12080125 CITY OF CUPERTINO BUILDING PERMIT
RUILDING ADDRESS: 19976 PORTAL PLZ CONTRACI'OR:FRANK FIALA ROOFING PERMIT NO: 12080125
INC
O\vNER'S NAME: AL17REDO ORTIZ 1228 QUARRY LN 91-E C DATE ISSIJED:08/132012
OWNER'S PHONE: 6509613000 PLEASANI'ON.CA 94566 PHONE NO:(925)484-0124
❑ LICI.NSED CON RAC'FOR'S DECLARATION /Q/-7 BUILDING PERMIT INFO: BLDG r ELECT 1- 1'LU\113 r
License Class L Lic.q �Uub/� r r r
)''' ��/ 7�--- RIECII RESIDENTIAL COhI11 E12CIA 1.
Contractor r--,VAI-.• y oLV male / —/.�'�Z
I hereby affirm that I am licensed under the farmisions of Chapter!) dOB DESCRIPTION: REMOVE BUILT-UP ROOFING AND INSTALL 5.33 SOS
(commencing w'i Ih Section 7000)of Division 3 of the Business S Professions NEW
Code:tad that niy license is in full force and effect. 12"CDX PLYWOOD;INSTALL 1/4"DENS DECK;REPLACE
FLASHING;INSTALL NEW CLASS A DURO-LAST ROOFING
hereby affirm under penalty of perjury one of the following two declarations:
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 I'or which this permit is issued.
I have and will maintain Worker's Compensation Insurance,as provided Ibr by
Section 3700 of the Labor Code,for the performance of die work foryhich this
permit is issued. Sq, FI Hoor Aren: Vnieation:$5920
',\PI'LICAN'1'CFR'I'I FIC.\'PION
I certify that I have read this application and state that the above information is .0;N Number:36945004.00 Occupancy Type:
correct.I agree to comply with all city and county ordinances and state laws relating
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save
indemnity,and keep hannlessthe Cit•ofCupertino against liabilities,judgments, PERMIT EXPIRES IF WORK IS NOT STARTED
costs,snit expenses which may accrue against said City inconsequence of the -
grantingofthispermil. Additionally,the applicant understands mid will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR
with all non-point source re patio, e Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION.
9.18.
Signature Date Issued Irv: �rl��Date:
❑ OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law fur one of RP:ROOFS:
the following neo reasons: All roofs shall be inspected prior to any roofing material being installed If a roof is
I,as owner ol'Ihe property,or my enmployees with wages as their sole compensation, installed without first obtaining an inspe tion,1 agr a to remove all new materials for
will do the work,mid the structure is not intended or of7ered for sale(Sec.7044, inspection.
Business S.Professions Code)
1t.coLas owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant: Date: 97 -12-
construct
nstruct the project(Sec.7044,Business l Prolessions Code).
hereby affirm wider penult'of perjury one of the following three ALL ROOF COVERINGS TO ISI?CLASS"A"OR BE I'I'ER
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's IIAZARDOUS NIATE.RIAI S DISCLOSURE,
Compensation,as provided for by Section 3700 ofthe Labor Code,for the
performance of the work for which this permit is issued. I have read The hazardous materials requirements under Chapter 6.95 of the
I have and will maintain Worker's Compensation Insurance,as provided for by California I lealth S Safety Code.Sections 25505.25533,and 25534. 1 will maintain
Section 3700 o(the Labor Code,for the
compliance with the Cupertino Municipal Code.Chapter 9.12 and the I lealth S
cr(ormm�ce of work for which this
p Safely Code Section 25532(x)should I store or handle haznrdmis material.
permit is issued Additionally,should I use equipment or devices which emit hazardous:lie
I cerlify that in the perfornance Of the work forehich this permit is issued,I shall contaminants as defined by the Bay Arca Air Quality Management District I will
not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code.Chapter 9.12 and the
Compensation laws of Califamia. If,alter making this certificate of exemption,I I lealth S Sufen' ode;Sections 25505,25533,and 25534.
