01060128 CI BUILDI C DIIV'ISSIIONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10012 N FOOTHILL BLVD SHELTON ROOFING 01060128
OWNER'S NAME: APPLICATION SUB DATE
ACADIA VET CHINIC 1988 LEGHORN ST 06/21/2001
SANITARY NO. CONTROL NO.
(650) 961-7699
7PHONE:
RCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATIONz )ob Descri tion
1 hertby affirm thm 1 am littnsed under provisions of Chapmr 9(commencingPpwithSection7")ofDin3oftheBusinessandPromonomCole.andmylicense REROOF.
i`.i«�:°fl �'°o 1. R"J� c,a (d 9 T/O BUR. W/CAP.
°' Dnm Contrzctnr
r ADD BUR. W/ CAPSHEET.
ARCHITECT'S 134CLARATIO
t g D I understand my plans shall be used as public records
as
p O Licensed Professional
OWNER-BUILDER DECLARATION
'-" I hereby affirm that 1 am exempt from the Contractor's License Law far the
t z following reason.(Sattion]0315.Business and Professions Code:Any city or county
c�O which requires a permit to construct,altar,improve,demolish,or repair any structure
003_ prion.its issuance,also requires theapplicant mrsuchpermOtn EMaaigned stammer,
dbil,W51intn<ed pursmtm to the p!n4.aun..of the Cummetnr,Lirense Law(Cnapter9 JJ 1
(commcnumil with Serlum,704)0pf Divlsiva 3nfthe Business and ProSq.Code) ':{Y,'. �'i;k`I tq`PLFloof 5 ,Fl `:�tea:.tl'1 '13i, >\; $31 uation
nr that tic ii exempt therefrom amt the busts for the alle&ed examptinn.Any violation
ogre ion 7031.5 by any uppllcam for a pemn,v bjems the applicant m.civil penalty
. of Marc than five hundredaolmrs(5500). 3266"Y1'mIR Occupancy Type
°1,as ownerof the property,or my employees with wages as their sole compern ation, I
-'will do the work,'and-the 1111h re is not member!.1 offered for sale(See:7044, - -
'Busiren'surd'PlufessionsCode:The Connnel.,a License Ww,do.not apply to an 305 - FRAME Required Inspections
owner of property Who builds or improv.themen,and who does such work himself 307 — INSULATION
AT I O_N_
or through his own employees,provided Nm such improvements arc not intended or _ i
,oendfar sale. wner-l<v<r.the llhave to impn of prom sold within nit Wild of 601 - ROOF TEAR OFF
completion,the owner-builder will have the bathes of proving that he did not build or 602 - ROOF PLYWOOD NAIL
improve for purpose of sale.).
__._.-___.___. _.._._._._________.,_._-_ting.. ._._ _-_._. ._.. ._-_ _..... - ... -
10
I,m owner of the properly,um exclusively commding with licensed conwcrors m 60 3' - 'ROOF BATTENS" ----
L-drum the project(Sec.704e,Business end Professions C.&O The Convactor's l
License Law Ices nota I man owner of t who builds or ire 604 - ROOF IN-PROGRESS
improves thereon.
e - ...and ho contracts f tach pmltttn wth� qty mr(s)Ic sed p rsuant to the
❑le pt under Sec i 't : sBA P C frthu reason 1('.' t
O a t .Date (� -ml-a
a
- - WORKtR S COMPENSATION DECLARATION /��
1 hereby aRrm tanderpenalrymfkr,ay o -of thefollowing dedarauom:
° 1 have'and will mmnmm a CCioricate of Conxm.to to for Worker's
Comperuation,-. pmvideJ fist-by-Saalon 3700 of the Labor Code, for the V
pert rmu a of the w rk ro h'ch tNs perms' i ed.
It
,'�J}�O�h d'wi11'maintain Worker"Cn pe t Inssonce,as required by Section
- 9'100 of the'Lmm'C d,for the perfummrcb of the work'for which this permit is
M Worker's'Com tion Insurance cava and Policy Y pcnxa ynumberarc:
.- ._..
