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11080148 CITY OF CUPERTINO BUILDING PERMIT BI H,DING ADDRESS: 19934 PORTAL PLZ CONTRACTOR:FRANK FIALA PERMIT NO: 11080148 ROOFING INC OWNER'S NAME: VIJAYAKUMAR KULKARNI & ROOPA RAO 1228 QUARRY LN STE C DATE ISSUED:08/23/2011 NER'S PHONE: 4087157165 PLEASANTON, CA 94566 PHONE NO:(925)484-0124 ❑ LICENSED CONTRACTOR'S DECLARATION F— f— F_ [ BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class_ 'C_-32 Lic.# Q� P r r— (-'- //-- /� / MECH RESIDENTIAL COMMERCIAL Contractor_F/^�.) elks ��1Date_ / JOB DESCRIPTION: BLDG N-RE-ROOF 6 SQUARES-REMOVE OLD B.U.R. hereby affirm that I am licensed under the provisions of Chapter 9 INSTALL 1/4"DENS DECK.INSTALL NEW CLASS A DURO (commencing with Section 7000)of Division 3 of the Business&Professions LAST ROOFING SYSTEM,INSTALL NEW 1/2"C.DX.PLYWOOD Code and that my license is in full force and effect. I 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 for which this permit is issued. Sq. Ft Floor Area: Valuation:$6500 1 have and�Nill 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. ��j�� APN Number:36945013.00 Occupancy"Type: APPLICANT CERTIFICATION " 1 certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save ISS DAY OM LAST CALLED INSP T N. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs.and expenses which may accrue against said City in consequence of the / granting of this permit. Additionally,the applicant understands and will comply Issued by: Date: / "ith all non-point source regidations pe the Cupertino Municipal Code,Section 9.18. _ � ROOFS: Signature Date All roofs shall be inspected prior to anyny roofing material being installed. If a roof is installed without first obtaining an inspection,I agree to remove all new materials for inspection. u OWNER-BUILDER DECLARATION Signature of Applicant: -- 7 Date: 1 hereby affirm that 1 am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I.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(Sec.7044, Business&Professions Code) I.as o%Nner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business& Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. 1 will 1 hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous Compensation.as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 2550 , 5533 nd 25534. Section 3700 of the Labor Code,for the performance of the work for which this 41— permit permit is issued. Owner or authorized agent: t-- Date: - 1 certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If,after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,I must 1 hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.) Lender's Name 1PPLICA\"T CERTI FICATI ON Lender's Address 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 and state laws relating to building construction,and hereby authorize representatives of this city to enter anon the above mentioned property for inspection purposes.(We)agree to save °notify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION is,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. "ranting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9 18. Signature Date CITY OF CUPERTINO 3 ITEMS OF 15 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec : Twp : Rng: Sub: Blk: Lot : APN . . . . . . . . : 36945013 . 00 DATE ISSUED. . . . . . . : 08/23/2011 RECEIPT # . . . . . . . . . : BS000014535 REFERENCE ID # . . . : 11080148 SITE ADDRESS . . . . . : 19934 PORTAL PLZ SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : VIJAYAKUMAR KULKARNI & ROOPA R ADDRESS . . . . . . . . . . : 19934 PORTAL PLAZA CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : WILLIAM FIALA CONTRACTOR . . . . . . . : FRANK R. FIALA LIC # 31229 COMPANY . . . . . . . . . . : FRANK FIALA ROOFING INC ADDRESS . . . . . . . . . . : 1228 QUARRY LN STE C CITY/STATE/ZIP . . . : PLEASANTON, CA 94566 TELEPHONE . . . . . . . . : (925) 484-0124 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 6, 500 . 00 1 . 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 6 , 500 . 00 0 . 65 0 . 00 0 . 65 0 . 00 1REROOFRES SQ FEET 6 . 00 84 . 00 0 . 00 84 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 85 . 65 0 . 00 85 . 65 0 . 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION - ------- ---------------------------- -------- ---------------------------- 309 EXTERIOR LATH 311 SCRATCH COAT 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 604 ROOF IN-PROGRESS 605 FINAL REROOF REROOF PERMIT APPLICATION ;>C COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 G:UpER`i'INC> (408)777-3228• FAX (408)777-3333 • building ccDcupertino.orq 11c�8'61`�� PRi)JECT ADDRESS .�r , 1 APN k 2 Lo 9 I ON'N AME/. f i l(M 1 1 1 I PIL �� �I�� E-MAIL IJ STKEFTADD`N _PU r 1 1 I TY, ST ,Z{P. J 9i( FAX CONTACT NAME"L r��l ` PHONE �-( �1 E-MAIL ST,CEI:T ADDRESS CITY,STATE,ZIP FAX ❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT *CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CO^lTKACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LICFia # WL Acda I P Y lc& :Rc ( ci TneE-MAIL FAX/) STI; T ES / 61 If 7 ` 1 P' Ily ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC CO MP ANY NAME E-MAIL FAX STKEET ADDRESS CITY,STATE,ZIP PHONE USF. OF ❑ SFD or Duplex Multi-Family ROOF AREA: /, VALUATION : "�.{_- STkUCTURE: ❑ Commercial (�/ © 14 W ),S-1 1 • Lt C) EXISTING ROOF TYPE: 15RUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHBJGLES ❑OTHER(SPECIFY) REMOVE/REPLACE `VYES IF NO, PLYWOOD 1'/;' 13 _ PLYWD El OSB PITCH: l ROOF ❑NO k LAYERS: THICKNESS: ❑ 5/8" TYPE: CDX /� '12 CLASS: A w o- ICC-ES REPORT k PRvPOSED ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES 'OTHER DEtiCRIPTIONOFWORK: �S COA\ " L ma�Is v edit., s c..s n e�e�le� �-e vvt c,•v By my sign re below,I certify to each of the following: I am the property o er or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided is correc. 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 construc/oV [ representatives of Cupertino to enter the above-i cVntified p perty for inspection purposes. Signature of ApplicantlAgent: Date: SUPPLEMENTAL INFORMATION REQUIRED nc `' r� r If building is associated with a Home Owner's Association,provide letter „ttorhrtNG:sir of approval from HOA. o-� DING PLANREVIEIY k',/k h i' ” t� rtr t 4 zr i i sou it —Provide Planning approval to verify if there any restrictions. Provide copy of Manufacturer's Installation Specifications. r c i, enih ac "* 5r1 Y _ Provide signed copy of Cupertino's Tear-Off Policy. aUa {L"��Ii 1 ry rGfr g,; ,£. ReroofApp_2011.doc revised 03/16/11 I . . REROOF TEAR-OFF POLICY COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL C U P E RTI N O 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 (408)777-3228- FAX (408)777-3333•ksTii r .i, . 1_�rc, rc: PROJECT ADDRESS / J / APN# OWNER NAME P/O ��_ 7/ J� E-MAIL, STREET ADDRESS J FAX CONTRACTOR NAME j ~-7��� `� �i /Q LICENSECIJ NUMBER ®..7 LICENSE TYPE BUS.LIC.# 3 1 3— y f CO ANY NAMf, �, ', � / �- ��`L E-MAIL .X _.,.._ STREET ADDRESS ' /V CITY,STATE,ZIP d� PI�gN , J� __r0 j2 / 1 egs O I UNDERSTAND AND AGREE TO THE FOLLOWING: 1. 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 1/4"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$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 monoxide detectors are re uired toLintalled in accordance with Sections R314 and R315 of the 2010 California Residential Code. Signature of Applicant/Agent: - Date: ReroofPolicy_2011.doc revised 02/16/11