B-2017-1780 CITY OF CUPERTINO BUILDING PERMIT '
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 0.Zci i..1— fl O CSA)
11816 PINE BROOK CT CUPERTINO,CA 95014-5114(366 55 037) JIREH INC ,
LOS GATOS,CA 95031
OWNER'S NAME: CHANG THERESA HUE-MIN DATE ISSUED:
OWNER'S PHONE:415-225-8800 PHONE NO:(408)298-9399
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-29 Lic.#800707
Contractor JIREH INC Date 10/31/2019 X BLDG _ELECT _PLUMB ,
MECH X RESIDENTIALCOMMERCIAL
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 COMP-(20 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
Iperfmance
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:$6590.00
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 366 55 037
representative's of this city to enter upon the above mentioned property for
insPdctioni purposes. (We)agree to save indemnify and keep harmless the
City of'C;upertino 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.
,E1,,,-\,..._
` nature ; i� .-- ----"-`—Date 10/17/2017 Issued b �u�
y��ax�
' '1 ', Date:loi 1'l(Zo-
OWNER-BUILDER DECLARATION 4 •
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 aninspection,I agree to remove all new materials for
11 inspection.
• compensation,will do;the work,and the structure is not intended or offered for ,;
sale'(Sec.7044,Business&Professions Code) ,> !,4
2. I,as:owner of the property,am exclusively contracting with licensed S.a,•. a of Applicant: ,.Ptf ,.
contractors to construct the project(Sec.7044,Business&Professions Code). p.d.,t®' 0/17/2017 w
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER .
i. 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,
material. Additionally,should I use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the 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 CupertirlMunIcipal Code,Chapter 9.12 and
exemption,I become,subject to the Worker's Compensation provisions of the the Health&Safety Code,SecNo,n'25505 25533,and 25534.
Labor'Code,I must forthwith comply with such provisions or this permit shall ',/,'A
be deemed revoked. •w��;:,r"authorized agent: i/ __-.---"'�
APPLICANT CERTIFICATION :.1:'e:10/17/2017
I certify:that,l-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.
Signature Date 10/17/2017 Licensed
Professional
i
\ / REROOF PERMIT APPLICATION R 1
1111 COMMUNITY DEVELOPMENT DEP p,RTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(408)777-3228• FAX(408)777-3333•buildinct a(�,cupertino.org
CUP5RTINO ,, -
PROJECT ADDRESS J/ // /^ , __ Aesi,e4lAPN# 3(��/ cV� V37OWNER NAME `l ( / ���/ PHONE E-MAIL
V5 PIS teff./
STREET ADDRESS CITY, STATE,ZIP 4 56/,,
. .
CONTACT NAME PHONE E-MAIL
STREET ADDRESS CITY,STATE,ZIP FAX
❑OWNER 0 OWNER-BUILDER 0 OWNER AGENT ,CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER 0 TENANT
CONTRACTOR NAME
NUMBER LIC
�NSETY � BUS.Lig.
J irte , ' r OollO 4 0 1_45
—
COMPANY NAME E- IL FAX tii M Los 6-'ed--os Ro/-Flhe p/z�6'/ s �c Paa . niAr ,2 i /)
STREET nn� rCITY,S ,I/iMJ1.345 e N `7, `R, q 9s,J�/ fi /
ch
ARCHITECT/ENGINEERNAME
LICENSE NUMBER BUS.LIC.#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF SFD or Duplex 0 Multi-Family ROOF AREA: VALUATION:kf
STRUCTURE: Commercial /" q `S �/� 5 '0
EXISTING ROOF TYPE: 0 BUILT-UP ROOF 0 ASPHALT SHINGLES WOOODDSHAKES 0 OOD SHINGLES ❑'OTHER(SPECIFY) ,
REMOVE IREPLAC)YES IF NO, I PLYWOOD ><AlitlEIL LLYYWD OSBPITCH: 12ROOF A��/��/ ❑NO #LAYERS: THICKNESS: ❑ 518" TYPE: ❑ CDX CLA S.
ICC-ES PORT#
PROPOSED ROOF TYPE: 0 BUILT-UP ROOF �SPHALT SHINGLES ❑WOOD SHAKES- ❑WOOD SHINGLES ElOTHER
DESCRIPTION OF WORK: '
•
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I O - - ,
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 bpi di struct, . I authorize repr'sentatives of Cupertino to enter the above-iden'fled property for inspection purposes.
