professional
f CONSTRUCTION PERMIT APPLICATION
/ COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 •
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(408) 777-3228 • buil dillg�?cupertino.org PEMIT#B-
CUPERTINO REV# DEF#
❑ NEW CONSTRUCTION ❑ADDITION ❑ALTERATION ❑T.I. ❑MEPRE-ROOF ❑SWIMMING POOL/SPA
PROJECT ADDRE554/ /a,0.d. / APN P 5 5-
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OWNER NAMEfs 1PHO Ec fig—Sq E-MAIL
STREET ADDRESS CITY,STATE,ZIP
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CONTRACTOR NAME OW R-BUILDER COMP NY NAME LICE SE NUMBER LICENSE TYPE
Y
I STREET
��jADDRE ,� STATE, ZIP l/��f�Jy� I
O/ v � � BUS.LIC A�O V
E-MAIL
❑ARCHITECT ❑OWNER ❑OWNER AGENT ❑CONTRACTOR AGENT❑ENGINEER❑DEVELOPER❑TENANT
CONTACT NAME 4.:/ E-MAIL
Vey/7
STREET DRESS ATE,ZIP PHON5.
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DECRIPTON J `40 yK +'�
7 f
^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 S TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION(5)
REMODEL REMODEL KITCHEN REMODEL OTHR GARAGE ❑ATTACHED
BATHROOM SF SF SF SF ❑DETACHED
EXISiNG'. ❑YES' EICHLER 0 YES SECOND STORY ADDITION ❑YES
FIRE SPRINKL,ERS 0 NO 0 NO 0 NO
DWELLING SECOND DWELLING ❑YES 0 ATTACHED DETACHED OTHER
UNITS S ', , UNITADDITON: 0 N SF
POObi, . ❑'FTBERGLASS ❑VINYL-LINED D GUNITE 0 PREFABRICATED .
POOL-SF SPA-SF I SPA ATTACHED ❑YES 0 NO I-TOTAL-'SF
RE IY: n TOTAL VALUATION:
Commercial or Multi-Family Buildings with Public Swimming Pools requires Department of Environmental Heath approval 1 17Z/ �
RE-ROOFI EXISTING ROOF TYPE: ❑BUILT-UP ROOF ASPHALT SHINGLES❑WOOD SHAKES❑WOOD SHINGLES TILE OTHER(SPECIFY)
REMOVE/REPLACE❑NO IF NO PLYWOOD ❑w U '"A PLY OOD TYPE: PITCH: ROOF��i ASS
, YES C OF LAYERS THICKNESS❑5/8"pm ER ` / OSB ❑CDX OTHER f�:12 /ti
PROPOSED ROOF
,K
DBUILT-UP ROOF ❑ASPHALT SHINGLES ❑w••D S-'AKES❑WOOD SHINGLES 0 OTHER `•rte
*Provide a signed copy of the Cupertino's Tear-Off Policy SF,1/41:9_ Sof SQUARES�//
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 for ins ction purposes. I knowledge and authorize all information ntained on this application form
to be made available for public record. .
Signature of Applicant/Agent: Date: e .
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
BldgApp_2017.doc revised 08/0//17
REROOF TEAR-OFF POLICY
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COMMUNITY DEVELOPMENT DEPARTMENT.BUILDING DIVISION
ALBERT SALVADOR,P.E., C.B.0,,BUILDING OFFICIAL
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255.
CUPERTINO
(408)777-3228'FAX(408)777-3333.building@cupertinoorci
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coN]RAt'.)R.NAME (50:4 ' 1,1a1,61:ALNI 1.;12. ,,. i LICENSE•rypE„.. 131;5.LIC.
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I UNDERSTAND AND AGREE TQ THE FOLLOWING:
1. 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 businessIlay b.efore.the requested inspection date.
,. . . _ . .. .
`To schedule inspections call (408) 777-3228 from 7:30.:.:35Qpb) (MOn-ThurS) dr 7:30-2:30pm (Friday) to
schedule Inspection For Tear-Off and Nailing InspectionS,I.you must alsocall on the day of the
inspectiOnlonly 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 730-10;30ant 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 priOito this inspection.
Unless tie*plywood roof sheathing is proposed throughout, all the nalls/fasteners'4iall bp either
. 1
completely knocked-down or removed prior to this inspection. . .
4. If plywood is installed, a plywood Nailing Inspection is required.
. .
. . .
5. Roofingshall 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 inspetio.n will
require the removal of all new material down to the sheathings° a proper inspection carible performed.
! , ,
6.. A Final Inspection and approval shall be obtained:front thebuilding inspector vilen the re-roofing is
completed To receive a final sign-Off,the following.iterhsWill be verified:
, a. . Flat roofs shall have a minimum of l/4"perfoot of Slopeand demonstrate.there is no ponding.
b. Listings from approved testing agencies for all premanufactured products used'shall be
available on-site to review at the time of the inspedtion.
