12080124 CITY OF CUPERTINO BUILDING PERMIT
RUILDING ADDRESS: 19974 PORTAL I'LL CONT'RACT'OR:FRANK FIALA ROOFING PERMIT NO: 12080124
INC
OW;NER'SNANIE: KNOYJOANK 1228 QUARRYL '41"C DA'Z'E ISSUED:08/130012
OWNER'S PHONE: 6507231036 PLEASANfON,CA 94566 PI IONENO:(925)484-0124
❑ LICENSED CONTRACT'OR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
License Class G—3S Lie.# M7(97
M
y, ECII r RESIDENTIAL r MI\
COIERCLU.r
ConlqLtractor C s,/� pLa.4)_mf V—/2—/
I hcrehN affirin that Into
^/2—/Iherebpaflirnmthatl:lin licensed under the provisions of Chapter 9 JOB DESCRIPTION:REMOVE BUILT-UP ROOFING AND INSTALL 5 SOS NEW
(commencing with Section 7000)of Division 3 of the Business S Professions I0"
Code and that nn-license is in full force and effect. COX PLYWOOD;INSTALL 1/4"DENS DECK;REPLACE
FLASKING;INSTALL NEW CLASS A DURO-LAST ROOFING
hereby affirm under penalty of perjury line of the following boo declarations:
I have and will maintain a certificate of consent to self insure for Worker's
Compensation,to provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of die work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$5920
A I'I'LIC.\Nf CEIf1'I I�IC,\'PION
I certify that I have read this application and state that the above information is APN Number:36945005.00 Occupancy Type:
correct.I agree to comply with all city and count ordinances and state laws relating
to building construction,mid hereby authorize 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, PERMIT EXPIRES IF WORK IS NOT STARTED
costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
of this permit. Additionally,the applicant understands and will comply
with all non-point source regain its per ie :rtino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION.
9.18.
Signature Date 3 '/ 7-1 — Z Issued by; Date:
❑ O\VNER-13111LDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License Taefor one of RF:ROOFS:
the following twu reasons: All roofs shall be inspected prior m any roofing material being installed.If a roof is
I,as owner of the property,or my employees with wages as their sole connNnsation, installed without first obtaining an inspe tan,I air f to remove all new materials for
will do the work,and the structure is not intended or ofl'ered for sale(Sec.7044, inspection.
Business S Professions Code) C'^/a �r
1,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicme Date: d d L
construct the project(Sec.7044,13usiness C Professions Code).
1 hereby affirm under penalty of perjury one of the following three ALL ROOF COVIiRINGS TO BE CLASS"A"OR BF.TITR
declarations:
1 have and will maintain a Cenilicate of Consent to self-insure for Worker's IIA%\RDOIIS MATERIALS DISCLOSURE
Compensation,as provided for by Section 3700 of the Labor Code,for the
perforiitance of the work fur which this permit is issued I have read the hazardous materials requirements wider Chapter 6.95 of the
I have and will maintain Worker's Compensation Insurance,as provided for by California llealth S Safety Code.Sections 25505,25533,and 25534. 1 will maintain
Section 3700 of the Labor Code,for theerfomhance of the work for which this compliance with the Cupertino Municipal Code.Chapter 9.12 and the Health&
p Safety Code,Section 25532(x)should I store or handle hazardous material.
permit is issued Additionally,should I use equipment or devices which emit hazardous air
I certify that in the performance of die work for which this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District 1 will
not employ any person in any manner so as to become subject to the Worker's maintain con)plia nce with the Cupertino Nlunicipal Code.Chapter 9.12 and the
Compensation Iawvs ofCalil'omia. If,after making this certificate ofesemption,1 Health S Safety de.Sec' ns 25505,25533.and 25534.
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 Owner or all 'ited age t:
Date:
A I'I'LIC,\N'I'CFR'I'IhICA'1'10N CONSTRIX-71ON LENDING AGENCY
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 a d state Imus relating I hereby affirm that there is a construction lending agency for the performance of work's
to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.)
upon the above mentioned property for inspection purposes.(toe)agree to save Lender's Name
indemnify and keep hamiless the Cit'of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the Lender's Address
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulation per the Cupertino Municipal Code,Section ,1RCII IT'ECI"S DECLARATION9.18.
I understand my plans shall be used as public records.
Signature Date
Licensed Professional
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 19974 Pgrtal Plaza (Bldg M) DATE: 08/10/2012 REVIE\VED BY: Sean
I.-IIAIIN: BPO: 4aU 01o7-11 VALUATION: 1$5,920
*PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY Building is PENTAIIATION
USE: Multi-Family Dwelling >3 Stories Yes No PERNIrP'1'YPE: 1R2R00
WORK Remove built-up-roofing and install new 1/2" CDX Plywood; install 1/4" Dens Deck; replace flashin
SCOPE and install new Class A Duro-Last roofing system (see ESR-1660).
