B-2017-1632 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1632
10487 HENEY CREEK PL CUPERTINO,CA 95014-0828(342 48 012) LINDY ROOFING
COMPANY INC
SAN JOSE,CA 95110
OWNER'S NAME: HA JOHN C AND SUSAN M TRUSTEE DATE ISSUED:09/21/2017
OWNER'S PHONE:408-853-5006 PHONE NO:(408)286-9990
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C39 Lie.#215816
Contractor LINDY ROOFING COMPANY INC Date 08/31/2018 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;INSTALL OSB;COMP SHINGLES-(35 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
C 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:$20000.00
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 342 48 012
representatives of•this city to enter upon the above mentioned property for
inspectipn 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 a Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signatur Date 09-21-2017 • Issued by:Kim Dunbar
Date:09/21/2017
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 obtaining an i ispection,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 App _
contractors to construct the project(Sec.7044,Business&Professions Code).
Date:09-21-201
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
t. 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 Cuperti pp Municipal Code,Chapter 9.12 and
. exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code :•ct' As 25505 25533,and 25534.
• Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent:4
•
APPLICANT CERTIFICATION Date:09-21-2017 ti^
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 indemnifyand 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 09-21-2017 Professional
CONSTRUCTION PERMIT APPLICATION
f1 COMMUNITY DEVELOPMENT DEPARTMENT •BUILDING DIVISION
j 10300 TORRE AVENUE • CUPERTINO,CA 95014-3255
Vsz,",\ (408)777-3228 • building@cuperfino.org -VA_- 1(03
CUPERTINO REV# DEF
0 NEW CONSTRUCTION ❑ADDTITON ❑ALTERATION
ALTERATION❑T.I. 111 MEP /i RE-ROOF
EI SWIMMING
MING POOL/SPA
PROJECT ADDRESS/0 Lie 37Ken. cfn,e ` melCe. IAN S J ' La` _ O/
OWNER NAME. PHONE E-MAIL
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CONT CT'tNAME • E-MAIL
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,INGLE-FAMILYrDUPLEX 0 MULTI-FAMILY ❑INDUSTRIAL 0 COMMERCIAL I
EXISTING USE I EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES 8 TOTAL NET SF I USE TYPE OCC 'SQ.FT. VALUATION($)
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REMODEL REMODEL KITCHEN REMODEL OTHR GARAGE ❑ATTACHED 1 i..
BATHROOM SF SF SF SF 0 DETACHED I ',
FIRE SPRINKLERS 0 NO EICHLER YES0 SECOND STORY ADDITION 0O I 0
DWELLING SECOND DWELLING. ❑YES 0 ATTACHED 0 DETACHED OTHER ,
UNITS n UNIT ADDITON: 0 NO S F +
POOLS! ❑FIBERGLASS 0 VINYL.,LIVED 0 CONFER ❑PREFABRICATED .
POOL-SF SPA-SF I: SPA ATTACHED❑YES ❑NO II TOTAL-SF
REQ_k 0 , ,•TALVALUATION:
Commercial or Multi-Pmnily Buildings with Public Swimming Pools requires Department of Environmental Heath approval II. 0"",(/V 000
RE-ROOF!EXISTING ROOF TYPE 0 BUILT-UP ROOF 0 ASPHALT SHINGLESSWOOD SHAKES❑WOOD SHINGLES 0 TILE OTHER(SPECIFY)
REMOVE/REPLACE❑NOI ❑
IF PLYWOOD ❑3/8 PLYWOOD TYPE PII'CFI [ 12I ROOFACLASS
At8 OF LAYERS ! "THICKNESS❑SIB" OTHER
NOSE cox ()TREK ; A
PROPOSED ROOF TYPE❑BUILT--UP ROOF AZASPH ALT SHINGLES 0 WOOD SHAKES❑WOOD SHINGLES 0 OTHER 1 ,,
*Provide a signed copy of the Cupertino's Tear-Off Policy ,--1414(—''
t tR s '
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 iuformation I have provided is correct. I have read the Description of Work and venlfy 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 inspection purposes. I acknowledge and authorize all information contained on this application form
to be made available for public re I r• ,t
Signature of Applicant/Agent Date: q(lq (7'
i
SUPPLEMENTAL INFO' 9' 'EQUIRED
*New SFD/Second Dwelling Units/Multifamily Dwellings:A Demolition permit is required prior to issuance of a building Pe:::
Trm t f'1,r.,
r all new construction.
, *Commercial Buildings: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as p,art of this project ,
*Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. ;'i i' t
i; *HOA-Provide a letter of approval from the Home Owners Association ';,I1 ' i'
,i iii III`;
BldgApp,2017.'doc revised 08/01/17
•
• REROOF TEAR-OFF POLICY
•
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
•
ALBERT SALVADOR P.E., C.B.O.,BUILDING OFFICIAL /1,1) 1, LP 1)
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTINO I
(408)777-348•FAX(408)777-3333•building@cupertino.org
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OWNER NAME n, • 1 E-MAIL
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I UNDERSTAND AND AGREE TO TIlE 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.husiness•Za* before the requested inspection date.
To schedule inspections call (408) 717-3228 froth 7:30:30pin( on-Thurs) or 7:30-2:30pm(Friday) to
schedule inspection. For Tear-Off and Nailing Inspection 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. The hours for this service are: 7:30-10:30am and 12:30-3:30 (Mon-Thurs)
and 7:30-10:30ani 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. Roofing shall 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 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-the:building inspector when the re-roofing is
completed. To,rective a final the following kerns Will be verified:
a. Flat roofs shall-have a minimum of 1/4"per foot of Slope and 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 inspeCtion.
c. Proper spark arrestor installation, vents painted, gutter/downspouts installed, debris removed.
7. NOTE: If you call fdr a tear-off or plywood nailing inspeetion and the work is not complete, you will be
charged a re-inspection fee. The re-inspection fee shalt be paid before another inspection can be
scheduled.
By my signing beloW, 1 certify each of the following is true: I ant the property owner or authorized agent to act on the
property owner's behalf. 1 understand and agree to comply with the re-roof policy stated above. I also understand that
smoke detectors and carbon monoxide d tectors are required to be installed in accordance with Sections R314 and R315 of •
the 2016 California Residential C . ,
Signature a fAppl ieantiA nra: .de Date: e7
RerooToliv..2014,doe revised 06/01i7
{
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
-css, COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
UPERTtNf 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333•buildinq aC�cupertino.or0
PERMIT CANNOT BE FINALED UNTIL THIS CERTIFICATE HAS BEEN
COMPLETED;SIGNED AND JI.ETUfNED 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 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 -7 below /
Address: /6 ! l /�GCt Permit No /7 Co 3
VV
Specify Number of Alarms. #Smoke Alarms. Lt., I #Carbon Monoxide Detectors. I I__
I have read and agree to comply with the terms and conditions of this statement
Owner(or Owner Aggnt's)Name:6;‘ r
300.11
Signature - -
D
ate:
jContractor Name: /
lam( V_ llt,,,i Ck v sit - Lic.#.04V?�'C cf/ Date: . .
Smoke and COfonn.doc revised 01/10/2017