B-2017-1788 •
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1788
10487 WESTACRES DR CUPERTINO,CA 95014-2938(359 14 033) CUPERTINO ROOFING
INC
SAN JOSE,CA 95129
OWNER'S NAME: MADHATHIL SATHEESH K AND ATANCHERY KAVITHA DATE ISSUED: 10/19/2017
OWNER'S PHONE:408-834-0839 PHONE NO:(408)973-9427
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C_39 Lic.#565437
Contractor CUPERTINO ROOFING INC Date 03/31/2018 �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(27 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
(erformance of the work for which this permit is issued.
%• f'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:$16000.00
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 359 14 033
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 pe^the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 10/19/2017 Issued by:Abby Ayende
111 Date: 10/19/2017
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 roofmg material being installed.If a roof is
• 1. I,as owner of the property,or my employees with wages as their sole installed rit nit first obta'•' g 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)
2. I,as owner of the property,am exclusively contracting with licensed i of Applican•contractors to construct the project(Sec.7044,Business&Professions Code)• &ature
Date:10/19/2017
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_compfiance with the Cupertino Municipal Code,Chapter 9.12 and the
'Health&Safe de,Section 25532(a)should I store or handle hazardous
3. I certify that in the performance of the work for which this permit is issued,I R,
shall not employ any person in any manner so as to become subject to the material. Additionally,sh a uld I use equipment or devices Management
emit hazardous
air contaminants as defined . the Bay Area Air Quality ManagDistrict I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with e Cupertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the t sfIealth&Safety o o e,Sections 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall .•F,„;
be deemed revoked. 'a, n'r or authorized agent:
,APPLICANT CERTIFICATION s ate:10/19/2017
I certify that I have read this application and state that the above information is CO 'UC 0 L NDING •G C
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm t t -re 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,theapplicant 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 10/19/2017
Professional
CONSTRUCTION PERMIT APPLICATION
'j f COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
.,
10300 TORRE AVENUE • CUPERTINO,CA 95014-3255
s (408)777-3228 • building@cupertino.org PEMIT#B- (�
CUPERTINO REV# DEF#
❑ NEW CONSTRUCTION ❑ADDITION ❑ALTERATION ❑T.I. ❑ME�RE-ROOF ❑SWIMMING POOL/SPA
•
PROJECT ADDRESS ) D–t U 1 -R c3 c-cR I APN# C^ \J��n.3
OWNER NAME '- Cti- IRR. , 14A lJ _, 1_ •1�H0� •et "- g 7 �1 (5 ?1 E-MAIL
STREET ADDRESS' \ l^ �T�` CITY, STATE,ZIP t
1 b' "1 Liq s-,--)- lee 3 C,vp-e;2d-1 n'c1 Cc\ `\ 'S----e `i
'J CONTRACTOR NAME ❑OWNER-BUILDER COMPANY NAME LICANSE NUMBER LICENSE TYPE
M c 54.,x, et•-)P-Qr-}"Ir..., QC 6/)1 'S L 3`1 3
•
I STREET ADDRESS n CITY STATE, ZIP
• l O s2 kl °ire s� , sS of 1Z9
E-MAIL PHONE BUS.LIC#
0 ARCHITECT 0 OWNER ❑OWNER AGENT ❑CONTRACTOR AGENT❑ENGINEER 0 DEVELOPER 0 TENANT
CONTACT NAME E-MAIL •
•
STREET ADDRESS CITY,STATE,ZIP PHONE
DECRE'TON
,. Ftp-c;( IJ1 �� O , m�� �v 1�
•
. .
