00090021 - 'CITY OF CUPERTINO'
BUILDING DIVISIONt pERMIT . i' CONTRACTOR INFORMATION: .
BUILDING ADDRESS f f + .. r ' - '� PERMIT NO.
OWNERS NAME: - - APPLICATION SUB DATE,
. 1,0040aBUBB RD" 00090021
PHONE
SANITARY" SANITARY NO. CONTROL NO.
MOCK'INGBI'RD` NETWORK 2
I S • •
" 09f06/�000
w O p ARCHITECT/ENGINEER:- - _ - BUILDING PERMIT INFO
J C BL ELEcr PLUMB MICIH
y j
LICENSED CONTRACTORS DECL 1RATION
z��_ 'Ih hereby ff and that licensed J p I'Chapter (van nv y t' JobDescr' tion .�
5 C ei wish Sesfo.711g1)pf D 'Sion 7 alien Ru nen and f efts.ons C,ido and ny I vine via,a•. - "
w is int$llf deffe'. A:. at
C.sundtor
t•ad - ARCHHECT S DFCLARAI'ION t `
rI so
I d " d ypl .almuheusela Public reeord, MOISIUMENT SIGN, FOR, MOCKINGBIRD NETWORK
a.C Licensedlr,fes,urirl f _ Y i
°' ,o�y . ' OWNER-BUILDER DECLARATION d
w I Etrell,aff du l e ,ex apt Iran,if,.C.ithashear,License Low for tl e ' - -
05'Ti o f)lhl g (S t 9011 5 U i d P C 1 A Y tY county ( s
N[- requiresoperate t I 'll t.pr ede Ih p city t a
w 3 pri, t t t al. q IM1optionalf i p tt 11signedstatement,a. _ -
hat he licensed pursuant i (hep o of the Contractor L L (Chapter J + Sq. Ft Floor Area Y Vlu
aation '
(co g 'Insect 70(X))of Davis 3 JlheBrdoe dP t ..Code) v y
or that lieI. pt Ih f and the ba f r thealleged pt A y lawn t y
ofSection 913I5by' y apaicantfriire itmllcuF the..ppl'Lat to acivl penalty
of rannuadlhadr,enna'eddollarsS5011) 'APN"''Number. - 'Occupancy Type '
01..1owue,of the property,ar my employeedwithwuge'as theirsole cntnpanswlna. - 'will do the work,andflan structure Is not intd J oroffered for are(Sec.91M4. - _
Bac d P I ..tor,CodaTh C t t L Law does our apply tom � Required Inspections • -
ownr fp Perry Whobuilds { "d d I d ssuch x kl'nsdf
ar through his l y ..p d d hot sb ,pre t, mended or ' 357200126. OIG
,dared for saleIt,tin eu,the building or t,pn,unen's. W withinone yearof 1
ompleaion,the owner-bn.ilder will have the burden of proving that he did not nuilJ or - Y
• Im lor' Isvled. -
prove Inn panto ]:0,1 —° FOUNDATION,
❑l .—Incoollhe prpty. I- nyly contracting -mfe. d t I :t 103 -' UFER • '
Lmmstu the p lett(Sec 71 4'Bn Business d Professions mm ons OxIch Thi Comr s -
icense Law does a,,,apl.ly n,an(,.her oI Depeny.wov
no build,or ink es meson, : 104 — REB'AR"
Gadd who contracts for such p jects with amommcmr(s)licensed pursvmt to the {.
Cbmracter's License Law. . - 105 — ANCHOR BQI.:SS '
❑I and exemw •
pt under Sec. N'&PC drift,ree
n' C '
Owner - 'DNe _ ° - 34x4.:;- ROUGH ELECTRICAL '
WORKER 5COMPPNSAIION Dr. LARATION505FINAL EI ECTRTCAL- "
Ibriefly infiral anderpsuallyolpel ryone of,hefullowinglicalarations4 514 — FI'NAL PUBLIC WORKS . -
❑ I nood ad dl andiats'and a Certificate r Consent In el[ t for WUrkf „gy�pp gg
Conp .Bron a, pm d d f by S I Sino r the,Label code IF.. m INd�"^'A A•.r< i•--8 .
