B-2017-1586 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1586
10269 CRESTON DR CUPERTINO,CA 95014-1013(326 37 032) R E ROOFING AND
CONSTRUCTION INC
SAN JOSE,CA 95124
OWNER'S NAME: DAVIS BARBARA R TRUSTEE DATE ISSUED:09/15/2017
OWNER'S PHONE:408-739-3968 PHONE NO:(408)626-9320
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#727599
Contractor R E ROOFING AND CONSTRUCTION INC Date 09/30/2018 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:
REMOVE(E)SHAKE ROOFING AND INSTALL(N)1/2 CDX
I hereby affirm under penalty of perjury one of the following two declarations: UNDERLAYMENT WITH"LIFETIME"COMPOSITION ROOFING
1. I have and will maintain a certificate of consent to self-insure for Worker's (3100 SQ FT).
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued.
2. I have and will maintain Worker's Compensation Insurance,as provided for by
4- Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$30000.00
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 37 032
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 agains said .in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Adds i`t o It —t - ap. cant understands and will comply with all non-point
source regu:ti ferthe s.-rtin. . icip- ode,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
. . ure "- abate 9.15.17 Issued by:SEAN HATCH
Date:09/15/2017
OWNER-BUILDER DECLARATION
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 roofingmaterial 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:9,15.17
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- omp to ith 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 �"'th&Safety Code, ection 25532(a)should I store or handle hazardous
shall not employ any person in any manner so as to become subject to the m terata Additionally,shou : I use equipment or devices which emit hazardous
a r contaminants as defined by he Bay Area Air Quality Management District I
Worker's Compensation laws of California. If,after making this certificate of w l maintain compliance with t.• upeft1 unicipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&'Safety Coit tions 2 15,2 53 •nd 2,5,534
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked, Owner or uthorized aged_ 1`rr►
APPLICANT CERTIFICATION Date:9.15.17
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.
Licensed
Signature Date 9.15.17 Professional
CONSTRUCTION PERMIT APPLICATION
o /' COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
.. ,
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10300 TORRE AVENUE • CUPERTINO,CA 95014-3255
(408) 777-3228 • building@cupertino.org PEMIT#B-7G> 7 - /566
CUPERTINO REV# DEF#
❑ NEW CONSTRUCTION ❑ADDITION ❑ALTERATION ❑T.I. ❑MEPyE-ROOF ElSWIMMING POOL/SPA
PROJECT ADDRESS t r,^ /�
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OWNER NAME A k /I _ f PHONIEk/I(, — —]3n_ %�E MAIL pow 5 b ax,,bct ra, t�1 U .4
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STREET ADDRESS U.2-10q
rU ^ VCITY, STATE,ZIP• uV )E�T1 •aI(
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JJlJJI<ONTRACTOR NAME '0 OWNER--BUIDER COMPANY NAME LICENSE NUMBER LICENSE TYPE
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STREET ADDRESS CITY,STATE,ZIP
E-MAIL PHONE BUS.LIC#
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0 ARCHITECT 0 OWNE 2 ❑OWNER AGENT 0 CONTRACTOR AGENT 0 ENGINEER 0 DEVELOPER 0 TENANT
CONTACT NAME E-MAIL
STREET ADDRESS CITY,STATE,ZIP PHONE
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( \x MILY/D‘PLEX ❑MULTI-FAMILY 0 INDUSTRIAL 0 COMMERCIAL I
E°• _..;'S• 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 SF SF 0 DETACHED ,
EXISING 0 YES EICHLER ❑YES SECOND STORY ADDITION.❑YES
FIRE SPRINKLERS 0 NO 0 NO 0 NO
DWELLING SECOND DWELLING I 0 NES 0 ATTACHED 0 DETACHED OTHER
UNITS# UNIT ADDITON: ;❑NO S F
POOLS' 0 FIBERGLASS '❑VINYL-LINED 0 GUNITE 0 PREFABRICATED
POOL-SF SPA-SE + I SPA ATTACHED❑YES 0 NO 1 TOTAL-SF
I RECEIVE ,4 TOTAL VALUATION:
Commercial or Multi-Family Buildings with Public Seuimu:ing Pools requires Department of Environmental Heath approval /�j h/ 'S Q/o Od
RE-ROOF'EXISTING ROOF TYPE: E BUILT-UP ROOF❑ASPHALT SHINGLES❑WOOD SHAKES❑WOOD SHINGLES❑TILE OTHER(SPECIFY) /
REM /REPLAC O, IF NO PLYWOOD ❑3/8" PLYWOOD�TY,{PE� PITC j ROOF CLASS
S;I #OF LAYERS THICKNESS❑5/8" OTHER OSB W CDX OTHER r(2 12 A
PROPOSED R OF TYPE:❑BUILT-UP ROOF�G] SPHALT SHINGLES 0 WOOD SHAKES❑WOOD SHINGLES` 0 OTHER 5.02—
*Provide a signed thpy:of the Cupertino's Tear-Off Policy • SF #of 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 ord. es and state laws relating to building construction. I authorize representatives of Cupertino to
enter the above-identified property for mspecti oses. . o ge . .uthor'.e all information gont ' ed on this application form
to be made available for public record. 9 I 1
Signature of Applicant/Agent: • Date: `
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 08/01/17
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENTS BUILDING DIVISION
ALBERT SALVAOOR, RE.,C.B.O.,BUILDING:OFFICIAL
CliRSR11140 10300 TORRE AVENUE•CUPERTINO,CA 95014-3285
(408) 777-3228•FAX(408)777-3333•buliding@cupertinoorg
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PROTECT'ADDRESS . fl" a V AIN g.
