B-2017-1911 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1911
10205 JUDY AVE CUPERTINO,CA 95014-3522(375 07 058) WESTSHORE
ROOFING INC
SAN JOSE,CA 95131
OWNER'S NAME: WOODS THOMAS J DATE ISSUED: 11/06/2017
OWNER'S PHONE:858-25-8255 PHONE NO:(408)456-0200
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-39 Lic.#787221
Contractor WESTSHORE ROOFING INC Date 11/30/2018 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;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
performance of the work for which this permit is issued.
N,i. 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:$15096.00
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 375 07 058
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 regul 'ons perNth upertin unicipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature 'Z-2-�7�— Date 11/6/2017 Issued by:Jasmine Archbold
Date: 11/06/2017
OWNER-BU DER tECLARATION
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 !ection.
sale(Sec.7044,Business&Professions Code) i
2. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant: .4 , 1111 lb
contractors to construct the project(Sec.7044,Business&Professions Code). Date: 11/6/2017 .
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 Cupertino Municipal 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 5 25533,a 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent: a ► °s•
APPLICANT CERTIFICATION Date: 11/6/2017
I certify that I have read this application and state that the above information is CONSTRUC 11.N L Di DING AGENCY
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a co tructio 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 11/6/2017
Professional
CONSTRUCTION PERMIT APPLICATION
�\ / COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
v10300 TORRE AVENUE • CUPERTINO,CA 95014-3255
Cyt.I yJJ
(408)777-3228 • building@cupertino.org PEMIT#B- 20t R-
CUPERTINO REVS DEE It
❑ NEW CONSTRUCTION ❑ADDITION 0 ALTERATION 0 T . ❑MEP ARE-ROOF ❑SWIMMING POOL/SPA
PROJECT ADDRESSAPN S
102-0g- Ju Ik�l'� . .-is- -6amo6-8,
NAME E-MAIL
ilireak Woo 6r5 -252-g2WM'
STREET
0206 SS J 1.4 /'t V� ZIP +rto , Com- q S-b( `i.
CONTRACTOR NAME ❑ NER-BUILDER COMPANY NAME LICENSE NUMBER LICENSE TYPE
ecu I Poo ter- VJ� koNr��o -lel 2z / 'L'3�I
STREET
ADDRESS I o>-1uf e V r• ATE. Jos e__ C& 9 513 1 f
E-MAIL / PHONE ` ` 66p RIrC/ reP�
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0 ARCHITECT 0 OWNER 0 OWN R AGE .4:CONTRACTOR AGENT 0 ENGINEER 0 DEVELOPER 0 TENANT
CONTACT N AM E E-MAIL
(U �n wl r (Ams+5l-tary-e>roart vt Y'a O,�-rn
STREET f� � CTT )TE,�� as_ 01 5-1
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COp �Id( %' th i- uAd`evrl ru nif
lra.tks Co r L p : e-&h .f O0e-ill ^ vt.e._ -ia.rvz,e 9140416 - orr.1.0
PlJ806 ko50? fxt' /I7)f' '
SINGLE-FAMILY/DUPLEX 0 MULTI-FAMILY 0 INDUSTRIAL ❑COMMERCIAL
EXISTING USE EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO SF STO$!ES It TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION($)
REMODEL „SE REMODEL KITCHEN SF REMODELOTHR - ATTACHED
BAD DETACHED 2M 15/ O q6
THROOM SF � �SF SF
EXISING ❑YES EICHLER 0 YES SECOND STORY ADDrFIO YES
FIRE SPRINKLERS 0.>„-------- 1 NO
DWELLING SECOND DWELLLNG n C ❑ATTACHED O DETACHED OTHER
UNITS 8.0 TABBff 1E U : 0
POOLS' 0 FIBERGLASS 0 VINYL-LINED 0 GUNITE 0 PREFABRICATED
POOL-SF SPA-SF '"" - •• TOTAL-SF 1
REcEIVED BY: TOTAL VALUA N:
Commercial or - - "may Buildings with Public Swimming Pools requires Department of Environmental Heath approval -----104q^-
0 q^_ Artjoalikii 1 5-Oct
5.
