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09090073 CITY OF CUPERTINO BUILDING PERMIT BUILMING ADDRESS: 19860 PORTAL PL BLDG C CONTRACTOR:FRANK FIALA ROOFING PERMIT NO:09090073 INC t"''NER'S NAME: PORTAL PLAZA HOA C/O MR.B GEISER 1228 QUARRY LN STE C DATE ISSUED:09/10/2009 .. PLEASANTON,CA 94566 PHONE NO:(925)484-0124 NER'S PHONE: 4082410023 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class L 3 r Lic.# 7�d V 7 Oq7/ MECH f— RESIDENTIAL COMMERCIAL Contractor �R-��-r/d[�900 rZ4+ Date //P'D/�� JOB DESCRIPTION:BLDG C, 19860 THRU 19882 PORTAL PL,RE-ROOF I hereby affirm that I am licensed under the provisions of Chapter 9 REMOVE (commencing with Section 7000)of Division 3 of the Business&Professions OLD B.U.R.INSTALL CLASS A DURO-LAST ROOF Code and that my license is in full force and effect. SYSTEM.50 MIL P.V.C. INSTALL 1/4 INCH DENS DECK 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 Section 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Floor Area: Valuation:$39500 permit is issued. APPLICANT CERTIFICATION APN Number:36946029.BLDGC Occupancy Type: I certify that I 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 regulati ns per the Cupertino Municipal Code,Section 9.18. )AP/40 �� 9 �7� --Z— Date: Date / !/©// Issued by: S;-^ature D ❑ 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 an ins ection,I agree to remove all new materials for I,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, Date: 9/�d7/v9 Business&Professions Code) Signature of Applicant: 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: HAZARDOUS MATERIALS DISCLOSURE 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 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& 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 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,1 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 aunt e Date: forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I certify that 1 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 r, 'he above mentioned property for inspection purposes.(We)agree to save I aify 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 ARCHITECT'S DECLARATION with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records. 9.18. 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 .BLDGC DATE ISSUED. . . . . . . : 09/10/2009 RECEIPT #. . . . . . . . . : BS000008651 REFERENCE ID # . . . : 09090073 SITE ADDRESS . . . . . : 19860 PORTAL PL BLDG C 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 39, 500 . 00 2 . 00 0 . 00 2 . 00 0 . 00 1BSEISMICR VALUATION 39, 500 . 00 4 .00 0 . 00 4 . 00 0 . 00 1REROOFRES SQ FEET 32 . 00 416 . 00 0 . 00 416 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 422 . 00 0 . 00 422 . 00 0 . 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 604 ROOF IN-PROGRESS 605 FINAL REROOF ICS Building Department De CITY OF CUPERTINO 10300 TORRE AVENUE • CUPERTINO,CA 95014-3255 CUPERTINO TELEPHONE:(408)777-3228 • FAX: (408)777-3333 January 22, 2010 Frank Fiala Roofing Inc. 1228 Quarry Lane, Suite C Pleasanton, CA 94566 SUBJECT: Permit application extension Dear AL: Your roof permit application#09090073 for 19860 thru 19882 Portal Place has been extended the maximum 6 months until September 10, 2010. This is a one time only extension. You need to start the project and have inspections by this date or your permit will re-expire and you will necd to pay all new fees. If you have any questions or concerns, please contact me at 408-777-3246. Sincerely, Susan Winslow City of Cupertino, Building Department FRANI4C FIALA ROOFING INC. 1228 Quarry Lane, Suite "C" Pleasanton, CA.94566 Ph (925)484-0124 (510) 582-6929 Fax(925) 484-2752 (510) 582=2851 Page Of ;2- Date / 1'7/2-co i0 TO: p Crl�.hp p ATTN: P /'r►�r�� D�!'G_rt�, -� �G�G`�t�J', l ��6p - j9��� FROM: Az Gc//f �sloJ 9is=.7 �'T3 NOTES: Pal ell )e c- c� To cow � ° y � �� "o re �mw