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10060192 CITY OF CUPERTINO B UILDING PERMIT BUILDING ADDRESS: 19912 PORTAL PLZ CON'rRACTOR:FRANK FIALA ROOFING PERMIT NO: 10060192 INC -'VNER'S NAME: CHRISTOPHER LEE 1228 2UARRY LN STE C DATE ISSUED:06/30/2010 v WNER'S PHONE: 5109150300 PLEf,SANTON,CA 94566 PHONE NO:(925)484-0124 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT r PLUMB I— License Class Lic.# ayc / ` MECH r- RESIDENTIAL f- COMMERCIAL r Contractor FOl� �i«lta Date 2 / / L' 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. INST 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:$6583 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. l APN Number:36946007.00 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 180 DAYS FROM LAST CALLED INSPECTION. granting of this permit. Additionally,the applicant understands and will comply with all non-point source regula ions pe heCupertino Municipal Code,Section 9.18. An Issued by: Date: °'mature Date ❑ OWNER-BUILDER DECLARATION RE-ROOFS: All i Hofs 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 lled without first obtaining an inspecti n,I agree to remove all new materials for the following two reasons: insp action. 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, Sign ature o Ap licant: Date: Business&Professions Code) — I,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER construct the project(Sec.7044,Business&Professions Code). 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 have 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. 1 will maintain performance of the work for which this permit is issued. cors pliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& I have and will maintain Worker's Compensation Insurance,as provided for by Safi ty 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 Ad(itionally,should I use equipment or devices which emit hazardous air con aminants as defined by the Bay Area Air Quality Management District I will permit is issued. mai ntain 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 Hea lth&Safety Code,Sections 25505,25533,and 25534. not employ any person in any manner so as to become subject to the Worker's 41 Compensation laws of California. If,after making this certificate of exemption,I Ow ter or author' ent: 7 become subject to the Worker's Compensation provisions of the Labor Code,I must — Date:-- /Z/t,?7 forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I he reby 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 xhich this permit is issued(Sec.3097,Civ C.) correct.I agree to comply with all city and county ordinances and state laws relating Ler der'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 Ler der's Address nnify 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 ur derstand my plans shall be used as public records. 9.18. Licensed Professional Signature Date CITY OF CUEERTINO 2 ITEMS OF 36 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 36946C07 . 00 DATE ISSUED. . . . . . . : 06/30/2010 RECEIPT #. . . . . . . . . BSOOOC10736 REFERENCE ID # . . . : 10060192 SITE ADDRESS . . . . . : 19912 PORTAL PLZ SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER CHRISTOPHER LEE ADDRESS 19912 PORTAL PLZ CITY/STATE/ZIP . . . : CUPERTINO, 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 . . . : PLEASI.NTON, 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 IPTY OF � �� � C:) l CITY OF CUPERTINO ROOF CUP RTt Ed PER 1 APP CA". ION APN# Date: �! d Building Address: Owner's Name: h r t OL, 'p► / �- - Phone#. HOA: Yes No If yes, provide letter from HOA Contractor: �'r Phone#:q ` �`��p C P�Ct S .- 9 Fay#: �}Cupertino Business License.#: Contractor License : p 31 a, Type of Roof Covering: Existing: Proposed: • ❑ Built-Up roof Built-Up Roof P ❑ Asphalt Shingles a Asphalt Shingles ❑ Wood Shakes ❑ wood Shaves ❑ Wood Shingles o wood Shingles. ❑ Other(Specify) X Other(Specify)b UtCG L6.S��jj T V Q. Number of existing coverings ©lie, ❑ Provide I.C.C.E.S. Report# To,be Removed ❑ Provide Nlfgr. Installation Specs. Job Descriptio eY►no\ � �CI,SS Vit- �i..t �a• �.C�s� �Zoa~�t � S�� t� Residential Commercial El Green Buildings Please cow lete relevant portio a,of the Confirmed with Planning Dept. if Green Binding Checklist& #ach it to the application or if there are any restrictions: ❑ appficabl include in Ian set & the sheet index. Valuation: I have Read,Understand and Will Comply with Cupertino's Tear-Off Policy: Signature Revised 42/05/49 CITY OF CITY OF CUPERTINO REROOF CUPERTINO FEE SCHEDULE Number of Fee ID Fee Description Fee Permit Type Squares Group 1REROOFCOM Re-roof Commercial B 1COMM[LROOF 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICO Seismic Commercial B 1RER00FRES Re-roof Residential B 1SFDWLR00F 1BCBSC Cal Bldg Staidards B ALL PERMIT TYPES Commission Fee 1BSEISNUCRE Seismic Residential B 1REROOFMRES Re-roof Mull i-Family B 1MFDWLROOF 1BCBSC Cal Bldg Staidards B ALL PERMIT TYPES Commission Fee 1BSEISMICRE Seismic Residential B 1BUSLIC Business Licanse B REROOF TEAR-OFF POLICY COMMUNITY DEVELOPMENT DEPARTMENT- BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 E UJ-PE R"1l'1No (408)777-3228•FAX(408)777-3333•buildirg&,Cupertino.prct PROJECT ADDRESS C, O O 6 W D APN# w E-MAIL OWNER NAME C h r i sic; h ►� (.��- L__7T ..O�1(�,C�1S.O,3 C:6' , n Y ATE.ZII; /� FAX STREET ADDRESS qjq�;� �0$lY4 ptcc.Z�- �so t LICENSE NUMBER. �' V-� LICENSE P BUS.LIC.N ' CO RACTOR AM �i i1C V y. ✓ v 3,4 LST!P-EETMPANY N E � L a'9- (SLI t0. t r1 � e. IA 0.X i1 ' fp, J ,�+STATE,ZII qJ` tU"6• via � 4.I�� 1�,1 C, ue C10 � , I I UNDERSTAND AND-AGREE TO THE FOLLOWING: 1. The re-roof project shall comply with all applicable Irovisions 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 fo:-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::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 inspectioi 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 pf 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 items will be verified: a. Flat roofs shall have a minimum of%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-impection 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 on the property owner's behalf. I understand o c nply with the re-roof policy statedAbbove. Signature of Applicant/Agent: Date: -i C� ReroojTolicy_2010.doc revised 05/17/10