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10060068 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19802 PORTAL PLZ CONTRACTOR:FRANK FIALA ROOFING PERMIT NO: 10060068 D,C VNER'S NAME: JORGE&NANCY CORDON 1228 QUARRY LN STE C DATE ISSUED:06/10/2010 OWNER'S PHONE: 9254840124 PI EASANTON,CA 94566 PHONE NO:(925)484-0124 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIAL License Class C' -77 Lic.# V 0' 7O7 IRE-ROOF BLDG A-REMOVE OLF B.U.R. INSTALL 1/4" j DENS Contractor F/4-074 FK lCt /ems©>t�r. ate O O D ECK. INSTALL CLASS A DURO-LAST ROOFING SYSTEM I hereby affirm that I am licensed under the provisions of Chapter 9 7 (commencing with Section 7000)of Division 3 of the Business&Professions SQUARES. 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:$1105 1 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 �this — AIN Number:36946043.00 Occupancy Type: permit is issued. G""'/ APPLICANT CERTIFICATION I 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 180 DAYS FROM LAST CALLED INSPECTION. 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: with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: nature Date ��d All roofs shall be inspected prior to any roofing material being installed.If a roof is ins ailed without first obtaining an inspection,I agree to remove all new materials for ins section. E] OWNER-BUILDERDECLARATION //40 �OSignature of Applicant: Date: I hereby affirm that I 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) 1,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I hive read the hazardous materials requirements under Chapter 6.95 of the Ca ifornia Health&Safety Code,Sections 25505,25533,and 25534. I will 1 hereby affirm under penalty of perjury one of the following three ma ntain compliance with the Cupertino Municipal Code,Chapter 9..12 and the declarations: He;dth&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 ma:crial. 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 I performance of the work for which this permit is issued. wil 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 25505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Ow ner or authorized agent: Date: I 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 I he-eby 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.) Ler der's Name APPLICANT CERTIFICATION Len der'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 building construction,and hereby authorize representatives of this city to enter ,n the above mentioned property for inspection purposes.(We)agree to save .ademnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION costs,and expenses which may accrue against said City in consequence of the I un lerstand my plans shall be used as public records. granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Lice nsed Professional 9.18. Signature Date Building Department City Of Cupertino LM 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: PERMIT# d OWNER'S NAME: p(` o-elCCoArle`2 PHONE# GENERAL CONTRACTO : �Cpv BUSINESS LICENSE# 3��Z ADDRESS: 1Z Q G CITY/ZIPCODE: *Our municipal code requires all b finesses 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 SUBCONTRAC70 S HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. ��/' C� `1 2© I am not using any subcontractors: b iQ� �Q Signatt re Date Please check applicable subcontractors and complete the following information: 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 Date CITY OF CUFERTINO 3 ITEMS OF 18 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec : Twp: Rng: Sub: Blk: I,ot: APN . . . . . . . . : 36946043 . 00 DATE ISSUED. . . . . . . : 06/10,'2010 RECEIPT # . . . . . . . . . BS000()10608 REFERENCE ID # . . . : 10060()68 SITE ADDRESS 19802 PORTAL PLZ SUBDIVISION . . . . . . CITY CUPER'CINO IMPACT AREA . . . . . . OWNER JORGE & NANCY CORDON ADDRESS 19802 PORTAL PLZ CITY/STATE/ZIP . . . : CUPERPINO, CA 95014-3363 RECEIVED FROM FRANK FIALA ROOFING 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 1, 105 . 00 1 . 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 1, 105 . 00 0 . 50 0 . 00 0 . 50 0 . 00 1REROOFMRE SQ FEET 7 . 00 91 . 00 0 . 00 91 . 00 0 . 00 ---------- ---------- ---------- --------- TOTAL PERMIT 92 . 50 0 . 00 92 . 50 0 . 