04080175 CITY OF CUPERTINO �
BUILDING DIVISION pE CaONTRACTaR INFOy7 N
y°„ k r .8c
BUILDING ADDRESS: ACTIVE SIGN CO
PERMIT No.04080175
PERMIT ISSUE DATE
OWNER'S NAME:
2'1
NE: SANITARY NO. CONTROL NO.
(408) 297-6640 .
ARCHITEC rEHOINEER: BUILDING PER O PLUMB
BLDG ELECT PLUMB MECH
0 0 0 0
p¢ LICENSED CONPRACIORS DECLARATION
CI hereby affirm Unit 1 am licensed under provisions of Chapter 9(mmmcncing lob Description
D with Section 7000)of Division 3 of NC Bismentnd Pros mo Code.and my license is
in full fa doff I SIGN- -NON-TELCOMMATED ONUMENT SIGN
Liccrne c Lt..N
f Date
Carter
a
CHECTSDECLA O
¢ Iharrat5aund my plans shall W used res public meads
an l
CLufcnxd Professional
OWNER-BUILDER DECLARATION
3 I bcrthy from But 1 am cumpt from Ne Conwcmr's License Law for the
o O fallowing meson.(Section 7031.5.Business and Pmfe.rims Code:Any city or county
m which squires a permit Rs consumer,alwf,improve,demolish,or repair any nmcwm
Zi priorinitsissuance.alsomquimstheapplicantforsuchpermittofileasigned statement Valuation
Zo thatW is licensed putmantmde pmvisiors oftWCamrxwh lJmase law(Chapter9 Sq. Ft. Floor Area
s-� that ha is ng of dominant
and t f Divnioa r the staged
coaaM on.Any
that he n ucmpt therefrom and the bass far de alleged.•.mption.My violation of
Sutton 7031.5 by airy applicant for a permit subjects the applicant to a civil penalty of 3 AFN 61W rier 0 0 Occupancy Type
not mom don fin hundred dollars($5(10).
❑1,as..or of the property,or my employees with wages no their role contpenadon,
win do the wort.and the gracious is not intended or offered foraale(See 7W.Business Required Inspections
:ad Prof eskma Cade:The Cunmcmts License law itis not apply w m owner of q P
property who Wildsor improns thereon tend whorl.such muchinn.1forthmu11,his
own employ=.provided deg such improwmens tie not intended moaned for ale.If.
howcwn in.building or improvement is mid within me year of completion,the owner.
Wilder will have the burden of proving that he did not Wild w improv far pulpae of /
idle.). tl�
❑I,as owner of the pfopeny.am emlusivcly convecting with licensed mmrmbm m 9/ CF
cons`-vuet the project(Sec,700a,Business and ProBsvots Code:)The C°nmcteri Li- 7
c nLaw dos not apply w Wil
an owner of property who ds or impious daemon,rod, '4J
who cones for such projects wit a eonvmmr(s)licensed pursuant m the ConvacmYs
License Law.
O 1 am exempt wader See. .B&P C far this moon
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby afTnm under perulty of perjury orc of the following decsredome
haw and will maintain a Cwdfiote of Consent m self-insure Int Wmimes compere
ation,as pmvidcd for by Section 3700 of the Labor Code.for den performance of the
work for which this permit is issued.
(]I ban and will maintain Worker's Compensation Insurance,as mquimd by Section
3700 of the labor Code,for the performance of the work far which this permit is issued.
My Wormer earnpensation Insurance c�apnis and Policy number sm: >
Carrier. —,fA 12s-.Jit Polity No.:
CERTIFICATE OF E%EMMUMF$091 WORKERS
COM NS CE
transaction need notbacwnplced i}tW permit is for one hundred dollars($100)
car loss)
1 certify that in due performance of Ne work for which this permit is issuc4 I shall not
employ any heron in any matterm as w Wromc subjoeuo the Wohers'Compensedan
Laws of California.Dam
Applicant ✓bf
NOTICE TO APPLICAWT.If Mr making all,Cenirate of Exemption,you should
accurate subj.to the Worker's Compensation pmvisiom of the liber Code,you moa
�z !:sMwiN comply with such pmvidms or this permit shall W dcemcd revoked.
