01050101 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
22075 MC CLELLAN RD GB GROUP 01050101
OWNER'S NAME: APPLICATION SUB DA'Z'E
CURREN DOROTHY A 8921 MURRAY AVE 05/09/2001
PHONE: SANITARY NO. C'ON'I'ROI.No,
(800)65377172
O acZ ARC]111'ECUENGINEGR: BUILDING THEM]I'INTO
f?GGO BLUG ELECT PLUMB AIECH
y:n
F)�< LICENSED CONnsedRACTOR
rude,R DECLARATION Job Description
Z. I hereby affirm mm 1 an,of he B under prm'iciob of.,Core.
(cnmmeneing
o�e� wirhScmiun7a)U)of Dlvi,ion3 nfthe Busincx%and Profo,inn,CnJe audit,
<y � i% nfalllor andeffet. Gill REROOF / SIDING & TRIM.
z d Liccnw Cle" 1}]�_ Lick 0
°�°�O y U I}aC e` Contractor
tai 5 ato ARCIII'1'1;C1"S DECLARA'T'ION
t u to 1 mar,i ul mY p1ru,.hall he uwd a,public me us
ca c4 p O I.Ican¢d Profcuiowl
OWNER-BUILDER DECLARATION
w o m 1 hereby offimt that 1 am cmmpt form the Comracmrk License Law fur the
H Z 6 folhm;ng maven.(Senior 7031.5.Erosion,and Pmfeuion%Code:Any city or county
SFO which¢quirts a permit to construct. mwre
construct.ahimprove demolish.or repair any ruc
n 3°O priora or, I:.mature,he pelt t for suchpermit file a signed.wmmcm
that he is fiversedpursuant tton t the Commi1 - I (Chapter9 Sq. Ft. Floor Area Valuation
ot,tromencia, uhStrout]a)0p it'D t ofth Brone,andI f e,Codq
or that he aat mcefro, and 11 e book for the dl.,d ex ,a Any violarun $10294
Saudi on
of Scc703M15 by any i9,pllemn for to Pcrmit,ubjcct,the apphcnm to a dvil penalty
of mot snore than Lou bunmcd dopar%(x500). APN Number Occupancy Type
O 1.as owner of Tho progeny,or my employees with wase,a,their sole con.Is momian. 35713028. 00
will Jo the work.and the structure is net intended or offered lit%ate(sec.7044.
Business and Pmfe,.inn,node:The Contractor%License low a«,nm apply to an Required Inspections
oas r of progeny Who build,or improve%thereon.and who docs such work himself
or through his own employees.prosided that such improvements am not mended or 305 — FRAME
offered for.ale.H.h vocvct,ore building or improarmem is sola within nee year or 307 — INSULATION
iompletion,me owner-builder will have the burden of proving that he did not build or
mprove for purpose of sale.). 601 — ROOF TEAR .OFF
C L as owner oft he property.mor eta%suety anoureing with wom,cl amunators to 602 — ROOF PLYWOOD NAIL
malmct the project(see.7044.Bor,ine,and Promxsinns Code t'The Conlractor',
n, _
hieunm Law J.,not ip,,11,lbio nn w r of pmpeny who hlNd,nr hapmve,Ihamon. 603 — ROOF BRTI ENS
mW who crmmoo,fupi , with umnbacloHa) Ilecn,ed pumu ire to theshi ` 604 — ROOF IN—PROGRESS
cm B,kl' Tor ,i,reason
Owner Date);1HIENSArION DECLARAT
I heroby affirm under penalty of perjury one of rhe fol lowing aeclarm;nn,: �'
• Q I have and will maintain ;I CeNticvteof Consent sat salbinsarc for Worker, A L eo
Ibr
Cntnlun%atlnn, v% provianl by Section 3900 of the [abut Coda for he
pat nn:mec of Thu work tsar which ILh panuil is issued, f
OI have and will maintain Worker's C'unlpenm0nn mn¢
Iunc,n%required by section Nov1`I f/ O 8 ZOO 1
37x1 of(be Labor Code.for the lurlbrnmmce of the work Ifor whirl,this permit i,
i%wed.My Workyeerr,},/Compen%.lion ln,ur:mce came�..J,Pulicy rather arc:
Carrier s� `�CATI Oh Iipolicy o, Feo�—IT as' BUILDING
COMPENSATION INSURANCE
('This section need not he completed if the permit i,for one hundred dollars
($100)or IcoJ
I.coil,That Ia The Iwdername sac the work for which this Iwnuit is Issued.I
,holt nal,...ploy any...on in ally Inunncr so as to bcconm subject to the Workers' .
Cntnlenmlinn Laws nl Cullfomia.Dane
Alq,l;cnnl
NOTICE TO APPLICANT:II: Into making Wi,Certificate of lboulaption,you should
lucnme subject o the Workers Compensation provision%of the Lahr Code.you muss
Q Q fonhwlth comply with...h powmanx or this permit,hall he dccnmd revoked.
FCONSTRUCTION LENDING AGENCY
a I hereby affirm that them is a construction lending agency for the performance
of the work for which this permit is issued(Sec.3091,Civ.C.)
S Q Lender,Name
Z Lender'.,Address _
U 0 I at(dy mat l have read tb;,applicutinn: •that the above halo...union I,
W F. creel. ngu Io....old,with .It oily are con y iwnee% rul,nae law,calming
QU in bulmin,mmtnma..n, hemh cps -norke,ol ml,dlytocmaapm
} (p] the above mentcon),too• IY iry irpur e,.
Fa' (vel agree ln, et,eifr .en( m,Ie%xt chs()I Caperton asamst
(A bids.lines.judgment c e and ea who Y way accrue a t d
U 7_ City in nmxqucn h e grumi a sat. T
API'LICANTU'IERSI' NDS I If :OSIPLY WITH ALLNDIK Issued by' JD� �� � Date "C'/
sOURCER[G'r. T S. /� /
S,mour,nr rean/Con a, - — a Re-roofs
HAZs,RDOUS MATERIALS DISCLOSURE
Will the applicant ter htotm hubding occupant store or handle hvardam twtcrial Type of Roof
as JetineJ by the Capert'mn Mlttd.ipal Cool,Chopmr 9.12•nod the Ileallh and Safety.
Coact See, 25532tm'r / .•
ED as All roots shall be inspWe
r material being installed.
Will the applicant(it hour=bnlmingoccupant use equgnmtn ordevices which If a roof is install. nspection, 1 agree to remove
��fined hY IM1c Buy Arca Art Umlity ManngcmemDi...;c,? � r ren all new material or iderstands and will corn ywt❑Ye% f%' all non-point rce re
1 have mad me hvarod % term tem,code,Chapter 6.95 of the
California ticahh Smcl cti, 255( .25533 25514.I under'an that
Cif the huilJing, n, ren v num sal" say rc,rymninimc
'cup:mI of( erecta rche, %t M e,to ixwance of it C 1 m of
Oe'r"an 1. Signature of Applic• t Date
Dw—m, -h d,en sap - �� All roof coverings to be Class 'B%% or better
OFFICE