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10060072 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19822 PORTAL PLZ CONTRACTOR:FRANK FIALA ROOFING PERMIT NO: 10060072 IN VNER'S NAME: YOHAN LEE 12 N QUARRY LN STE C DATE ISSUED:06/10/2010 OWNER'S PHONE: 3102183884 PL EASANTON,CA 94566 PHONE NO:(925)484-0124 ❑ LICENSED CONTRACTOR'S/DECLARATION J(111 DESCRIPTION: RESIDENTIAL COMMERCIAL License Class C—3 Lic.# ��Cy R E-ROOF FOR BUILDING A=REMOVE OLD BUR AND ��?� INSTALL 1/4" DENS DECK,CLASS A,DURO-LAST Contractor ,4la mate O 2 l� R 3OFING 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. 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 Al'N Number:36946041.00 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 Cy/old granting of this permit. Additionally,the applicant understands and will comply Is ued by Date: with all non-point source regulations per the Cu ertino Municipal Code,Section _ 9.18. lO�� RE-ROOFS: Mature ` Date Al roofs shall be inspected prior to any roofing material being installed.If a roof is in:tailed without first obtaining an inspection,I agree to remove all new materials for in:pection. Ay ElOWNER-BUILDERDECLARATION A &I �t Date: /D I hereby affirm that I am exempt from the Contractor's License Law for one of Si;;nature of Applicant: 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) 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 I ave read the hazardous materials requirements under Chapter 6.95 of the Cs lifornia Health&Safety Code,Sections 25505,25533,and 25534. 1 will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: H4 alth&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 m;iterial. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the ah contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will 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 25505a-25531,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this 6//010 permit is issued. Owner or authorized agent: Date: 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 hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. w(rk's for which this permit is issued(Sec.3097,Civ C.) Lf nder's Name APPLICANT CERTIFICATION Le rider'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 '-uilding construction,and hereby authorize representatives of this city to enter 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 understand 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 Li sensed Professional 9.18. Signature Date CITY OF CUPERTINO 3 ITEMS OF 18 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blk: I,ot : APN . . . . . . . . : 36946041 . 00 DATE ISSUED. . . . . . . : 06/10/ 2010 RECEIPT #. . . . . . . . . : BS000010608 REFERENCE ID # . . . : 10060072 SITE ADDRESS . . . . . : 19822 PORTAL PLZ SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . . YOHAN LEE ADDRESS . . . . . . . . . . : 19822 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 . . . : PLEAS111TON, 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 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -- ------------------ CHECK 555 . 00 225 --------------- TOTAL RECEIPT 555 . 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 10 0 00OU C U P E RT I N O PERMIT APPLICATION APN# Date: Building Address: C a D, PbYJCL� Plo-c"_ ` 1 C Owner's Name: Lem Phone #: 3i0 aIB + 3 �S ` HOA: Yes �oE] If yes, provide letter from HOA Contractor: ? j Phone#: a - LA(e)+-004 t S C::�/\ y CO3_ a� Cry Fax#: �'` b- � Cupertino Business License#: �,, Contractor License � 1 � � , +C F Type of Roof Covering: Existing: Proposed: -fBuilt-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles ❑ Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles. ❑ Other(Specify) qP Other (Specify)6W0--L6 .�-- Number of existing coverings one ❑ Provide I.C.C.E.S. Report# _d To be Removed ❑ Provide Mfgr. Installation Specs. Job Description: rn tck 1.�. "1 V� �-c t '-I It �f15 r I ce.,L - �5 LA V_ R0(jfL11j Residential Commercial Green Building: Please complete relevant portio:i 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: / (,o n c I Have Read, Understand and Will Comply with Ci pertino's Tear-Off Policy: Signature Revised 02/05/09 REROOF TEAR-OFF POLICY COMMUNITY DEVELOPMENT DEPARTMEN-'• BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE•CUPERTINO, CA 91014-3255 CUPERTILN4 (408)777-3228 FAX(408)777-3333•buildinla(a.cupertino.orct PROJECT ADDRESS �� F I � I, l� APN# OWNERNAME L ^hc 1 ,alJ� PHONE,3 1 1 �.�3Q4 E-MAIL STREET ADDRESS�,` w I- ` — TY, STAT ZIP `�� FAX r., 01A CO TACTOR NAM J ��j Irrl LICENSE NUMBER + LICENSE TY,P� BUS.LIC.9,3 f> E l>CTc rlC -1 ice► tr C� S1 COMPANY NAME, E-MAIL FAX aA as cof nti, M LI- STREET AD Y STATE,ZIP �� ^- Pxo NE 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 Sam 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 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 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 i:ispection 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. 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 understandand m y with the re-roof policy stated above. Si nature of Applicant/Agent: Date: �Am zi, /Q g ReroofPolicy_201 0.doc revised 05/17/10 CITY OF CITY OF CUPERTINO 91 RER(�OF cuPERrtINo TEE SCHEDULE Number of Fee ID Fee Descrip tion Fee Permit Type Squares Group 1REROOFCOM Re-roof Commercial B 1COMAI[LROOF 1BCBSC Cal Bldg Standards B ALL PERIVHT TYPES Commission:Fee 1BSEISMICO Seismic Commercial B 1RER00FRES Re-roof Residential B 1SFDWLROOF 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMLCRE Seismic Residential B 6 3o S'7 A 1REROOFMRES Re-roof Multi-Family B 1MFDWLROOF 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICRE Seismic Residential B 1BUSLIC Business Licf:nse B