D ^ CONSTRUCTION is.c ON IF.NDING AGENCY
I hemwhich thi then dart is s ed(See
7.Cint agency for the perfotmarus of
�> the work fur which this permit n issued(Sec.J097,Civ.C.)
t1 A Under's Name
L
z Lender's Address
�
P I certify that I lues cud this application end sow Nat the gran information is
corms 1 agree to comply withall city and county wdinancof soend sign laws relating to
U
� building cntimeddestruction.
roanti Wrebyespssenutiws of 04 city reenter upon the
w LS1 aWw mendowee in s property fin hesitance akeep ha
y O. (Wt)ii me s.caw,indemnifyexpn and kith hay in m the City o Cupertino s id City
Z incost
idestuargmentecussand expenses may in my way attmc against said City
Z APPLICANTeof UNDERSTANDS Agranting of rND WIL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE GULATIONS.
Re-roofs
ii;zourtt.f cand ontncwr D
H RDOUS MATEItIAIS DISCLOSURF/,7 Type of Roof
Will applicaultr few.building occupmtnoso orba�fAleluranlousmamrfal
u defsrwd by the Cupertino Muni pal Code,Chapter 9.13,and de Health and Safety
Code.Section 255320)? All roofs shall be inspected prior to any roofing material being installed. -
❑Yu o
Will the applicnm or future ildin6 occupant tax equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
I haurdaus air coauminans as cfined by the Bay Ama Air Quality Management all new materials for inspection.
,av;en
❑Yes
1 have mad the hazardous materials requircmens under Chapsrd.95 of Ne Califon
nu Hca aiJa SafctyCadc,S comin505,25533 am12553d.l auditioned thatif the Wilding
does not currently ban a¢nam.Wt it is my res'asihility to notify the aaupam of de
seyvirem whmhmus*rmIpraftuissumceafa .IranfOct cy. Signature of Applicant Date
L :YRIOC41 Owner or Ourinlirignin All roof coverings to be Class "B"or better
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3Taylor s , 1 : (408)297-0640 10060 9OO8O'Bubb Road
�3a se,Ca 9 3 ex : (408)297-0743 Cupertino, Ca95O14
•
OCITY OF CUPERTINO0
SIGN
SUPEkTINO PERMIT APPLICATION FORM
APN # Date:
Building Addres :
lDD6D -/0,)&
Owner's Name: Phone #:
c)AYN� coo �
Contractor: � n- License #: did z
Contact: �U Phone #:
Applicant/Contractor:
Building Permit Info:
Bldg Elect Plumb Mech
Job Description: /
Residential: (/Yt —% vx7Mw �„s>1 S Commercial:
Sq.Ft. Floor Area: $/Sq.Ft.:
Architect/Engineer: Cost of Project:
ype of Construction: Occupancy Gro
Qtif
Ap i b Fee ID Fee Description Fee Group
BENERGY Energy BUILIDNG
BPERMFEE Bldg Permit Fees BUILIDNG
BPLANCHK Plan Check Fee BUILIDNG
BSEISMICOM Seismic Commercial BUILIDNG
EPERMITFEE Elect Permit Issuance ELECTRICAL
BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL
BREMSIGNS Rmdl Signs, Marquee ELECTRICAL
BUSLIC Business License BUILIDNG
e
z6 - 7 �
9-� z � 66
CITY OF CUPERTINO
BUILDING DIVISION PERMIT gCONTRACTOR INFyQRMATION `�;
BUILDING ADDRESS: ACTIVE SIGN CO PERMITNO.04080175
OWNER'S NAME: PERMIT ISSUE DATE
E; SANITARY NO. CONTROL NO.
ARCHITEC iENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
y0o LICENSED CONTRACTOR'IDECLARATION lobDescri tion
uF I hereby affirm the 1 am licensed under provisions of Chapter 9(commencing P
uF�u� with Section 7000).(Di Division 3of fine Business and Pra signs Code.and mYliecnsc is
^ia6 in fail fo deffe y_ •1
5q"z LicenseC a Lie.as SIGN--NON—TELCOMMATED 011ilw 1�N
1"0 Dam Contracltppr "'0V ��l//�/((�]/�fD
q�q � CHf1ECT5 DECLAR'�O 1 t U////
Alm dlTrsunJ my plans shall eaused as public record O
�yU 1
u.G Lmcnscd Pmfcssional fool Q
3 OWNER-BUILDER DECLARATION F. J�
1 hereby affirm Nal 1 am mxcmpt from the m Contractor's License Law for the F.a o following mason.(Section 7101.5.Business and Professions Chiba:Any city or county `v
m which requires a permit to comswct,a1er.Improve,demolish,or¢pair any structure
prior to its issuance.also residues the applicant forsuch permit In file a signed summers
?< that he is liaised pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft. Floor Areamssions las[ n
s�m (comencing with Section 7MB of Division 3 of the Busimaturd ProfeCale)tar U
i $ But Le is uempt therefrom and the buil for the alleged ucmpJon.Any violation of AN
Section 7031.5 by any applicant for a permit subjects We applicant to a civil penalty of 3a�ora��r (]O Occupancy Type
nos mare than five hundred dollars(M).
