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11040218 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19924 PORTAL PLZ CONTRACTOR:FRANK FIALA ROOFING PERMIT NO: 11040218 INC OWNER'S NAME: SOHA MATY AND SHOSHANA 1228 QUARRY LN STE C DATE ISSUED:04/28/2011 OWNER'S PHONE: 9254608890 PLEASANTON,CA 94566 PHONE NO:(925)484-0124 LICENSED CONTRACTOR'S DECLARATION F BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class (.�-`� � Lic.# / MECH�f— RESIDENTIAL COMMERCIAL Contractor' (;6-11-1 P—o Date /I I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:RE-ROOF REMOVE OLD B.U.R.INSTALL 1/4"DENS (commencing with Section 7000)of Division 3 of the Business&Professions DECK.INSTALL NEW CLASS A DURO LAST ROOFING Code and that my license is in full force and effect. SYSTEM,INSTALL NEW 1/2"C.DX.PLYWOOD OVER I hereby affirm under penalty of perjury one of the following two declarations: 1 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. 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 wl4ich this Sq.Ft Floor Area: Valuation:$7401 permit is issued. APPLICANT CERTIFICATION APN Number:36945018.00 Occupancy Type: 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 upon the above mentioned property for inspection purposes. (We)agree to save PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-point souycer/elations,per theCupertino Municipal C de,Section 9.18. L � Issued by: Date: ZT. G-� Signature Date z ❑ OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: installed without first obtaining an insp ction,I agree to remove all new materials for 1,as owner of the property,or my employees with wages as their sole compensation, inspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, / � Business&Professions Code) Signature of Applicant: l� ' Date: (g 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: HAZARDOUS MATERIALS DISCLOSURE 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 I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material. Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health&Safety C e,Secti 25505,25533,and 25534. Compensation laws of California. If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,I must Owner or aut i d a Date G f ✓1` l� forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address costs,and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. I understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO 3 ITEMS OF 66 PERMIT RECEIPT OPERATOR: patg COPY ## 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36945018 .00 DATE ISSUED. . . . . . . : 04/28/2011 RECEIPT #• . . . . . . . • : BS000013317 REFERENCE ID # . . . : 11040218 SITE ADDRESS . . . . . : 19924 PORTAL PLZ SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : SOHA MATY AND SHOSHANA ADDRESS . . . . . . . . . . : 19924 PORTAL PLZ CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-2207 RECEIVED FROM . . . . : WM. A. 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 7,401.00 .1.00 0. 00 1.00 0. 00 1BSEISMICR VALUATION 7,401. 00 0.74 0. 00 0.74 0. 00 1REROOFRES SQ FEET 6. 00 78. 00 0. 00 78.00 0.00 ---------- ---------- ---------- ---------- TOTAL PERMIT 79.74 0. 00 79.74 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 1, 753 .64 VISA --------------- TOTAL RECEIPT 1, 753 .64 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 INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE CITY OF CUPERTINO PERMIT INVOICE OPERATOR: patg Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36945018.00 INVOICE DATE. . . . . . : 04/28/2011 REFERENCE ID # . . . : 11040218 SITE ADDRESS . . . . . : 19924 PORTAL PLZ SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : SOHA MATY AND SHOSHANA ADDRESS . . . . . . . . . . : 19924 PORTAL PLZ CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-2207 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 DESCRIPTION DUE FOR AMOUNT DUE PAID BALANCE --------------------------- ---------------- ---------- ---------- ---------- CAL BLDG STAND COMMISSION F PRINTING PERMIT 1.00 0. 00 1.00 SEISMIC RESIDENTIAL PRINTING PERMIT 0.74 0. 