B-2017-0963-CANCELLEDCITY OF CUPERTINO BUILDING PERMIT
BUILDINGDRESS:
CONTRACTOR: PERMIT NO: B-2017-0963
16891 STEVE CANYON RD CUPERTINO, CA 95014-5511 (351 16 023)
BELZ
CONSTRUCTION INC
ORANGEVALE, CA
95662-3551
OWNER'SN : MIDPENINSUI.A REGIONAL OPEN SPACE DISTRICT
DATE ISSUED: 06/192017
OWNER'S P1 NE: 650.691.1200
PHONE NO. (916) 222-9923
BUILDING PERMIT INFO:
License Cast H Lic. (5093.55
Contractor Data 10131/2017
S BLDG _ELECT _ PLUMB
I hereby afgn that I am licensed under the provislom of Chapter 9 (commencing
MECH $RESIDENTIAL _COMM CIAL
with Section 7 ) of Division 3 of the Business & Professions Code and that my
He—, n in In forecast! effeeL
JOB DESCRIPTION:
R&ROOF; TEAR-OFF; INST COMP SHINGLES - (6 SQ); DRY
I hereby afar under penalty of perjury one of the following two declarations:
ROT; FLASHING -GARA
t I ha a and will maintain a cemficate of consent to sclf-insure for Worker's
Co ...fine, as provided for by Section 3700 of the Labor Code, for the
per [mance of the work for which this format is issued
u 1 ha a and will maintain Worker's Compensation Insurance, as provided for by
Sec on 3700 of the Labor Code, for the performance of the work for which this
Sq. Ft FI Mea:
Valued— $4000.00
pc it ismesued.
App .T NT CR.RTIFI ATION
I certify that I ave read this application and elate that the above
Number:
Occupancy Type:
information is orrect. I agree to comply with all city and county ordinances
and state law relating to building construction, and hereby authorize
At 16 023
representativ of this city to enter upon the above mentioned property for
inspection pu sec. (We) agree to save indemnify and keep harmless the
City of Cupeil to against liabilities, judgments, costs, end expenses which
PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue a ainst said City in consequence of the granting of this pe
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally, t applicant understands and will comply with all non-
source regula onsthe Cupertino Municipal Code, Section 9.18
180 DAYS FROM LAST CALLED INSPECTION.
/per,
Signature Date
Issued by: Kim Dumbgf
Data: 19/2017
1 hereby afar that 1 am exempt from the Cootr.et s License Law for one of me
RE-ROOFS•
All roots shall be io,,— ed prior to any roofing material being installed. If a roof is
fallowing two sons:
2. 1, a caner of the property, or my empl with wages as their sole
installed without first obtaining an inspection, I agree w remove all new materials for
crortion, will Indic work, and a structure is not intended or offered f
potion
sal Sec.7044, Baines &Profs bei
2. 1,owner of the property, am elusively contracting with licensed
Signature ofApplicanr
c ,tore to construct the p Sect (See 7044, Business & Professions Code).
Date: 06-19.2017
1 hereby affirs under pe&try of jury one of the following three declarations:
ALLROOF COVERINGS TO BE CLASS "A" OR BETTER
r I h e and will eum a Certificate ofConxnsure nm to self-ifor Worker's
Cor licrisatio.. as vided for by Section 3700 of site labor Code, for the
pe oce of work for which this permit is issued.
H DOUS MATERIALS DISCLOSURE
2 1 hes a and wi intain Worker's Compensation huurance, as provided for by
I have read the hazardous material, requirements under Chapter 6.95 of the
Sec on 37 of the Labor Code, for the performance of the work for which this
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
pc 't is sued.
3. 1 ce t at in the performanec of the work for which this person rs issued, l
maintain compliance with the Cupertino Municipal Code, Chapter 9.11 and the
Health & Safety Code, Section 25532(.) should I store or handle hararduus
she of employ my Perron in any manna so ss [o become subject to the
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area AU Quality Management District I
is Compensation laws of C.hfirmi If, after making this certificate of
will maintain compliance with the Cupertino Munict ode, Chapter 9.12 and
e ption, l become subject to the Worker'. Compensation provisions of the
the Health & Safety Code, Seedo , -111, and 15534.
Lab r Code, I must forthwith comply with such provisions or this permit shall
bemad evoked.
o
Owner or authorised eg
APP .1 NT .RTIFI ATION
Date: 0&19.2017
I certify that I ave read this Blpfica en and slate that the above information is
CONSTRUCTION TINDINC. AGENCY
I hereby affirm that there is a construction lending agency for the performance
correct. I agr to comply with all city and county ordinances and state laws
of worWs for which this permit is Issued (Sec. 3097, Civ C.)
rotating m bui ling construction, and hereby authorize representatives of this city
to enter upon he above mentioned property for Inspection purposes. (We) agree
Landers Name
to save Inde ify and keep harmless the City of Cupertino against liabilities,
judgments, cc As, and expenses which may accrue against said City in
Lenders Address
consequence f the granting of this permit. Additionally, the applicant understands
and will cons with all non-point source regulations per the Cupertino Municipal
ARCHITECT'S DECLARATION
Code, SectJoi 9.18.