- ISSYC � Q, �p o
Cartier: QiL/�:'/3^.Cs.Policy No.S (f l �. s ,_.,`.; y.' f .:__.'.
-ICERTIFICATION,OVEXEMPTION FROMWORKERS" i
rf_'- " a. .a-:t a' z 1. }..4.a. . 1kJ'Y:
COMPENSATION INSURANCE'..o_r 4,
action need not becrimpleted if rhe permit is for one hundred dollars ,IT,�',
i
($I W)or leas')
shallal ,I certify that n the per p m ntt of the to which. the issued ) t'. r„r i t l,i l p.;l'dzL f•' '
hall n t on L any pe - :my man m become rt e t td the Workers
Compensot an Caws ''Cal tom a.Dam
. NO'AiiT[um. , P ICA .It. ,_Ia n ., ,.. shout ... .__. .. .._....-
tNOTICETOAPotheWorker aftermakingjaoitim,ofume the
Uln�r Cede,you should + - -
� Obcc mesubject to the Worker Cions oro p ions 6f ih Wbor Cole,Wali must
form ith comply with such provisions o this permit at be domed revoked.
`� s,l I -q "` -"CONSTRUCTION LENDING AGENCY '- __ � � 's - �- -•-_--- - -
F'' 1 hereby aPomi ihht there iz a conswetion lending agency for the performance - 9.
Mshe work ror'which this permit ii isiucd(Sec.309].Civ.C.)
L (� _.Lender's Naive
Led Add-'
��. - r
V_ .,( ,1 c n Ty ihm 1 ha a rend this apphcmion anJ smm theuhe abt ve infarmmion is
iz YE[r cornet.I agree to comPlylwith all city and county oNinances,and.vnm laws relating
u " co t _cri undh reh^`mh step<senmtivc ftb': rytp rete pan
p.'W .the abmammaedp pent f,.l .peat nD rya ....
F. d IW 1 agree io see a Iden nify end keep harm) s the Cuy f C pen no again,,
V1 liab'"a
u s j dgments co ra d expense h yin any > again t said / / -
U�z Cty co quence of the gr t got{hs L b
APPLICANT UNDERSTA� A. DWILLCO.yy11PLYwftH ALLNONPOINT"-
SOURCEREGULATIONIssued by: Date
.?S?pwwm of AppImam ommmm.Vs� ." ,Date', ' Re-roofs
HAZARDOUCL
S MATERIALS DIsOSURP '.
Will the applicerit or ralum building occupant'toie or hmdl haemduus trend Type of Roof
'os defined by theCup m Mme ip I Cad Chapter 9,12,and theHealth and Safety
Cob S°c Y a 25532{ 1 s •s i 14 I
All roofs shall be inspected pricr_to.any-roofing-materia] being,installed
'1tsII the liut f rums igoccupant use equipment td •en n.. If a roof is installed without firs[obtaining an ins ectior;Pa tee o removeere t M1aWNo anc sar atl faal by the Aa QualityManagement
District? all new materials for inspection Applicant understands and will comply-with
°Yea " . all non-point source regulations
I have mad,'he hazarra s at n I q m u de Chage 695 9f she.
Celt Health&Safetyetcontend,
on Code have
2550ur itis d25p51understandfiat
'tfthbId ge recut rn which
at tthtrsrnW W bdtyr notify the'
_ ace pant of th Inquire em h ch'mu r be met p or ro es a e of a enific t'of
G' o - Signature of Apple ant Date
Occupant Y, '
..
o m.p alage r Dam All roof coverings to be Class "B" or better
OFFICE
Building Division
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
ICUPEkTINO
Building Department
Subject: Reroofing policy for the City of Cupertino.
1. Prior to permit issuance, you must agree to comply with 1997 UBC Standards and
manufactures specifications on reroofing.
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 reroofing 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) Preinspection 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 that the proper City inspection
can be performed.
We understand the above policy on reroofing and will /comply with this policy.
Homeowners Name:
Address: D 0 J r-2-
Reroofing
Reroofing Company Name:
Applicants Signature:
Joe Antonucci
(Chief Building Official)
6/13/00