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01050100 CITY OF CUI'ECONTRACTOR INFORMATION: BUILDING DIVISION stou PERMIT BUILOINUADDI ESS: PI!ItMITNO. 22069 MC CLELLAN RD GB GROUP 01050100 OWNER'S NAhIF,: APPLICATION SUR DI ADAMS GEORGE B 8921. MURRAY- AVE 05/09/2001 PHONE SANITARYNO, CON'IROLNO. (800)653-7172 ❑s Z ARCHITIicmiNGI HER: BUILDING PERMIT INFO O❑O NLUG17.1.1.(7 PLUMB MECH �` IJ I=1 I_1 I_i 4 uCRnsuDCONTRAcnderpDIicn%ofCON Job Description O Z_ 1 hereby170 Minn that 1 n 3licenced under pnr'i,inns or n,Cod.9lcommenese win+Seen n,It 7axn ornivi,ion3or me Rnsloca%ard rror%mm%cam, mmrhanae a'oJ i,in fillba,cand eR t. del REROOF/ SIDING & TRIM. J —05rC z�S License Clan hie,M 3 a F Date % _ Contmcror L = nlgan'll:cr's Decl.nlennon' C— 1 orders Illy plans%hall be used as public records o o Llecnsel rrofe',wmd OWNER BUILDER UIiCLAItAIION I hereby alliin dots I an,exempt firm the CnntracaW,].is...c how for 0e F•Z Q following reawa(Section 703L5.lmmess and Proleaioin Cale Any city ur-comay ` Z o I,hich requires a psanst ill consumer.dier.implove,demolish. repair an,a cmre as i ct m prior( is a, 4 re:th (til t f such pem+lu fl g d-,at emrnt m:In lir:dpun tt the provisitacalns c 1 , r License Law(Chapter 9 Sq. Ft. Floor Area Valuation (vo s I,[,S", 70ag r�wl g +fthef k,v dI tmaromn Cock.) $10294 rr Ilett he Is clamps theira s an I she ilea,It,,she nllegcd"vorpeon.Any viamion of Sectio 7031.5 by any applicant fora Permit w:bjem%the applicam at a civil pewlty of not mote tnaIl Five bumhed dollar.S500l. APN Number Occupancy Type ❑Lavowncrofthe property.orn+ycmploycc.with wages a,stheir wdeentopen.arnn. � 35713027. 00 will do the work,and Inc,nuilnrc I,% +n(mlm+ded o,ore rod nt,,alc(S".7344. Required Inspections Hl'tor s send Prnl'es,innx Code:The Con.mcso",Lian,n Law dna not apply(oi 9 P owncrof propctY will,builds or imIthereon.and who doe%such work himself 305 — FRAME or thrnagh his as,is empdyas.provided that such improvement,use not intended or offered for sale.If,however the molding or improvement is sold within one yea of 307 — INSULATION completion,the ownerbui Wer will have the madal of proving that he did not candor in:provemt, for „male). 601. — ROOF. TEAR OFF ❑La.owacronIt,noducrty.all,c.cwsaely cmtrutimg was hcenwd c,nInto,a(^ 602 — ROOF PLYWOOD INA.TI_ ionswa the project(Sm..7f44.Its it sand In.. sinm Cude:)ne Comranm: meIl.e l/d., ofgl W11III)IS"Ar[ON . property who nudmmia+pmvcs mereor. 603 — ROOF BATTENS and whokIcontaamgs)licensed pntauant a,thecmrne _ 604 — P.00F TN—F'ROGP,ESS , .It&I' Inc - wenn Owner_ .�� 1 DECLARATI I nereny affirm sad,,penally of perjuryone of Inc following dcelarations 1 N A L E D ❑ I have and will mal am Is Calfi,:(o of Cun.en w sell'-loure ler Worker, Congwnvatim. as provided for by Section 37a) of the Labor Code. for the peHotnanee of she work for which lhi,permis is issued. NOV 0 8 2001 ❑1 have and will muinlain Worker's Cnmpcnsation Insurance,as requirad by Section 3700 of the Labor Cudc,for the pcdo...mIr of the veld lot which shl%pemtil is i,sned M/y Workck,Cmn stiohoulaaacto..,a)n.1111',..m....bar�ro / BUILDING Cumer.:j /—�/ I CERI'11•ICAI'ION OP h%IeMrr10N FROM WORKERS' COMPENSAg'ION INSURANCE ('nil,svOion need not be colupicard if OIe per nni(Ix till one hundred dollnm SI(XI)or leas.) I cenify that in flue performana of the work an which this permi(i%issued.I shall not employ any person in any stunner so as u,become subject to the Worker Coone...no.Law,of California,Vase Applicant Not WE 10 AI'I'LICANI`I IIL aller making(h Ia Ccdlliram of Itesquinn,you should Mcome subject a,she worker',Cnmpematiem provision. afire LarCode.you nett U 0 forthwith comply with such provisions or this permit shall be deemed mvuked. Z E• ^ CONSTRUCIII)N LENDING AGENCY a yI hescot affirm that there I,;, aa,ru,aam sta, 309th ng agmmy Ibr the Isrrnnnuncx of the r,was kN fur which(his Ism+is in Iaw,cJ(Sas 3I97.Civ.Cd 1 Q bander',Name .L Isndvr',nddreu U C 1 cenifyathus 1 Wore read this apps jail inn and%title that the alm c inli,rmatina i% Ifs [r e, cct.1 aree m l, if,eo,,dy wall all city and ey diranecs and,tate laws relating O U It,mndd'n"con,lmeaon•cad Ill ynomod, repr cnmdvesonhla city metier she uho(We)st...%., for it Pur Y a (N'elagramnm InJ• d 1 chi m. .. (he way against fin City I. .,iudsmnnl%. at,. d e vet am way sec sin%t sono U Z City in amncquenee d NID t nil. ^ APPLICANT UND STAND WI COb1PLY WITH PLL '0 -P INT Issued by. . Dille 15�: e/' SOURCE RF,GU 'I' �S( Signature or II II radslo — b to Re-roofs HA%ARDOUS MATERIALS DISCLOSUR. Will the applicant or future buildln acupaIn enc or his Is hvnNos material Type of Roof as denned by me Cupertino nmmcin;d.�+dc.cnapmr v,12.an the sevum and Safety Coda.Scudo„2.9532(Io'r ❑Ye. .LI No All roofs shall be inspected prior to any to( lig material being installed. WiHmeappreamorfamrebaidm occupant use equipment or devices which If a roof is installed w' hoot first btaini a spection, I agree to remove emit Is... lair nmmninams je de' dby the HuY res Air Quality Management District?ve> No all new materials f ms an ndersamds and will c rep with all non-Point sou e r I a[i 1 have mad t IiawNous req, e urns under Ch,,ser 695 of she California Hcalsh& metyC IS 550 .255)3a _5534.1 un enppa that Hthe nuilofthedo, nm Intl a nam +m" ry l....c hili,(I fearsthe «capma of the q ' mete Ic n t prior m iv,aaocc nf: c limnshe °iaopuney / Signature Applicant Date here,or orl,sd ager 7`— - )O k All roof coverings to be Class`B"or better OFFICE