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! coNTRActoRNAm • ' LICENSE NUMBER -72.--1C9cI/ LICIINSEn. c2.._ BUS LIC,,zob lc
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COMPANY SIAMP' ( 1.,\ T.Noor\14 / E-MAIL
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STREET ADDRESS no \..1 ffb,sve:. CITY,STATE,ZIP 4.3- ci 2q JC&OLOt‘1 PHONE Lck—n --01-• 2)
1: Cum i
I UNDERSTAND.AND AGREE TO 7171,1E 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 busines&dav before the reqUested inspection date.
To schedule inspections call(408) 777-3228 from 7:30 .3.,30iiii,:.(Wn4h.urs) Or17:30-2:30pm (Friday) to
schedule inspection. For Tear-Ott and Nailing inspeetionS,,,You 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. Thehours for this service are: 7,1*)-19:::40fun and 12;30-3:30 (Mon-Thurs),
and 7i30-10:30ant and 1.2:3,0ons 2:30 (Friday). Final Inspectiwill be giverra.two hour window.
' I
3. Tear-Off Inspection is required. Any and all, dry-rotted wood shall,be replaced prior to this inspection.
UnlesSneW
plywood roof sheathing is proposed throughout, all the nails/fasteners shall be either
completoly knocked-down or removed prior to this inspection. '
4. If plywood is installed, a plywood Nailing Inection is
5. Roofing shall not be applied first obtaining altprior 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 Fingi,Inspection and shall be obtained-frointhOilwildinz inspector when the reHrooting is
. ,., -!
complete& To receive a fingSign-bff,the following:itemWill be verified;
a. 1 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 ptcinantifactuted products used shall be
available on-site to'review at the time of the inspection ! i
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c. Proper spark arrester installation, vents painted, gutter/downspouts iiiMalled, debris removed,
!! !
7. NOTE: If you call for a tear-oisnot complete,:you will be
charged a re-inspection fee. The re-inspection fee-sh all,be aid before another ins ection 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 abore. I also understand that
smoke detectors and Carbon no oxide ;1‘tecto . ; - -4 air to ben stalled in accordance with'Sections:R314' nd R3'15 of
the,201California Residenti Code. A '
Date:._
*nature6 ofApplicanti,Agent: .._ , )
ReroqfPoliev 2014,doc revised 06/01/7
\ SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
QST:,sa - COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CUPERTINO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333•building a(�cupertino.orq
PERMIT CANNOT BE FINALED UNTIL-THIS CERTIFICATE HAS BEEN
f 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,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 SMOKE ALARM CO ALARM
Outside of each separate sleeping area in the immediate vicinity of the X X
bedroom(s)-(Smoke alarms shall not be located within 3 feet of bathroom door)
On every level of:a dwelling unit including basements and habitable attics 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 accessby 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: (V L 4 (9 ' Permit No. �/4-Q1 I
/°
Specify Number of Alarms: mi-2311 rnzs: 1 .`� 1 FOL. b ore o ox.i o e D tech s: I �, I
/have read and agree to comply with the terms and conditions of this statement
Agent's)
Owner
'N\Z (' \`J \S Sjgilatur, . . l .tom \C , . luV1 C-\\ W.
Cor.actor Name:
0I� 727
1 v I ��L/ v `-� Si ature ' — Lic.# 1 Date .. .�...{...
Smoke and CO formt.doc revised 01/10/2017