10060067 CITY OF 0XPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19810 PORTAL PLZ CONTRACTOR:FRANK FIALA ROOFING PERMIT NO: 10060067
INC
WNER'S NAME: ALLA ROZENVASSER 12.8 QUARRY LN STE C DATE ISSUED:06/10/2010
OWNER'S PHONE: 6509446596 PL--ASANTON,CA 94566 PHONE NO:(925)484-0124
❑ LICENSED CONTRACTOR'S
/DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIAL
License Class - Lic.# ;�O7 RE-ROOF BLDG A-REMOVE OLF B.U.R. INSTALL 1/4"
���& / DIENS
Contractor i/x�c� Date O l DECK. 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
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 this AF N Number:36946042.00 Occupancy Type:
permit is issued. Wvotl—
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 Is5 ued by: Date:
with all non-point source regulations per the Cupertino Municipal Code,Section _
9.18.
`/O RE-ROOFS:
nature Date // / All roofs shall be inspected prior to any roofing material being installed.If a roof is
installed without first obtaining an inspecti n,I agree to remove all new materials for
ins lection.
❑ OWNER-BUILDER DECLARATION — 41 /,
Si€nature of Applicant: Date: ��/G
I 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
1,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 owner 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
I hereby affirm under penalty of perjury one of the following three ma intain 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 ma terial. 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 I maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by th( Health&Safety Code,Sections 25505,2 3,a 25534.
Section 3700 of the Labor Code,for the performance of the work for which this 1
Owner or authorized agent: Date: 1110
permit is issued.
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 h.reby 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.)
Le�der's Name
APPLICANT CERTIFICATION Le�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
f^building construction,and hereby authorize representatives of this city to enter
i the above mentioned property for inspection purposes.(We)agree to save
....,emnify 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 u iderstand 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 Licensed Professional
9.18.
Signature Date
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
CUPERTINO Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: �/Q ,^ L PERMIT# I00 0 7
OWNER'S NAME: ,4LC en VL`SS� PHONE# ,Sr
GENERAL CONTRACTOR: /6 Fak K .�z BUSINESS LICENSE# 3/ 2
ADDRESS: Z.� L CITY/ZIPCODE: �o
*Our municipal code requires all busin sses working in the �,ity 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 AVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
Signature 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
Date
Owner/Contractor Signature
CITY OF CUPIRTINO
3 ITEMS OF 18 PERMIT RE-_EIPT OPERATOR: SylviaM
COPY # : 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN 36946042 . 00
DATE ISSUED. . . . . . . : 06/10/2010
RECEIPT # . . . . . . . . . BSOOOC10608
REFERENCE ID # 10060067
SITE ADDRESS 19810 PORTAL PLZ
SUBDIVISION . . . . . . .
CITY CUPER"INO
IMPACT AREA . . . . . .
OWNER ALLA ROZENVASSER
ADDRESS 19810 PORTAL PLZ
CITY/STATE/ZIP CUPER"INO, CA 95014
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
---------- -------------
---------- ----------
---------- --
0 . 0
1BCBSC VALUATION 1, 105 . 00 1 . 00 0 .00 1 . 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
RER()OF
eUpERTiNO
PERMIT APPLICATION
APN# Date:
aqa-0 c
Building Address: Rn r CLQ 71 a Za,
Owner's Name: A IQ- V7,L S S e.i�' /41
ne#:
;50 _ gyy - S9c�
HOA: Yes [� No ❑ If es, rovid71"T:from:HOIAPhone#: ,- 0 04
Contractor: i Wit= �A c'
� t,�C�rv`+- LC a�G Fax#: - �
License
Contractor L #• ,�
Cupertino Business License#: c (> +0
Type of Roof Covering:
Existing: Proposed:
I Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
eci Other (Specify)bW0-L6j i ?- V,Q..
