B-2018-0241CITY OF CUPERTINO BUILDING PERMIT
BAHL ST CUPERTINO, CA 95014-1011(326 13 091)
IS NAME: BECHER JONATHAN D AND BALESTRERI DENISE M
PHONE:
LICENSED CONTRACTOR'S DECLARATION
Class C-39 Lic. #411239
or CARL BECKS AND SONS ROOFING SPECIALISTS Date 09/30/2019
hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
IHn Section 7000) of Division 3 of the Business & Professions Code and that my
cense is in full force and effect.
hereby affirm under penalty of perjury one of the following two declarations:
r. 1 have and will maintain a certificate of consent to sel6insure 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.
2. 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.
APPLICANT CERTIFICATION
certify that I have read this application and state that the above
nformation Is correct. I agree to comply with all city and county ordinances
and state laws relating to building construction, and hereby authorize
epresentatives of this city to enter upon the above mentioned property for
nspectlon purposes. (We) agree to save indemnify and keep harmless the
)Ity of Cupertino against liabilities, judgments, costs, and expenses which
nay accrue against said City in consequence of the granting of this permit.
\dditionally, the applicant understands and will comply with all non -point
source regulations per the CupertlyiplMuniclpal Code, Section 9.18.
Date 02/0712018
hereby affirm that I am exempt from the Contractor's License Law for one of the
Blowing two reasons:
n. 1, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered for
sale (Sce.7044, Business & Professions Code)
2. 1, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec.7044, Business & Professions Code).
hereby affirm under penalty of perjury one of the following three declarations:
r. 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.
2. 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
pom»t is issued.
s. I certify that in the performance of the work for which this permit is issued, I
shall not employ any person in any manner se as to become subject to the
Worker's Compensationlaws of California. If, after making this certificate of
exemption, I become subject to the Worker's Compensation provisions of the
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked,
APPLICANT CERTIFICATION
certify that I have read this application and state that the above information Is
xrect. I agree to comply with all city and county ordinances and state laws
listing to building construction, and hereby authorize representatives of this city
enter upon the above mentioned property for inspection purposes. (We) agree
save Indemnify and keep harmless the City of Cupertino against liabilities,
dgmenls, costs, and expenses which may accrue against said City In
asequence of the granting of this permit. Additionally, the applicant understands
id will comply with all non -point source regulations per the Cupertino Municipal
ode, Section 9.18.
)NTRACTOR: PERMIT NO: B-2018-0241
iRL BECKS AND
INS ROOFING
ECIALISTS
LN JOSE, CA 95123
DATE ISSUED: 02/07/2018
PHONE NO: (408) 365-8979
JILDING PERMIT INFO:
BLDG ELECT —PLUMB
MECH X RESIDENTIAL _ COMMERCIAL
)B DESCRIPTION:
3 -ROOF; TEAR -OFF; INSTALL COMP - (35 SQ)
. Ft Floor Area: Valuation: $20000.00
IN Number: Occupancy Type:
6 13 091
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
by: Jasmine Archbold
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection. 1
Signature of Applicant:
Date: 02/07/2018
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Cade, Section 25532(x) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code 7Sec s 2550 11 533, and 25$.3.4.
Owner or authorized agent
Date: 0 210 71201 8
CONSTRUCTION LENDING AGENCY
I hereby all ban that there is a construction lending agency for the performance
of work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • building@cupertiizo.org PEMIT #B - U [ S - 7:- 1
CUPERTINO REVs'_ DEF#_
n NEW CONSTRUCTION nADDITION n ALTERATION n TT. n 74FP YI RE -ROOF n SWIMMTNc PnnT./.grA
PROJECTADDREE$
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fh CONT�RACTORNAMENMEMUUILDER COMPAh7NAAf_E/ CENSE LICENSE
TYPE
NUMBER
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CITY, STAT/E5, ZIP —i
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❑ ARCHrrECT 0 OWNER D OWNER AGENT ❑ ONTRACTOR AGENT ENGINEER 0 DEVELOPER 0 TENANT
CONTACT NAME
STREETADDRESS s
CCTY, STATE, ZIP �...--. ✓ PHONE
DESCRIPION'
SINGLE-FAMILY/DUPLEX D MULTI -FAMILY D INDUSTRIAL ❑ COMMERCIAL
USE
TYPE
OCC
BQ,FT.
VALUATION (�
EXISTING USE
EXISTING SF
NEW FLODR SF
PORCH
SP DECK SF
DEMO SF
STORIES k
TOTAL NET SF
REN40DEL
REMODEL KITCHEN
REMODELOTHR
GARAGE [3 ATTACHED
BATHROOM SF
SP
SF
SF 0 DETACHED
EXISING ❑ YES
FIRE SPRINKLERS D NO
EICHLER DYES SECOND
❑ NO
STORY ADDITION O [DYES�
DWELLING
SECOND DWELLING DYES DATTACHEDD DETACHED OTHER
UNITst
UNITADDITON: ONO SF
POOLS 0 FIBERGLASS 0 VINYL -LINED D GUNITE 0 PREFABRICATED
POOL SF _ SPA -SF_ I SPA ATTACHED OYES D NO I TOTAL -SF
Cmnme¢in7 or AArAti-Fnmilu eeildinss -lith Public Ssninanive Pools eme'esDrnnt +nU olE n'm ntrtlH tl - IRX_
LVED BY:
TOTAL VALUATION:
7— 1 LTo 0
RE -ROOF
EXISTING ROOF TYPE: ❑BUILT-UP ROOF ASPHALT,SMNIGLES❑WOOD SH.N:ES❑WOOD SHINGLES❑TILE OTHER(SPECUY)
REMOVE /REPLACE ❑NO
IFNO e
PLYWOOD 111"❑3/8"
PLYWOOD TYPE;
PITCH:
ROOF CLASS
jZyES
9 O LA-YERS
THICKNE S/S" O'rHEIi
❑OSB ❑CDX OTHER
-T—:12
A
PROPOSED ROOF TTTE: DBL'LLT-UP ROOF DASPHALT SHINGLES D WOOD SHAKES OWOOD SHINGLES ❑ OTHER
'Provide a signed copy of the Cupertino's Tear -Off Policy SF S'oo zof SQUARES FJ•
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 itis 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 acknot edge az d uthorize all information contained on this application form
to be made available for public record.
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 o£ 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_2017. doe revised 08101117
CUPERTINO
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(c)cupertino.org
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 nl the immediate vicinity of the
bedroom(s) - (Smoke alarms shall not be located within 3 feet of bathroom door)
X
X
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.
Address: �-�"� q
Permit No. -6 Ippl0 62 -VI
Specify Number of Alarms: # Smoke Alarms: I I # Carbon Monoxide Detectors:
I have read and agree to comply with the terms and conditions of this statement
Owner (or Owner Agent's) Name:
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Si nature.......... ..�.VI/.0 :.ikff.F.
................................................. Date:...... .l.
Contractor Name:
I
Signature........... :..... .......... Licl .......[..�.. `........... Date: .. . ... ..
Ra
Smoke and CO form.doc revised 01/10/2017