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10060195 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19811 PORTAL PLZ CON TRACTOR:FRANK FIALA ROOFING PERMIT NO: 10060195 INC NER'S NAME: SRINIVAS&MADHAVI POTTABATHULA 1228 QUARRY LN STE C DATE ISSUED:06/30/2010 OWNER'S PHONE: 6503316476 PLE,,SANTON,CA 94566 PHONE NO:(925)484-0124 ❑ LICENSED CONTRACTOR'S DECLARATIONF / � � BUDDING PERMIT INFO: BLDG ELECT. PLUMB License Class (.-� Lic.tt r r j, / MECH RESIDENTIAL COMMERCIAL Contractor/ {��.Z��L�f!4- Date �/1 l T� JOB DESCRIPTION: BLDG G-RMV OLD B.U.R.INSTALL 1/4"DENS DECK. I hereby affirm that I am licensed under the provisions of Chapter 9 [NST kLL CLASS A DURO-LAST ROOFING SYSTEM 6.3SQ (commencing with Section 7000)of Division 3 of the Business&Professions 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. I have and will maintain Worker's Compensation Insurance,as provided for by Sq.f t Floor Area: Valuation:$6630 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. 6�/ APN Number:36946036.00 Occupancy Type: APPLICANT CERTIFICATION 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 HERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION. granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Issu,-d by: Date: ature Date ❑ OWNER-BUILDER DECLARATION RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed.If a roof is I hereby affirm that I am exempt from the Contractor's License Law for one of insta led without first obtaining an inspection, agree to remove all new materials for the following two reasons: inspc ction. I,as owner of the property,or my employees with wages as their sole compensation, will do the work,and the stricture is not intended or offered for sale(Sec.7044, Sign,&ureppI' ant: Date: of Business&Professions Code) P 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 HAZARDOUS MATERIALS DISCLOSURE declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's I hal a read the hazardous materials requirements under Chapter 6.95 of the Compensation,as provided for by Section 3700 of the Labor Code,for the Calit ornia Health&Safety Code,Sections 25505,25533,and 25534. I will maintain performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& I have and will maintain Worker's Compensation Insurance,as provided for by Safe y Code,Section 25532(a)should I store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air cont,iminants as defined by the Bay Area Air Quality Management District 1 will permit is issued. mair tain compliance with the Cupertino Municipal Code,Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 5505,25533,and 25534. 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 Owner or authorized n • _ 7� become subject to the Worker's Compensation provisions of the Labor Code,I must Date: forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I her;by affirm that there is a construction lending agency for the performance of work's 1 certify that I have read this application and state that the above information is for v hich this permit is issued(Sec.3097,Civ C.) correct.I agree to comply with all city and county ordinances and state laws relating Lem ler's Name to huilding construction,arid hereby authorize representatives of this city to enter the above mentioned property for inspection purposes.(We)agree to save Lem Per's Address ._,omnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section I unc erstand my plans shall be used as public records. 9.18. Lice ised Professional Signature Date CITY OF CUF ERTINO 2 ITEMS OF 36 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Iot: APN . . . . . . . . : 36946( 36 .00 DATE ISSUED. . . . . . . : 06/30/ 2010 RECEIPT #. . . . . . . . . : BSOOOC10736 REFERENCE ID # . . . : 10060195 SITE ADDRESS . . . . . : 19811 PORTAL PLZ SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : SRINIVAS & MADHAVI POTTABATHUL ADDRESS . . . . . . . . . . : 19811 PORTAL PLZ CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : WM A F'IALA CONTRACTOR . . . . . . . : FRANK R. FIALA LIC # 31229 COMPANY . . . . . . . . . . : FRANK FIALA ROOFING INC ADDRESS . . . . . . . . . . : 1228 QUARRY LN STE C CITY/STATE/ZIP . . . : PLEASINTON, CA 94566 TELEPHONE . . . . . . . . : (925) 484.