01050103 CPI's OF CUPERTINO
BUILDINGDIVISIONPERMIT CONTRACTOR INFORMATION:
BUILDING A0L)Rf SS: PERMIT NO. '
22067 MC CLELLAN RD GB GROUP 01050103
OWNER'S NAME: _ APPLICATION SUB DALE
ET A 8921. MURRAY AVE 0S/09/200i.
I•HfyNE SANITARY NO CONTROL NO.
(800) 653-7172
O re z ARCHITEMENGINEER: BUILDING I'IIRMI'i'INFO
w C CCp BLDG ELECT PLUMY h1ECH
��p - IJ IJ C7 CI
FN firm thtiDrnNTRd under
sviiCLARAnCN Job Description
QZ_O 1 hceby alum that I am of he lli nndcr provisions Pr,ns of c,Codehapter 9 ndm licenng
se se
H= with Section 70N0l of Divisinn3ofthe liu.ims,and lkofession.GNe.and my liwnx
Is in rel face nnJ erect. I '�
a � uaea.acw„ ._ Lic.Mw�I� REROOF / SIDING 8 TRIM.
O Dine Comarcna
¢S 3 v ARCHITECT'S DECLARATION
t'yyy=C 5 I understand my plans shall be uxd as public faced
pO L1,a,,d Prefcn,ionnl
OWNER-BUILDER DECLAINr10N
m I hereby affirm that I am exempt fear the Contmetor•s License Law for me
fallowing reason.(Section 7031.5.Business and Pmfessiam Cole:Any city or county
Dwhich oequile,a worilt tcma,after, p Ictidish p y%trader,
aa4an,illkow,uh,,Ili pli l ralarchpermit ifilen 111mal.virmmoent
3”
'hat her,licensed(ursnanlill the powimon,of theL to,,Laco,c La.(Charter9 Sq. Ft. Floor Area Valuation
(commencing withSwion 700)of Division 3 of Inc Business and Pefesvion%CMe)
or that he is exempt therefrom and the basis for the alleged exemption.Any vialmion
of Section 7031.5 by any applicant for a Permit subjects the applicant a,a civil penalty
of not I lac malt fixe hmaford dollars(s500f. A PN Number occupancy Type
EI 1.as owner of the property,or my enrldoyee.with wages as their sale compensation. -
r- 17in
will do the work,and the ormare is not intended or offered for sale(Sec.1611-1.
Business acid Pmfeesinn.Cale:The Contractor',License Law dons not apply In an Required Inspections
net pommy Who builds or improves Thereon,iced whe su
does ch work n orleaf
��,through hll:awn elnpmyee,.pmvaden rant..Belt iapm,emcm,are sat intruded it 305 — FRAME
offered for sale.If,however,the huilJing or improvement is slid within sac year of
completion.the mvner.hdder will have the burden of proving that he did not mild or 307 — INSULATION
mprovefarpaaweofsk.). 601. — ROOF TEAR OFF
❑1,as owner of the pn,peny,an,c,, Ively contracting wen licensed convusmrx Io -
,nstmm me Pejeet see.nus.B` sad Praas.tnn.Cams)The Coarramar, 602 — ROOF PLYWOOD NA T I_
Licerrce Law Jars aPPlY town 'n or Pepeny who build.or improve.thereon.
unit who contra ins Lae >„ 'ith a contractor(.)licensed pmxmnt to the 603 — ROOF BATTENS
Conain",.Li l a I: t
I]lcircle,
nn can .nkrclat x 60.ijQO. — ROOF TN—PROGRESS
n _ - - Date � /✓� .
;R'S COSIPENSAT[ON DECLARATION
1 hereby stroll nndcr penalty of rOjmy one of the following Jed:uahon,:
] I have and will madntaln a Certificate of Concent to 61-insure for Wadsr',
:tion, as provided for by section 370 of the Labor Cafe. for the FINALED
pc rmwce of the work for which Ilii.Iamnit is Lswcd.
J l M1,r rad will meinmir Workers Compensation lowers,sir r,,.i,,d by Section NOV 0 8 2001
J7W of the labor Code,for the performance of the work for which this permit is
sued Myy WWo-rkeev Compensation Insurance carrier and Policy number are:
C'arriur:,j_1�} TVNI/_Ibllcy No
CER'n1dCAI ION OF EXEMPI IOAG1 'ONKGR$' �������
coldPI i,;sxr10N INSURANCE B
_ v
(Ilii,section need not he enn,plelM if the pxnnit i%for one hundred dollar
(SI(Inlor less.)
1 eerily the is the perfomunee of the.,,,it f n,which this permit is issued.I
shall not employ,any person in any runner so as to become subject to the Wodeo,
Cn e,cnxul'um Laws of California,lane
APPliaau
NO]'ICE'r0 APPI.ICANT:If.alternating his CcnlBcalc of Hxenaptior.you.hnulJ
Mcome object m the Worker'.Cnminn,mion provision.of the labor CMG,you must
Q O forthwith enloply withsuch pnc or mi,permit.hall be deanN revoked
F = CONST RUCi'I ON LENIII NG AG ENCY
a , 1 artery off nn that theta is a ennsl metros lending openey tin the perf tnmme
of me well,for which this Permit is issued(Sec.3197.Civ.C.)
O IsnJer's Name
G 7 Leader,Address
f..) Q I cenily that 1 have read mi,application and.state don the above iminmation i..
k. I Galea.I agec or comply with all city and county ordinance and state law,rclaing
Q C.) to huilJing construction,and hereby numarize representative,of this city to enter upon
the to fly for inspection p.",e
F ISI OtAf al,cr Io s: irderrily and cp hon ss the Chy of caTemno against
l iuhllltle,,jndgmuno ,,s Iced cx mew which t y In nay way e,cruo against said
fJ Z City in conxWcnc tithe g. of is perm. 7 t
APPLICANTUN 'RSL .is N V'J.0 IPLY WITHALL NON OfNT J Q` rc4pv—5 A.I,JL,Lf Da1e "12/
URCEREGI ..vlolvs. gk Issued by:
. goatare of p a -Came or - ' - I Eric Re-roofs
HAIABDOUS IATERIA ti DISCLOSURE
Will the applicant it future holding occupant,sure or h bd1c formalism,Immnal Type of Roof
ns JefinM by the Cupertino Municipal C .Chapter 9.12,and the Health and Safety
Cala Section 255320x)'! fir/
❑Yes All root's shall be ins ecled prior to y ofing material being installed.
wBthe arphmm toam had tam^ span as evuipineal or device,which If a roof is install with f t.' mg an inspection. I agree to r move
•mit harardom tar contaminant,as Jcf J M1y` a Bay Arca Air Quality Manugem in
uisnal? all new materi. for s A is erstands and c reply with
ElYe, all non-point our re
1 have read th ,aamdou.mat - reyoi rents under Chapter 6.95 of the
Califomiu lie.ill& alety Codec 25505, 533and 534.1 undcr.unddint
it bunliinsdan art carrel mm6d re,pmLrihinty nti fy me
,emmn m ere sit"m s a Inn,a is,,,c ofIu C rilfiemc al'
04cupane% IL ( Signs e of Applicant at
>wmaa: the a-agege.,, — �'`�i' All roof coverings to be Class "B" or better
OFFICE