❑1,ss owner of the pwpeny,or my employcea with wegm u Weir sole compensatlon,
aill do the work.and rte arrocmrt is not intended oraffered for sale(Sec.7066.Business nppp�___�'''
nd profeviom Cade:The Communes License law does hal apply m m owner of RegUlre InspCC(io/n�s
own
property who Wiprovilds id thatuchimprovemethassion.and ha are notchwork or himseeerthrsalerough his OOV .r/ VO
awn cmplayccs,ping orithmmchimpavemenmarem sad of ompimnd forsale. O
however.We have
this,n6 or improvement is sold within one year of completion,Nepose of
builder will have burden of proving that he did not Wild or improve for purpose of 10
sale.). OMet
❑1,ru owner of ct praperi am704.B sin ssiv nd contacting with licensed rnnu¢u's i.constant dproject(Sec.o an Businessend Professionsds orImprovestheThe cmr's n cense Law does oat apply c an owner of prapeny who Wilda or improve thereon,andwho anuacu far such pnajeeu with aeanuacsor(s)lianscd pursuant m the CanuecttsLicense law. `\\J�
❑1 ern exempt under Sec ,B&P C for this reason
Owner Dam
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury arc of the fallowing declarations:
ave and will maintain a Cenifiate of Consent to=If-imum for WhrkersCompcn-
atiam
sn, provided for by Section 3700 of the Labor Code,for lie performance of the
work for which this permit is issued.
❑I have and will maintain Worker's Compensation Insurance,as repaired by section
3700m`the labor Code,far the performance of the work for which this permit is issued.
My Workers Compensation Insurance carrier and Policy number am: ! t
cium": � 7y 'll.�s..J/1 Policy No.:
CERTIFICATEOF�Pf1OINNEB (WOR S'
COMPENSATION NS CE
(THs a x,k n recd not bo completed itl W permit is for one hundred doilars(SIM) ,
or less.)
I certify that in the perfmmance of die work for which this permit is issued,I shall not
employ any person in any manner ao as to become subject to WC Winters'Compensation
Lawsof California.Dam
Applicant
NOTICE TO APPLICANT.lIamk-i
CcniOcsc of Eacmptiao,you should
become subject m We Worker's Compewnon provisions of 1W labor Code,You must
Z fhMwith comply with such provisions or this permit shall he demand revoked,
Z O CONSTRUCTION LENDING AGENCY
[-� I Wrtby alarm that Wert is a construction lending agency for the performance,of
a > thc work far whim this permit is issued(See 3097.Civ.G.)
W Q Lender's Name
] Z Lender's Address
U O 1 certify that I have read this application and sum that We above uncommon is
W F' chances 1 agree W comply with all city and county ordinances and sum laws relating in
0 V building construction.and hereby authorize representatives of this city in enter upon the
r W above-mentioned infelicity for inspection pub••.
d„ 6. (We,)agree in save,indemnity and keep harmless the City of Cupertino against
N (imilitia,judgmcnu.costs and expenses which may in anyway see=against mid Cry
in
of the grating of this Permit.
V z APPLICANT CUNDERSTANDS AND WIL COMPLY WITH ALL NON-POINT Issued by: Date
SOURozle
C GULATIONS.
d Re-roofs
hfA anI/ onaaclor D f
H RDOUS MATERIALS DISCLOSIL Type of Roof
Will applicant or for=building occupantstum or hei104Jfe rda matenal
as defined by the Cupertino Muni pal Code.Chapter 9.12.and Jfe Health and Safety
our. [3Yeaection 255320)? All roofs shall be inspected prior to any roofing material being installed.
❑Yu o
Will the applicant or fund.lipildirt,occupant um equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
hazardous air conuminanm as cfined by the Bay Arca Air Quality Management all new materials for inspection.
evict?
❑acs
I hate mad the hmumme s materials equimmc us under Chapter 6.95 of the Califs,
ilia Health&Safety Co ,Scedom25505,35533md25534.lundmauadthmifthc Wilding
dhm not currently haw a tenant boat it is my respunsi hility m runty the ohcupant of the
otfinim whim and Ire mel poor m causna ora nifiam of sap ter. Signature Of Applicant Dale
Owner at hila ;gem Dam All roof coverings to be Class "B" or better