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10060069 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19812 PORTAL PLZ C DNTRACTOR:FRANK FIALA ROOFING PERMIT NO: 10060069 Ir C WNER'S NAME: J&M SHANMUGAVADIVELU 1,28 QUARRY LN STE C DATE ISSUED:06/10/2010 OWNER'S PHONE: 4082410023 PLEASANTON,CA 94566 PHONE NO:(925)484-0124 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL El COMMERCIAL 11 License Class C'.3 Lic.# �� F.E-ROOF FOR BUILDING A=REMOVE OLD BUR AND �� ���� n INSTALL 1/4" DENS DECK,CLASS A,DURO-LAST Contractor r. 1W, Date /©//0 ROOFING I hereby affirm that I am licensed under the provisions of Chapter 9 SYSTEM (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. Sc.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 AI'N Number:36946039.00 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 granting of this permit. Additionally,the applicant understands and will comply Is:;ued by: Date: with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. nature �GRE-ROOFS: Date �//O/�O Al roofs shall be inspected prior to any roofing material being installed.If a roof is installed without first obtaining an inspection,I agree to remove all new materials for inspection. ElOWNER-BUILDERDECLARATION AV I hereby affirm that I am exempt from the Contractor's License Law for one of Sil,nature of Applicant: Date: 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) 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 have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. 1 will 1 hereby affirm under penalty of perjury one of the following three maintain 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 material. 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 the Health&Safety Code,Sections 25505,JOP33,ajrd 25534. Section 3700 of the Labor Code,for the performance of the work for which this ` O permit is issued. v 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 hf 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. wo k's for which this permit is issued(Sec.3097,Civ C.) Lender's Name APPLICANT CERTIFICATION Lei ider's Address 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 building construction,and hereby authorize representatives of this city to enter n the above mentioned property for inspection purposes.(We)agree to save ...,iemnify 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 or derstand 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 Lia:nsed Professional 9.18. Signature Date Building Department City Of Cupertino 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: /767/1 y r L PERMIT# A0 OWNER'S NAME: J-4- ?;LS- ��- GENERAL CONTRACTOR: Fr F` p© BUSINESS LICENSE# ADDRESS: , Z CITY/ZIPCODE: LC *Our municipal code requires all businesses 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 SUBCONT CTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. G I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: s/ SUBCONTRACTOR BUSINESS Is AME 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 /'z' V///0 2—V/0 Owner/Contractor Signature Date CITY OF CUE ERTINO 3 ITEMS OF 18 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec : Twp: Rng: Sub: Blk: Iot : APN . . . . . . . . : 36946C39 . 00 DATE ISSUED. . . . . . . : 06/10/2010 RECEIPT #. . . . . . . . . : BSOOOC10608 REFERENCE ID # . . . : 10060069 SITE ADDRESS . . . . . : 19812 PORTAL PLZ SUBDIVISION . . . . . . CITY CUPERT INO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : J & M SHANMUGAVADIVELU ADDRESS . . . . . . . . . . : 19812 PORTAL PLZ CITY/STATE/ZIP . . . : CUPERTINO, 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 . . . : PLEASINTON, 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 1 CSD 6090 [I- REROOF C u P E RT r N o PERMIT APPLICATION APN# Date: Z/(PC)31. ov �y Building Address: C C- 1 Ct'LCA_. B tj Owner's Na;ne:(` m 0 CV-1l ve�LA, Phone #: - 4 HOA: +Yes No f es, provide letter from HOA y l Contractor: �`�c"/�� 1 C�.tC . u.j 1-%'� , , Phone #: - °�4 > 04 tJ �LtSC:i/� C qa� � Fax#: CA � � " ��� Cupertino Business License#: JIDLcA Contractor License +��`1" Type of Roof Covering: Existing: Proposed: Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles ❑ Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other(Specify) y Other(Specify)�wC'`_L&i - Number of existing coverings nn -a ❑ Provide I.C.C.E.S. Report# L f' d L-- CL p To be Removed ❑ Provide Mfgr. Installation Specs. Job Description: Yn t L�. "1.o S �c� �t ( << Residential Commercial Green Building: Please complete relevant portiai 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: $ G� '30 . e.�d.: �/ l ' � Ile 5 I Have Read, Understand and Will Com i Cupertino's Tear-Off Policy: Zi- Signature Revised 02/05/09 REROOF TEAR-OFF POLICY COMMUNITY DEVELOPMENT DEPARTMEN--- BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDINC OFFICIAL 10300 TORRE AVENUE -CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228- FAX(408)777-3333 -buildin a Qcupertino.orq PROJECT ADDRESS 1 , IA '777- OWNER NAME CY /Ly\n/�U ��_ A 1 1� '� PHONE, I&�- 9_q C! `,] E-MAIL STREET ADDRESS ' t 8 + �� /1„ (� P la`C� CITY, STS VE.ZIP ,) n �1 Ail- C)S01 l I FAX CO�RACTOR NAM , LICENSE NUMBER C 1L LICENSE TYPE BUS.LIC.# 4"'E� n c' uca��t i'1� a t'1 $ r U C;_39 COMPANY NAME E-MAIL FAX f.. . �ta�1a. oo �n ��ttrs c1 '�a �r n� .c ; CA a,5 Ll- 7 � STREET AD CIS STATE,ZIP S f� C!/q;�� � �- L4gLl- `y t l, �c�r Ln� L t� i ' _" �J ) CiJ4 �I 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 within one hour. There are special hours for this service: 7:30 — 10:3 dam and 1:00 — 3:30pm (Mon—Thurs); 7:30 — 10:3 dam 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 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. 7. A final inspection and approval shall be obtained frorr. the building inspector when the re-roofing is complete. To receive a final sign-off, the following iti;ms will be verified: a. Flat roofs shall have a minimum of I/4" per foot oi'slope and must demonstrate there is no ponding. b. Listings from approved testing agencies for all pr,;-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-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 to act on the property owner's behalf. I understand and y with the re-roof policy stateyl abov . Signature of Applicant/Agent: Date: ReroofPolicy_2010.doc revised 05/17/10 CITY OF CITY OF CTPERTINO REROOF c T� CUPERTINO FEE SCBEDULE Number of Fee ID Fee Description Fee Permit Type Squares Group 1REROOFCOM Re-roof Commnercial B 1C0MMLR00F 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMIC0 Seismic Commercial B IREROOFRES Re-roof Residential B 1SFDWLROOF 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICRE Seismic Residential B 6• ���� 1REROOFMRES Re-roof Multi-Family B 1MFDWLROOF 1BCBSC Cal Bldg Stajidards B ALL PERMIT TYPES 1 Commission Fee IBSEISNUCRE Seismic Residential B r 1BUSLIC Business Liccnse B