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10060182 CITY OF CUPERTINO DUILDING PERMIT BUILDING ADDRESS: 19960 PORTAL PLZ CON TRACTOR:FRANK FIALA ROOFING PERMIT NO: 10060182 INC NER'S NAME: HENRY SHIN 1228 QUARRY LN STE C DATE ISSUED:06/30/2010 OWNER'S PHONE: 4082961520 PL&►SANTON,CA 94566 PHONE NO:(925)484-0124 ❑ LICENSED CONTRACTOR'S DECLARATIONr— BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class --7 Lic.# I � �� � METH r- RESIDENTIAL f- COMMERCIAL ContractorFrs,tk r,stIct JCp(f�)Date /--7 f0 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.\LL 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. 1 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. W APN Number:36945033.00 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, `JVITHIN 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 regulations per the Cupertino Municipal Code,Section 9.18• ` Issued by: Date: 3ture Date ❑ OWNER-BUILDER DECLARATION RE-ROOFS: All rc 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, 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, Signs ture of Ap licant: 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: I have and will maintain a Certificate of Consent to self-insure for Worker's I ha,,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 Calif 3rnia Health&Safety Code,Sections 25505,25533,and 25534. I will maintain performance of the work for which this permit is issued. coml liance with the Cupertino Municipal Code,Chapter 9.12 and the Health& I 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 conts minants as defined by the Bay Area Air Quality Management District I will permit is issued. maintain 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 Heal h&Safety Code,S ctions 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 Own 3r or authorize t: become subject to the Worker's Compensation provisions of the Labor Code,I must f Date: / forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I herr 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 w hich this permit is issued(Sec.3097,Civ C.) correct.I agree to comply with all city and county ordinances and state laws relating Lend er'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 Lender's Address _minify 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 und.rstand my plans shall be used as public records. 9.18. Liceu ised Professional Signature Date CITY OF CUPERTINO 2 ITEMS OF 36 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot : APN 36945C33 . 00 DATE ISSUED. . . . . . . : 06/30/2010 RECEIPT #. . . . . . . . . BSOOOC10736 REFERENCE ID # . . . : 10060182 SITE ADDRESS . . . . . : 19960 PORTAL PLZ SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER HENRY SHIN ADDRESS 19960 PORTAL PLZ CITY/STATE/ZIP CUPERTINO, CA 95014-3365 RECEIVED FROM . . . . : WM A F'IALA CONTRACTOR FRANK R. FIALA LIC # 31229 COMPANY . . . . . . . . . . : FRANK FIALA ROOFING INC ADDRESS 1228 QUARRY LN STE C CITY/STATE/ZIP . . . : PLEAS]iNTON, 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 Or, � �v ('0 L)I p CITY OF CZ PERTINO REROOF CUPERTWO PERMIT APPLICATION ( -?� _ ' APN# r f� j r lO Date: /,;zq/0z �© �O"` `� 33 Building Address: CIC[ �'-�cLQ CeZr�.. I l [('0Ste/ Owner's Name: km � Phone #: HOA: Yes- No El If es provide letter from HOA Contractor. 00A L VX j Phone #:q aco, 40 Fax#: +L P,Ct,S C� Cupertino Business License31#: Contractor License#: ,-x► C� +o Type of Roof Covering: Existing: Proposed: Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles ❑ Asphalt Shingles ❑ Wood Shakes o wood Shakes ❑ Wood Shingles o Wood Shingles. ❑ Other(Specify) X Other(Specify)b WO-La.S V,Q. Number of existing coverings ©ng,, o Provide I.C.C.E.S. Report# E5' 6 �60 j To.be Removed a Provide IVlfgr. Installation Specs. Job Descriptio eme� -Y� S_ Ck_1 t .tel �` .b`1S ' " L Residential Commercial Green Building: Please cont lete relevant portiOlL of the Confirmed with Planning Dept. if Green Bolding Checklist& A#ach it to the application or if there are any restrictions: ❑ applicayh include in plan set & the sheet index. Valuation: I Have Read,Understand and Will Comply with Cupertino's Tear-Off Policy: Signature Revised 02/05/49 REROOF TEAR-OFF POLICY y,...� COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 C tJ PE Ft'fi1N0 (408)777-3228• FAX(408)777-3333•buildirgCcDcupertino.prg PROJECT ADDRESS !©'Chi I V (�6 APN# OWNERNAME (U l P > �� l E-MAIL FAX STREET ADDRESS l�G � O 1V"C ` IC(Z�. Cm'=(V l ll CO RACTOR AM LICENSE NUMBER. �l LICENSE TYP BUS.LIC.# E-MAIL FAX COMPANY N a,5-q ►a cur � , . () 1 'p, / 6 l ST L o� � ��V 1. STATE,ZIP lO l q"t-S p�J Plfa 6 .�!U"6. U i U 14 C� G 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 minimurr. of one day before the requested inspection date. Please schedule inspections online or call (408)777-3 7,28 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 al.. 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:_,Oam 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 ar.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 ii.ems will be verified: a. Flat roofs shall have a minimum of%a" 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 nspection and the work is notcomplete, 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 o ajtnply with the re-roof policy staated,abov/e.. Signature of Applicant/Agent: Date: L-Z 9/ RerooJPoUcy_2010.doc revised 05117/10