01050090 (2) CITY OF`CUPERTIINO CONTRACTOR INFORMATION:
PERMIT
13UILDING ADDRESS: PERMIT NO.
2201.5 MC CLELLAN RD GB GROUP 01.050090
OWNIiR'S NAMI:. A[TUCATION Stili nNra
WATKINS VIENNA R 8921 MURRAY AVE 05/09/2001
. PHONE: SANITARY NO. CONTROL No.
(800)653-7172
O C Z ARCH(I HCI IIENGINHHR: BUILDING PLRMI'P INPO
sO CO HLDG ELL'CT PLUMB ML'CIt
ufy C7 1=1 Lal L=
a.
add
NS LIC
rmthtIaCONTRACTOR'SOF.ionsof [ONhaps Job Description
I hereby... . afllnn that 1 am licensed under provisions of Chapter Y(c('mmencing
�m F m
""See
7lXNB of Uiv" 3 tithe llnnincss and Pr �C he y(l h cerise
r, ,t rau fm ml elle. �D/- CC,II)) (,//. REROOF/SIDING AND TRIM
rt Licansc C,_1
Lica_
K o d u nate Commc,m
F a I O fin ARCHIiCI'S URCLARxi
I understand my Plam.ball he used.,public record,
of O LiccnmJ Pruf xional
OWNER-BUILUIiR DECLARATION
m I hereby nlfirnt that I an,exempt from,he Cnnmacmr',License Law for the
C> Ibll—ing rca.....IScaian 7031.5.Itu,incnx and P I ..was Cndc'.Any city or uemy
2 p which requmr a pcnnil 1t,mn,l uet.Nler,improv,,dennoli,h,or repair any structure
n5re
� prior..as i.suanve.al.,require.dicappl icant or such permiOo file a signed statement
that he is licensed purruannuthe pnwi.innsof the Coomaeme,Licensc Law(Chapter 9 Sq. Ff. Floor Area Valuation
(commencing with Section 7003)of Division 3 of the Husinev and Professions Cade)
or that he is exempt therefrom and the basis for the alleged exemption.Any,mixion $10294
of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty
of not more than five hundred dollar.($500). APN Number Occupancy Type
O Ltower.free propertymmy cul,kyce,wrdt Iac,las rbeir.,le c.mlen.lnion, 3571301 2 X10
will do the work,and 111c stnmaue is nnn mended or oI'fced for sale(See.7(W4,
Business and 1bolessions Calc The Contractor's License 1.aw d,ka not apply to an Required Inspections
owner of property Who build,or improve%thereon.and who does ach work himselfv
or through his own employees.provided that such improvements arc not intended or 305 — FRAME
offered fell .Is.IL however.the building or improvement i,sold within one year of 307 — INSULATION
completion,the ownaobuilder will have the burden of proving that he did not build.' 6
irnpmacfor non,..eor.ale.). 601 — ROOF- TEAR OFF-
❑I.a,owfc,0flu,pmp..y.thin es,lu i Iyc, tmcna,will Iieen..dconor,lon,to 602 — ROOF PLYWOOD NAIL
Lindorcl the protect IS .70.14.1 ar Profen s Cale)The Cnnlnemr
m 'n
cec Law does not )ply ml ,if ,pert,wea;'Mld..r improve.menton. 603 — ROOF BATTENS
and who comms. r such wit c tad,)bccnwd urs t m @c
comme..r.,lacen Law 604 — ROOF IN—PROGRESS
❑I am exempt t er 5 _ — _ .H A C �hiz¢anon
Owner_ al
OR 'O. HN A'TIGN DLCLAII f
• I herebyif innunder Israeli,of M,jo,one of.he following declaration.:
n
❑ 1 have and will maintain a Certificate of Convent tv',clf-imam for Worker's
Compensation, as provided for by Section 37W of the Labor Code. for the
perlormuncc nl the work fur which this permit is ismeJ' F 11!1 A L E D
01 luoc and will maintain Worker',Cmuperoa.ien htsnnmce,its required by Section
97(X)of the Labor C,de,for the Ilelharence nr the work for which this).'roil In
....ed.My Worker,Comf�,jy1'allonl oJnnrutee carrier and l'I liey noorwZerar• NOV 0 8 2001
'�Aily Smile
Caniee,( R IC el (A'E.CEMYI'10\ 103WORKERS' p
COMPI!NSAI'[ON INSURANCE BUILDING
(Titin cclion need nal be nmq,lered if the permit is lin nuc hundred dollars
IS l00),u I'll.) - , -
1 certify than in the peifnnna fee of the work for which di.,p_mtit is inured,1
.,ball not employ any peso.in any canner so as to account subject to dte Wnd.en'
Compene.ion L.ws.f California.[)ale
Applicant
NOTICH IU APPLICANT.II,after making this Cer iGcne ul Eaemp.ion.You should
become whin'...the Worker's Corm,wh a0.n froull r,of the LaMrr Code,yon mut
Q Q ronbwidr comply will,such pool,!om or IM1is permit.bull hu deemed evoked.
In CONSTRUC MEN LENDING AGI:NCY
1 hereby uffino that there in a ev nametion lending agency for the perfomtmce
of the work for which this pcnnil is issued(Sec.3W7.Co.C.)
LQ Lender's Name
Z Lender's Admits,
V I aunl(y the have real.his application a sun 111,11 mea ale infollo,a m is
li F'I a rrect.I a,"to comply h d1 oily' r y m� u.n,vs and.,are law,relming
Q V .o building con..m,.tinn, dherch 1In prem ..siva.of this city e,eneru n
�] the ulxwe-memiuncd p pcny f nspe- orpr
a, IWc)agrecn, vein mnilyl eph a c cityofcupe no eint
to liabifities,jad&nen ,ro11 rates . 'fin any way accrue rgair 1%aid
U Z Citv in comcquen of the gramim > �[�p ,/� ^
APPLICANTIJ 4'RST NDS Ll IPLY WITH ALL NtN I�r Issued by:c�VC HN/y�J�. Date
SOURC17 RTIC I S.
Slgnammuf ApplleenVCmi nem _ Ice Re-roofs
HAZ DOUS MA'1'Ir.RIALS DISCLOSURli
Will theapNiean.or ream wadi areapant.lore.,handle haoudomaraterial Type of Roof
as defined by the Cupertino Atunicip dc.Chapter 1.12,and the Heel@ and Safety
Code.❑Yen 25532(x)^ No `
All roofs shall be iWpriorring material being installed.
Will me appli .r falure 1, 11lrr re n, eegon,rocritm devices which If a roofis install an inspection, 1 agree to remove
mit hueunlon,oil confluninunw u.vAd , H: Nva Nr Quuli.y MunagumnnD;,,r;c,'r all new material ft u derstands and ll nnply with
�Ye.. all non-points urcI have read m hard a tegt em oder Chapter .95 theCaliforniaIlcaOh Swild ,dc, 1i - 31 and 25534,l un 'n., d that /�Iffin,milmngd -,n ncunemly tact t. m h i.al"cxgmsibilit n a theI/eupamofd requiou"o,- cl o be r.prie,to iwnmce of icam t
onapaanv. Dale
Signa. of Applic
Owner "aadronlede, — — eatF'— All roof coverings to be Class "Br' or better
OFFICE