FEE 11) ROOFAREA
s.f.)
1REROOFMRES 540
Alech. Plan Check Plumb. Plan Check Flee.Plan Check
Aleah. Permit Fee: Plumb. Permit Fee: F,lec•.Permit Fee:
Other Adech. lnsp. Other Plumb Insp. Other Elce.hap.
A-loch,hup. Fee: Plumb. roup. Fee: Elea,Insp.Fec:
NOTE: This ectitraue does not include jecv rite to other Departments(i.e. Planning, Public Works, Fire,Sunitary Suver District,School
District, etc.). These feev are based on the prelitninan information available and are onb,an estimate. Contact the De t or aaldn7 info.
FEE ITEMS (Fee Resolution 11-053 Elf 711111) FEE QTY/FEE N11SC ITEMS
Plan Check Fce:
Suppl. PC Fee
Phimb./11ech./Elec
Permit Fee: $90.00
Suppl. Insp Fee
P1umh.1A1ech./Glee
Pluntb.hNech./Elec Permit Fee:
Construction Tac:
Adininlstr-ative Fee:
Work Without Permit? 0 Yes (F) No $0.00
Adcanecd Planning Fees:
Travel Documentation Fees: A
Strong Motion Fee: IBSEISAIICR $0.59 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
su6•rOTALS: $91.59 $0.00 TOTAL FEE: $91.59
Revised: 07/01/2012
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408)777-3228 • FAX (408)777-3333•building@cupettino.org -
C:P1P..ERTINO 1'2 800 AP3 (�
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CFAX — 72-
El OWNER ❑ OWNBR-BUILDER ❑ OWNERAGENT CONTRACTOR XSONTRACTORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR'NAME �Ct,�Ct LICENSE NUMBS LICENSE TYP ^�/5 BUS.LIC4 Cj
COM Y NAME l• E L `7 I'
rG v�IL \ �a\e� foo orf eiulwfooFi be lofrl nef ,�5 �k8y alsa
SPI' DDR r_Y I Y,STATE,ZIP P a,4Vi-01,
AIRCMTECTIENGINEERNAME LICENSENUMBER t� BUS.LIC.4
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑ SFD or Duplex 10 Multi-Family ROOOFFA/R'EA: VAL TION:
STRUCTURE: ❑ Commercial 544 � " 'q70
EXISTING ROOF TYPE: 44BUILTdJPR00F '❑ASPHALT SHINGLES C3 WOOD SHAKES ❑WOODSHINGLFS ❑OTHER(SPECIFY)
REMOVEIREPLACEYES IF NO. PLYWOOD %" ❑ PLY ❑ OSB PITCH: ROOF
0 OLAYERS THICKNESS: El 5n.. TIVDYPE: COX '17 CLASS'. A
all - .Ir ES REPO TO O
PROPOSED ROOFTYPE: C3,BUILT-UP ROOF ❑ASPHALTSHINGLES FI WOOD SHAKES ❑ .-
WOOD SHINGLES OTHER
CWPnON OF WORK: e
2. l " C. D l wfsod o u L L l v,
'(1101.2 U�G �Z '�p�, Net 2
�uvs�wl► 1/4 tI be.v1s ��ek . �recukoL t St4Lo a,s v\eej ,pc�
LJv/�Co- �(tiS. a�1 `jam 1Y.VV1 — SOm� C.-'h'he..'ww �c�sCiC,-
By my signature below,I certify to each of the fol owing: am t c property owner or authorized agent to act on the property owner's behalf. 1 have read this
application and the information prov'fed Is correct. hav r d c Description of Work and verify iris accurate. I agree to comply with all applicable local
ordinances and state Iowa rel ng t'I (g a;sinm' n. I a re I [Tues of Cupertino to enter the above 'fled p op��e77rty for inspection purposes.
Signature of Applicant/Ag 1: Date:
' / SUPPLEM TAL INFORMATION REQUIRED
V - g' provide
_If buildin Is associated with a Home Owner's Association, letter ON
�r ROHTIbcsl IP ��
of approval from HOA. r~?"bve`x Ti UvrrEa"�' '�n � `�""
"to Plannin approval to verify if there an restrictions. vR�y ^L+ j+c ;�j i' 4r
6 PP Y � Y „��vPaEsa�,h"�T ��'f�<���KT�4❑��LPA�vI�N1G�P,�LAY'RRviEivp',s,'+�,
Provide copy of Manufacturer's installation Specifications. S,q�s��DARWto- y T +y�
T � 7I vtntn„"taa ""�'"Z r vas'
l/Prgvidc signed copy of Cupenino's Tear-Off Policy, �� q . ` „r, ❑ oT� �
- Rero'ojApp_2011.doc revised 03116111