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11040178 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19932 PORTAL PLZ CONTRACTOR:FRANK FIALA ROOFING PERMIT NO: 11040178 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 DECLARATIONf— ( ' �7 BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class C t Lic.# J _7 _ L f t� MECH F RESIDENTIAL r COMMERCIAL r Contractor f'/�siJ>/c f i�zlt fit . Date 7 ` Z 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 DECK (commencing with Section 7000)of Division 3 of the Business&Professions & Code and that my license is in full force and effect. INSTALL NEW CLASS A DUROLAST ROOFING SYSTEM.INSTALL NEW 1/2"C.D.X.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 whic this permit is issued. Sq.Ft Floor Area: Valuation:$5835 APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is APN Number:36945014.00 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 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 granting of this permit. Additionally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR with all non-point source regula'ons per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION. 9.18. � Signature u - Date t_ ✓ ' / Issued by: Date: ❑ OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS: the following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is I,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspe ion,I agree to remove all new materials for will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection. Business&Professions Code) /� 1,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant ✓--� Date:%/ construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE 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 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 Health&Safety Code,Sections 25505,25533,and 25534. I will maintain 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. permit is issued. Additionally,should I use equipment or devices which emit hazardous air I certify that in the performance of the work for which this permit is issued,I shall contaminants as defined by the Bay Area 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 California. If,after making this certificate of exemption,I Health&Safety Code,Sections 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 autho Date: APPLICANT CERTIFICATION CONSTRUCTION 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 and state laws 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.(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 this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION 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 . . . . . . . . : 36945014 .00 DATE ISSUED. . . . . . . : 04/28/2011 RECEIPT #. . . . . . . . . BS000013317 REFERENCE ID # . . . : 11040178 SITE ADDRESS . . . . . : 19932 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, 835 .00 1. 00 0. 00 1 .00 0.00 1BSEISMICR VALUATION 5, 835 .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 t [ Qq � REROOF PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255 (408)777-3228• FAX(408)777-3333•building tx(kupertino.orq CUIPERTINO _30 PROJECT ADDRESS 'k Q G APN# u4.00 400 OWNER NAME ` S©1 E-MAIL STREGTADt0t i1 ���� C[TY, TATEE,,ZIP ggog FAX CONTACT NAME ' PHONE570 E-MAIL STREb:T ADDRESS ` CITY,STATE,ZIP J ' FAX ❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME / ^ 'J LICE NSENUMBE 8 W LICENSE TYPE BUS.LIC.NS/ ^ ( E-MAIL -MAIL F com"WML LiaAL�-oot s STIESS 0jjJ P s 19 J ARCHITECT/ENGINEER NAME LICENSENUMBER BUS.LIC N ]�S � COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑ SFD or Duplex Multi-Family ROOF AREA: //�� /)') VALUATION. STRUCTURE: C3Commercial 0 l/ t J 1 s 3q -51D EXISTING ROOF TYPE: BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY) RE MOVE/REPLACE YES IF NO. PLYWOOD fw, ❑ PLYWD ❑ OSB PITCH: ROOF ❑NO #LAYERS THICKNESS: ❑ S/8" TYPE: CDX '12 CLASS: A ✓V, 1(: -E REPO T PROPOSED ROOF TYPE: ❑BUILT-UP ROOF 11ASPHALT SHINGLES ElWOOD SHAKES C3WOOD SHINGLES OTHERS t� O DESCRIPTION OF WORK: '--' " ijASUl I& he_nk ba-k - 1(4_4 1\)Qi�­) PA"S �z _'!NAiDW� 1�AO�j "�S By my signature below,I certify to each of the following: I am i1he property owner or authorized agent to act on th roperty owner's behalf. I have read this application and the information I have provided is correct. I ha read the escription of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building construction. I ri tatives of Cupertino to enter the above-id tified p perty for inspection purposes. Signature of Applicant(Agent: i Date: f SUPPLEMENTAL INFORMATION REQUIREDImi mw _ If building is associated with a Home Owner's Association,provide letter W " �`$011T�NGi;iP of approval from HOA. s « , i, s t ' 4�aBy4�DI�IGPLAN�REVIT'H"��,<�� }k �t. Provide Planning approval to verify if there any restrictions. , SPY¢N>VutNG PC AN11` BEVf $ y tac ukrI74 .rr tea r _ Provide copy of Manufacturer's Installation Specifications. _ Provide signed copy of Cupertino's Tear-Off Policy. ReroofApp_2011.doc revised 03/16/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 1 Cr 3 Z Portal Plaza DATE: 04/26/2011 REVIEWED BY: RDW APN: BP#: "VALUATION: 1$5,835 xPERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof PRIMARY SFD or Du lex PENTAMATION 1SFDWLROOF USE: P PERMIT TYPE: WORK SCOPE FEE ID ROOF AREA s.f. 1REROOFFRES 600 T_ NOTE: These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Pee Resolution 09-051 Eff 1,"1 LFEE QTY/FEE MISC ITEMS Permit Fee: $78.00 Work Without Permit? Yes No $0.00 A Strong Motion Fee: IBSEISMICR $0.58 Select an Administrative Item 1314,r 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 Is ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228• FAX (408)777-3333•b,T_i i'i :ilv': .?j_e�i�;"_.;;,, `F'. PROIECTADDRESS / y Q 3 APN# OWNER NAMES t__7 �s / PLi HONE7- ?- W_ E-MAIL STREET ADDRESS /� CITY, STATE,ZIP v 9 y©8 7 FAX / ®•7 CONTRACTOR NAME j �,L 6L/� LICENSE NUMBER 9� ©.-� LICENSE TYPE BUS.LIC.it 31 ry 7 t CorNY NAME r I E-MAIL FAX - t J� STREET ADDRESS a �J CITY,STATE,ZIP PI�QNE-b oil L/ 07 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-roofmg 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 detectors are required to be installed in accordance with Sections R314 and R315 of the 2010 California Residential Code. Signature of Applicant/Agent: Date: .2 ReroofPoliey_2011.doe revised 02/16/11