01050099 (2) CPPV OF CUPERTINO
H911,DwG DIVISION PERMIT CONTRACTOR INFORMATION:
IIUILOING ADDRHSS: PIiItMIT NO.
22057 MC CLELLAN RD GB GROUP 01.050099
ONYN17R'S NAME: APPLICATION SUB DATI?
S JACK G TRUSTEE 8921 MURRAY AVE 05/09/2001.
PHON : — SANITARY NO. CONTROL NO.
717
Q IY z ARCHITIUVIiNGINEER: BUILDING PERN11'1INFO
�.G
O O BLDG IiLHCT PLUMB MECH o o u o
Fla
o So y LICENSED curvowd under p occLARArION Job Description
=c I hereby amrm mal I.I„r I c under previxbe m'Chapter�)tcolnlnenemg
Fu, with Section 7lxNBof Division 3 of the Business anill'mfnsions Cod andinylarimse
"an,
in full force unA cRwt.
Licen¢CI Cie. [/�y��(���( REROOF/ SIDING 8 TRIM.
S o t u Dam�,/— Cn rlra,lu "—
•+ 3 a y ARC111'1'IiCT'S DECLARATION
C g�� I undemm�d my Plain shall be used as puhliC rtrords
w ap Licrowd Professional ,
�f OWNER-BUILDFR UECLARXIION
WLo I hereby admit that I., c.an,pl t Ihu Cnnm,clar.Licenx Law for the
C a follnwin,cea...a(Section 7031.5,Business and Pndesslons Code Any city or county
x= whim
w3m
prior am issuance.also requires
wsuer applicant vsuch puralitt o file.signed Icarment
ieo.igned,taememrc
mat lie i,Ecvn.ed.arsaammme pmaisnwn,er me c..mmwnr,uex.w Law lchaprer4 Sq. Ft. Floor Area Valuation
(ci acndngwilhScom,7000)orDL,W...I3oi'the Basinu.ss and Profe,,inm Code)
or that he Is eaen,"Ibcm Erin and Inc hast.for Inc alleged cxcmplloa.Any v,.hdilm
of Section 7031.5 by any applicant lir a permit.subjects the applicant a,a civil penalty
of no,marc than rive hundred dollar.($500). APN Number Occupancy Type
❑I,as uwnccnf the prawrty,ornty employee,wit wagc,o,Inch sola cnntpen,ation. 357 1
will do the work,and the suuemre is nal ilaceded lir olfumd lin wlu(Sr,,70.13.
Business and Pmressinn,Cade rhe Contmcmr.Liren.w Law does a,,,artily m n„ Required Inspections
r ope
f prorty Who bus..
ildr improve,mercnn,and who does such work himself
or through his own employees.pnwided that such improvements am not intended or 305 — FRAME
nRemd for,ale.It,however,the huilJing ur im","amm is sold within line year nI'
I...let...l,me awnen...Ider will nage liehardenlir pro Ingmar he did mil baudar 307 — INSULATION
„grove sur fora""fxale'1' 601 — ROOF TEAR OFF
OLasowner othe propeny.amexclu velycontractingwithlicensedcontractorsm E0� — ROOF PLYWOOD NAIL
instruct the pnjecl(Sec.7MJ,I Ii a and 1'mfessio.s CWeO Thu Contra.....'. s v
s,
mice iw
a rmpe, win,ntdld. ,i,npre,momon, 603 — ROOF BATTENS
3eew wah n u,nweur(s)Recused....son l..Ihu_ .B&P ni a 604 — ROOF IPI—PROGRESS
Dalenn MPIiN$ATHIN DECLAIN'I'ION !r tri
1 hereby affirm m under penalty of perjury one of the following declarations:
• ❑ I have sad will maintain a Certificate lit Con cat .,wIf-in.me far Worker', ED
ca;n.vn,ae II, 'coined 1... by Srcfi70
on 37 „f me Lobar code, fm the FINAL
E13 of the work for which dd,.emit is Israeli.
❑1 have and will maintain Wnrkrr'.Comrcmallon Insurance,as,,uired by Section Z�0�
37W of the Irhnr Cute,for the perl6rmantt of he work for which thi,permit is Nov
0 O
xxned.Nfy W' k C��o���//VVJJ'^^gYY'��Mion Insurance carner'Lod Polic/yy aqnn/,ynyer�)oray/.�y� 1\ V O
Conics - 1 IPI AlIt1 P_policy EXEM1II'I�IONI �R5l!vwi COMPENSATION INSURANCE; BUILDING
(This,celI need bol br uonjularl if the permil i,for oac hundred dulhnx
(Y IIq)or lexs.l
I cenify that in the performance lir the week for which this permit i.issued.I
,hall not employ any person in any manner so as to bnnme subject to the Workers'
C...npensolion Laws of Cnlil'nmiu,Date
An,
NO kali TO AI'I'LICAN'I':ILtruer looking Ibis Ceailicme nl Exemption.You shmlA
Mcnme wbjccn I the W'orker's Campe
cn,zon provii %of me Labor Code.you must
Q O forthwith comply with such prnvi,inns or this permit shall be deemed invoked.
L
F ^
CONS'1'Iv,,a LI IJ!NDINa AGENCY
orkhca,hyfin which thin lh mi is ow merit.Icndingngency for lhe.ertmm;mec
oI the work lin whim this pencil is isnuad(Set.3097.Ci,C.1
S 0 Lender's Name
Isndcr',Address .
U O 1 anal Winn I name read mi,,appfica ou and stats that ma above'information is
I., to comply wit all city and cm3 , once,and late laws relating
Q U a,build,.g comwel arta berebYamar, mcc,nfmi,caymrmI,mym
F yIhexh,ve-mentioned PmPcnv res
(WI,)amee R,save.' . .III I mph. alcsste Cayof Cupcn )against
VJ Ilahildn" jadglneax,cis d e e his'I n Y way Iq ain,t sold
U z City in cunw,ucnee of , gnmi g I /1
APPLICANT UNUE .TANU f II MPLY WIT�H�A/J�/'J..��^NT Issued by: /— Date .�
SOURCE Rf:GUh IONS. ✓Y ca
Signature drop -)c,- liar ITtu� Re-roofs
IIAZAI I )US MAT17IUAI S DISCIIISURC
wolmeappliemlor rmme badg
ao, ,apor"a
ccre ,,handle haardoos mnten;d Type of Root'
a,defined by the Carvajal,NJ i jpal e.Chapmr 9.12.mad the Health and Saf..y
(',We.Section 25532(a)7
❑Yee, All roofs shall be inspec d prior to an fi g material being installed.
WiEme apprcamor trou,building oc,umnl ow a Wpmenlar daises which If a roof is installed thout - o n n inspection, I agree to remove
nnithuallou.oir n,mamin'vnls as do elbydo BryA a At,Quality Management
M Ir)mn all new materials r ec ' i, t understands and w/coi )Iy with
❑Yee, No all non-point s re regul 1
1 M1lrvc mud m ,nnvA ,nl alx 9th.' cot,under ChaPlc.605 0' he
Colib,mio Ileull gale, .de.5 505. 533 end' . .1 under un Ihm
ifthc huilJing, rrcndy n th iti espemsibibyor or ythe
ccuo nt of t n mans w nor to isot of a Cif,arc If
Oe....ney rc rc Signat )f Appl' ant Date
r owner mamhnrired ager — D' e All roof coverings to be Class "B" or better
OFFICE