01050087 ,('ITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS'. PERMIT NO.
21987 MC CLELLAN RD GB GROUP 01050087
OWNER'S SAME. APPLICATION SUIT DATE
HECKROTTF_ MICHAEL 8921 MURRAY AVE 05/09/2001
'.PHONE: SANI'T'ARY NO, CON'I'Rol.No.
(800)653-7172 '
+ML,00 A RCI I II'ECT/ENGI N ITR: nUILDING PERMIT INFO
ad f:, L1 ELECT PLI3MC
Tl MICH
r Z w L .1 I_I l_l IJ
LICENSED CONTRACTOR'S DECLARATION
oz�_o I hereby ani.,,, ha,I or lilt anderr ,offhrt yr<e me ins Job Deseripti n
F,4 w with Sectiun7W0)o1Domluflbu llusinus�. ac ,nndmylii,en
n
urn audelr"' REROOF/SIDING AND TRIM
0 d �.i<em.a cm-s
s6 3 a Dare Immerser
F
0< ARCHITIiM S DECLARATION
I mobr m al my plans dull be used as public records
td++ca p O Liccnwd I'rvfosinnal
a
OWNER-RUILUER DECLARATION
,YIr v 1 hemhy aRnn that 1 am exen,pt from the Comment, Licenm Law Por the
C? following mason.(Section 703 1.5,RuZic,and Profe,ions C,vk:Any city or county
❑ which mquirex a rental to ctnwnma,alcor,improve,demolish,or repair any amemrc
i5L Prt a ...ilkII ITIi tl Irrniot II ogneJ.vum,cu
shall I' - Ipum n th P ata: Itl C l cmr.'I' La, -9 Sq. Ft. Floor Valuation
Ch;ple
(commencing with Section 7M))of Division 3 of the Rusinecd and Pndcssiuns Cee)
or that he is exempt therefrom and the basis for the alleged exemption.Any violation $10294
of Section 7031.5 by any applicant for a permit subjects the applicant e,a civil penalty
of not more man five hundred collard(SNX)). APN Number Occupancy Type
°1,a.nwncrolihc,mo,rr.army..npluyred with wvgus a,dirir sole con,pmuotinn, 357 1 73004, 00
will do the work,and the structure is mm Intended lar offered too sale(See.7004, Required Inspections
Businessend Prefessi x Code The Cnmtanor',Licenx U.does not apply m an
g propery Whrbuild,or improves merda,am on,doe.such Werk hurawlf 305 - FRAME
,owner
hmu n his n , Inc vides that such Ila ern Intended nr
effemd lin xlc IL howevaq the huilJing or impro e a erm is d�ld within Inc year of
nmplenem,the owner-uiId"
will he'd the bond•.A ndin,thus he did mt build o, 307 – INSI_ILAT T ON
improve forpuym,wofmle.' 601 – ROOF TEAR OFF
01,W,owner ri pro ,umc a el mnracting wlm licensed drntruior, 602 – ROOF PLYWOOD NAIL
ungr.a,he P,,,jcc,('c.701 J T'mfro s Csde: The G,menon s
a e I ince apply s nro,aorl,,ho up.n s het nn' 603 – ROOF BATTENS
,µ,
and hit<nmrttn'd L tit jc`n w a<n -) heuuul nx`a.n mann
Oil at
wW"` _ 604 – ROOF TN–PROGRESS
❑lam exemr nuersa. .Ex P 'o�mm maxnn
Owner 1: SCOMPEL 'ATION )FCL\RA N��1
I hemby afGnt under proudly no perjury one of the fol low an,declaration, o
• C I have and will maintain a CettilSecti of Conant to L,Ikoure for Worker's
he 111 6/Q
Car,.pmm o,r,A he pork lot for by Smion 37(gl of the Luton CWe, aur the /
pen'ora.a.ce nnhe work E.which ndx permirad wd.al.
C I have and will maintain Worker's Cumpen.,dion Insurance,us required by Sttnion
1700 of the LaMn Cede,for he perfmmarice of the work for which this Penni,
Csue.My�N'orker's Cotgpr,.atinn lnsurancerrrieryn�%olicy mm�berare: —
Cunior ly( ff/ (r (/,a�tf��X17NI I ONFk
CER :(CAI ION Oh EXIIA1P'I'ION PROM WORKER.'
COMPENSATION INSURANCE
(This-¢tion need not be completed if the permit is for one hundred dollars
051t)0l or less,)
I eerlfy that in the petlonnunce of the work for which this Innnit is issued,I
shall not employ any person in any manner so as to become subject to the Workers'
Compcnsmlon Laws of Califomiv.Dam
Applicant
NOTIC17 TO APPLICANT:If,after making this Certificate of Eacngmion,you should
b,,vne-hjeaxt,o t he Worker's Ontlwnsntion ranvki is of the Lubar Cod a ye„mud
O C) torball all comply atm,dothnnew...is nr this w,aeo shall be it revoked.
G
F' 4 CONSTRUCf10N LENDING AGENCY
I hereby affirm that there is a construction leading agency for the performance (1
of the worA far which this peruse is Issued(Sec.30W Civ.CJ
6a Q Lender:,Nua is _
Z Lender's Address
U O 1 unify that I base J this upit slate th the a aberration is
F.. correct.I agree m v aply rah au cl v y on iw - , scorn laws Mining
O fJ mbuilditgcanstmctlnn, she Wl ofthis<ity to enter
y y the ubo(Wr) hmto pr lar it n e r1 had. is m
L., F c,.j.d rcem: sc, cm it a Ac 1 I Ila M1O City nincrueflCu,en , l ad
Vi City inco judgment- coq.,and x s ich na y a any wary v<cme gest sail
V Z City inconsequent of the gr. ,i , hi -m,it.
APPLICANIFUN FRS 5 W Ob WITHAI "a" /r" Q T C
SOURCE REGLI Al. ISSICd by: J V t�� `•� � C r DBIC / �1
S.....mm of Pf undConn o" t>✓a' Re roofs
IIA%ARDOUS MATE IALS DISCLOSURE
Waal appheununratuml,u,m, o< p:,a.aumornaawfe 'conal s„-a,eriw Type of Roof
v-dehnedhyth Cupanino Munici 'sde.Chvp¢r 9.l2.andthe Health and Safety
Code,Section 25532.)'
°vex No - All roofs shall be inspecte e'ant
toal being installed.
Will the spplicunl or famed M'I gsne.pan,ax e, noun,devices which If a roof is installed wi utn, I agree to remove
emit It.mdome,vv comaminvms as caned by the yAres ar Quality Management
Hoofer? all new materials for spe and will comp with
°Ye` ”" all non-point Sourreg i
I have read,I u'don un a ymuno under CMgnvr .95the /
Calianniv Hcdth ,drily C Se t 505.255 and'_5530,1 un •n! J tut
ifthchuilJingd not cit ntiyh: • ma at Insibilit to ify9a,
ce<upam oft h qui tors wM 1. t r m ansae, Cer ficin of 14
o«ar:m<y. /'
Signature Applicant Dale or
If
ow an,,e aaen, --"— — hat — All to coverings to be Class "B" or better
OFFICE