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B-2017-1724 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1724 10460 PINEVILLE AVE CUPERTINO,CA 95014-4523(369 13 036) CUPERTINO ROOFING INC SAN JOSE,CA 95129 OWNER'S NAME: BOLICH GLENN M AND MARY ANN DATE ISSUED: 10/06/2017 OWNER'S PHONE:408-564-3941 • PHONE NO:(408)973-9427 LICENSED CONTRACTOR'S DECLARATION' BUILDING PERMIT INFO: • License Class C-39 Lic.#565437 l Contractor CUPERTINO ROOFING INC Date 03/31/2018 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;COMP SHINGLES(36 SQ) I hereby affirm under penalty of perjury one of the following two declarations: t. I he and will maintain a certificate of consent to self-insure for Worker's ompensation,as provided for by Section 3700 of the Labor Code,for the 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:$17000.00 APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct..1 agree to comply with all city and county ordinances APN Number: Occupancy Type: and state laws relating to building construction,and hereby authorize 369 13 036 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 10-6-2017 Issued by:Kim Dunbar ' Date: 10/06/2017 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. • sale(Seowner of44,t 1e e's&Professions Code) 2. I,as owner the property,am exclusively contracting with licensed Signature of Applican�^ - contractors to construct the project(Sec.7044,Business&Professions Code). Date: 10-6-2017 • 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 CupertinoiMunicipal 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 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. Owner or authorized agent' APPLICANT CERTIFICATION Date:10-6-2017 I 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 10-6-2017 Professional • . CONSTRUCTION PERMIT APPLICATION \ NITY DEVELOPMENT DEPARTMENT • BUILDING DIVISIONB . • \o COMMU10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 ws '''r (408) 777-3228 • building@cupertino.org PEMIT#B-2b` 7 / O`" (7 CUPERTINO REVS DEFE El NEW CONSTRUCTION ❑ADDITION ❑ALTERATION ❑T.I. ❑MEP L E-ROOF ❑SWIMMING POOL/SPA 1 PROJECT ADDRESS(O 14 cop Pik-evi I 1 t /f ve APN A 0(eel_ f - 0340 OWNER NAME PHONE ,/i.Pll l.� "` — /(` 40 DOLte. .59-/l EVILIt'cif e ROT. £o"-\ STREET ADDRESS CITY, ATE,ZIP ONTRACTgR NAME jl OWNER-BUILDER COMPANY NAME LICENSE NUMBER LICENSE TYPE �'� LA -� (' v i %I..® Af4.5-437 STREET ADDRESS CITY, ATE, ZIP p P� ii s� , 9-'/ a E�AV V I AICA I l�i 1[ T�Ly(��l�IPH NEer- 40 --977-91(-2 BUS. .LIO 41/ 3 ❑AR TELT'0 OWNER ❑OWN AGENT ONTRACTOR AGENT D ENGINEER 0 DEVELOPER 0 TENANT (7L_ • CONTACij N;C p L\-7611 14.. c� EC o\ l V 110 dc7-14./ 7f4.c j. 441°TSTREET ADDRESSCITY TATE,ZIP ONE DECRIPTOG • r r u-ova sA e( _17'14 ST^i (( -��T ;L.-0N (�'0,S 49 17 54,•(.7/(0) T � Tg4 k • 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 A TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION($) REMODEL REMODEL KITCHEN REMODELOTHR GARAGE 0 ATTACHED BATHROOM SF SF SF SF 0 DETACHED EX1SING DYES S SPRINKLERS D NO EICHLER 0 YES NO 0 SECOND STORY ADDITION 0 YES FIRE NO DWELLING SECOND DWELLING ❑YES 0 ATTACHED 0 DETACHED OTHER UNITS A UNIT ADDITON: ❑NO 5 F POOLS' ❑FIBERGLASS 0 VINYL-LINED 0 GUNITE 0 PREFABRICATED POOL-SF SPA-SF' I SPA ATTACHED❑YES 0 NO I TOTAL-SF RE �E} ILj lay.�� Tt' VALUATION: Commercial or Multi-Family Buildings with Public Swimming Pools requires Department of Environmental Heath approval ,�A�`�/� ( � RE-ROOFI EXISTING ROOF TYPE; E BUILT-UP ROOF E ASPHALT SHINGLESNOOD SHAKES❑WOOD SHINGLES❑TILE OTHER(SPECIFY) REMOVE/REPLACED NO IF NO PLYWOODf„ El 3/8" PLYWOOD TYPE: PITCH: ROOF CLASS EYES A OF LAYERS THICKNESS ]5/8" OTHER ❑OSB ,CDX OTHER :12 A PROPOSED ROOF TYPE:❑BUILT-UP ROOF ASPHALT SHINGLES 0 WOOD SHAKES❑WOOD SHINGLES/// 0 OTHER 'pi $�/ *Provide a signed copy of the Cupertino's Tear-Off Policy SF 7G Aof SQUARES /`, e) 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 acknowledge and authorize all information contained on this application form to be made available for public record. �( Signature of Applicant/Agent: - Date: 1]��� 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_20/7.doc revised 08/01/17 \rod REROOF TEAR-OFF POLICY COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION I9, ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL CUPERTINO 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 (408)777-3228• FAX(408)777-3333•buildinqa,cupertino.orq r 2-0 11---17 PROJECT ADDRESS r ( I/�_� I)r r U1 I/ Ate APN# 3 t -/3 - 03-/3 - a3 OWNER NAME/1 PHONE(P�'1� epoitV "f c � 40q-Sr-64-5q E II ( �8irr STREET ADDRESS le ve CITY, ATE,Zr 9 ^ FAX c CONTRACTOR NAME , �I I �� LICENSE LIC�SET E� BUS.LIC.# Vr1/ _©O4q COMPANY NAMES \ �/ V P'f J E--MAIL('` S /n� ,A, FAX STREET ADDRESS D / /i // LDERSTAND Dr `` LA, Poa,477,5,ip7 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'7:30-2:3Opm (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. 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 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: ReroofPolicy_2014.doc revised 06/01/7 SMOKE / CARBON MONOXIDE ALARMS . OWNER CERTIFICATE OF COMPLIANCE C017-17 f 0— °s, COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION CUPERTINO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408)777-3228•FAX(408)777-3333•buildinq(a cupertino.orq PERMIT CANNOTBEEFINAI ED UNTILJTHIS CERTIF'IC .TE HAS BEEN t, w t"`COs MLETE; D„, SIGND Ah,; DR' ETURNEr� DTO THEBUILDINGDVISON • AT 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 below. 1 „ -7 Address: ( O�C Q �'PiU t lie A l�To. 17 - l U, Specify Number of Alarms: #Smoke Alarms: I ? I #Carbon Monoxide Detectors: 3 I i . ' I have read and agree to comp,with the terms-. • :nditions of this statement Owner r Owner Age t' me: r ( Signature ....j. �... .. �,,. Dated%%f.. Contractor Name: r Signature Lic.# _ Date:- " ' : `r Smoke and CO form.doc revised 01/10/2017