❑ Other(Specify)
Number of existing coverings o re- ❑ Provide I.C.C.E.S. Report# L Y i �'
To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description: ,rn , �c� 1.�. 1 V� S �c r y " i ��` L k-
Sq
Residential Commercial
Green Building: Please complete relevant porti 3n of the Confirmed with Planning Dept. if
Green Building Checklist & attach it to the app lication or if there are any restrictions:
applicable, include in plan set & the sheet index:.
Valuation: $ (� W esu:
I Have Read,Understand and Will Comply with Cupertino'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 9.`014-3255
CUPERTINO (408)777-3228• FAX(408)777-3333-buildinci(a cupertino.ora
PROJECT ADDRESS 1 I �y 0C)
f 1, / 7 /, �' APN#OWNER NAME ��//� »CCC 1. C.�I - C E-MAIL
ze�n ��sSzr 50 �y C( fc�
STREET ADDRESS CITY, S- TE,ZIP FAX
1 I( o -
[� LICENSE NUMBER LICENSE TYP BUS.LIC.#,3
COI RACTOR NAM i
n e l,>L&k rl4 .-Iii (�` fes- 1
COMPANY NAME E-MAIL FAX �-yr
cam. as 1\c .C , r. s�- �(c(�j" T7t l
STATE,ZIP
t 0�q� ` P i k' L49l
LI-
I UNDERSTAND AND AGRE'J?TO THE FOLLOWING:
1. The re-roof project shall comply with all applicable piovisions 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 wit lin 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 obtaining 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 from the building inspector when the re-roofing is
complete. To receive a final sign-off, the following ii ems will be verified:
a. Flat roofs shall have a minimum of I/4" per foot of slope and must 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.
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.
3y my signing below, I certify each of the following is true: I am the property owner or authorized agent:toact
on the property owner's behalf. I understand a ;imply with the re-roof policy stated oveSignature of Applicant/Agent: Date:
RerooJPolicy_2010.doc revised 05/17/10
C17Y OF
CITY OF UTERTINO
REROOF
C U P E RT t N O FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1REROOFCOM Re-roof Commercial B 1COMNII,ROOF
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee
1BSEISMICO Seismic C.onunercial B
1REROOFRES Re-roof ResidentialB 1SFDWLROOF
1BCBSC Cal Bldg Standards PERMIT ALL PERT TYPES
Commission Fee
1BSEISMICRE Seismic Residential B
1REROOFMRESFRe-roof Multi-Family B 1MFTDWLROOF
1BCBSC ldg St�ndards B ALL PERMIT TYPES
Commission Fee
1BSEISMICRE Seismic Residential B
1 BUSLIC Business License FB
CITY OF CUPERTINO FUILDING PERMIT
BUILDING ADDRESS: 19811 PORTAL PLZ COP[TRACTOR:KRT INC PERMIT NO: 10060119
OWNER'S NAME: SRINVAS&MADHAVL POTTABATHULA 21031 SAN RAMON VALLEY BLVD DATE ISSUED:06/21/2010
ER'S PHONE: 4082530724 SAID RAMON,CA 94583 PHONE NO:(925)556-0632
1V Z LICENSED CONTRACTOR'S DECLARATI F r
f
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic.#
MECH RESIDENTIAL COMMERCIAL
Contractor Date
I hereby affirm that I am licensed under the provisio ofVap�t JOB DESCRIPTION: REPLACE ROOF WINDOW SHRINK OPENING TO
(commencing with Section 7000)of Division 3 of the Business&Professions NEPOMIDATE ROOF FLASHING INSTALL NEW SIDING&TRIM LIKE
Code and that my license is in full force and effect. FOR LIKE
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. ,t Floor Area: Valuation:$1600
I have and will maintain Worker's Compensation Insurance,as provided for b
Section 3700 of the Labor Code,for the performance of the work for whit is APP Number:36946036.00 Occupancy Type:
permit is issued.
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 Z
granting of this permit. Additio y,the applicant understands and will comply Issued by: Date:
with all non-point source regul io per the Cupertino Municipal Code,Section _
9.18.
/ RE-ROOFS:
Signature Date ` All►oofs shall be inspected prior to any roofing material being installed.If a roof is
insu lied without first obtaining an inspection,I agree to remove all new materials for
insp action.
