11040209 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19891 PORTAL PLZ CONTRACTOR:FRANK FIALA ROOFING PERMIT NO: 11040209
INC
OWNER'S NAME: KUBALEK THEODOR AND ELIZABETH 1228 QUARRY LN STE C DATE ISSUED:04/28/2011
OWNER'S PHONE: 4082555455 PLEASANTON,CA 94566 PHONE NO:(925)484-0124
LICENSED CONTRACTOR'S DECLARATIONF-
� �� n''`om BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class C Lic.#
j MECH RESIDENTIAL COMMERCIAL
Contractor�i 7,` z- r�^ � ►_,�/4. ��.oW Datey/29 j/
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: SSADRE-ROOF REMOVE OLD B.U.R.INSTALL 1/4"DENS
(commencing with Section 7000)of Division 3 of the Business&Professions DECK.IN INSTATALL NEW CLASS .DURL LAST ROOFING
Code and that my license is in full force and effect. SYSTEM,INSTALL NEW 1/2"C.DX.PLYWOOD OVER
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 whig.13,this Sq.Ft Floor Area: Valuation:$7401
permit is issued. U
APPLICANT CERTIFICATION APN Number:36946005.00 Occupancy Type:
1 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
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 regul ons pert "Cu ertino Municipal Co e71,,
9.18.
Issued Date:
Signature Date
❑ 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 lins tion, 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,
Business&Professions Code) Signature of Applicant: Date:VI�2-?i 1�
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. 1 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 ode,Se ' ns 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 oraut rzed a t: fi
forthwith comply with such provisions or this permit shall be deemed revoked. tAlDate:
/.2-
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 Aork'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
upon the above mentioned property for inspection purposes.(We)agree to save
indemnify 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
9.18. 1 understand my plans shall be used as public records.
Signature Date Licensed Professional
CITY OF CUPERTINO
3 ITEMS OF 66 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36946005.00
DATE ISSUED. . . . . . . : 04/28/2011
RECEIPT #. . . . . . . . . : BS000013317
REFERENCE ID # . . . : 11040209
SITE ADDRESS . . . . . : 19891 PORTAL PLZ
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : KUBALEK THEODOR AND ELIZABETH
ADDRESS . . . . . . . . . . : 19891 PORTAL PLZ
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-3371
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 7,401 . 00 1. 00 0. 00 1.00 0. 00
1BSEISMICR VALUATION 7,401 .00 0.74 0 .00 0.74 0.00
1REROOFRES SQ FEET 6 .00 78. 00 0. 00 78.00 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 79. 74 0. 00 79.74 0.00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
309 EXTERIOR LATH 311 SCRATCH COAT
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
...............:........_ ..
C)
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408)777-3228• FAX(408)777-3333•building(cDcupertino.org
ld 1,
PRokCT ADDRESS ( (�,ICA t y" � APN# lbo q q C0 CZ5-co
OV.NERNAM E i� n ��C PHONE - S-�; E-MAIL
G LA
STREET ADDRESS �`I STA!; �y CI
ZIP -_o 4A (q so(4 T FAX
CONTACT NAME "�, t .. PHONE E-MAIL
STI<EI,T ADDRESS CITY,STATE,ZIP FAX
❑ 'JW NER ❑ OWNER-BUILDER ❑ OWNER AGENT *CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ I-ENANT
CONTKACTOR NAME LICENSE NUMBER LICENSE TYPEO-1,
BUS,LIC HRaIcA, R LIN ,
ll
P Y E-MAIL FAXq�J�� y,[` �
STI; TUJQ ES ��, / j Y(�" 1 P /(�
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC a (�
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑ SFD or Duplex Multi-Family ROOFREA: VALUATION:
E: El Commercial V C) `(;�/ %. —11 q0 t,
EXISTING ROOF TYPE: 15RUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY)
ROOF
RENtOVE/REPLACE VYES IF NO. PLYWOOD /i' ElPLYWD 11 OS"
PITCH:
❑NO #LAYERS: THICKNESS; 5/8" TYPE: CDX 12 CLASS: A
'Iwo-L" ICC-ES REPORT IV
PRuPOSED ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES 'OTHER
DESCRIPTION OF WORK: 7 CAVES Q"L,-,-,) 2 it C b. Y, �N. 1�l oo r�h-
QA U, I S: S tJc�c
_16S c_ L'\ ' 14 " L
CAS
Y2 c�lira > 11\-�` -lr
e �4j LV��1-1
By my sign'tt&e below,l certify to each of the following: I am the property owner or auth rized agent to act on the property owner's behalf. I have read this
application and the information I have provided is correct. I have rejd the Description of Work and verify it is accurate. I agree to comply with all applicable local
ord minces and state laws relating to building construe/5/1 au representatives of Cupertino to enter the above-Id tified p perty for inspection purposes.
