01050098 !-'ITY OF CUPERTINO
nult•nlNG DIVISION PERMIT CONTRACTOR INFORMATION:
BU1LOING ADDRESS. PERMIT NO.
2055 MC CLELLAN RD GB GROUP 01.050098
OWNER'S NAME. APPLICATION SUIT DATE
LALLY JAMES' AND LYNN Y 8921 MURRAY AVE 05/09/2001.
PHONE: SANITARY NO. CONTROL NO.
(800)653-717^c
❑z a ARCHITECT/ENGINEER: BUILDING PERMIT INFO
W O O_ BLDG ELECTPLUMB MECH
aR I"i I-j 1=1 1_I I-1 1=1
2N
v.
LICENSED a licensed OR'S
DECLARAI s ot'Chap Job Description
I hereby(BVnn Ire I r licemnl ander provisions of Chepwf. (commencing
liv . -
F y l_-J with fill]t cc and et uivixinnt erata Ro%ines,and Prof.sites Csw any Leen
Lar, h,raanaelTeC I REROOF/SIDING AND TRIM
R Liam'ce c1a%a_ Lie.a_
X�X O i o Dem Convucwr
W'3a RCHI'I'B:CI"S Ill!CLARAI nits
1 understand my plans shall be used u,public reconls
e. Littesed 1'mfeuimwl
z poo
°' WNER-BUILDER DECLARATION
u� 1 bercnr n1'frm U)mut I.,if exen,In rrtnn he Commrmr'-r Licence Law for he
F b¢ L+Ilawing n n.(Scnian 7031.5.B-I and Protcx ms Calc.Any e'uy or may
F O wldel,mgnire a permit m eonwmel,clue,improve,den...Nu ar repair any slmamrc
3o poor, m its issuance,al.a,"tors.s the applicant for such permitto rile a signed statement
tnatheislicensed punuonmothe mass>besofineConmator'%Juvaxcl,aw(Chapter 9 Sq. FL Floor Area Valuation
(commencing with Salon 700)of Division 3 of the Business and Professions Core)
or that he is exempt thurefnnn and the basis for the alleged everriptionAny violation
o1'Seel fou 7031.5 by any applicant for a pont, object,the nppl'anm m a civil lnrally
of not nava than live Imminent dollars(x500). APN Number Occupancy Type
O h on,owner of me property,or my employee whh wage%as their sole compensation.
will do the work.and the awnmc is not intended or offered for sale(Sec.70H1.
Business and professions Code:The Contractors License Law docs not apply to an Required Inspections
r or properly WI bmild%nr improves thereon.Iced who dons such workm
hiself
or11 r,„IgI1 his oven cusp o'ecn.nnwlaen mw xush ou,ne non,am an onemled or 305 — FRAME
offered for.safe.if.however,me budding ,,improvemcm is sold wimp,,.rte year or X07 — INSULATION
5
nnpletion.the owner-0uilder will have the burden or ihh
proving that e did nm build or
impose h+fpu,se,of,dr.). 601 — ROOF TEAR OFF
❑Lax owner afthe property.an,caaW: dy m,tramingw;mEamseeeomm"°` 1.
602 — ROOF PLYWOOD NAIL
comet the pmject f''c.7044.Bus al Pores ry Gxle:)The Cnmractnd
License Law does no apply 5'%progeny wi111 hmddv nr iif.pnwex thereon. 603 — ROOF BATTENS
.
and who mlmatx onoamon.l Eamam pm ,Int to me
and Licen it w e 1t E04 — ROOF IN—PROGRESS
01ame%emptu er Sea. .Hs�PCftn/l/-A
Owner_ _ :rte / n
OS 'OMPENSAHON IIEChAI1A'r10N
I hereby arfrld under venally nr perjury one of the following dularations:
0 1 ban nd will maintain a Certificate of Consent a,self-insure for Worker's F IV A_'"Ep
Compento
smn, ax provided for by Section 37W o1' the Labor Qwe, for the
perllnmancn of the work or which this IF,, it is issued.
01 have ana will mulnwin Worker'.Cmnpcnsmion Inwrntee,as captured by Section 0� O O O 200
301X1 of the Labor Cale.for the pconoulance of the work tor which this permit is Nov V
issued.My Wmkels Cnng psmlon Insurance carrier and Policy number arc:
si
Carrico:t�'1 T`�'�XHMFTIONI Mw(� — BUILDING
COMPENSATION INSURANCE
(This seuntutored!not Is completed if the pewit is for one hundred dollars
(SIIMB ur lou.)
I certify that in the grfa roance of the work for which this permit is issued.I
shall nal employ any,......in any Inannar sen ax to bcco.ne xuh1M to the Workers
Compensation Lows ol'Cohlomia.Date
Applicant
NOTICH TO APPLICANT:If,after making,hix Cenificateof Exemption,you should
become subject to the Workers Compensation provisions of the labor Cure,you mm,
Q 0 suronhwith comply with such provisions or this permit%hull he deemed revoked.
Fy CONSTRUCTION I,IiNDINGACENCY
� ' I hereby wlmt this mere is a issued(Sri. Iending ugcncy ror II,c�rlinmm�ce
Ise work for which this permit is issued(Sec 31191.Civ,C.)
L Q Isnder'a Name
Q Z Lender's AJdress
UQ f
Q ' ffyI rise wail nI+ at a:rt ain
is
4F u ......q m all0l, % lo
g
I.) larildro,mor,friod rd hro,lb,
md p liolnt:city
tont pan
,y/o
A. th M , al pe nYf - pe [•D
tom. a cs.j dgmem.cost ,rip arm in
y fC pe a gaiail ,
Vl liahllldea juJF,nems,a+.ns m pen x 1 m, v y ae vis gainxt said
V'z City in conxequenm of a g ming. r
APPLICANT UNDER. ANDS A % ,C t IDLY sun'1 Al 'rOINT Issued by:t �/`�/�,N' Dale
SOURCBREGULAT NS.
Signawreof Applies —of cor O to Re-roofs
HAZARDOU MATERIAIS DISCI(OSURE
Will the applicant or town ho I Ig cupant store nr handle haeanlnus,material Type of Roof
as defined by in,Cm iumno Municipal ' c,Chapter 9.12,and the Health and Safe',
CeIf.Seel 2553200 '
13 Yc% + All rooks shall be ins p 'tett prior to any 1 material being installed.
Will the applicant c fuwre bmWin eupant m equipment or device,which If a roof is installed ithou o g • inspection, I agree to re) vis
emit hxeardous aircomuminums ax Ac' dM1y ,e YAmu Air Quality M1fanagemen,
Dixoieft all new materials r i ect' n a un . ands and wi/'Ooly with
❑Yes N^ all non-point so cis gula
I have read d hxan :rte Imnems under Chapter h95 of the
fc od of s2sr ,25533 5534. a ,smnd th
if the building des a rose as. I m t, a my lessee lit u,notify the
cupam o(the ncmcmn Ich , e priormissmnn of Cenlfirm of
°vnalr°"s'. Signatu f Applicant Date-
i
Owns,ar, th ,ea as at - Iare All roof coverings to be Class "R" or better
OFFICE