B-2017-1583 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1583
22168 MCCLELLAN RD CUPERTINO,CA 9501474041(356 08 022) SHADOWFAX
ROOFING INC
CAMPBELL,CA 95008
OWNER'S NAME: LEE GORDON M AND PEGGY S TRUSTEE DATE ISSUED:09/14/2017
OWNER'S PHONE:408-605-8961 PHONE NO:(408)628-0065
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-39:B 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:
REROOF;TEAR OFF;INSTALL OSB;COMP SHINGLES(33 SQ)
I hereby affirm under penal of perjury one of the following two declarations:
i. I'have and will•aintain'a certificate of consent to self-insure for Worker's
Compensa'. ,as provided for by Section 3700 of the Labor Code,for the
is'fo v.nce of the work for which this permit is issued.
I h. and will maintain Worker's Compensation Insurance,as provided for by
,0 :ection 3700 of the Labor Code,for the performance of the work for which this
',, • permit is issued. Sq.Ft Floor Area: Valuation:$19000.00 •
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 356 08 022 ,
repres'e'ntatives 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 acceue net said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionallyy,,the applicant understands and will comply with all non-point
source regul s,per the Cup Ino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
I ignat re . Date 9/14/2017 Issued by:Abby Ayende
Date:09/14/2017
OWNER-BUILDER DECLARATION
s
I hereby affirm:that I ant 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 inspec?.n.
sale,(Sec.7044,Business&'Professions Code) ,/
2. I as owner.of the.properiy,am exclusively contracting with licensed ignature of Applic. ,, ,i_., i(Lr/ _
contractors to construct the project(Sec.7044,Business&Professions Code). Date:9/14/2017 1r
I hereby affirm under penalty of perjury one of the following three declarations:
it , I haveland 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
•
l; I"performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
• $2: I,h'ave and will maintain,Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the
' California Health&Safety of the Labor Code,for the performance of the work for which this Code Sections 25505,25533,and 25534. I will
;permit is issued' maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
a. 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 Cornpensation,laws of California. If,after making this certificate of will maintain compliance with the upertino Munici•al Code,Chapter 9.12 and
exemption,'I become subject to the Worker's Compensation provisions of the the Health&Safety ' Sections 2550 25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall / /
be deemed revoked.l
ner or authorized agent,: � .�/L.�.:,/
APPLICANT CERTIFICATION .ate:9/14/2017
Al
I certify that II have read this application and state that the above information is CONS 'UCTION LEN i ING A r CY
correct.I:egree 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 'end 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,grantipg,of this permit. Additionally,the applicant understands
and•,will complyy 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 9/14/2017 Licensed
Professional
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
..(111& 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
st:l�s, 1533
(408) 777-3228 • building@cupertino.org `�"
PEMIT#B- -
CUPERTINO REV DEF#
❑ NEW CONSTRUCTION ❑ADDITION
� l ALTERATION El T.1. ❑ME? ❑RE-ROOF ❑SWIMMING POOL/SPA
PROJECT ADDRESS 2eC_a.l . APN S ?3_ LO-o27
ZZ/�P �G Q
OWNE ADDRESS
/ / P E/���•9� E-MAIL
STREET_,,,v,,,d6!/�/,y0'• D9���7�� CI I/Y'ASTATE,ZIP . ;�
C/j e �'��" '"f
CONTRACTOR NAME OWNER-B DER COMPAN NAME F LICENSE NUMBER LI SE TYPE
3 Aleteir44
ISwDJ,
*AT.
ZIP
,7, ivt) .,----
E-MAIL PHO E 1708 0A l/'" BUS.LIC p
0 ARCHITECT 0 OWNER ❑OWNER AGENT [CONTRACTOR AGENT!:ENGINEER 0 DEVELOPER ❑TENANT
CONTACT NQNv ME ``„/ /�/� E-MAIL
STREET ADDRESSf`/ 7 !cr��i'�— CITY,STATE,ZIP P O E
DECRIPTO/ 11.:41. 1 " "e` _4,0 ' . itenrif 44' -
7,(O i ` _ Li47^fi� z / 67
1,410 'iii. Ave/.
LE-FAMILY/DUPLEX 0 MULTI-FAMILY ❑INDUSTRIAL 0 COMMERCIAL
EXISTING USE EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES I TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION(5)
i
REMODEL REMODEL KITCHEN REMODEL OTHR I GARAGE ❑ATTACHED
BATHROOM SF SF SF SF 0 DETACHED
EXISING ❑YES EICHLER ❑ YES SECOND STORY ADDITION ❑YES
FIRE SPRINKLERS 0 NO ❑ NO ❑NO
DWELLING SECOND DWELLING ❑YES 0 ATTACHED DETACHED OTHER
UNITS N UNIT ADDITON: ❑NO S F -
IPOOLS) ❑ FIBERGLASS ❑VINYL-LINED ❑GUNITE ❑PREFABRICATED
POOL-SF SPA-5F I SPA ATTACHED ❑YES 0 NO J TOTAL-SF
--- RECEIVED BY: TOTAL VALVAL�ON:
Commercial or Multi-Family Buildings with Public.Swimming Pools requires Department of Environmental Heath approval atif1n . AAA
1 �S1
RE-ROOF E. -" G ROOF TYPE: ❑BUILT-UP ROOF❑ASPHALT SHINGLES❑WOOD SHAKES El WOOD SHING ES❑ LE OTHER(SPECIFY) / 6�/�:/
REMO NO IF NO PLYWOOD ❑'h ❑3/8" PfL�YWOODTYPE: H: ROOF CLASS
YES A OF LAYERS THICKNESS❑5/8" OTHER p�OSB ❑CDX OTHER PITCr :12 A
P OPOSED ROOF TYPE:❑BUILT-UP ROOF f ASPHALT SHINGLES 0 WOOD SHAKES❑WOOD SHINGLES ❑OTHER 22 �•
C
*Provide a signed copy of the Cupertino's Tear-Off Policy SF.336I(T� Prof SQUARES 33
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 A ws relating to building construction. I authorize representatives of Cupertino to
enter the above-identified propert .,inspection purpe.e;. I acknowledge and authorize all informatio rconta' ed on this application form
to be made available forpublic -cor..