00 0.74 RE-ROOF: RESIDENTIAL PRINTING PERMIT 78.00 0.00 78.00 ---------- ---------- ---------- 79.74 0.00 79.74 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 I I REROOF PERMIT APPLICATION rt COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255 C U ER`'I N:C (408)777-3228• FAX (408)777-3333•building as cupertino.org PRJJLCT ADDRESS ' Q �^ ^ AIN N I^ 445 0 1 Q',00 fa 7 Ow NER NAME �h aG PHONE y� O E-MAIL a 1, 9 STREET ADDRESS ' Y,ST TE,7,I 6-J f q FAX CONTACT NAME PFICINE ;J�j E-MAIL STKEET ADDRESS CITY,STATE,ZIP FAX ❑ )WNER ❑ OWNER-BUILDER ❑ OWNER AGENT 1JiDCONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHTI-ECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CGNTKACTORNAME LICENSE NUMBER g a LICENSE TYPE BUS.LIC.4 P YFLaICA, R �� E-MAIL FAxglq, - qW-cV ST T ES t� 1 P /j, ARCHITECT/ENGINEERNAME LICENSE NUMBER BUS.LIC/.4 [((11 (l COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USI OF ❑ SFD or Duplex Multi-Family ROOF AREA VALUATION: STP.UCTURE: ❑ Commercial 00 A EXISTING ROOFTYPE: 1RUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY) REMOVE/REPLACE `VYES IF NO. PLYWOOD 'h- ❑ PLYWD ❑ OSB PITCH: ROOF ❑NO #LAYERS: THICKNESS; 5/8" TYPE: CDX •12 CLASS: A uao- ICC-ES REPORT 4 PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES 1�❑WOOD SHINGLES 100THER DESCRIPTION OF WORK: C> D III I�� C CLS S t- Ot�By my sig re below,I certify to each of the following: I am the property'05W ner 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 ha read the Scr' tion of Work and verify it is accurate. I agree to omply with all applicable local ordinances and state laws relating to building construction. ori sentatives of Cupertino to enter the above-i entified roperty for inspection purposes. Signature of Applicant/Agent: Date: L 2-` ,ZQ SUPPLEMENTAL INFORMATION REQUIRED 2 P If building is associated with a Home Owner's Association,provide letter of approval from HOA. Xa� a " aha rcF'I t C H� ��BiDINGPLANyREYI$ rws _ Provide Planning approval to verify if there any restrictions. SS PAN(tI1(G FI AN REV1sW ,{.�1"» f.) `''may y •R�yr 1 f � y'a�1« + s,e` —_ Provide copy of Manufacturer's Installation Specifications. _ Provide signed copy of Cupertino's Tear-Off Policy. Z 111. ReroofApp_201 Ldoc revised 03/16/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ItADDRESS: 19,92-Y Portal Plaza DATE: 04/26/2011 REVIEWED BY: RDW PN: I BP#: "VALUATION: $7,402 y PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof PRIMARY PENTAMATION 1SFDWLR00F USE: SFD or Duplex PERMIT TYPE: WORK SCOPE FEE ID ROOF AREA s.f. 1REROOFFRES 600 ED ____j NOTE. These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addh 7 info. FEE ITEMS (Fee Resolution 09-05I Eff. 7/1,10) FEE QTY/FEE MISC ITEMS Permit Fee: $78.00 Work Without Permit? 0 Yes No $0.00 Strom Motion Fee: IBSEISMICR $0.74 Select an Administrative Item Bld#;Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $79.741 $0.00 TOTAL FEE: $79.74 Revised: 04/01/2011 REROOF TEAR-OFF POLICY 12 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)777,7-3333 PROJECT ADDRESS `4 y '� � d J APN# -7 OWN ER NAME J�^ kr, W PHONE /I w/ E-MAIL i STREET ADDRESSCITY, STATE,ZI / FAX 10161 Z C / / d� CONTRACTOR NAME j ^w�� % / LICENSE NUMBER % _7 LICENSE TYPE BUS.LIC.# y '1 7 CO NY NAME /,-r ' „ E-MAIL X 1y ,�� P� I/ a Q? / w TJU C .0 STREETADDRPSS y �J CI ,STATE,ZIP CC4- P[-1la 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'/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 detectoyirnstalled 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 r _ Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: Po 0"-r c Z PERMIT# OWNER'S NAME: SS c,"� , ,-t PHONE # GENERAL CONTRACTOR: Fe- F, ,1t c" BUSINESS LICENSE# ADDRESS: f),� CITY/ZIPCODE: "Our municipal code requires a I businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. t� I am not using Y an subcontractors: Signature Date Please check applicable subcontractors and complete the following information: V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring/Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature