B-2019-1189 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2019-1189
10696 PAR THREE DR CUPERTINO,CA 95014-4025(356 07 045) KNIGHT ROOFING
SERVICES INC
FREMONT,CA 94539
OWNER'S NAME: Yukelson Michael And Olga Trustee DATE ISSUED:07/03/2019
OWNER'S PHONE:408-257-7983 PHONE NO:(510)438-9077
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C39 Lic.#a44-108
Contractor KNIGHT ROOFING SERVICES INC Date 08/31/2020 X BLDG _ELECT _PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing MECH X RESIDENTIAL_COMMERCIAL
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 SINGLE PLY ROOF MEMBRANE-
I hereby affirm under penalty of perjury one of the following two declarations: (14 SQ)
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.
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
l permit is issued. Sq.Ft Floor Area: Valuation:$15750.00
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 Number: Occupancy Type:
356
and state laws relating to building construction,and hereby authorize 356 07 045
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 Cit ' I onsequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applican ndersands and will comply with all non-point
source regulations per e Cup tino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 07/03/2019 Issued by:Jasmine Archbold
Date:07/03/2019
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the -ROOFS:
following two reasons: All roofs shall be inspected prio o a-y 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 obtainin n in ection,I agree to remove all new materials for
compensation,will do the work,and the structure is not intended or offered for ins ection.
sale(Sec.7044,Business&Professions Code)
2. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:07/03/2019
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
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 Ar fir Quality Management District I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupe mo unicipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,S tions 5505,25533,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:07/03/2019
1 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.
Signature Date 07/03/2019 Licensed
Professional
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION
f 10300=TORRE AVENUE CUPERTINO, CA 95014-3255
(408) 777-3228 buiidin @cupertino. PERMIT#1BCUPERTI
.:
RE's# DEF#
❑ NEW CONSTRUCTION [—]ADDITION ❑ALTERATION ❑T.I. ❑MEP ®RE-ROOF SWIMMING POOL/SPA
80� -
PROJECT ADDRESS 10696 Par Three D r . APN
OWNER NAME PHONE E-MAIL
Michael Yukelson 408 257 798
STREET ADDRESS 10696 Par Three D r . CITY, STATE,ZIP Cupertino C A 9 5 0 1 4
El CONTRACTOR NAME ❑OWNER-BUILDER COMPANY NAME LICENSE NUMBER LICENSE TYPE
Knight Roofing Services, Inc. Knight Roofing Services, Inc. 844108 C39
STREET ADDRESS CITY,STATE, ZIP
3240 Darby Common Fremont CA 94539
rE-M,
AIL PHONE. BUS.LIC
____—1 — 514 438 9077 400738
ARCHITECT ❑OWNER El OWNER AGENT ®CONTRACTOR AGENT❑ENGINEER❑DEVELOPER [:1 TENANT
CONTACT NAME E-MAIL
Greg Knight :%^,
STREET ADDRESS CITY,STATE,ZIP PHONE
3240 Darby Common Fremont CA 94539 510 438 9077
DESCRIPTON
Remove existing roof on flat roof area .
Install single ply roof membrane
[ZSINGLE-FAMILY/DUPLEX ❑MULTI-FAMILY ❑INDUSTRIAL ❑COMMERCIAL
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 REMODEL OTHR GARAGE ❑ATTACHED
BATHROOM SF SF SF SF ❑DETACHED
EXISING ❑YES EICHLER []YES SECOND STORY ADDITION ❑YES
FIRE SPRINKLERS❑NO ❑ NO ❑NO
DWELLING ISECONDDWELLING []YES []ATTACHED❑DETACHED OTHER
UNITS# UNIT ADDITON: ❑NO
SF
POOLS C]FIBERGLASS [IVINYL-LINED ❑GUNITE ❑PREFABRICATED
POOL-SF SPA-SF SPA ATTACHED❑YES ®NO TOTAL-SF
LlLDB : TOTAL VALUATION:
C07117r1erclal or M1rlt2-Pl1711111/Building's w th Public SZp1}Y7r11111E Pools requires Department of Enyirolllllelztal Heatll approval
1, - — 0- ", a --..&
RE-ROOF EXISTING ROOF TYPE. ®BUILT-UP ROOF❑ASPHALT SHINGLES❑WOOD SHAKES❑WOOD SHINGLES TILE OTHER(SP C Y)
REMOVE/REPLACE❑NO IF NO PLYWOOD 0'/2" ❑3/8" PLYWOOD TYPE: PITC 11 ROOF CLASS
EYES #OF LAYERS THICKNESS❑5/8" OTHER CDX / :12
❑OSB ❑ OTHER
PROPOSED ROOF TYPE:❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES❑WOOD SHINGLES IR OTHER S in e 1 P q 14
Provide a signed co f the Cu ertino's Tear-Off Policy Py oe p y SF 1400* #of SQUARES 14
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 inspectio poses. I acknowledge and authorize all information contained on this application form
to be made available for public record. pP
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.
'WHOA-Provide a letter of approval from the Home Owner's Association
B1dgApp_2017.doc 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 • buildinga-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 in 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: ' � 61
� J (.)NPermit No. 0r' I
Specify Number of Alarms: # Smoke Alarms: �j # Carbon Monoxide Detectors:
I have read and agree to comply with the terms and conditions of this statement
Owner (or Owner Agent's) Name:
+^
C 4. �L-i:t Signature ............ �'
................... ..............I.............................
Date: ..�..�.`1.
Contractor Name:
Signature...................................................................... Lic.#........................................ Date:..................
Smoke and CO form.doc revised 0111012017