10060180 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19958 PORTAL PLZ CON'CRACTOR:FRANK FIALA ROOFING PERMIT NO: 10060180
INC
'NER'S NAME: CHE-WEI CHANG 1228 QUARRY LN STE C DATE ISSUED:06/30/2010
OWNER'S PHONE: 4088878208 PLE�.SANTON,CA 94566 PHONE NO:(925)484-0124
❑ LICENSED CONTRACTTO(R''S/DECLARATION BUILDING PERMIT INFO: BLDG F_ ELECT PLUMB
License Class ,3/ Lic.# (J O G' ^ o7
MECH r— RESIDENTIAL r— COMMERCIAL �
Contractors /`/cj.der ate
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: BLDG K-RMV OLD B.U.R.INSTALL 1/4"DENS DECK.
(commencing with Section 7000)of Division 3 of the Business&Professions INST ALL CLASS A DURO-LAST ROOFING SYSTEM 6.3SQ
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:Floor Area: Valuation:$6583
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued.
APN Number:36945034.00 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 regulAI ons per a pertino Municipal Code,Section
9.18• 7. Issued by: Date:
•ature Date r /�
❑ OWNER-BUILDER DECLARATION RE-ROOFS:
All n 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 instal led without first obtaining an inspection I agree to remove all new materials for
the following two reasons: inspe:tion.
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:ture of A plicant: Date:
Business&Professions Code)
1,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:
1 have and will maintain a Certificate of Consent to self-insure for Worker's I hai 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 Calil ornia Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
performance of the work for which this permit is issued. coml diance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
1 have and will maintain Worker's Compensation Insurance,as provided for by Safei 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
contaminants as defined by the Bay Area Air Quality Management District I 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, ections 25505,25533,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 a thor' aj e // Ila
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
I 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 building construction,and hereby authorize representatives of this city to enter
the above mentioned property for inspection purposes.(We)agree to save Lem ler's Address
,innify 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(erstand my plans shall be used as public records.
9.18.
Lice rsed Professional
S ignature Date
CITY OF CUFERTINO
2 ITEMS OF 36 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: lot:
APN 36945C34 . 00
DATE ISSUED. . . . . . . : 06/30/2010
RECEIPT #. . . . . . . . . BSOOOC10736
REFERENCE ID # . . . : 10060380
SITE ADDRESS 19958 PORTAL PLZ
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER CHE-WEI CHANG
ADDRESS 19958 PORTAL PLZ
CITY/STATE/ZIP . . . : CUPER"INO, CA 95014
RECEIVED FROM WM A FIALA
CONTRACTOR . . . . . . . : FRANK R. FIALA LIC # 31229
COMPANY . . . . . . . . . . : FRANK FIALA ROOFING INC
ADDRESS . . . . . . . . . . : 1228 QUARRY LN STE C
CITY/STATE/ZIP . . . : PLEASANTON, 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
VTY Of
CITY OF CUPERTINO
RERC)OF
CUPERTMO PERMIT APPLICATION
APN# _ Date:
�1,;7-,g 40 IV
Building Address: ����'� �C��1•cLQ ,���Z��.. '� � � �
Owner's Name: z Phone #:
HOA: Yes 9 NoIf es, provide letter-.from HOA
Contractor; rC4..(1 1 otGL C?C t Vjj T4k.G . Phone #:q a ,- ���A C � .
eCa,S.0 n eco Fax#: q
Cupertino Business License#: jc� Contractor License##:
Type of Roof Covering:
Existing: Proposed:
It Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles o Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ wood Shingles.
❑ Other(Specify) ( Other (Specify}�wo-L S 4 • 1� .
Number of existing coverings e ❑ Provide I.C.C.E.S. Report# -+6 �
To.be Removed a Provide Mfgr. Installation Specs.
Job Descriptio : ern00 Ick •1.1• J-Y� S�' - .� `` a'1S �,�" k.
�s-�a,�1 L 1 sS f - u ,ra l.c� s -oo-ft S
Residential Commercial
Green Building: Please cora Iete relevant.portion of the Confrrned with Planning Dept. if
Green Building Checklist & ftach it to the application or if there are any restrictions: ❑
applicable,include in plan set & the sheet index.
Valuation:
I Have Read,Understand and Will Comply with Cup ertino's Tear-Off Policy:
Signature
Revised 02/05/09
CITY OF
CITY OF CUPERTINO
,is I RERO OF
cuPERYINo
FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1REROOFCOM Re-roof Commercial B 1COMMLROOF
1BCBSC Cal Bldg Stwidards 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
1BSEISMICRE Seismic Residential B
6'30 S 1REROOFMRES Re-roof Mul, -Family B 1MFDWLR00F
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee
1BSEISMICRE Seismic Residential B
1BUSLIC Business License 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
C U P1+t0
(408)777-3228• FAX(408)777-3333•buildirg(8cugertino.9r4
PROJECT ADDRESS �A Q C� R i,.I �7APN
1(�� �j 1 , �J tT E-MAIL
OWNER NAME � �
S I`,p ���Z C� Cm ATE,zIf,. t �l `O GL l FAX
STREET ADDRESS a
CO RACTOR AM LICENSE NUMBER. . LICENNSE 139
P BUS.LIC.#3 + � „.4
J
Roof,VA1.1 C r�
COMPANY N E-MAIL C a rJ- V LI-J 75
—t 0. t r1 +L• 10. Cl f n
VSTATE
�
ZIP 4
STREET AD G qUq.
jS 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)777-32_28 between 7:30-3:30 (Mon-Fri).
3. Tear-off roof inspection is required. Please call foi tear-off inspection after the roof is torn off and all
the nails/fasteners have been removed. Any and a1'. 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::;0am and 1:00—3:30pm (Mon—Thurs);
7:30 — 10::;0am 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 ars 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 froin the building inspector when the re-roofing is
complete. To receive a final sign-off, the following i:ems will be verified:
a. Flat roofs shall have a minimum of%a” 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 nspection 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.
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 M
o cnply with the re-roof policy statedabove.
Signature of Applicant/Agent: Date:
ReroolPolicy_2010.doc revised 05/17/10