SignatureofApplicant/Agent: - IX X /
SUPPLEMENTAL INFORMATION REQUIRED
—_ If building is associated with a Home Owner's Association,provide letter
of approval from HOA.
A VAT-, Cc°at
Provide Planning approval to verify if there any restrictions. s
s• d � N� I>�NING PLATIRE1Yrft"I;'�w r1 x�'�'
__Provide copy of Manufacturer's Installation Specifications.
s S
Provide signed copy of Cupertino's Tear-Off Policy. IR
^'• ����pt�'�:d����y x,�1 Fey Fy�� � µyd"fir
$.. •.. .. '�r .. � 1ts'rh:A��F,a' }c� � L �' `'.6 chi 27 '4t;,a ;.
ReroofApp_2011.doc revised 03/16/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
WDDRESS: l FRI Portal Plaza DATE: 04/26/2011 REVIEWED BY: RDW
PN: BP#: "VALUATION: $7,402--,
y°PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY SFD or Du lex PENTAMATION 1 SFDWLROOF
USE: P PERMIT TYPE:
WORK
SCOPE
FEE ID ROOF AREA
s.f.
1REROOFFRES 600
Li
NOTE: These
-fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'1 in o.
FEE ITEMS (I"ee Resolution 09-05I Iff, 7;1I N FEE QTY/FEE MISC ITEMS
Permit Fee: $78.00
Work Without Permit? 0 Yes No $0.00
Strom Motion Fee: IBSEISMICR $0.74 Select an Administrative Item
Bldg;Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: 1 $79.74 $0.00 TOTAL FEE: $79.74
Revised: 04/01/2011
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 P E RT I N O (408)777-3228•FAX(408)777-3333• _
PROJECT ADDRESS 8 � 7APN
OWNER NAME k bCjr�� PH 6 8, ff _5-//�j E-MAIL
STREET ADDRESS 9
y�1 I�Y, STATE,ZI � -C) i � FAX
CONTRACTOR NAME f�rct_�17 AL F1�1_XCL LICENSE NUMBER g�7®.7 LICENSE TYPE J� BUS.LIC N 31
'!
CO NY NAME /-- E-MAIL LAX J�
STREET ADDRESS CITY,STATE,ZIP egstw1rd� Cn— 2'��
O I UNDERSTAND AND AGREE TO THE FOLLOWING:
1. The re-roof project shall comply with all applicable provisions of the 2010 California Codes.
2. An inspection request can be scheduled up to the day before the inspection date. Please call (408)777-
3228 from 7:30 - 3:30pm (Mon-Thurs)or 7:30 - 2:30pm (Friday)to schedule the next day inspection.
For Tear-Off and Nailing Inspections, you must also call on the day of the inspection only after that
phase of the work is completed. The building inspector will be available within one hour. Progress
and Final Inspections will be given a two hour window.
3. Tear-Off Inspection is required. Any and all dry-rotted wood shall be replaced prior to this inspection.
Unless new plywood roof sheathing is proposed throughout, all the nails/fasteners shall be either
completely knocked-down or removed prior to this inspection.
4. If plywood is installed, a plywood Nailing Inspection is required.
5. Roofing shall not be applied without first obtaining all prior inspection 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.
6. Progress Inspection is required when approximately 50% of roof covering is installed.
7. A Final Inspection and approval shall be obtained from the building inspector when the re-roofing is
completed. To receive a final sign-off, the following items will be verified:
a. Flat roofs shall have a minimum of 1/4"per foot of slope and 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, vents painted, gutter/downspouts installed, debris removed.
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-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 and agree to comply with the re-roof policy stated above. I also understand that
smoke detectors and carbon monoxide detectors are re uired to be installed in accordance with Sections R314 and R315 of
the 2010 California Residential Code.
Signature of Applicant/Agent: Date:
A/ 4ell
ReroofPolicy__2011.doc revised 02/16/11