U O ER-BUILDER DECLARATION
Sigr ature 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
1,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 owner 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
I hereby affirm under penalty of perjury one of the following three mai stain 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 mat-rial. 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 lity Management District I
performance of the work for which this permit is issued. will maintain compliance with the Cupertino Mu Vic' al Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sectio 25505 557WDate:Section 3700 of the Labor Code,for the perfonnance of the work for which this Ow ier or authorized agent• to /
permit is issued.
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 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. wor:s for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
APPLICANT CERTIFICATION 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
—on the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION
mnify and keep harmless the City of Cupertino against liabilities,judgments,
,..,ts,and expenses which may accrue against said City in consequence of the I un Jerstand 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 Licc nsed Professional
9.18.
Signature Date
CITY OF
CITY OF CU PERTINO
GENERAL BUILDING
C u P E RT!N o PERMIT APPLICATION FORM
I oCLP
APN # (( LA -UJ Date: VJ
Building Address: l qg �o2?-Ll 4 llLA 2A
Mailing Address (if different from building address):
Are Hazardous Materials being used as part of this project? Yes ❑ No
HOA: (Exterior work only) Yes ❑ No O�if yes, provide letter from HOA
Owner's Name: 5 R I V l NAS Phone #: -Vol? . d53. O�acf-
A �4 A V L �F3 rN y LA,
Contractor: 1<s;i�-c- t f-�C, Phone: 995 - 65 4.-0 to 3 2-
Fax: 5A-PA(S
Contractor License #:
Cupertino Business License #:
Contact: K6464 -VROIXT Phone: `t 2.1 -'S 0-8831
Fax: of-P5- 551p-o� 3 Z
Residential Commercial El
Job Description: tlaPo c-,S - C kCi r R LL kG - Roo F W&N t;70 U,.r-
SIhRiN'K 01*2csotNG TD r4GGc�YriDLl y.�(,�S' �aOl� FL�SNINV-
1 Q 5TA LL 9 CXl,.s 5L V IN C-s 46 rr,N\ • Lt kcg (A;c4'Z
Building Permit Info:
Bldg E�-- Elect ❑ Plum) ❑ Mech ❑
Type of Construction (Usage Class): Occupancy Type:
1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV-HT, V-B ([— V- —t
Valuation: V//�,Bo. ap Square Footage:
Project Size: Expresg7ff�' Standard ❑ Large ❑ Major ❑
Green Building: Please complete relevant portion of the Green Building/LEED Checklist& attach it
to the application or if applicable, incliide in plan set& the sheet index.
oints Achieved:
i i or help, contact Build it Green at www.builditi!reen.org 16�_
Revised 07/14/09
CITY OF
CITY OF CUPERTINO
GENERAL BUILDING' APPLICATION
CUPERTINO FEE SCHEDULE
Quantity/Sf Fee ID Fee Descripti)n Fee Permit Type
Group 1GENRES or
1GENCOM
1STUCOAP Stucco Applications (up to 400 sf) B
additional stucco application
1 WINREP Replacement windows/sliding glass B
door ea 8 windows
1 WINMEWSTR New Window-:tructural shear B
wall/masonry ncludes plan ck fee
IEPERMITFEE Electrical Permit Fee E
1 MPERMITFEE Mechanical Pei mit Fee M
1 PPERMITFEE Plumbing Perry.it Fee P
1 ELCPLNCK Stand Alone El-ctric Pln Ck(hourly) E
1MECPLNCK Stand Alone M.-chanical Pln Ck (hrly) M
1 PLMBLNCK Stand Alone Pl ambing Pln Ck(hrly) P
I 1 STPLNCK-(3 Hr Min Standard Plan (:heck (when no E/M/P) B
when not over counter) hourly-stand al)ne
I 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT
TYPES
' 1BSEISMICR Seismic Residential B
1BSEISMICO Seismic Commercial B
1TRAVDOC Travel & Documentation B
1BUSLIC Business License B
5 of 5