1 understand my plana shall be used as pllbile records.
Signature G� Date 0&19-2017
9
Licensed
Professional
CFOREROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO CA 95014-3255
CFO
(408) 777-3228 • FAX (408) 777-3333 • bu)Iding(Mcuoerttno oro
72,— 2n
t ,,,I -1I'I Q9 Steven Canyon Rd. Cupertino., CA 95014
uo KtR •„ Ir Mldpeninsula Regional Open Space District
^ 650-691-1200 I' Ichung@openspace.org
(Jean ChunM
,Iw-I1. .11, 330 Distel Circle. ('m sl"s m, nP Los Altos, CA 940 "s
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6656 FilbertAve , I, . n, Oranga-le, CA 95662 Pla^E 650-996-3336
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SUPPLEMENTAL INFORMATION REQUIRLD
ovElcRl'RF.on
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NUi TIA(: tiI.IP
-
II ilding is aNsoclateJ with u Home Owucr, AsmuaunlT, Pea\ iJe tenor
u U1'RwTtl&(mV'.ATER
❑ RITuIIFG PI•w.A REVIEW
nwalfmmHOA,
Prl ide Manning approval W eerily III all) ttUTlCllan�.
❑ -xrxvw
r PI.A.tiNIAa ?1- RT.VIRW
I'r idc copy of Manufaetureis Installation Speciticauans.
d IMAWARD
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❑OTNEN:
Pr 'idc signed copy oCC'upertino c fcur•Otf PoliC\.
REROOF TEAR -OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
ALBERT SALVADOR P.E E. C.B 0, BUILDING OFFICIAL
CUr RTINO 10300 TORRE AVENUE • CUPERTINO. CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building0cu0ertino.org
"xr'rl' IDRFSl 10691 Steven Canyon Rd. Cupertino ,
CA 95014 +°^ ^
.n v _ Midpeninsula Regional Open Spam sr
(Jean Chung)
wanly "1 330 Distill Circie,
x,10 650-691-1200 ' "`
rr1t v,,n M, Los Altos, CA 94022
jchung@oDenspac rg
rIs
cuff ia,r ANEW Alex Belz
i„nv v wma 8909355 J=1 B
nos s
r u++r•,+ +-+rr Benz Constwction Inc.
+110 gaIz2000(c�9mail com
.rami,. -1 6656 Filbert Ave,
Orangevale, CA95662
650-996-3336
1 UNDERSTAND AND AGREE TO THE FOLLO iNG:
I. "1' re -roof project shall comply with all applicable provisions of the 16 Califomia Codes.
7. A inspection request can be scheduled n to one business da be re the requested inspection date.
PI ase schedule inspections ordure or call (408) 777-3228 from 7. 0.3:30pm (Mon-Thurs) or 7:30-
3: Opm (Friday) to schedule inspection. For'I'cai -Off and Nail' g Inspections, you must also call on the
d of the inspection only after that phase of the work is co pieced. The building inspector will be
av ilable within one hour. The hours for this service ore: 7 0-1U:30am and 12:30-3:30 (Mon-Thursj
ai I 7:30-I0:30am and 12:30-2:30 (Friday). Final Insp tions will be given a two hour window.
3. T r -Off Inspection is required. Any, and all dry -rot d wood shall be replaced prior to this inspection.
C less new plywood roof sheathing is proposed thro shout, all the nails/fasteners shall be either
c tpletely knocked -down or removed prior to t '. inspection.
4. If lywood is installed, a plywood NailingIns tion is re uired.
5. R offing shall not be applied without first obt,' ing all prior inspection and written approvals from the
h (ding inspector. Any roofing which is ap ied without first obtaining an approved inspection will
re uire the removal of all new material do n to the sheathing so a proper inspection can be performed.
h. A Final Inspection and approval shal a obtained from the building inspector when the re -roofing is
ct repleted. To receive a final sign -oft' the following items will be verified:
a. Flat roofs shall have a min' um of'/," per foot of slope and demonstrate there is no ponding.
b. Listings from approncd sting agencies for all pre -manufactured products used shall be
available on-site to rev' w at the time of the inspection.
c. Proper spark arresto Installation. cents painted, gutter'downspouts installed, debris removed.
7. 1'E: If you call for a tc -off or plywood nailing inspection and the work is not complete, you will be
c rged a re -inspection f . The re -inspection tee shall be paid before another inspection can be
s eduled.
By rm signing below, l c ' y each of the following is true: I am the properly owner or authorized agent to act oil the
Polite owner's behalf. understand and agree to com t there -roof
policy stated above. 1 also understand that
smok ectors and on monoxide detectors quired to be 'installed in accordance with Sectio �ft of
the 20 6 California R identiat Code.
Si na of A lican Agent:
Dere:
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