/
Signature of Applicant/Agent: :_JLd4 :` '1
Date: r'
/
SUPPLEMENTAL INFORMATI• REQUIRI•
*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 08/01/17
•
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
ALBERT SALVADOR, P.E., C.6.0.,BUILDING•OFFiCIAL
AVM."::•
CUPERtINIO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408) 777-3228• FAX(408)777-3333.building@conertino.orci
PROJECT ADDRESS
Me. c/ ‘ APN a:1.9 02L
OWNER NAME 00e • E-MAlL
PF.40 en/
FAX
STREET AD ern, ,TE,ZIP
DRESSX/ /ild a e , ro
CONTRACT R.NAME LICEWF 1,121:SiEfYPE259 BUS LIC.
COMPANY N E-MAIL FAX
Zrie
STREET A4.31tES} C1T',STATE, p
let //lead de 6-za
I UNDERSTAND AND AGREE TO TUE FOLLOWING:'
1. The re-roof project shall comply with all applicable provisions of the 2016 California Codes.
2. An inspection request can be scheduled upto one business4a:_befIate.
to'schedule inspections call (408) 777-3228 from 7:30-;-330pinftn-Thurs):.C& 7:30-2:30pm (Friday) to
schedule inspection, For Tear-Off and Nailing InspectionS,you must.also call caUçn.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;30ant and 1.2:30.r3:30 (Mon-Thurs)
and 7:30-1.0:30am and 12:30-2:30 (Friday). Final Inspections will be givena 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/fastenets shall be either
completely knocked-down or removed prior to this inspection.
4. If plywood is installed, a plywood Nailing Inspection is required.
5. Roofing shall not be applied without first obtaining ail 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 thebuilding inspector when the re-roofing is
completed. To receive a final sigt-off,the followingiterns,Will be verified:
a. Flat roofs shall have a minimum of 1/1"per foot of slope and demonstrate there is no ponding.
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, gutter/downspouts installed, debris removed.
7. NOTE: If you call for a tear-off or plywood nailing inspection and the work isnot complete, you will be
charged a re-inspection fee. The re-inspection fee hjjbe aid before another inspection can be
scheduled.
. .
By my signihg below, I certify each of the following is true: I ani the property owner or authorized agent to act on the
property owner's behalf, I understand and agree to comIly with the re-roof policy stated abolve. I also understand that:
smoke detectors and carbon monoxi• 'etectors are r Aired to be installed in accordance with Sections R3li-and R315 of
the 2016 California Residential 'ode
' ,0)0
Signature of ApplleantDate
lAgcnt: _
RerogiPolicy_.2014.doc revised 06;01/7
SMOKE / CARBON MONOXIIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION
10300 TORRE AVENUE—CUPERTINO,CA 95Q1.4-3255
CUPERTINO (408)'777-3228•FAX(408)777-3333 ilding@ 12--ertinoro
PERMIT CANNOT J E F'INAI.,EP TIL TUTS CER"I;TLCATE h AS BEEN
C®Ml'Y�E��`rlD SIGl9'EII AIYD R;ET I�TU
i u»Fifmts Y + .41ti}esar,.lk _... ? FA TIEIVE-Ic�IJILI�IN..G D�Vl[S`IO
V &
PURPOSEMonoxide
This affidavit is
a self-certification for the installation of all required Smoke and Carbon Monoxii nAr omacc for
compliance with 2016 CRC Section R314,R315,=2,016 CBC Sections 420.6 and 907.2.112 where
no for inspections are required.
GENERAL:INFORMATION
Existing single-family and multi=family dwelling �te alterations,orprovided
repaixs.to existing dwelling units exceeds
Monoxide alarms. When the valuation of additions,
$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
SMOKE ALARM CO ALARM
Outside of each separate sleeping area in the immediate-vicinity of the
bedrooms (Smoke alarms shall not be located within 3 feet of bathroom door)
On everlevel of a dweilin:unit includin;.basements and habitable attics
Within each slee•in:room 1111111101111111111.1111.1
Carbon Monoxide alarms are not required in dwellings which do riot 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.
,:, ma be solely battery operated.
Power Supply:In dwelling units with no commercial power supply,alarm(s)q, y
In existing dwelling units, alarms are permitted to be solely batter ao operated
tedwhere repairsof a ior alteratiOns
or crawl
not result in the removal of wall and ceiling finishes,or there is bymeans
space.Refer to CRC Section R314 and CPC Sections 907.2.11A and.420.6.2.An electrical pert'nit 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 beentested and are operational;as of the
date signed below.
13
Address:
a ..\tsl e_ .C. ` Permit Nay 1 1 "'rs
° �
Specify Number of Alarms: #Smoke.Alarms: #Carbon Monoxide Detectors,
(have read and agree to comply with the terms and conditions of this.statement
Owner(or Owner Agents)Name: A
: � y Signature...�
Contraoame:
Signature
Lica# Date:
Smoke and GO form.doc revised 01/10/2017