05020150 CITY OF CUPERTINO
BUILDING DIVISION PERMIT 4CONTRACTOR�INFORMATION ss
BU ILDING ADDRESS: ALLEN SIGNS INC PERMITNb5020150
OWNEWS NAME: lI]7•
PA -a alTJ�G oeu G (J PERMIT ISSUE DATE
F aVV 7
E; SANITARY NO. CONTROL NO.
(408) 280-6500
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECr PLUMB MECH
taro LICENSED CONTRACTOR'S DECLARATION O O O O
wF I hereby affirm n
that 1 am licensed under provisions of Chapter 9(mmmcncing Job Description
iuy with Section 7")of Division 3 ofihc eusune�and Prafcssiom Code,and my license is
^<to in full fume and a/le .s
Oqi ucenm clan; t Lies S3 SIGN
4'p Do. Conmwlor
tt ARCHITECT'S DECLARA ION
< I understand my plans shall be recd as public records
oaU
u. Licensed Prefcssi...I
f.p< OWNER-BUILDER DECLARATION
eft 1 hereby.(firm that 1 am exempt from the Contractor's License Law for the
o O following mason.(Section 703 1.5,Business and Professions Code:Any city as county
K S� which require a pmmit to cnnswct,ater,improve,demolish,or mpoir any suuaum
FZiprior to its issuance,also requires dm applicant for such permit to file a signed statement
that he is licensed pursuant to she provisions of tW Contractor's Lianm Law(Chapter 9 Sq. Ft. Floor Area Valuation
ex (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
— that he is exempt therefrom and the basis for the alleged..,tion.Any Imittuen of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3 Sr9ffiS/ffitOoD 0 Occupancy Type
not more Nan five hundred colla.($500).
❑I,as owner ofthe pmpeny,or my employee with wages as finis role compensation,
will do Newark,and the swctum is not immmded oroRered for mle(Sa<.7066,Business
and Pmrexam.Codc:The Conuacwrs Liame law doe ort apply to an owner or Required Inspections
prupeny who builds or improve flu mon,and whodaessuchwork himself or through his
own employes,provided Nat such impemmenu are nos intendederr oLffe for role.IL
however the building of improvement is sold within am year of completion,1, owner-
builder will have the burden of proving that he did not Wild or improve for purpou of
sale.),
❑1.as owner of the property,am exclusively contnming with licensed co=,e n
construct the project(Sec.7066,Business and Profession Code:)The Contncmrs Li-
cave law does not apply to an owner of property who Wilds of improve demon.and. _ 1
who contracts for such projects with a coneactor(s)licensed pursuant be the Comnslo/s f
License law.
❑1 am exempt under Sec. .B&P C for this rearm
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby Nem under penalty of perjury ane of the following declaration:
have and will maintain aCenifieate or Consent to self-inure for Worker's Compen.
on,as provided for by Section 37M of Ne labor Code,for the peformance of the .
work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance,a required by Section
7 office labor Cade,for tW performance of the work for which this permit is issued.
My Workcrs Compensation Insurance cannot and Policy number am: T•
Carrier: - Policy No.: 00S—OGN&2I4k
`RTIFICA OF EX MON FROM WORKERS'
COMPENSATION INSURANCE
This section need not W completed if the permit is for one hundred dollars($lm)
n less.)
I century that in d e performance of the work for which this Permit is issued.I shall not
employ any pefan in any manner an as to become subject o the Workeri Compcnation
Laws of California.Date
Applicant
NOTICE TO APPLICANT.If,after making this Certificate of Exemption,you should
became subject m the Worker's Campcaation previsions of she Labor Code,you must
0 O forthwith comply with such provision or this Permit shall W deemed revoked.
'Z r CONSTRUCTION LENDING AGENCY
[— � Ibereby arm that Vert is a convection lending agency for the Perfarmana of
C the work for which this Permit is issued(Sec.3097,Civ,G)
U]A IsndcY1 Name
U, Lender's Address
L) S
0 1 certify Net I have mad this application and state that tha W
e vc informaliun is
0 U cortex 1 agree m comply with all city and county collimates aiveof and sum laws relating e
�V building construction,and hereby anNorim rtprecnutiry of this city to eraser upon the
roc shove-memioned Property(a,imperious puryoacf. vr
(We)agree m at indemnify and keep hafmkss the City of Cupertino against ��
f•'py liabilities,judgments,cosuandezpaveswhichmayinanywayaccrucagainstmid City
V Z in consequence of Nc granting of this permit.
.-. APPLICANT UNDERSTANDS AND WILL COMPLY WITH LL ON-POINT Issued by: Date 21
SOU R ULAT N5.
Wier 06 ON-POINT
Sign urc of Appl ant/Conuacmr Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future Wilding occupant from or handle hvafeous material
as defhncd by the Cupertino Municipal Code.Chapter 9.12,and fire HcaW and Safety
Code.section25532(a)7 All roofs shall be❑ere inspected prior to an roofing material being installed.
Will the applicant or Tamm building ocerp.nt use,equipment or teens.which
a roof is installed without first obtaining an inspection,I agree to remove
t ha>srdous air conuminanu a dcfincd by the Bay Area Air Quality Management all new materials for inspection.
run?
C]Yea )IN.
I have mad der haallous materials mquimmenes under Chapter 6.95 of the Califm-
nia Health&Safety Cade.Satire 25515.25533 and 25534.1 understand Nat if the Wilding
docs not tune by ham a t ant,that it is my resp osihility m notify he occupant of the
mghircm hie must •met�rior toiumbeeofa Ccrtirle of Occur
�. Z DS Signa[ur of pplicant Dale
owner rf..marl>ed ant Dam All roof coverings to be Class"B" or better