Signature of Applicant/Agent: A, %�`� Date: G
�i k'Sv ,..ager .pq* , - " ., x '��s Nti �, "h34 , Rti�t.G},�.i*
SUPPLEMEN AL IN ORMATION REQUIRED .- . E ,..;,. .kir. ig,,,i;,OFFIg USErONLYt,.A,.� l,W;, .,:a,a:i-
i�.i PLAN CHECK;YPEKYrI1 s 2a 4,1? - 3.c.,l3 ?- z.. s `x� ,4,31: z. I
If building is associated with a Home Owner's Association,provide letter r '...at i Par, ROUTING SLIP �sh> ,14 . ,
u -.7 7 s: z. l r, £.'Y-^ as a .2 f is 3Fc"Y
of approval from HOA. ,;L OVER THE-COUNTER� f £3 L BUILDING:PLAN REVIEW x ,i
Provide Planning approval to verify if there any restrictions. ❑ ExPREss �, { k ® PL ' GP{IAN_REVIEWe
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Provide copy of Manufacturers Installation SpecificationsI . 4sTwAaRD t 2 tEYIRDEPAE ,kfl+ ,,,,,, 3 , t� e wF � +
t ,urr � €
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Provide signed copyof Cu ertino's Tear-Off Policy. - E ' OTHEka� r �
., Ms >' , e � ,nLt6 at v w4f
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ReroofApp_2011.doc revised 03/16/11
•
\\/ REROOF TEAR-OFF POLICY
t®' COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
�41,,Dsf ALBERTISALVADOR, P.E., C.B.O., BUILDING OFFICIAL
CLJpERTINO •
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 ,
(408)777-3228• FAX(408)777-3333•building@cupertino.orq P r2z { ^7— (7'c
PROJECT ADDRESS kr y,,),,/ 666�, A.„../. z7e-- APIs"
PN H 'S //'// J//i!
OWNER NAME / (f`! PHONE /5 2-Z-S- 18.0aE-MAIL
..,d7./---
STREET ADDRESS CITY, STATE,ZIPFAX
�4,1 /7// 71P3 °.1‘7-
CONTRACTOR NAME i;-)r _ I , ) C LICENNIIOBEjt ,^ LICFSE TE, BUS.LICA
COMPI+N/I�LNAME 1 S lV�/l goal
11 E-1-01 VCS' 1 Qs gi-i)s V(/1 49.ce:-..-, -FAX )/O c m-9371
STRE AD RFSS La
/ / CITY TATE, PHONE '
sxuishdfs �1-1111 \3 � �s� e4 9s/10 925I9,
I UNDERSTAND AND AGREE TO THE FOLLOWING:
1. The re-roof project shall comply with all applicable provisions of the 2013 California Codes.
2. An inspection request can be scheduled up to one business day before the requested inspection date.
Please schedule inspections online or 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
available 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-roofmg is
completed. To receive a final sign-off, the following items will be verified:
a. Flat roofs shall have a minimum of I/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 detector are required to ae installed in accordance with Sections R314 and R315 of
the 2013 California Residential o•- /.
Signature of Applicant/Agent: A ,,_ Date: ` 0)d//6 Ai 7
G
Rerooj1 olicy;,2014.doc revised 01/15/14
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. .' SMOKE / CARBON MONOXIDE ALARMS
'` OWNER CERTIFICATE OF COMPLIANCE
_{F COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CUPERTINO 10300 TORRE AVENUE• CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333•buildino{ftuoertino.orq
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PURPOSE �. -„ _,.._r .u....
This affidavit is a self-certification for the installation of all required Smoke and Carbon Monoxide Alarms
for compliance with 2016 CRC Section R314,2016 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 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 X X
the bedroom(s)
On every level of a dwelling Imit including basements 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 ,
Address. ://?/4, !” t h... a004 674 Permit No o ag/ /' 70
Specify Number of Alarms: #Smoke Alarms. J #Carbon Monoxide Detectors nill
I have read and agree to comply with the terms and conditions of this statement
Owner(or Owner Agent's)tame: �
Signature , Date:M.4
CZ?C‘tforame: "' ”'
ISignature Lic.# Date:
Smoke and CO form.doc revised 12/15/16