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CONTRACTOR INFORMATION:
BUILDING DIVISIONPERMIT
BUILDING ADDRESS
ANZA BLVD
SIGN A RAMA
PE�MIT02080072
DSTB
WRAPS
1179 E HOMESTEAD RD
DATE
APPLICA08/14/2002
PHONE:
4082437388
SANITARY NO. CONTROL NO.
Z0 ARCHITECf/ENGINEEILBUILDING
PERMIT INFO
BLDG ELECT PLUMB MECH
y
LL f "Ul ILJ I. -s
z LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that l am licensed under 'tam of Chapter 9(conmenting
with Section 7. of Division 3 of the Bmmc"g Professions Code, license
obb Descri [ion
SIGN--ILLUMINATPD CHARTNEL LETTERS
and my
nn _ 2- 13
'
U Licc se Class Lic. a
V�j�'�eJ Ce�so�mmoy_y
�i✓�
HITECr'S��( RATION'
5 1 urkemand my plans shall be oud as pubftc records
OLicensed Professional
OWNER -BUILDER DECLARATION
on I hereby affirm Nat I am exempt.rom the Cmurtemr's License law for the
< following reason. (Section 7031.5. Business and Professions Code: Any city or county
$3000
$ 3 0 0 0
0 which requires a permit to commuct.Iter, improve demolish. p y structure
$ -Prior to its istrusunce, also refuses th< applicant for such permit to file asgned statement
.. ---- ... ....._._ _. .. _.__.
- "at be sedp soam'pm p v-nsad"'Cantrector License (Clupt 9
Ica Seen ]000) 1D' mm� 3 of the'bames ndP f<stonx Cwle)
�p-� �g A
+-3'A1�IVY4Dt'VC�3're ✓✓-t
s�-l)�p ,3s r --.10: v?j1, e`
, Valuation
o. thm a,exempt therefrom and Ne bons for the alleged aso ption Any violation
-'A"
-af Section N131.5 by any applicnm arepermit mbject Ne epphirem m a civil penalty
of ant more thnn five hundred danacr("dift
1 1AP-0I Lti®LtWDAT I ON
,., Occupancy Type
01, as owner of the pmpenny, or my employees with wages as their sole compensation,
103 - LIFER
:
will do the work. -and the structure isnot intended or offered for sale (Sec: Two;
Busimss and Professions Cock: The Cmunicmr's License Law does not apply m an
10 4 - REBAR Required Inspections" `
owner of property Who builds or improves thereon, and who does such work himself
105 - ANCHOR BOLTS
or Nro gh h ploys provided that such p nt art r intended _.:off d ..
.. _ . .f
ti 'Idin
_..__. -__ . _
-ELECTRICAL"-:�,.n.
l_ If er du b m t sold th `y
se
304- - ROUGH
completion, the owner -Wilder will haw baron of
improve far purpose of sale.). Prov'ng that he d d not build or
,.
505 - FINAL ELECTRICAL
01,asowner o.thepmpeny,am a.ommming withcdr:)uA contrumrsrs—
5-1-4-----FTNAL PUBLIC'WORKS----------- - --
the project (app. Business
a, Business and Professions Cade:) The Contractors
'
... Liceww
to
License Law does not apply m an owner of propenY who builds or improves Hereon,
I
_.and.who.co with u.commcmrts)licensed. Pursuant.m.tne.
'.
LremseLaw.cM1.pmjeds.
Connamxe License taw;, .,
"�' ',B&PCfor
❑lam exempt under Scc.' dox
'Owner we
WORKER'S COMPENSATION DECLARATION
'1C
` I hereby affirm under penalty of perjury one of the following declarations:
1 have and will of Consent for Workers
a Cby Se
provided
Compensation, as provided for by Section 3issu o. the Labor Cadc, for the
ti the
E
�� ��D
pertonwn<e of the work for which this permit is issued,
0 I have and will malnuin Worker's Compensation Insurance, as restated by Section
37.00
of the Labor Code. for the performance for
S Q 2 3 20 02
of the work which Nis permit is
'tiv J My Worker pe i tet and Policy number am
Insurance tI(aTm.14, e
.r
H_O
J�rl Zfh
It`t Y; s
' OFGXEMWORKERS
k f E
B.. � LD'NGFROM
L!'
seciioti need not be Completed -f the permit is for one hundred dollars
' 'I' ° 1 e 1'P
(81001m l I x,)
'
rty.tnnpe t. ce of thework for which Permits-.amed1
-
- _. - .:.....• .. -. ,_. .... _,_-.
,hall -n., employtoyaany Per n m any ma s t as ¢t bac tme subject to the Workers
t� T: •..' ' •'
Compensation Laws of California. Date
ApplicantNOTICr. .-.
, TO APPLICANT If afar maki Cenificveo Exemption: youshous,
heerme the W.T
suomply the Workers mo anon provision
amnpl a Labor Code you must
�become
fontiwith comply with such provisions this permit shall be deemed evoked.
ibri
' ".' •CONSTRUCTION LENDING AGENCY
_ _...._.