RE-ROOF I EXISTING ROOF TYPE: 0 BUILT-UP ROOF 0 ASPHALT SHINGLES❑WOOD SHAKES 0 WOOD SHINGLES 0 TILE OTHER(SPE l
REMOVE/REPLACED NO IF NO PLYWOOD ❑h ❑3/8PL❑YWosOB THER
OD TYPE: PITCH: :12I ROOFCLASSA
ygS I✓!OF LAYERS THICKNESS❑5/8
" ER
PROPOSED ROOF E: BUILT-UP ROOF PHA LT SHINGLES 0 WOOD SHAKES❑WOOD SHINGLES El OTHER 'f /�"]� 7
*Provide a signed copy of the Cupe o's Tear-Off Policy SF Z'1�/oY4QUARES G
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' 'on purposes. I acknowledge and authorize all information cont ined this application form
to be made available for public record. o tf
Signature of Applicant/Agent: 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 letter of approval from the Home Owner's Association
B1dgApp_2017.doc revised 08/01/17
r J
E REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
yT.rvs� ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
CUPERTINO 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(408)777-3228• FAX(408)777-3333• buildinci cupertino.orq _20 . 1 ^ ( t l
PROJECT ADDRESS 10 .20s V\,l®J \ 4. APN# - S_o-1 -051'
OWNER NAME (;),AN Po DS / r PHONE �1 J E-MAIL
2
STREET ADDRESS CITY STATE,ZIP ht, FAX
f
ert-i VIP
Av
CONTRACTOR NAME V-O LICENSENUMBER } I LICEN$E TS BUS.L0.O
L V wt4 2 7 L)_G... � _tl
COMPANY NAME r' E-MAIL i l Hop p I N `J 4 I; FAX
tA)S-C-c il-baf Rob r(IQ G InJ l I ALJ` Co-"
STREET ADDRESS 92,1 cA ort u T\6 C Al E Zt G 64_
PHONE ,-jP _02tV n
I UNDERSTAND AND AGREE TO THE FOLLOWING: Y
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 I/"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 requi d to be installed in accordance with Sections R314 and R315 of
the 2016 California Residential •de.
Signature of Applicant/Agent: - L•�� Date: Ii UC 17
ReroofPolicy_2014.doc revised 06/01/7
•
.___ _
. ..
1, ..
In4 SMOKE 1r CARBON MONOXIDE ALARMS f
+IOWNER.CERTIFICATE oF•COMPLIANCEj{{ COMMUNI's;DEVELOPMENT DEPARTMENT•SUIUtD!Nt3,DI`VIS1ON
•
••,arm .11
III 1'03000 TORRE AVENUE.•CUPERTINO.CA:95014.-.52555. !
CUPERTINO t • _ _
X08 32'1 •FAX 4.8)'7 Q t
tHa;iJ)��/-J_�� 1:Yl.(Y08�17��'���N�4ltlt din4l'Liitlertiiio.urti
1•
• PERI IIT CANNOT BE FllvALt l)-IINTI.L THIS CEI~,TIPICATE i AS.BEEN -
• - COMPLETED,s1CNED,,AIND RETURNED TO THE BUILDING D VlsiON -
PURPOSE
This affidavit iss-a self.-certification for the installation of all required Smoke and Carbon Monoxide Alarms for
compliance with 201&-CROSection I 314,.R31S,2016 CBC Sei-t-ion 420.6 and:90 .2.1.1.2 where no interior access-
far inspections are required. .
GENERAL INFORMATION
Existing single-famlyandmulti=family dwellings shall be provided with-Smoke Alarms and Carbon
MonoXide alarms_ When the valuation of additions,alteraticitis,-or'repairs to existing dwelling units-exceeds .
$1000.00,CRC Section R314,R315,and'CBC Sections 907 2.1.1.5 and 420.6 require that Smoke Alarms and/or
Carbon-Monoxide Alarms be installed in the-followinglocations:.
_
AREA SMOKE ALARiM. 1:ARM
Outside-of each separate sleeping area in the immediate vicinity of the X 1_�CO-A.
7
bedroom(s) -(Smoke alarms shall not be located 1%401;ri,3 feet of bathroom door) ^� `
on evert'levetda a dwelling unit including li:se ntcrlis and littbitalale attics \ E n 1
I Within each sleeping room - 1 i
Carbon Monoxide alarms are iw3trectitired in dwellings which do not i:untain fitel-burning appliances arid that
do not have a n aitidbed garage. Carl:on'monoxide alarms rt-mibined with smoke alarms shall,comply ttith
• • -BC Section4206 and shall be approved by the Office of the State Fire-Marshal.
Power Supply:In dwelling units withno commercial power su: Iv,alarms)may be solely battery q . rated.
-Inelititing GVei:i;i unitS, alarms`re permitted tohe.solely battery 2 pe::iii. ! <re repairs or alterations ltie
not.resuit in the removal of wall and ceiling finishes or there Is no access by.nneans-.ofattic,basement or crawl
space.Refer to.CRC Section 11314 and CBC Sections 907.2.11.4 and 420,6.2.-An electrical permit is required for
alarms tvliich must be connected to the build_ng wiring. .
iks pwner of the above-referenced property,I hereby certify that the alarm(S)referenced above ha{/have been
installed in accordance with the manufacturer's.instructions and in compliance with li-ie California Building
and California Residential Codes.The alarms specified below have been tested and are Operational,as of the .
- date signed below.
Addt'ess: I 1,32-6•75 —Ilk III ut.& Permit No. ---a!o ^ 1
Specify'Number of Alarms: if Smoke Alarii s._q i � .4.Carhon Motio ide Detectors: _ ,{'_.
t have read end agree to corlioty with the ternidnd conditions of this statement
t -0circer(o OwnarAgent's)!tame- _ �
lr J �1/',�I.CI S V L�j SPcnatu e.. ��f f '... 1./. ......... Date:. �t...
.Ccotraetor Name::
nn,:f,'e and'COArly.dor reraed.t(!:'l ii 201 i •