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.eorriplete,you will be
charged a re-inspection fee. The re-inspection lee 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,ag'nit O at on the
property owner's behalf, I understand and agree to comply with the re-roof policy stated aboye. I alsOUndcrStand that
smoke detectbrs'and carbon mono'-.:0,- deteetors.f. -e required to be installed m accordance with SeCtions10 4.41 d R315:of :. :....j
, : ,, ill
the 2016 califOrnia Resident' y.., j ,
: . . ..'.'d°
i Signature of Applicant/Agent -Z„„,!,„ 10: Atr40.4,/ 13 .: .<' /31
. 1. 'J •
. . Reroq1Po1icy2014:&?c ravised 06/01/7
. ,
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO CA 95014-3255
CUPERTINO
(408)777-3228•FAX(408)777-3333•buildincacuoerilno.orq
PERMIT CANNOT BE FTNALED UNTIL THIS CERTIFICATE HAS BEEN
COMPLETED,.RONED,Al)RenTRNED TO THE BITILDING 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,R315,2016 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,R315,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 r SMOI5FALARM Iic2 ALARM
Outside of each separate seeping area in the immediate vicinity of the I X X
bedroon,(s)-(51noke.alarins shall not be Imatedwithin 3 feet cfbathroorn door)
On eve level of a dwelling unit including basements and habitabie attics X X
Within each sleepin_g 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 ot the State Fire Marshal.
Power Supp,y 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
:arid California Residential Codes.The alarms specified below have been tested and are operational,as of the
date signed beloW
Address. • el ""' Permit No.b:DCA-1 —
Specify Number of Alarms: #Smoke Alarms:I 2._ #Carbon Monoxide Detectors:
have read and agree to eomil with the terms and conditbos of this statement
Owner(or Owner Agent's)Nerhe:
Nov3
G•4 SIgtraiLfre(- -
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gont..actor Nem :
, Dale: .
Snzoke and CO firmdoc revised Of/10/2017
• • fr .
• S , I CARBON MONOXIDE ALARMS
. . .
QVYNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT..-E3UILDING DIVISION
• •••• 10300 TORRE AVENUE CUPERTINO;CA 95014-3255
CJP.E,RT160
(404771-3228-FAX(408)777,3333•buildiriectierertinciora
PERK.1.:T CANNOT.BE:FINALED UNTIL THIS coatin Al IVISSEEN `scp-' it?
eb1,601-Fjk0,.,51 714EiVi.OrD Attlfil.NOtotitE.BUILVING '
PI.T.POSB
• This affidavit is a self-Certificadonfor the installation of all requirectSmokeand.CarbonMonoxide Alarms for
corr011aika with 2016 CRC$eCiioriP„.314„,F,.315,2016 CBC Sections 4206,and 07.2 11.2 where no friterior-access
for Mspeedons are required.. •
EN '.4A.,1„,tiNFPftTIQN
Existing aid dwellings shallbe provided with Smoke-Alar,rns and-Carbon
IviOnekidealathis',. When thevaluation of.additions,'alterations;or repairs to-existing at eiling Lnts Exceeds
$1009;00,CRC.SeetiOn). 314 R31.5;and;0.3c.• •eCtlorts'9Q7.•,2,1.1.5,..a.rid 420,6 require.tiat Smoke Alarms ancVoif
Carbon MorioNiderAlarrns.beinstallect in'the following locations:
•
AREA " SMOKE A't ARM CO 41A RM .
Otitsiae.of e.c i epe in the irnmediate Aricalityof the X X
bedrooln(0:-..(britoke.alarins shall rtai,be located,,';rithin 3 feet athathroorn door
t:On eery leve:oka:.dwetting unit mcloding basements alid habitable attics X 'k
I'VVithiti each.sleejiing.room. I
Carbon,14.eno4de alarms are not-required in dwellings which do not contain fuel-burning.appliances and that
do,nothavepnaitached garage. Carbon monoxide alarms combined-viith smoke alarms shall comply with.
Oqsectioti40'„6 aidshall the Office of,the StateireMarshal.
•
Power Siipp.1 ,'Llt,cfl,velling units with-no;commercial power supply,alar.m(s),may,be solelyIaartery operated,'
In.e)cistingclwo)4,.onnsialarms are permitted to26e-soloy battery Operated"where repairS or alterations do
•
notrestilfin iherernoval'ofwail and ceiling finishes or there is no access by means ofattic,:basement or crawl
spaCe.•Referi-o CRC Section P.314 and CBC Sections 907,2.11.4 and 420 6 2 Ari eleclricalperMiriS required for
alarms which Must:beconnected to the building wiring.
As owner of aboye,-referenced property.,I hereby certify that,the alarro(S5,referenced above has/have been
installed in;accordance.with the Manufacturer's instructions and incompliance with the'California Building
and.California-IZesidentiai•Codes.The'alarms specified below have been.tested and are operational,as of the
date signed l?eJbi\1.
Address: . . . PernmitNo. cfl
-ff-71„.0
Specify.Nturiber of Alarms: • #Smoke Alarms: #Carbon Monoxide Detectors; Mit
. .
. .
1 have read end agree to corn/alit with the terms and conditbns of this statement
Ownr'(ar Owner Ageries).Name: • I •
•c-4 t,
• , ,eate: A—
Cdfit.racfor Narn6: J.
I Sign.tre Lit.g ' - Oats' . ...
• ,FinOi(Ma C0,19nn.4oc rOisWRI/10/2017
•