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10060187 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19890 PORTAL PLZ CON TRACTOR:FRANK FIALA ROOFING PERMIT NO: 10060187 INC "NER'S NAME: ERIKA ORTIZ 1228 QUARRY LN STE C DATE ISSUED:06/30/2010 OWNER'S PHONE: 4082573051 PLE.kSANTON,CA 94566 PHONE NO:(925)484-0124 ❑ LICENSED CONTRACTOR'S DECLARATION BUI LDING PERMIT INFO: BLDG[_ ELECT F_ PLUMB F c License Class c—— Lic �� MECH RESIDENTIAL COMMERCIAL Contractor Date � / �� I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:BLDG D-RMV OLD B.U.R.INSTALL 1/4"DENS DECK. INSTALL 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.It Floor Area: Valuation:$6583 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:36946010.00 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 PERMIT 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 t80 DAYS FROM LAST CALLED INSPECTION. granting of this permit. Additionally,the applicant understands and will comply with all non-point source regul tions per the Cupertino Municipal Code,Section 9.18. / Issued by: Date: mature ❑ OWNER-BUILDER DECLARATION RE-ROOFS: All r)ofs 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,I agree to remove all new materials for the following two reasons: inspcction. 1,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 iULLe of App icant: �- Date: Business&Professions Code) 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 ha ie read the hazardous materials requirements under Chapter 6.95 of the Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain performance of the work for which this permit is issued. corn Aiance with the Cupertino Municipal Code,Chapter 9.12 and the Health& 1 have and will maintain Worker's Compensation Insurance,as provided for by Safety 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 contaminants as defined by the Bay Area Air Quality Management District I will permit is issued. mabitain 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 Kea th&Safety Code,S ctions 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 Owr Ler or author' gen become subject to the Worker's Compensation provisions of the Labor Code,I must Date: 711110 forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I her eby affirm that there is a construction lending agency for the performance of work's I certify that I have read this application and state that the above information is for%ihich this permit is issued(Sec.3097,Civ C.) correct.I agree to comply with all city and county ordinances and state laws relating Len ler's Name to building construction,and hereby authorize representatives of this city to enter the above mentioned property for inspection purposes.(We)agree to save Len Ier's Address .mnify 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 un,lerstand my plans shall be used as public records. 9.18. Lic(nsed Professional Signature Date CITY OF CUFERTINO 2 ITEMS OF 36 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot : APN 36946C10 . 00 DATE ISSUED. . . . . . . : 06/30/2010 RECEIPT #. . . . . . . . . : BSOOOC10736 REFERENCE ID # . . . : 10060187 SITE ADDRESS 19890 PORTAL PLZ SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER ERIKA ORTIZ ADDRESS P.O. DOX 2775 CITY/STATE/ZIP . . . : CUPER"INO, CA 95014 RECEIVED FROM WM A PIALA CONTRACTOR . . . . . . . : FRANK R. FIALA LIC # 31229 COMPANY FRANK FIALA ROOFING INC ADDRESS . . . . . . . . . . : 1228 QUARRY LN STE C CITY/STATE/ZIP . . . : PLEAShNTON, CA 94566 TELEPHONE (925) 484-0124 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---- ------ ---------- ---------- ---------- 1BCBSC VALUATION 6, 583 . 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 CITY of �� 40 co 7 CITY OF Cj PERTINO RIEROOF C PERTMO PERMIT" APPLICATION APN# �(429 4�p c) Date: /�,q/,zo 1© Building Address: � C'I Owner's Name: L Y i iLL� Qr l Z. Phone#: HOA: Yes 9 No If es provide letter from HOA ds Contractor;(' l 0-to- o0 '-A0 ZCIA(il Phone �c� J1Ce Fax#• � � " �3. Cupertino Business License.#: Contractor License#: , Type of Roos'Covering: Existing: Proposed: Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles ❑ Asphalt Shinngles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles. ❑ Other(Specify) X Other (Specify),t,I.f o-L S V Q, Number of existing coverings ©tie, ❑ Provide I.C.C.E.S. Report# F a-16 � To.be Removed ❑ Provide Nlfgr. Installation Specs. Job Descriptio e-nnoo c Ick .�-t. ,. :1�(1 S�'�- L4 �` ( Pa.fis �'�-k:. - Residential Conmercial El Green Building: Please cold Iete relevant.genion of the Confirmed with:Planning Dept. if Green Building Checklist &attach it to the application or if there are any restrictions: ❑ applicabl2,include in plan set & the sheet index. Valuation: $ I have Read,Understand and Will Co ly with Cupertino's.`.fear-Off Policy: Signature Revised 02/05/09 CITY 4F CITY OF CUPERTINO V6 RER()OF CUPERTINO FEE SCHEDULE Number of Fee ID Fee Description Fee Permit Type Squares Group 1RER00FC0M Re-roof Commercial B 1COMMLROOF 1BCBSC Cal Bldg Staidards B ALL PERMIT TYPES Commission Fee 1BSEISMICO Seismic Conmercial B 1RER00FRES Re-roof Residential B 1SFDWLR00F 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICRE Seismic Residential B /30 sf��,� 1REROOFMRES Re-roof Multi-Family B 1MFDWLR00F 1A 1BCBSC Cal Bldg Stzndards B ALL PERMIT TYPES Commission Fee 1BSEISMICRE Seismic Residential B 1BUSLIC Business License B REROOF TEAR-OFF POLICY ,. .t COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING;OFFICIAL 10300 TORRE AVENUE•CUPERTINO, CA E5014-3255 C U.PE Ft`if'1i+t0 (408)777-3228• FAX(408)777-3333•tggS r go-cupertino.gra PROJECT ADDRESS i O�I U 6 /, R f.I TAYN k �!` t7 /(�,/ IJpKH,�� E-MAIL OWNER NAME Y �L� ��1 Z. C) �� �c piSTREET ADDRESS (� Cn Y, ATE Zl] � �J C-/�I FAX ct CO RACTOR NAM LICENSE NUMBER. O( LICENSE BUS.LIC.Il t U 7 CCfPANYN `t Q E-MAIL c aJr- OLI- T�a W� I p, / y STREET AD STATE.zII 1 i G� / _ PITr�Jr- `-1 C)q• o 1 a,4 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)777-3228 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 wi-hin 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 ah 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 al plied without first obtaining an approved inspection will require the removal of-all new material down to-he 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 i tems will be verified: a. Flat roofs shall have a minimum of V4"per foot c f 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 inspection and the work is not complete, you will be charged a re-inspection fee of$126.00. The re-in,,pection fee shall be paid before another inspection can be scheduled. By my signing below, I certify each of the following is true I am the property owner or authorized agent to act JA on the property owner's behalf. I understand o c nply with the re-roof policy sta ted pove. ISignature of Applicant/Agent: Date: /xe ReroojTolicy_2010.doc revised 05/17/10