become subject to the Worker's Compensation provisions oflhe Labor Code,I must
forthwith comply with such provisions or this permit shall he deemed revoked Oo ner nrar }^/razed cuC
/i Date:
.U'1'LICA N'I'CISIfI'I FIG\'I'Il1,N CONIURIICI'ION LENDING AGENCY
I cenily that I have read this application and state thin the above information is
correct.I agree to comply with all city mad county ordinances and state laws relating I hereby affnm that there is a construction lending agency for the performance of work's
to building construction,and hereby authorize representatives of this cit'to enter for which this permit is issued(Sec.3097,Civ C.)
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the Lender's Address
granting of lhis permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section ARCH1TEC-1"S DECLARATION
9.18.
I understand any plans shall be used its public records.
Signature Date
Licensed Professional
REROOF PERMIT APPLICATION
.COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
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(408)777-3228 • FAX (408) 777-3333' buildinGCakuperlino.orG
C UP.ERTIN
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❑OW,NER ❑ OWNER BMDCR ❑ OWNRRAGE.T CONTRACTOR SJCOPTRACTORAGE.T ❑ ARCHIT110 ❑ HNOTNIiER ❑ 21EVI'L01.1R ❑TENANT
CONiNALTOR NAME LIC!I SLNUMIHLICLN'SH rYYP -� I Itus i,rp��
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ARCHITECT/E.NOINEER NAME UCF.NSENUMBER I bus.l.ICa
COMPANY NAME E-MAIL I FAN
SrREIT ADDRESS
CIT}'.STATE,ZIP 1'I IONG
USE OF ❑ SFD or Duplex '[ Multi-1'Dnlily ROOFAREA: r�r v,atrur}n-nON�J /"�
SrKUL7URE: ❑ Commercial 51 '0 S f'-7•, •SV 9 �-l/
EXISTLUG ROOFTYPE: BUILT-UP ROOF ❑ASPHALTSHINCI-Es ❑WOO/DSHAKPS ❑W'OODMIWGLCS ❑OTHHKxI-HCIF}')
REMOVEMEPLACE }'ES IP NO. PLYWOOD 6'• ❑ PL}14'D ❑ OSD PrrCH, R(JOF
HO q LAYER THI KNFSS' ❑ 5/S'• l'YPE' Cox -)
.I` 'Lass, :�
PROPOSED ROOFTYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES 11 WOOD SHAKES (3 WOOD SHINGLES �OTIIHf0-Ll"I �� -iNam-OI rJ'
5 I ,p
'sCRIPnON OF WORK: \
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B)'my signature below,1 certify to each of the fol owing: I um the property Owner or authorized agent to act on the property Owner's behalf. I have real this
application and the inCormotion I>I a e prov;det.s come h•'e cad the Ucscr;plion of Work and verify;1 is Bttmate. I agree lu comply}v;lh all appl;cairle Intal
ormnanees and stale laws relati,g to di constm on. I ,c cseT •Bees oI'Cupertino to umur the ubo+'c-ide tilled ropunY for inspcniva purpose,,
Signature ofApplicanJAgen r.?- 1 Date: C1 [J
SUPPLEME TAL INFORMATION el
REQUIRED f `'k ` 'I Via? x}•* a
.( 11n �" -•y,%k.n6+ Y 01.1 ICh t}I-UYI
__ ICbuilding is associated with a Home Owner s "SSOCIaHoll,provide letter � bZyU8}�Cul n 'ty 'vra
ET '3 ROIPINO I:n
of approval from HOA. t�re,"x'l.f �i:'r�"i) tr,Pl.ML ,> I c J
�,�yO�VLR.�I�,IVIh4C0 L\T I ItaVir❑ab UII til\(,
rovidc Planning approval to vcnfy i(there an} restrictions, t Q r7t`r"R' "Jv 3��F `a A•rv, ! k* r5u -,•�
t rj as 1-F's,�7C s i 11❑ I I�\ 11CII L'A.l ,II}�„ �J' -ary
Provide copy of Manuf acturcrs Installation$Jccilirnians. t,411-6 rlr
I R-❑eST'�\D}RD s yt•r'N4t se "4'+ 1'• W'-5 "a
Provide signed copy Of Cuperlino s Tcar Off Policy.
