B-2017-1648 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1648
10095 ALHAMBRA AVE CUPERTINO,CA 95014-1238(326 25 029)10093
ALHAMBRA AVE CUPERTINO,CA 95014-1238(326 25 029)
OWNER'S NAME: AGHA MOHAMMAD DATE ISSUED:09/25/2017
OWNER'S PHONE: PHONE NO:
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class Lic.#
Contractor Date 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-(26 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
performance of the work for which this permit is issued.
2. 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:$11000.00
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 25 029
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.
Signature Date Issued by:Kim Dunbar
Date:09/25/2017
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 inspection,I agree to remove all new materials for
compensation,will do the work,and the structure is not intended or offered for inspection.
1�,� sale(Sec.7044,Business&Professions Code) 1000
r/ I,as owner of the property,am exclusively contracting with licensed Applicant: _ 7
• ,.. .�
I contractors to construct the project(Sec.7044,Business&Professions Code). P ,
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
I 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. Ow uthorlzed agent:
APPLICANT CERTIFICATION
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 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.
/
ature f, �mg., / A ; Date 1 ,-21-7,81 Professional
9
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CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO,CA 95014-3255
�
'S.P9.� l/ / - 1 1lC�e
(408)777-3228 • building@cupertino.org PEMIT#B-(%/� l/ ,
CUPERTINO REV# DEF#
❑ NEW CONSTRUCTION ❑ADDITION ❑ ALTERATION ❑T.I. ❑MEP ®RE-ROOF ❑SWIMMING POOL/SPA
PROJECT ADDRESS APN 8
10093-10o?5 ALHAMt3QA-AYE c .f
p Na> cv 15-15-0/4i� 32 0-a.-= C) 2 9
OWNER NAME PHONE E-MAIL
E Ma4AmmorDPC to CAfo 8)al-018-4 Mr _/4A6/Aga,.com
557 ADDRESS CITY,
/AYE s STATE, , CA- 95I 4
o CONTRACTOR�1TONAA1MMEj�JtA OWNER
--B�UIILLDER COMPANY NAME LICENSE NUMBER LICENSE TYPE
I/V 1OI1` litAkAD 11644
STREET ADDRESS CITY,STATE, ZIP
E-MAIL t v PHONE BUS.LIC 8 .
f�
0 ARCHITECT p�OWNER ❑OWNER AGENT 0 CONTRACTOR AGENT 0 ENGINEER 0 DEVELOPER 0 TENANT
CO TnACT NAME pcE-MAIL
AmAkAD
5TREET 51 fl ADDRESS C i%tf&� Av6 C TEhiika -so� GA 150-4 1fc —ZIP PHONE 66/--0/8�
DECRIP
— RRN- ► T �'Afc,-- v,-- 1-f e*ci'-Nc.c,_ p._„eF isvv) 4 g)i,c--
4 w;tGt -i N ✓ Vivi- A5 11xi ,
SINGLE-FAMILY/DUPLEX 0 MULTI-FAMILY 0 INDUSTRIAL 0 COMMERCIAL I
XISTING USE EXISTING 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 ❑ATTACHED
BATHROOM SF SF SF SF 0 DETACHED
EXISING ❑0 YES EICHLER 0 YES SECOND STORY ADDITION OYES
NO
FIRE SPRINKLERS NO 0 NO
DWELLING SECOND DWELLING ❑YES ❑ATTACHED DETACHED THERR �
ur# IUNITADDITON: ❑NO SF - RPO
POOLS! ❑FIBERGLASS 0 VINYL-LINED ❑GUNITE 0 PREFABRICATED
POOL-SF SPA-SF I SPA ATTACHED ❑YES ® NO I TOTAL-SF
RE E BY: M- TA1 A U TION:
Commercial or Multi-Family Buildings with Public Swimming Pools requires Department of Environmental Heath approval ,Vim'
RE-ROOF EXISTING ROOF TYPE: ❑BUILT-UP ROOF❑ASPHALT SHINGLES WOOD SHAKES❑WOOD SHINGLES❑TILE OTHER(SPECIFY) V.-
REMOVE/REPLACE 0 NO IF NO PLYWOOD Nr1/2" ❑3/8" primisi
ROOF CLASS
$rYEs I #OF LAYERS THICKNESS❑5/8" OTHER OSB ❑�C►DX OTHER 71411-11r_.12 A
PROPOSED ROOF TYPE:❑BUILT-UP ROOF ❑ASPHALT SHINGLES❑WOOD SHAKES❑WOOD SHINGLES q,+OTHEI�$ /�u�00
�j�
*Provide a signed copy of the Cupertino's Tear-Off Policy (- SF �'V L BfSQUARES .(
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 - s relating to building construction. I authorize representatives of Cupertino to
enter the above-identified property fo inspectio I acknowledge and authorize all information contained on this application form
to be made available for public r-c' • + 1' ;•'
Signature of Applicant/Ag l,�;'/atj,7,�,0'.�• -i - /, A Dat
f „aim
SUPPLEMENTAL INFORIIYA' •` R : . if
*New SFD/Second Dwelling U • s/Multifamilllings:A Demolition permit is required prior to issuance of a building permit for all new construction.