Perforinia ce ar me work for which this partial is"sued. , , •- - •' ”
01have nl II [
idW k Compensation I 'd ' db Set �CT
!1 C� )C01.
l
39011 f the L h Csleat ilia pe .ours o f the w rk 1 which thin { t !1 u
issued My Workers Counicasedon Insurance carrier and P d y nhsrarc, -
aier`lll�.SivLIEN.eV. ePolicy No.: -Lu 90309 �{Ir1' Y
.° CIRTIFICAfION Or EXEMPTION,FROM WORKERS' YV IL k.Nrvc:I r I S
COMPENSATION INSURANCE - -
(This sectionneed not hewnpleW if(lie p mit ;for one hundred III -
ISlgl)
1 ryE t the p t of tile k( I hll Parini( issued.l
'hall Icarrier any person in any darder so its t Esperanto subject I the Workerst ..
Cep t' Lis afCadfirodu Date
Applicant
M1O1pICL fO APPLICANI ILafter ralkingthisCrurficatrof li .pt t you nh uld - -
net b)e u,lhe W,k C p 't npn n.- 1 theLabor C le you ad _
,7Q C) f adoein uh pI,with such p sons ar lh n l shall bed ci kcJ. • - d "
ti 'CONSTRUCTION LENDING AGENCY
a Ihereby off, that there .t I leading agency for me"rourneredof tire work for which this parrat's issued(Sao 3097,Cv.CI
W Q
Lennif swid, 't
a z Lend Address 'd
V 0 I cunity that Id this application d%into that lhe b r al
FT+ [y
rouser I agree eco.ply with all city and county ordinances and.nl law,hearing -
}'� O fo building constncte,and heraby mtno p'seaditives fah:city w enter upon
r� the b t d I 1 ty f p r P P - I
a (we)abre R, d 'fldk ph Is:th CtY fCUP f 'b - d -1' a
•tr Vi
liabilities,judgments, t d expenses which 'y. Y way rapow against 'J'
U Fz-t City in cousequouireorthe granting of this peen . y
A ^"
APPLICANT ERSTA S `.��AND WILL COMPLY WITH ALL NONMW _ Issued by: Date !/•+ 1.•
�
slgwnreol Abbiranalconaravtor a Der, Re-roofs. , „- • - - ,
HAZARDOUS MATERIALS DISCLOSURE - ' '
W'bthapplicant- fail',b la g P to n dl hoodd ' nal '�l Ty "of R f.
nsCode, - -
defined by the Cuperi no lvlt nic'pd Cl Chapter 9.12,and the Health and Safety -
Code,Sector 25512p)' _ - -
13 Yes. z°N All roofs shall be mspeeted prior to.any roofing'mateuat being installed.'
Will th IPI I f t b'I l' b p' t. :eep.p` d - ; 1'at. f, If a root is, ins[alled,without first obtaining an inspeedon -I°agree to remove
t nit l loos air ct mart.m t'as dented by the&ry Area A' Q duly Management
District? -all new materials for inspection. Applicant understands anil'.will comply with • `
❑vn. °No • allnon-point'sourceregulations. • - •' '
to
I nave read mehazardous amen ads raldhad niN under Chapter 695 of Inc s'�. � .
California Health&SfetyCode Sections 255U5,25533 and25534.1 u b,dai dthat
IflbeballJngdaos notearrcnlly Lavcale 'nithaf'tslly respmn'bil'ty to nnflylhe
n lll.avt tithtrust be .to pro, didre,df' C uficac of
Signature ot.App licant . - Dateall
'
0,renoradlul,ir,edagent *• ,+r, . , Date '" �, All roof coverings to be Class B':or better