11040191 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19926 PORTAL PLZ CONTRACTOR:FRANK FIALA ROOFING PERMIT NO: 11040191
INC
OWNER'S NAME: SOMEKH SASSON R AND ETA TRUSTE 1228 QUARRY LN STE C DATE ISSUED:04/28/2011
OWNER'S PHONE: 4087384221 PLEASANTON,CA 94566 PHONE NO:(925)484-0124
LICENSED CONTRACTOR'S DECLARATION
r ��/ 7C ,� BUILDING PERMIT INFO: BLDG ELECT PLUMB �
License Class / Lic.# E
/� MECH RESIDENTIAL COMMERCIAL
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Contractor -- ,� Wi Date L / t�
I hereby affirm that I am licensed under t e 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:
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.
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 is Sq.Ft Floor Area: Valuation:$5834
permit is issued.
APPLICANT CERTIFICATION APN Number:36945017.00 Occupancy Type:
I certify that I have read this application and state that the above information is
correct.1 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 source regul 'ons �te Cupertino Municipal Co e,Sec on
9.18.
Issued In Date: �,-- -Z
Signature L Date
❑ 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 inspectio I agree remove all new materials for
I,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:
I,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 Code,Sections 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 oriz e
forthwith comply with such provisions or this permit shall be deemed revoked. Date:
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
1 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 Hork'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 . . . . . . . . : 36945017.00
DATE ISSUED. . . . . . . : 04/28/2011
RECEIPT #. . . . . . . . . BS000013317
REFERENCE ID # 11040191
SITE ADDRESS 19926 PORTAL PLZ
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : SOMEKH SASSON R AND ETA TRUSTE
ADDRESS . . . . . . . . . . : 1307 S MARY AVE # 120
CITY/STATE/ZIP . . . : SUNNYVALE, CA 94087
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 5, 834 .00 1. 00 0. 00 1 .00 0.00
1BSEISMICR VALUATION 5, 834 .00 0 .58 0.00 0 .58 0.00
1REROOFRES SQ FEET 6 .00 78. 00 0.00 -----78_00 ------0_00
---------- ----------
TOTAL PERMIT 79.58 0. 00 79.58 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
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
LQ 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUPERTINC>
(408)777-3228• FAX(408)777-3333•building c1cupertino.org
PROJECT ADDRESS q a O r p//i 7� APN# to 1-4501-7
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OWNERNAME t�� e PHONE Sw / E-MAIL
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STREET ADDRESS/3() 1^#
S /l - /L/� CITY, STATE,ZIP
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CONTACT NME J //l/F PHONE ( E`--MAIL
__FSTREET ADDRESS CITY,STATE,ZIP FAX
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT I000NTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ///❑TENANT
CONTR ]R NAME �— /- _`� LICENSE NUMBER&y -y LICENSE T�GjPE? BUS.LIC.# (f
C0.1ADI�' I moi'f�i'L l/ �( CJ CI tV /C E-MAIL FAX-
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STRE'T SS (C �� CITY Tj4T_E,ZIP n j_ _ �J�1 / Wf-VW-pld
ARCHITECT/ENGINEER NAME LICENSE NUMBER , 7,J 1e BUS.LIC.#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑ SFD or Duplex Multi-Family ROOF AREA: / VALU TION:! �—
STRU('TURE: El Commercial 6/ D/4/f `y' I 6
EXISTING ROOF TYPE: BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY)
REMOVE/REPLACE ES IF NO. PLYWOOD h ❑ PLYWD ❑ OSB PITCH: I ROOF
tNO #LAYERS: THICKNESS: � 5/8" TYPE: CDX 12 CLASS: A
IA VO S ICC-ES REPORT#
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES OTHER C R S U
DESCRIPTION OF WORK:
By my signature below,I certify to each of the following: I am the property owndr or authorized agent to act on the property owne s behalf. I have read this
application and the information I have provided is correct. I hPit
ead the D ription of Work and verify it is accurate. I agree to co ply with all applicable local
ordinances and state laws relating to building construction. I re entatives of Cupertino to enter the above-id ntified pro rty for inspection purposes.
Signature of Applicant/Agent: Date: ZQJ
SUPPLEMENTAL INFORMATION REQUIRED � NV
PR
_If building is associated with a Home Owner's Association,provide letter
of approval from HOA. _ � ��' '
PP sQ y ,y �$UIUDI111G PIAN REYR_ t.
�4R�, 9.I XCS3 1 4 Y k
_Provide Planning approval to verify if there any restrictions.
t S � xg.a� a fFLINtCG PLAN REujI�W
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Provide copy of Manufacturer's Installation Specifications. !R; � f{ DEPT "�rk k
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PY of Cuiid
Prove signed co ertino's Tear-Off Polic '' Ina' MW
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lr�1r'Fro4x�iU
ReroofApp_201 1.doc revised 03/16/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: / g 2(o Portal Plaza DATE: 04/26/2011 REVIEWED BY: RDW
APN: BP#: r VALUATION: 1$5,835
PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY SFD or Duplex PENTAMATION 1 SFDWLROOF
USE: PERMIT TYPE:
WORK
SCOPE
FEE ID ROOF AREA
s.f.
1REROOFFRES 600
NOTE: These
-fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'1 in o.
FEE ITEMS (Pe Resolution 09-051 bIL 7/7%10) FEE QTY/FEE MISC ITEMS
Permit Fee: $78.00
Work Without Permit? 0 Yes E) No $0.00
Strong Motion Fee: IBSEISMICR $0.58 Select an Administrative Item
Bld�7 Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $79.58 $0.00 TOTAL FEE: $79.58
Revised: 04/01/2011
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
12 ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUPERTINO
(408)777-3228- FAX(408)777-3333• +. t f__ ""
PROJECT ADDRESS q 9 6 4etL PL APN#
OWNER NAME ), so /// PI3 �- 7. �_ / E-MAIL
STREET ADDRESS1 'TY_STATE,,ZIP FAX
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CONTRACTOR NAME � LICENSE UMB � LICENSE TYPE BUS.LIC.
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COPArNY NAME E-MAIL EAX ryl
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STREET ADD SS ' Y �f CITY,STATE,ZIP
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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 - 3:34pm (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 Va requir t be installed in accordance with Sections R314 and R315 of
the 2010 California Residential Code.
Signature of Applicant/Agent: Date: /
/,1,
ReroofPolicy_2011.doc revised 02/16/11