*Commercial Buildings: Provide a c. . - -.' azardous 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
I
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT* BUILDING DIVISION
,.•.%_., \ ALBERT SALVADOR, P.E.,C.B.O.,BUILDING OFFICIAL
,•.,,., -
i
! 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTINO 1
(408) 777-3228•FAX(408)777-3333*buildingacupertino.orq 'b - ?CD t -1 •-( c ((f
RoEcr ADDRESS 60 /41 1 APR 4i
. 0.4..1 - 0° 'Me to. .1 .1A14 6° i ^ CAI' kg cA 73 2 (_,, - 2__ —02_1
OWNER NAME A11404 PHONE E-MAIL IMMAbAAA411_ ' 'fp - i- °I V in.k. c_om 146444Q 01400:coeit.
STREET ADDRESSC ,2 , CITY. STATE.ZIP ; FAX
`DI .h ilk A . • at 151, I _
I
CONTRACTOR NAME LICENSE NUMBER I LICENSE TYPE BUS.LIC.#
I .
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
I UNDERSTAND AND AGREE TO 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 business day before the requested inspection date.
To schedule inspections 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 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 7:30-10:30am 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. 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 receive a final sign-off, the following items 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 pre-manufactured 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 for a tear-off or plywood nailing inspection and the work is not complete, you will be
charged a re-inspection fee. The re-inspection fee shall be paid before another inspection can be
scheduled.
• • .
1 . .
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
t smoke detectors and carbon monoxide detect. . , uired to be installed in accordance with Sections R314 and R315 of
the 2016 California Residential ode. /
. „ A
L i gn attire of Applicant/Agent: _.....i ..,,,d4r ,f,Tor; / i A_,14,i Date: 1 - .- /
- by,
Reroq/Pokv2014.cloc revised V(It
\ OWNER-BUILDER DISCLOSURE FORM
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
;,r=4ii� 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
C U P F RT I N 0 (408)777-3228 • FAX(408)777-3333 • buildinq(cDcuoertino.orq
Dear Property Owner(s):
An application for a building permit has been submitted in your name listing yourself as the builder of the property
improvements specified at:
SIT)O E A3DR IODRS , , tt�nw -490 APN BP#
OWNER NAME OWNER ADDRESS
nA014AftmAb tsicwA 1543q ' w 'AYs. BAN (3473c , 03 75,zy
DESCRIPTIONTIOF WORK: p�
R 5 —R OPOV-
We are providing you with an Owner-Builder Acknowledgment and Information Verification Form to make you aware of
your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner-Builder. We
will not issue a building permit until you have read, initialed your understanding of each provision, signed, and
returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless
you, the property owner, obtain the prior approval of the permitting authority.
OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION
(DIRECTIONS:Please read and initial each statement below to signify you understand or verify this information.)
016\ !/ 1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-
Builder" building permit that erroneously implies that the property owner is providing his or her own labor and material
personally. I, as an Owner-Builder, may be held liable and subject to serious financial risk for any injuries sustained by
p an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not
provide coverage for those injuries. I am willfully acting as an Owner-Builder and am aware of the limits of my
insurance� urcoverage for injuries to workers on my property.
Yak (/ 2. I understand building permits are not required to be signed by property owners unless theyare responsible
theconstructionand are not hiring a licensed Contractor to assume this responsibility. for
ii,94
1/ 3. I understand as an "Owner-Builder" I am the responsible party of record on the permit.
protect myself from potential financial risk byhiringa licensedthe I understandnthate I may
Contractor and having permit filed in his or her
na7 instead of my own.
