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09090071 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19831 PORTAL PL BLDG F CONTRACTOR:FRANK FIALA ROOFING PERMIT NO:09090071 INC f- NER'S NAME: PORTAL PLAZA HOA C/O MR.B GEISER 1228 QUARRY LN STE C DATE ISSUED:09/10/2009 0 vvNER'S PHONE: 4082410023 PLEASANTON,CA 94566 PHONE NO:(925)484-0124 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG F ELECT F- PLUMB F R'/ License Class / Lic.# � a 6 ! 0 —��� / MECH RESIDENTIAL COMMERCIAL Contractor /`(t,.t r ,ryl)ate O 1 hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:BLDG F, 19831 THRU 19863 PORTAL PL,RE-ROOF (commencing with Section 7000)of Division 3 of the Business&Professions REMOVE Code and that my license is in full force and effect. OLD B.U.R.INSTALL CLASS A DURO-LAST ROOF SYSTEM,50MIL P.V.C. INSTALL 1/4 INCH DENS DECK 1 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 Section 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Floor Area: Valuation:$48500 permit is issued. APPLICANT CERTIFICATION APN Number:36946029.BLDGF Occupancy Type: 1 certify that 1 have read this application and state that the above information is correct.1 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 upon the above mentioned property for inspection purposes. (We)agree to save PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. A/Z 1/ l c' !ture Date ® Issued t ! �—�-7 Date: ���t ❑ OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: installed without first obtaining jinsection,1 agree to remove all new materials for 1,as owner of the property,or my employees with wages as their sole compensation, inspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, ��.� f Business&Professions Code) Signature of Applicant: Date• 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 declarations: 1 have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material. Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534. Compensation laws of California. If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,I must Owner or autho forthwith comply with such provisions or this permit shall be deemed revoked. Date:/ APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name the above mentioned property for inspection purposes.(We)agree to save �. 'mify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address costs,and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION 9.18. I understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO 3 ITEMS OF 9 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36946029 .BLDGF DATE ISSUED. . . . . . . : 09/10/2009 RECEIPT #. . . . . . . . . BS000008651 REFERENCE ID # . . . : 09090071 SITE ADDRESS . . . . . : 19831 PORTAL PL BLDG F SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER PORTAL PLAZA HOA C/O MR. B GEI ADDRESS 19831 PORTAL PL BLDG F CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 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 . . . : PLEASANTON, CA 94566 TELEPHONE . . . . . . . . : (925) 484-0124 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 48, 500. 00 2 . 00 0 .00 2 . 00 0 . 00 1BSEISMICR VALUATION 48, 500. 00 4 . 90 0. 00 4 . 90 0 . 00 1REROOFRES SQ FEET 43 . 00 559 . 00 0. 00 559 . 00 0 .00 ---------- ---------- ---------- ---------- TOTAL PERMIT 565 .90 0 . 00 565. 90 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 1,409 .90 #205 --------------- TOTAL RECEIPT 1,409.90 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 604 ROOF IN-PROGRESS 605 FINAL REROOF CITY OF " ctUO( O c)-71 LIM CITY OF CUPERTINO REROOF C U P E RT I N O PERMIT APPLICATION APN# O -�. CT Date:'3(,q +(, 9� 0 /0 Building Address: ticd- /9g /-- J W-T Phone#: Owner's Name: CX:2k .. INS. ` c s A C O 8) zyl- 00,x•3 )c. /0 6 HOA: Yes No ❑ If es, rov><de letter from HO Contractor: Phone#: a15- �q r �"�C la:K(� l 1'1 `•-i-0L Fax#: Ga5 �bq-a. a Cupertino Business License#: Contractor License #: Type of Roof Covering: Existing:', Proposed: 1. Built-Up Roof ❑ Built-Up roof Li Shingles ❑ Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles L3 Other(Specify) Other(Specify)LMS� �• �- Number of existing coverings ❑ Provide I.C.C.E.S. Report# ❑ To be Removed ❑ Provide Mfgr. Installation Specs. Job Description: �e.rnc�� c)lc� 1.1 IZ �n>�l 1 C� V�5 14 lhu(o- ( ws _ism . -� .n,L �?i�c LrS t! �y ,.��� np� dWir-0 VveolDerk Residential Commercial Green Building: Please complete relevant portion 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: ' `� �© 0 c I Have Read,Und d 11 Comply with Cupertino's Tear-Off Policy: Signatur Revised 02/05/09 Community Development Department Building Division City of Cupertino 10300 Torre Avenue Telephone: (408)777-3228 Fax: (408)777-3333 Building Department Subject: Re-roofing policy for the City of Cupertino 1. Prior to permit issuance,you must agree to comply with 2007 IBC Standards and manufacturers specifications on re-roofing.All roofs are Class "A"per Cupertino municipal code 16.04.080. 2. New roof coverings shall not be applied without first obtaining all inspection and written approval from the building inspector. A final inspection and approval shall be obtained from the building inspector when the re-roofing is completed. 3. All roofs shall be inspected prior to any roofing installation. 4. To receive a final sign off from the City,the following steps are required: 1) Pre-inspection and/or tear off approval. 2) In-progress inspection approval. 3) Final inspection approval. a) Spark arrester installation. 5. If plywood is installed,a plywood nail inspection is required. 6. Any roofing which is applied without first obtaining an inspection, will require the removal of all new material down to the sheathing, so a proper City inspection can be performed. 7. NOTE: If you call for a plywood nail inspection and the job is not ready, you will be charged a re-inspection fee of$176.18. The re-inspection fee must be Raid before another inspection can be scheduled. IMPORTANT: 1. Flat roofs must have a minimum of 1/ "per foot slope and demonstrate that there is no ponding. 2. An I.C.B.O. report is required to be on the job site at the time on inspection. I understand and will comply with the above stated !policy on re-roofing. Homeowner's Name: o..4 M P 'ems Job Site Address: Roofing Company NamE e: I`&,,JL Applicant's Signature: — Date: 91101e Greg Casteel Building Official Revised 07/30/08 Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 ,,'UPEkTINO Buildin De artment JOB ADDRESS: (0� lbw PERMIT # �� �y O 1 — 9�' o ( f `1 OWNER'S NAME: n e/ � PHONE # ,Z.S VfV-00 GENERAL CONTRACTOR ��,,.L� o a FAX # I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date