06020159 CITY OF CUPERTINO p�,�
BUILDING DIVISION PERMIT
BUILDING ADDRESS: AMCOE SIGN COMPANY PERMIT NO.06020159
10201 N DE ANZA BLVD
R'S NAME: PERMIT ISSUE DATE
PICKETEER 974 COMMERCIAL ST. 02/27/2006
PHONE: SANITARY NO. CONTROL NO.
(650) 858-1221
ARCH=IENGINEER: BUILDING PERMIT INFO
BLDG l� ELECT lm PLUMB M�H
D l�
30o LICENSEDCONTRACOR'SDECLARATION Job Description
vd I hereby Affirm that l em licensed under previsions of Chapter 9(commencing
O�1 with Section 70110)of Division 3 of de Business and Profession Cods,and my he.is
in full fmce and cIT 7 SIGN--NON-I LLUM. MONUMENT
j q� License Clara
9 W Dau ARCHITECrS ECr N
i q 61 understand my plan shall he used As public records /
Licensed Pmfby Tonal ✓/
3E1 OWNER-BUILDER DECLARATION
rZ 1 hereby alien that i 1. exempt from the Cssion fs License Law for tM
O O following mason. arch t 7031.5.Business and Profession Co":Any city or county
9 which its amu•puma.reconstruct,eine improve.h Permit I m e ami any omensructure o$3800
_Iy priormitsueumro,it.nxrequires 0.Neapplicant tforhan Com paresis to Neaug. Raumem
<
that heincing¢dpunumttoNeofDivionafgftheBummrllJunclAw(CMpur9 Sq.Ft.Floor Area a[ion
$
(commencing is exe exempt
Sealant and of but&fee of Nc Business And Profinon.M inn Cattle)of
Out he u emmp.Oemfrom and the baba far Ne sile{ed emaciation.My violation of
Section 7031.5 by any applicant for a permit subjeav the applhsnt m a civil penalty of r panty Type
not tame than On hundred dollars(5500). VL
❑I.An Owner of the propcM.or my employees with wares As Nem Aute cmtpewtin,
will do Newark and the suuctum is sot attacked ar offered for nit(Sec.70th,Business
and Profusion,Cade:The Conuaclnr's License Law don naupply m an Owner of Required Inspections
property who builds ar impmvo thereon.and who doess tach work himself or Ouough hm
awn employees,provided that such Improvements w not Intended reoffered for da If.
bewewA the building or improvement is sold within am year of completion.the owners
builder will have the burden of proving Nat he did not build or Improve for purpose of
sem,).
❑1,As Owner of Oe property.am exclusively contracting with liceused conuacura to
contract the project(See.70".Business and Professions Cade:)The Contr czar's Li.
one law does not apply m an owner of property who builds or improv distant,and.
who conuects far such projects with a cormactm(0 licensed puma.,to Oe Cameramen
Lkatse Law.
❑1 am exempt under Sec. .B k P C for this muon
Dam
WORKERS COMPENSATION DECLARATION
I hereby affirm under penalty of perjury aro of the following dectaration:
under,
As and will for by
eCWOum of theLa or selBinurt(m WmkeAcompem
ration,r provided for by Ss issued.3]011 of the labor Code,far the perfanneme of the
work for which this permit is issnd.
❑1 Mw and will maintain Worker's Compensation Insurance,As required by Section
3700 of the labor Code,for the performance of the work for which this permit Is issued.
My Worker's Compenadon Insurance canter and Policy number are:
carrier. AU rMS4�Mfra' Poliry NO.:Oet- CM-LTLIZ
CERTIFICATE OF�P170N FROM WORKERS'
COMPENSATION INSURANCE
(Thi section aced not be completed If the permit is foram hun0eddolian($100)
or teas.)
1 certify that In the performance of the work for which this permit is issued.l shall not
employ any person in any manner An As In become subject to IM Workers'Compenmb n
Laws of California.Dam
Applleml
NOTICE TO APPLICANT:If,atter making this Ondfium of Exemption,you should
become object he the Worker's Compeention provisions of the labor Code,you muss
.JO foMwith comply with such proviaiun or this permit shall k deemed revoked.
Z(A EN
CONSTRUCTION LENDING AGENCY
[-r Ihmuhy&IRon that Nem Is a construction lending agency forte performance of
C 7 Om work far which this permit is issued(Sec.3097,Civ.C.)
Q Imdur',CLI Name
Z z Lender's Mdse••
U C 1 certify that I haw ms application and sum that the&bow information Is
U,!". const.I agree to comply with W city and county ordinances and state laws miming ur
rV' building construction.and hereby authorize reprennutiwa of this city at enter upon Ne
W aMvcmentiered property for inspection purposes,
(We)agree to sew,indemnify and I¢ep harmless Ne City of Cupertino again.
rrAA liabilities.judgment.cow and expenses which may in my way accrue agtlnt said City
V in consequence of the&toting of this permit
Fl APPLICANT UNDERSTANDS AND WILL COMPLY WITH ONPOINT Issued by: Date
SOURCE REGU W
��v � Re-roofs
Signature is On Aur � Dam
A7ARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or to=building occupml same mNckle hmardoua maurisi
fined by the Cupertino Municipal Code.Chapter 9.13,and the Huth and Safety
i .Section 355324)7 All roofs shall be inspected prior to any roofing material being installed.
Cl Yes 0410
Will the applicant or r ort building«cupant use equipment Or devises which If a roof is installed without first obtaining an inspection,I agree to remove
emit haramous air contaminants As dcOrcd by Ne Bay Area Air Quality Mangoment all new materials for inspection.
District?
A ❑Yes Oro
I have mW the hazerdeas roulettes,mpsmmenu underCluptcr 6,95.f ft Califon
nix Health B SafmyCotle.Solon 25505,M533 and 73534.1 understand thanif Ne building
does non curremly an a un n4 Nat It i my rcapanlbilit otily the accupmt of the
mquirementsw u et rani o sem of Occupancy. Signature of Applicant Date
own ar,at ,< spam Dom • All roof coverings to be Class"B"or better