Afl-A---
V 4. I understand Contractors are required by law to be licensed and bonded in California and to list their license
�, ( num ers on permits and contracts.
�IVtiC 5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the
total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be
cons'dered•an "employer" under state and federal law.
i/federal 6. I understand if I am considered an "employer" under state and federal law,uI must rraegister with the state and
nce, and contriute to
government, withhold payroll taxes, provide workers' com ens '
unemployment compensation for each "employee." I also understand my failure toabuideuby these laws may subject
A me to�serious financial risk.
�j��{ y 7. I understand under California Contractors' State License Law, an Owner-Builder who builds single-family
Y residential structures cannot legallybuild them with the
intent to offer them for sale, unless all work is performed by
licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work
is performed under contract with a licensed general building Contractor.
/i,„4. . I understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for
any financial or personal injuries sustained by any subsequent owner(s)that result from any latent construction
defects in the workmanship or materials.
OwnerBuilderForm 2010.doc revised 04/14/10
Mi( 9. I understand I may obtain more information regarding my obligations as an"employer" from the Internal
Revenue Service, the United States Small Business Administration, the California,Department of Benefit Payments,
and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State
License Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed
contr tors.
14-(4'1 10. am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I
am th party legally and financially responsible for proposed construction activity at the site address listed above.
.14 11. agree that, as the party legally and financially responsible for this proposed construction activity, I will abide
by al pplicable laws and requirements that govern Owner-Builders as well as employers.
rkilik I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the
information I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If
you contract with someone who does not have a license, the Contractors' State License Board may be unable to
assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed
Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or
employee of that individual or firm is injured while working on your property, you may be held liable for damages. If
you obtain a permit as Owner-Builder and wish to hire Contractors, you will be responsible for verifying whether or not
those Contractors are properly licensed and the status of their workers' compensation insurance coverage.
CONSTRUCTION LENDING AGENCY
(DIRECTIONS:Please complete the following construction lending agency information.)
I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued
(Sec 3097 Civ.)
Lender Name: Lender Address:
Before a building permit can be issued, this form must be completed and signed by the property owner and
returned to the agency responsible for issuing the permit Note:A copy of the property owner's driver's license,
form notarization, or other verification acce•table to • .y ,-y be required to be presented when the permit is issued
to verify the property owner's si sr=. `I
Property Owner's Signature: !. , 4. �4f11%hi_�i A ; i.4A Date:4-2'..70 �-
-LiININF ,
(NOTE: The following Authorization Form is required to be completed by the property owner only when designating an
agent of the property owner to apply for a construction permit for the Owner-Builder).
AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF
Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby
authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an
Owner-Builder Permit for my project. n
Scope of Construction Project (or Description of Work): KC- (ZOC (ik(S.--
Project Location or Address: 100,33-/0015 AL t ni& A Av. ) cD E&7,von CA ?so/y
Name of Authorized Agent: Tel No
Address of Authorized Agent:
I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the
above information and certify its accuracy. Note:A copy of the property owner's driver's license, form notarization, or other
verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's
signature.
Property Owner's Signature: Date:
Oti+'neBuilderForm 2010.doc revised 04/14/10
\ - 1 SMOKE / CARBON MONOXIDE ALARMS FILE
OWNER CERTIFICATE OF COMPLIANCE
8,194. .;. COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTINO
(408)777-3228•FAX(408)777-3333•buildinq(acupertino.orq
PERMIT CANNOT BE FINALED UNTIL THIS CERTIFICATE HAS BEEN
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 alarm's 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 specifiedbelow have been tested and are operational,as of the
date signed below 930 fq
Address: 1 /0c5q5 A et ([ t C `k(0) CJS' Permit No. . /61-10.7
Specify Number of Alarms #Smoke Carbon Monoxide Detectors.
have read and ag a to comply with •-terms and conditions o is statement
MOHAMMAD ,t\ + �� ifl �y�
Owner(or Owner Agent's)Name: ,
PKV4 Sig turev�. ,� ' r ��ti? Date: 1J•c `2017
f r 1
Contractor Name: �-
Signatu - Lic.# Date:
Smoke and COform.doc revised 01/10/2017