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ------ 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 603 ROOF BATTENS 604 ROOF IN-PROGRESS 605 FINAL REROOF CITY OF CITY OF CUPERTINO REROOF C U P E RT i N O PERMIT APPLICATION • 06& APN# Date: b � n � C) Building Address: Owner's Name: ne_ �)o C U r o n Phone #: qo[ _ qq(v �)L q 3 HOA: Yes "NoEl If ves , rovide letter from HOA Contractor: V Y�cu. -V d cC k a �� �-i��. , Phone #: aco- �a6 0�1C��r� l t � a� (� Fax#: 10_ `-I,�j ,� -jF'c is Cupertino Business License#: 1 A Contractor License& . � +C Type of Roc f Covering: Existing: Proposed: Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles ❑ Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other(Specify) qp Other (Specify),1,k*-L S Number of existing coverings Qn C ❑ Provide I.C.C.E.S. Report# i Z.-i L, c' ( To be Removed ❑ Provide Mfgr. Installation Specs. Job Description: �vyw')e, 1�1 y ►. Residential Commercial Green Building: Please complete relevant portion of the Confirmed with Planning Dept. if Green Building Checklist & attach it to the app Rcation or if there are any restrictions: applicable, include in plan set & the sheet index. Valuation: $ W,03c - o c //0 I Have Read, Understand and Will Comply with C upertino's Tear-Off Policy: Signature Revised 02/05/09 REROOF TEAR-OFF POLICY COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE -CUPERTINO, CA 95)14-3255 CUPERTINO (408)777-3228• FAX(408)777-3333•buildin (d)cupertino.org PROJECT ADDRESS ` C Ol C)�6_C NA w_ 13 l d f� APN# OWNER NAME PHONE R E-MAIL C CITY, STATE,ZIP c C C) FAX STREET ADDRESS'q 3c) �� r NAM LICENSE NUMBER l✓._ LICENSE TYPE BUS.LIC.9 CO RACT C' %.c q E-MAIL FAX COMPANY NAME STREET ADgE �Y STATE,ZIPS Cy ( PTNE ,�- 1 c� c�.Zi t�lC:Llr 1� ti i Ct 1 (G C I UNDERSTAND AND AGREE TO THE FOLLOWING: 1. The re-roof project shall comply with all applicable provisions of the 2007 California Building Code. 2. You must schedule all needed inspections a minimum of one day before the requested inspection date. Please schedule inspections online or call (408)777-3',28 between 7:30-3:30 (Mon-Fri). 3. Tear-off roof inspection is required. Please call for tear-off inspection after the roof is torn off and all the nails/fasteners have been removed. Any and all dry-rotted wood shall be replaced prior to this inspection. A building inspector will be available winin one hour. There are special hours for this service: 7:30 — 10:30am and 1:00 — 3:30pm(Mon—Thurs); 7:30 — 10:30am and 1:00—2:30pm(Friday). 4. If plywood is installed, a plywood nailing inspection is required. 5. In-Progress roof inspection is required. Call for an in-progress roof inspection to verify building is weather tight after installation of approximately 25% of the roofing material. 6. New roof coverings shall not be applied without first )btaining all inspections and written approvals from the building inspector. Any roofing which is ap?lied 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. 7. A final inspection and approval shall be obtained frorl the building inspector when the re-roofing is complete. To receive a final sign-off, the following i-.ems will be verified: a. Flat roofs shall have a minimum of I/4" per foot cf slope and must demonstrate there is no ponding. b. Listings from approved testing agencies for all p:-e-manufactured products used shall be available on-site to review at the time of the inspection. c. Proper spark arrestor installation. 8. NOTE: If you call for a tear-off or plywood nailing '.nspection 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. -1y 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 a ly with the re-roof policy state above. rr Signature of A licant/Agent: Date: s ReroofPolicy_2010.doc revised 05/17/10 CITY OF CITY OF UTERTINO rk REROOF T7 T CUPER'TINO FEESCHEDULE •E Number of Fee ID Fee Descrip tion Fee Permit Type Squares Group 1RER067FCOM Re-roof Comnercial B 1COMMLROOF 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICO Seismic C.orrmercial B 1REROOFRES Re-roof Residential B 1SFDWLR00F 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMLCRE Seismic Residential B FRER00FMRES Re-roof Multi-Family B 1MFDWLROOF 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission.Fee 1BSEISWCRE Seismic Residential B 1BUSLIC Business License B