B-2017-1708 •
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1708
19920 MERRITT DR CUPERTINO,CA 95014-2444(316 30 022) CAMPBELL ROOFING
INC
CAMPBELL,CA 95011
OWNER'S NAME: FONG FRANK Q L AND MAY M Y TRUSTEE DATE ISSUED: 10/03/2017
OWNER'S PHONE:408-242-9439 PHONE NO:(408)326-2611
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-39 Lic.#963201
Contractor CAMPBELL ROOFING INC Date 07/31/2019 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(30 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
,off-performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance,as provided for by
Se 'on 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$17000.00
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 316 30 022
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.
•
ignatur Date 1.11 3/2017 Issued by:Abby Ayende
Date: 10/03/2017
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 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.
sale(Sec.7044,Business&Professions Code)
z. 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:10/3/2017
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 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. veer or authorized agent'
APPLICANT CERTIFICATION Date: 10/3/2017
I certify that I have read this application and state that the above information is •►. -Ii LENDING A
'-
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 10/3/2017 Professional •
. CONSTRUCTION PERMIT APPLICATION
\ COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
ftv, 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
w1-1-06
.,-I'4, (408) 777-3228 • buildingPcupertino.org PEMIT#B- �� -
CUPERTINO REV# DEF#
❑ NEW CONSTRUCTION El ADDITION ❑ALTERATION ❑T.1. El MEP ❑RE-ROOF ❑SWIMMING POOL/SPA
PROJECT ADDRESS ' `
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OWNER NAME / ly PHONo7- e-g�_lgct -MAIL
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STREET ADDRESS CITY, STATE,ZIP
'[]CONTRACTOR NAME ❑OWNER-BUILDER COMPANY NAME LICENSE NUMBER LICENSE TYPE
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STREET ADDICESS \�,ST E, ZIP tq
33
E-MAIL PHONE BUS.LIC a
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0 ARCHITECT 0 OWNER ❑OWNER AGENT t�J CONTRACTOR AGENT ENGINEER 0 DEVELOPER ❑TENANT
CONTACT NAME n E-MAIL
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STREET ADDRESS CITY,STATE,ZIP PHONE
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DECRIPTON
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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# TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION(5)
REMODEL REMODEL KITCHEN REMODELOTHR GARAGE ❑ATTACHED
BATHROOM SF SF SF SF ❑DETACHED
EXISING ❑YES EICHLER 0 YES SECOND STORY ADDITION OYES
FIRE SPRINKLERS 0 NO 0 NO 0 NO
DWELLING SECOND DWELLING ❑YES ❑ATTACHED❑DETACHED OTHER
•
UNITS a UNIT ADDITON: ❑NO S F ,
POOLSI ❑FIBERGLASS 0 VINYL-LINED ❑GUNITE 0 PREFABRICATED
POOL-SF SPA-SF I SPA ATTACHED El YES 0 NO TOTAL-SF 1 4
RECE VVED BY: , TOTAL V UATION:
Commercial or Multi-Family Buildings with Public Swimming Pools requires Department of Environmental Heath approval ( p,//�i1 'nW; ,`',�, � Pih hlV l
l41 n)
RE-ROOFI ❑EXISTING ROOF TYPE: BUILT-UP ROOF❑ASPHALT SHINGLES O WOOD SHAKES❑WOOD SS IIANGL S u TIDE OTHER(SPECIFY) `4� u
REMOVE/REPLACE�r
D NO IF NO PLYWOOD L��• LJ 3/8" PLYWOOD TYPE: PITCH:' I:
v •SS
sES #OF LAYERS THICKNESS Ei 5/8" OTHER +1B ❑CDX OTHER •12ROS"
PROPOSED ROOF TYPE:❑BUILT-UP ROOF ❑ASPHALT SHINGLES 0 WOOD SHAKES❑WOOD SHINGLES 0 OTHER
*Provide a signed copy of the Cupertino's Tear-Off Policy SF eof 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 inspection purposes. I ackn..ledge and authorize all information contained on this application form
to be made available for public record.
Signature of Applicant/Agent: Date: - % ', -
SUPPLEMENTAL INFORMATION RE - - 1
1
*New SFD/Second Dwelling Units/Multifamily Dwellings:A Demolition permit is required prior to issuance of a building permit for all riew 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. I
*HOA-Provide a letter of approval from the Home Owner's Association , I.
i
BldgApp_2017.doc revised 08/01/17
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
AZT ss ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
CUPERTINO 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(408)777-3228•FAX(408)777-3333•building@cupertino.org
PROJECT ADDRESS Mize)
114-
or DY- APN# l Co 2 O-O2
OWNER NAMErk-alk V-0 PHO / ✓ E-MAIL
STREET ADDRESS v CITY, STATE,ZIP FAX
zo 144,
CONTRACTOR NAME 4..„," e_rio LICENSE NUMBER' 156121/CENSE TYPE BUS.LIC.#
COMPANY NAMEr D� �� E-MAIL FAX
Of co •�V 6
STREET ADDRESS r^ CITY,STATE,ZIP PHO
Z. rzc,� c C p to yar/
3?-6-Z611
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 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. iiiMpw
((e)
�
By my signing,belo certify ea' - o owing is true: I am the property owner or authorized a ent 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
smoke detectors and carbon monoxide detectors are required to be installed in accordance with Sections R314 and R315 of
the 2016 California Residential Code.
Signature of Applicant/Agent: __ Date:
r
ReroofPolicy_2014.doc revised 06/01/7
ALARMS
#:>
IDE
OWNER CERT I FIC OFXCOMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDIN (1I HTTP
G DIVISION
UPERTINC? 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333•buildinq(a�cupertino.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 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 907.2.114 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 / l 2_0 Al E- 2 i r r D (1 1° /Z T7idQ Permit No. 8 - 2-'17 -1701
Specify Number of Alarms #Smoke Alarms I R I #Carbon Monoxide Detectors. 2-
I have read and agree to comply with the terms and conditions of this statement
Owner(or Owner Agent's)Name:FA/4-4/K
,-2/1-04,1--1 O 6 Signature Date: /47AI 2°/7
Contractor Name:
Signature Lic.# Date:
Smoke and CO fonn.doc revised 01/10/2017