03010155 CITY OF CUPERTINO
BUILDWG DIVISION PERMITa�C0NTRAC-'TOR INFORMATION fi
' BUILDING ADDRESS: PERMIT NO.
1526 S STELLING RD 03010155
NER'S NAME: APPLICATION SUB DATE
MICHAEL PEARSON 01/27/2003
...ONE; SANITARY NO. CONTROL NO,
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
�00 LICENSED CONTRACTOR'S DECLARATION Job Description
(RjF I hereby of nd that I am o
licensed under provisions of Chapter 9(commencing
y.2 with Seninn]INNp of Diw,isinn Ldthe Business uAd Professions Cnde.anJ mYicenu is
t6=60 P
FI<y in fnB Inrec riff tree Q I1C a W REROOF
OZ;:o Lieent ,law - / FIieI�aLE®
FyF,� Da conuac
NCIII'IECT'S DE ATION
OU I understand my plans shall be used as public records
LLp� Licensed Isodiamuml FEB 2 6 2003
OWNER-BUILDER DECLARATION
c <f I hereby affirm that 1 am exempt from the Contractor's License law lir the
THO following react n secdan7031.3,Business and Professions Code:Any city of county BUILDING
N�$ which requires a Permit to consituation,allay,improve,demolish,or repair any situation
�y primo it iminuoue,also requires the applicant for such Permit to file a signed sWement
�O that he is licensed pursuant to the provisions of the Contractor's License Law(Charter 9 Sq. Ft. Floor Area $7YSWion
$ (commencing with Section]IXNI)of Division 3 of the Business and Professions Cmlc)or
— Net he is exempt therefrom and the brise for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant n a civil ritually of
nor more than five hundred dollars(SR)(q. bC Occupancy Type
1,of owner of the property,or my employees with wages as their In compensation,
will do the work,and the structure is not intended or offered for aide(Sm. Business 3 05 —
FRAME
and Professions Coda: pro Corrector's License Law does not apply to an owner or 3 07 — INSULA`J�fVLV ed Inspections
property who builds or improves thereon.and who does such work himself or through his
own employees,provided that such improvement are not intended or offered for sola If. 601 — ROOF TEAR OFF
however.the building or improvement is sold within one year of completion,the owner
builder will ban the burden of proving that he did nut build or improve for purpose of 602 - ROOF PLYWOOD NAIL
.10.). 603 - ROOF BATTENS
[D 1,as owner M the progeny,am exclusively conducting with licensed contractors to 604 - ROOF IN-PROGRESS
consumer the project(Sec.Tool,4Business and Professions Code:)The Contractor's Li. .
cense taw does not apply to an owner of property who Wilds or improves Neuron,and
who contract for such projects with a contactot(a)licensed random to the Convectors
License Law.
❑ I our eacmPt trader Sec. ,B&P C for this reason
net Date
WORKER'S COMPENSATION DECI.A RATION
1 hereby aRum under Penalty of perjury one of the following declainumay:
❑1 have and will maintain s Cenificac of Consentm self-insure for Worker's Compcm
cation,as provided for by Section 3]11(1 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,az required by Section
3100 of the Labor Code,for the performance of the work for which this Permit is issued.
My Wnrkc's CnmPcnsminn Imam canter and Policy mon rr`da:
Cart No.:_�7.�1 YI/.
FICATE OF C%' ION FROM WORKERS'
COMP17NSATION INSURANCE
(This section need not M completed KIM Permit is for one hundred dollars(S list)
or less.)
I candy that in the performance of the work far which this Permit is issued.I shall not
employ any person in any manner so as to Mcomc subjca to the Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:IL after making this Centficae of Exemption.you should
become subject m the Worker's Compensation provisions of the labor Code,you must
OO forthwith comply with such provisions or this permit shall he deemed invoked.
CONSTRUCTION LENDING AGENCY
(-. .�. I hemhy firm thin there isactms betion lending agency fn nM pmfanduarc of
r1, > the work ser which this Permit is issued(Sec.319].civ.C.)
LtdLandcr's Name
z Lcndcr's Addrtss
U Q 1 eenify that I have mad this application and sum that the move infra arisen is
Ck. H correct.I agree to comply with all city and county oNtnances and state laws rotating to
pU building construction.and hereby atrtharia representatives nl this city to enter upon the
(dl above-mentioned property far inspection purposes.
as (We)agree to save,indemnify and keep harmlessrM City of Cupentno against
h hihilities,judgments,cost and expenses which may in any way recruit,against said City
U 77 in coubecticaccol he granting of this permtl.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON POINT Issued by:S �ko_ Date
SOU S42
��rco Re-roofs
Sig t of Applicay/CnUCnnvumr ate
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building ovetpam store or handle baxordous material r'
def red by I'll,
lse CuPenido Municipal Code.Chapter 9.12,end the IIcahh and Safety
',de.5ectica 25D21a)] �3 \ All roofs shall be inspected prior to any roofing material being installed.lop ❑ria No
Will the applicant or future building occupant use equipment or devices which Ifo roof is installed without first obtaining an inspection, I agree to remove
emit huxardous air conaminanks as defined by the Bay Area Air Quality Management all new materials for inspection.
District/
C Yes
[haw ad e azomfimaeritrromenttmforChapter
ha er9fthe Calf
rialicalhCg.S255B5,25531M.I. . dNtifrWildin,
doesocurrently roc Ply have a tenant,Nal it is my malsonsibility to nialyfliettocapicatiOnti
m//y���Ise n st mat prior m issuance'if.Ce '•mcof vP gn t�pplicant Dale:
'-
Owner nr aI All roof coverings to be Class"B" or better
uthor' Datc
Building Division
10300 Torre Avenue
Cupertino,CA 95014-3255
i Telephone: (408)777-3228
oclo Fax: (408)777-3333
CUPERTINO
Building Deparitanent
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.
IMPORTANT:
1. .Flat roofs must have a minimum of'�'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 of inspection.
We understand the above policy on reroofing and will comply with this policy.
Homeowners Name:
Address: Z5a6 S • S7Q.e,/ffC�'
Reroofing Company Name:
Applicants Signature: � Date: ` 02
Joe Antonucci1
(Chief Building Official)
6125101