-0124 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ----- ----- ---------- ---------- ---------- 1BCBSC VALUATION 6, 630 . 00 1 . 00 0 . 00 1. 00 0 .00 1REROOFRES SQ FEET 6 . 00 78 . 00 0. 00 78 . 00 0 . 00 ----- ----- ---------- ---------- ---------- TOTAL PERMIT 79 . 00 0 . 00 79 . 00 0 .00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 604 ROOF IN-PROGRESS 605 FINAL REROOF Cf7Y OF CITY OF CUPERTINO 121 REROOF C U P S RT I N O PERMIT APPLICATION APN# c:3 6 q 4 ? Date: I Building Address: Owner's Name:9v x s £ Nick 0 1 ��- Phone #: HOA: Yes ❑ No ❑ If es, provide letter from HOA Contractor: L)'At-VJ Z/1C.- � Phone #:q a - LAI&)4 G Fax#: G�� - � ``� " a�IL Cupertino Business License#: 31 cA Contractor License_ Type of Roo''Covering: Existing: Proposed: t Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles ❑ Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other(Specify) y Other(Specify)b I,l,f c"-L A � �•�. Number of existing coverings_O n e ❑ Provide I.C.C.E.S. Report# E -d U L-,0 To be Removed ❑ Provide Mfgr. Installation Specs. Job Description: emco e, �Iu '-I Residential Commercial Green Building: Please complete relevant portion of the Confirmed with Planning Dept. if Green Building Checklist & attach it to the application or if there are any restrictions: ❑ applicable, include in plan set & the sheet index. Valuation: $ j Q /1 c: I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy: Signature Revised 02/05/09 REROOF TEAR-OFF POLICY COMMUNITY DEVELOPMENT DEPARTMENI - BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE-CUPERTINO, CA 9014-3255 CUPERTINO (408)777-3228- FAX(408)777-3333-buildinc(Qcugertino.org PROJECT ADDRESS 1 qS I ( W C APN# 09, INAM E PHO f Ami i E-MAIL STREET D RESS C Y, ST TE ZLIPPL FAX k1( f �`'lC Z c ��/ k'v c l-) g w(LI CO�RACTOR NAM BUS.LIC.N LICENSE NUMBER LICENSE TYPE c gat�'er�/ -T�^► CJ g �,-. cvr � I+ �a COMPANY NAME E-MAIL FAX �[� $ �c� 4 t� �n ✓tc�s r1 'eCLA X.r ivj ,tcwl cla!5_q� ,LI- ST t OL tT tl &tA�Vt.lr v, L� � 4 v Y� .�:•ZI "1, IUn eo, 4'1 q- 3 to(t"` Pf��- �1 a I UNDERSTAND AND AGREE, TO THE FOLLOWING: 1. The re-roof project shall comply with all applicable pr)visions 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)777-3228 between 7:30-3:30 (Mon-Fri). 3. Tear-off roof inspection is required. Please call for :ear-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 witldn 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 c btaining all inspections and written approvals from the building inspector. Any roofing which is apf lied without first obtaining an approved inspection will require the removal of all new material down to tf.e 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 it(ms 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 inspection and the work is not complete, you will be charged a re-inspection fee of$126.00. The re-insf ection 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 to act on the property owner's behalf. I understand a o pply with the re-roof policy stated bove Signature of Applicant/Agent: 1,7 - - Date: O!p ReroofPolicy_201 0.doc revised 05/17/10 CITY OF CITY OF CUPERTINO REROOF CUPERTI 1O F'EE SCHEDULE Number of Fee ID Fee Description Fee Permit Type Squares Group 1REROOFCOM Re-roof Commercial B 1C0NIlY LR00F 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICO Seismic C.orrmercial B 1RER00FRES Re-roof ResiJential B 1SFDWLR00F 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICRE Seismic Residential B 0 S 1REROOFMRES Re-roof Muhi-Family B 1MFDWLROOF 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISNUCRE Seismic Residential B 1 BUSLIC Business License B