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05030008LPOC �<W 5 Z�o 3yU Q� �p KO tom—nn Fit wit— or CITY OF CUPERTINOx-s`+'" O- nLender's ,z 17 t" U W .0.j z ^ BUILDING DIVISION PE..AIT ACONTRACTOR INFQA 1.TI0N seg*•:.. BUILDING ADDRESS: SIGN ART CO PERMIT NO05030008 OWNER'S NAME: PERMIT ISSUE DATE UNITED NATIO ONE: SANITARY NO. CONTROL NO. (626)287-2512 ARCHITECDENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 LICENSED CONTRACTOR'S DECLARATION Job Description 1 hereby affirm door l am licensed under provisions of Chapter 9 (commencing with Section 70W) of Division 3 of the Busircv and Profusions Code. and my he. is Lifiiacruuac sndercc 45 �� ���� SIGN--ILLUM. CHANNEL WALL Llex Data Contractor ARCHITECT'S DECLARATION 1 understand my plans shall he used as public ¢cart@ Licensed Professional OWNER -BUILDER DECLARATION 1 hereby affirm ma I am exempt from the Contractors License Law for the following reason. (Section 7131.5, Business and Professions Code: Any city m county which acquires a permit to consumer, alcor, improve, demolish. or repair any someone prior m its issuance, also acquires tbe applicant For such Permit file a signed statement that he u licensed pursuant to the provisions of the Contractor's License law(Chap¢r 9 Sq. Ft. Floor Area Valuation (commencing with Section 7000) of Division 3 of the Business and Prefesnoe Cook) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of 3 WN4aQd�erO 0 Occupancy Type Section 703 L5 by any applicant for a Penna subjects the applicant to a civil Penalty of our come Iran Five hundred doll.. (SSW). ❑ L as owner of the property. or my employee with wages as their sole compensation, Required Inspections will do Ire work and the structure u not intended or offered for sale (See. 7044, Business and Prefresiots Code: The Conuaclars License Law does awl apply m an owner Of property who outlets or improves thcroon. and who area such work himadfor thma la his own ui p m such improvcmc a. . are not intended oromilled ed forathe ith b verlthe building Or i e owner. buildingorimprovementissoldwithinone yearof completion, marodof ilde,,me builder will have Um burden of proving Nat W did not Wild Or improve for puryose of salt). ❑ h as Owner of the property, am exclusively contracting with licensed contractors to construct the pmjecl (Sec. 704 , Business and Pmfcssions Code,) The Conmctora Li- Lawdoforsuchpr ini and law does not apply in in owner of property who Wilds or improve thcacon, ontl econtramor(s)licensed whoc with pursuant Insthe Contractor's who contracts License Law. ❑ I am exempt under, Sce .B&PC far this ..an Q( Owner Data v\ WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑ than and will maintain a Certificate of CDnsenuo self -insure for Worker's Compen- sation, as pmvidcd for by Section 37W of the Labor Code. for Ne perfmmaned of Ute woN.for which this peen it is issued. I base and will maintain Winters Compensation I...... ss.qujmd by Section 7700 of the labor Code, for the performance of the work for which this Permit is issued. My Workers Compensation Insumnee carrier and Policy number am: cmrier.STAre hurl h Policy NO.: CERTIFICATE OF UEMP ION FROM WORKERS' COMPENSATION INSURANCE (This section need not he completed it the permit is forone hundred dollars (SIW) or less.) , I anifv tha in the Performance of the work for which this permit b issued. I shall not employ any person in any manner so m m became subject to ted Workers Compensation Laws of California. D. Applicant NOTICE TO APPLICANT: If, afscr making this Cenifieme of Exemption, you should become suhject m the Worker's Compensation provisions of the Labor Code. you must forthwith comply with such provisions or this Permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that mere is a construction lending agency lot the Performance of me work for which this permit is issued (Sec. 3097, Civ. C.) Name Leader's Address 1 ccltify that 1 have read his application and sexne Out me chow information is croacs.Ia&= to comply with all city and county ordinances and state laws relating to building construction. and herby aumOtim Rprecnlatins Or this city ur enter upon the above mentioned pmpory for inspection purposes (We) agree ID save, indemnify and keep harmless the City of Cupertino against liabilities.judgmcros, costs and expenses which may in any way accrue... just said City in consequence of the graining alibis Permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date SOURCE REGULATIONS Re -roofs Type of Roof !� f� 1 I C, Signature of ApplicanUCammeorData HAZARDOUS MATERIA S DISCLOSURE Will the applicant or future building neutrino stare or handle havardous material as declined by the Cupenmo Municipal Code(Chaprer 9. 12. and the Health and Safely zss3z(a)? code.[] 'a All roofs shall be inspected to any roofing material being installed. ❑ Yes B prior Itthe If a roof is installed without first obtaining an inspection, I agree to remove applicant or future building occupant use equipment or devices which mil huvand us air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. Disuia? ❑ Yes �f4u 1 have mad the hmardous materials requirements under Chap ser 6.95 of the Califor- m. Health &Safny Code. Secdmu 25505.25533 and 25574.1understantl that ifthe Wilding does not currently ban a mi that it is my responsibility io nutily Ire Occupant Of the requirem�hich mu t'6c mcI prior m issuance of a Cenificam of OccupaDCy. Signature of Applicant Date All roof coverings to be Class "B" or better Owner bac or authodmd .gem Ahoc an V� Cl FT� 04q z > o04 re� Zo, IW - -o- < z 0 22 00� 0 �Zoo�g 0.LO mL baa Z (D 0 Ow II aw� z 0 �ww z C:) w ow�o (Sc JigU Ahoc an V� Cl 04q z o04 re� z.l 0=5 IT Ij Ahoc an V� Cl 04q z o04 re� 9 0 N a N. DE ANZA P>L. m w z W z o U Q � (S) z m w w z / L-_ . 44. . . 0 C� 0 I A D X Z Z 2 m � Z m E Z O m D m Z �mOK n �Z m { Z G) O O Z Z O 3 Z n0 w = x ol .a.. cm of CUPEkTINO CITY OF CUPERTINO SIGN PERMIT APPLICATION FORM 0.P3QdO? APN # - P � bq'T /1 kJ Date: BUILIDNG Building Address: Meol N DU tJt,N 13Wb iSTr✓ too Cu0EAa---1t9cmsow- Owner'sName: ttrJ 1TE7 NNcTeo/V Phone #: Contractor: St Erni ART �M�AN`/ License #:C45y '76 7cJ03 Contact:�n Hst Phone #: App lic ant/Contractor: BUILIDNG Building Permit Info: Bldg Elect Plumb Mech Job- escription: �1-L U M i-KWTG4 etkANm6-(- Lc--Cn-= S Residential: V'4 -C-i' S 16oj Commercial: Sq.Ft. Floor Area: $/Sq.Ft.: Architect/Engineer: Cost of Project: ©CO— Type of Construction:Occupancy Group: Qty. if Anolicable Fee TD Fee Descrinrinn Fee Grnnn 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 277.96