1 SINGLE-FAMILY/DUPLEX 0 MULTI-FAMILY 0 INDUSTRIAL ❑COMMERCIAL I
EXISTING USE EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES I TOTAL NET SF USE TYPE .OCC SQ.FT. VALUATION($)
, REMODEL'; REMODEL KITCHEN REMODEL OTHR GARAGE ❑ATTACHED f
BATHROONI'SF SF SF SF 0 DETACHED 1 j O Lv
' EXISING,' 0 YESEICHLER 0 SECOND STORY ADDITION El YES
FIRE SPRINKLERS 0 NO 0 NO 0 NO
DWELLING' SECOND DWELLING ❑YES ❑ATTACHED❑DETACHED OTHER
UNITS# UNIT ADDITON: '❑NO S F
•
POOLS" ❑FIBERGLASS ❑VINYL-LINED ❑GUNITE ❑PREFABRICATED ,
POOL-SF , SPA-SF SPA ATTACHED❑YES 0 NO TOTAL-SF
RECEIVED BY:
/^! TOTAL VALUATION:
Commercial or Multi-Family Buildings with Public..Swimming Pools requires Department of Environmental Heath approval p� I /p i idI I('-`p y O
RE-ROOF"EXISTING ROOF TYPE: ❑BUILT-UP ROOF❑ASPHALT SHINGLES EI WOOD SHAKES❑WOOD SSHINGLES 0 LEV OTHER(SPECIFY) l�D IJIJIJ
REMOVE EPLACE 0 NO I IF NO PLYWOOD ❑Ii" ❑3/8”.....21 �PLYWOOD TYPE: PITCH: ROOF CLASS
ElyES #OF LAYERS ` THICKNESS I=1 5/8" OTHER ?Cr d OSB ❑CDX OTHER :12 A
PROPOSED ROOF TYPE:❑BUILT-UP RB6F-ASPHALT SHINGLES 0 WOOD SHAKES❑WOOD SHINGLES 0 OTHER
*Provide a signed a
d copy of the Cupertino's Tear-Off Policy SF #of SQUARES
By my'signature below I certify to each of the following: I am the property owner or authorized agent to act on theproperty 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'above1identified property or ection purposes. I acknowledge'and authorize all information contained on this application form
to be made available for public record. i�.^ i
Signature of Applicant/Agent: 1),^N— Date:
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 fetter of approval from the Home Owner's'Association .
BldgApp_2017.doc revised 08/01/17
\ " 7 REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
119s� 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(a.cupertino.orq
PROJECT ADDRESS I b4 e -
c e e n APN# 114 rerb�
OWNER NAME e;\ VNc-1"1PHO cifIL
" 8�T- J EMA
STREET ADDRESS V( j^ ` , J!- CITY, STATE,ZIP L. FAX
CONTRACTOR NAME LICENSE NU L7 LENSE1 YPE BUS.LIC.#
COMPANY NAME j'v e,,0+''nt E-MAIL FAX
1.
STREET ADDRESS f 0 z ce\ t le, CITY,STATF C l p PHONE�e_
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.
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 behal g - - d and agree to comply with the re-roof policy stated above. I also understand that
smoke detectors and carbon monoxid- detectors are required to be installed in accordance with Sections R314 and R315 of
the 2016 California Residential Code.
Signature of Applicant/Agent: • Date: 0 �1
ReroofPolicy_2014.doc revised 06/01/7
r
d.
1711 ____
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTINO
(408)777-3228•FAX(408)777-3333•buildinq(a)cupertino.orq
PERMIT CANNOT BE FINALE])UNTIL.THIS CERTIFICATE HAS.BEEl
COMPLETED;SIGNED`.AN 3 RETURNED TO THE IWILDING DIVISrrON.
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 m 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 I o 9i0;p
i -e - 12-P s r-Do Permit No.3_C7) -- 11 ge-
Specify Number of Alarms 3 #Smoke Alarms I I #Carbon Monoxide Detectors 1
I have read and agree to comply with the terms and conditions of this statement
Owner(or O • gent's) :
•II
er ent's Name kr
signature ...Sa .f. .. .C. -. ,`. Date:ContraName: 1
Signature Lic.# Date:
Smoke and COform.doc revised 01/10/2017