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EllREROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
ALBERT SALVADOR, P.E.,C.B.O., BUILDING OFFICIAL
CUPERTINO 10300 TORRE AVENUE •CUPERTINO,CA 95014-3255
(408)777-3228• FAX(408)777-3333• buildina0cupeFtino.orci
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COYI'R,\CF R i?IF� LICENSE WAIRERLICENSE TI'PE RUS.LIC.q
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UAn yl4l e/ a,,lv>, - 9 SZ(o its �/�O1zY
1 UNDERSTAND AND AGREE TO THE FOLLOWING:
I. The re-roof project shall comply with all applicable provisions of the 2010 California Codes.
2. An inspection request can be scheduled up to the day before the inspection date. Please call (408)777-
3228 from 7:30 - 3:30pm (Mon-Thurs) or 7:30 - 2:30pm (Friday) to schedule the next day 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. Progress
and 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. Progress Inspection is required when approximately 50% of roof covering is installed.
7. 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'14" 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.
8. 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 of S 126.00. 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 mo xidc de ectors are Lquir to be installed in accordance with Sections R314 and 8315 of
the 2010 California Residen ' I C c.
Signature of ApplicanUAgen Date: 8 Op
1z_—
ReroofPolicy_011.docrevised02/16/11
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 19976 Portal Plaza (Bldg M) DATE: 08/10/2012 REVIEWED RY: Sean
2,14 APN: RP#: la0 S0�as `VALUA'T'ION: $5,920
*PEWMIT TYPE: Minor Building Permit PLAN CIIECK TYPE: Re-roof
PRIMARY Buildina is PENTAMATION 1R2R00F
USE: Multi-Family Dwelling >3 Stories O Yes Q No PERMITTYPE,:
WORK Remove built-up-roofing and install new 1/2" CDX Plywood; install 1/4" Dens Deck; replace flashing;
SCOPE and install new Class A Duro-Last roofing system (see ESR-1660).
FEE ID ROOFAREA
(S.f.)
1RER00FMRES 540
,Nrclt. Plan Check Plumb.Plan Check Elec. Plan Check
,Meth. Permit Fee: Plumb.Permit Fee: Elec.Permit Fee:
Other,Meeh. Insp. Other Plumb Insp. Other Elco.Insp. El
bfech.Imp.Fee: Phuuh. he+p. Fee: Elec.Insp.Fee:
NOTE: This estimate does not inchulejecs due to other Departments(i.e. Planning, Public Works, Fire,Sanitan,Server District,School
District,ele.). 7'bese feav are based on the prelitninan information available and are onh,an estimate. Contact the Dept for addn'I info.
FEE ITEMS (Fee Resolution 11-053 Ej) UUIU FEE QTl'/FEE MISC ITEMS
Plan Check Fee:
SuppL PC Fee
Phtml.1A1ech./F1ee
Permit Fee: $90.00
Suppl, hisp Fee
Phimb./Mech./lilec
Phrnth.4fech./Elec Permit Fee:
Consnztction Tax:
Administrative Fee:
Work Without Permit? O Yes Q No $0.00
Advanced Planting Fees:
Travel Documentation Fees:
Strone N9otion Fee: IBSFIS,MICR $0.59 Select an Administrative Item
131(Ie Sids Commission Fee: IBCBSC $1.00
SUBTOTALS: $91.59 $0.00 TOTAL FEE: $91.59
Revised: 07/0112012