01050097 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
P,D04q Mr. 17-1 F1 LAN RD GB GROUP 7
OWNEWS NAME: APPLICATION SHE DAPI:
AVEmass JOHN A MURRAY
411
PHONE. SANITARY NO. CONTROL NO.
_ P
C WOO ARCHITIECT/ENGINEER: BUILDING PERMIT INFO
zW_ BLDG ELECT PLUMB MIiCH
¢Ui CI I--1 1—I IJ
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LICENSE[)CON'1'RACfOR'S DECLARATION Job Description
Z O a I hereby ulfinn Thal[;,,I Iicen.nl under pmvisiom ill'Chapter 9(commencing
OZ C with 5cainn]Wlp,l lkkkvvv,,,...���mtuf me Basincss anll,
cW C ix n lull I'nr nA cll`w/— �I^L /
teaU facen.rcla 'I �rlN ca REROOF/SIDING AND TRIM
g O U Onlc Convacmr
ARCIIHECT'S DECLARATION
1 understand my plane shall be used m.public mcrosls
w ce¢`- Licensed Professional
a OWNER-BUILDER DECLARATION
='v 1 hereby arTr that 1 um exempt firm the Contractor'.License law for the
F%< him%ing reason.(Section](DIS,Business and Professions Cole:Any city or county
210 wl M1 y panto :r t h. p demolish. p' 'ny.uveure
i 5 ce pr T of I rc m applicant I I 'h W fi t .
signed Icmenl
That he is friculedI u IT me proiasLans ofn C I T, Lictal,I (Chapter9 Sq. Ft. Floor Area Valuation
(cvn ing will,Stew, 7nm0)oiIfi m3of meat, , ullrles. ,Cone)
nmhe
ardor he is 31.5 esonaph Zany sap li tout the bwis fur The G,The
excmrdon.Ano vlolalion 10294
ofmit nn Iran fly any applicant doll for a pernrir svnJrnrx The nppllenn to a evil penuRy
or tint tame uaam d.n hundred dollars($50(h., APN Number Occupancy Type
❑Lass uwvnormc property.or nycmployce,with w'agcsas their Bole compensation, 357 -
x'ill do the work,and the structure is not intended or offered file sale(Sec.7Bl4,
Business and Pmfnninns Code:The Coastacmr's License law does not apply to an Required Inspections
w of property Who builds or improve% con,and who doves such work himself
tar it romar
ugh his own employees.provided mw such imprnvemcn¢ore nal intended tar 305 — FRAME
offered lar all.11.however,the building or impnweman Ix sold within one year or
onnpledon,the owner-hullder will fair me burden of proving that he did nol build or 307 — INSULATION
Gnprove for pamn.e of'ode')
❑1,aslju,,
propeny.mnexclod yronmctingwimEconstMronlrachasTo 60.1 ROOF TEAR OFF
n.rrue(Sees 7144.Bun d Pmfc.. .axle:)The Contraemr.. � 602 — ROOF PLYWOOD NAII_Llcenttm a yI,,n ropenrwM�hvildsorinipnwcs Thereon,and whh onmmods) licensed purst me603 — ROOF BATTENS
r ' we +n .Bxren, 604 — ROOF IN—PROGRESS
owner
O L' C)n1PL'SATION DIiCLARATI6N
I hereby a1Ebn under penally of er,ury one of ilm following dedarutiour,
❑ I have and will nmWmln a Cedili.... of Canvenl To soli-Insure for Worker's
Compensation, a, pro.11ed fur by S,,Ii,). 000 n1' Lha Labor Code, Tia the
performnnec of the work Iia which This permit is isanedF 1 N A L E D
❑I have and will maintain Worker's Compensation Insurance,as required by Section
3700 of the Latin Code,far The performance of the work fm which his permit is 0 0
chni'F1v M�ep lee's Con�(Ytilion In'u lint NartieJr�aTnd 1/obey numMrvrc: s 20 o I
E
�•-CERFI—FEA/1[ONN s(ni)p EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE BUILDING
I Far,eceian sued run Ile oonplocd if me Permit Is or into handled dollars
tslan ormm.l
1 eenify mut in the perlimnanae of The work far which this peril is issued,1
.hall sol employ any ps aur in any m ane,so a,m Secular mnjea et the Workers'
Compensation lair.of Calili,mia.Oam
Applicant
NOTICE TO APPLICAM1 1':IL after making Thi.Cebirirme of Esenpti m.you should
become subject to the Aorke,'s Comps romiun p..G,ions of the Latin,Calc,you must
Q O forthwith comply with such provisions or this pemm.hall he deemed revoked.
L
CONS'IRUCI]ON LENDING AGENCY ,
I horchy al firm tun There is a evmnum ion IcnAing ngnnay fnrlM1e ptrlbrnnmm
Wof the walk for which Iii.Iu.nnil is..xnW(Sec 3f19].Civ.C.)
L Q Lender's Name
.7 z Lender's Alice,
U Q 1 conify that 1 have mad this application and state that the abtwe information is
fa. F' a ren.1 searc m comply with all city and ill ordinances and state laws relining
Q O ut building consuar I(m.and hemhy author' se
xmaives tar this citynemerupm
the ab ve-mentioned pmpenY fo ,.pec m pel.
(W'e)agree I saes If': µre .umless the City of C.,mau against -
ZT liabilities,judgne e,a an ah . - any way unable ag aq said
C) City in mrvxeyuce the P nn. ( ��
APPLICANT ,DLRS'I' D I_COMPLYW[TH�AI.],f O' SIT Issued by: IQ� 0 0&-7nM.C1 , Date S�
SOURCER an v
Sigwnm f Plicmu 'nmrval Ekl Re-roofs
HA"/.A R DOUS MATERIALS IISCLOSURIi
Will the applicant or l'ulure Wilding occupant slumorbandlehdminhasmaterial Type Of Roof
H%defined by rhe Cupcninohlunicip. ode,Chapter 9.12,and the Health and Safety
Code,Section 35321:x1^
Ores ❑No All roofs shall be inspect prior to any r inmaterial being installed.
WiII the applknm tar ft„arc bm[it w Pam use aluipnem ordevire.which I f a roof is installed w' out fi ' g a nspection, I agree re ova
unit M1aeurJous ole contamin;uns as der, r me Buy Area Air Quality Management
Di.alder, all new is
fo asp can nderstands and wit co ly with
ores N., all non-point sour r at
I has read The Imr.ardnt redo' ante ander(Tarlac,6.95 tar The
California I lcallh Nr "Ivry Cate 2550 25533and 25534.1 unJecsnnJ at
Bile build ing doe. o e rte c near m akanyrespo.l%doliyh, on the
acupam of the yuim IS sh a r ml prior ce of a C bill to of
iAeapancy. Signature A plic Date
Owner, If red Its — are — All roof coverings to be Class "B”or better
OFFICE