1 hereby affirm Nw there its construction lending agency for the perfomtance
of the work for which Nie permit is izsued (See. 3090, Civ: C.)
(Sce.
-Lcodr's Natnc^-.__:... ------
LendeiAddrexs ':
,. _... _._. .. .__......._. _... _ ...
I certify ihnt I have rend this applicationiand xmm that the above infurrommo is
•eoricd
1 ogee to romply with all city and county ordinances and state laws relating
to building constructioWand hereby authorize representatives of this city to enter upon
Ne above-mentioned progeny for inspection pmpnscs. -
Iwe) agree to save, indemnify and keep h rmle,s ditc Ciiy of Cupcuioo against
I liabilities, judgments, costs and expenses which may in any way seems, against said
City in consequence of Ne gra is permit.
' 'APPLICAM1T
', k. A - AND 'ILL COMPLY WITH'ALL 60.' -PO S7
SOURC. E rU 13 ..
V V
Issued by; Date
Z
Signature of ApprcaorContmaor .. :oat
-
HAZARDOUS MATERIALS DISCLOSURE .
Will the applicant or future brilliant occupmt store or handle ba,�taom matanal
7Re-roofs
of Roof --'---'"'
+def dbyNeCupenmoM icipalCode Ch p 9 11 dN H IN ark 5 f ry
----Cod
Ssctiomr25532()i rrt.. ',
k9.:� A xr `: f �4 t d % N tt '+) ,y I'ti^ •,•
l
roofs shall be inspected-pnor.to
:, Will the ircomnto turn. Wilding t sxQchairmen, a ...,Burn r
h ' k e cies Ls as defined by thennow chQ I M rte e t
_All. any roofing material being,mstalled. _
If a roof is installed without first obtaining an'inspection; I•agree'to remove
Dist oY T-- ivn- - - - .. ..... .. .
.... all "new materials for inspection.- Applicant understands and will comply with
/mit
1 h vs, read mehaessious materials requirement under Chapter 695 of Ne
all non -point source regulations.. 1 -
,n "
California Health & Safety Crall. Sections 25505.25533 and 25534 1 understand that
if Ne building do of cuncn0y haveamnam, that it is my responsibility tonotify the,
occupam of th re irdme ficTi ist W met prior to issuance of s Certificate of
- --- -- _
-
OccupancY.
... _,A
' 1
_ -Signature
YIDII
Signature of Applicant Dale
._..
All roof coverings to be Class "B" or better
Owner or a athunzed agent. ate
CITY OF CUPERTINO
BUILDING DIVISION
- I
CONTRACTOR INFORMAi4N-
PERMI
B�525 DE ANZA BLVD
SIGN A RAMA
—ir NO.
PE 02080072
°M T WRAPS
1179 E HOMESTEAD RD
APPLIcAB8n4A72002
PHONE:
'4082437388
SANffARUY N0. CONTROL NO,
ARCHn ECTIENGIEER:
BUB.DING PERMIT INFO
"
BLDG ELECT PLUMB MECH
Its
LICENSED CONTRACTOR'S DECLARAnON
I hereby affirm dw l am bronaed ro
usn msm of Chapter 9(commencing
with Sation ] of Division J of the BusinProfessions Cade,
es�d Hume
J�bD CC1 tl
SIGN --ILLUMINATED '�IA RL LETTERS
and my
is in full fo �.�. 2 13
= LiccAR Cl.ra Lic. «
F I N A E ®
��7DVas� cunvac _
ItTrEcrs o`
tl V 65
Ano
i 1 understand my plant shall be and as Wb te records
SEP,2 "3 2002
Lmcansd professional
OWNER -BUILDER DECWtATION
t beuby affirm that I not exempt from the Common', License Law for the
folloj whichroueasaPerrott 7031-5, Business improve.
PmfessiomCode:Any city n Somme
which s a permit to on alis, i demolish, m repair any smcmR
$3000
BUILDING
j- its iss ume,
priormitsissuenca Wauquius Ne applicant for wch pemu°o file eaLaw sutement
t for such
Section
(ComeiSting itpSec0mfq.NepifDivissofoU,pusincrLicrosefwwonsCr)
I, basis J of Net aidcss,wC professions Code)
1,13 eO,'s���I,Aea..xJ .,�. Valuation
l �(,j �� l PWW�s'� Y •.), ;
o, fta a a cca con ad ,
or Nei he is eacmbt therefrom and Ne basis for alleged aanpdoh. Any violation
: r t\ ,
nationn any for pemut wbjms the applicrosmarivil perWry
bj
ad loss iv s
Of rtes moR Nan five hunduA do0an (8800).
oodredic dollart
10 JAPPN VMWI)ATI ON Occupancy Type
❑I.uowner of the property. ur my employm with wagcsaNe'v wl<rompcnmsatian,
103 — UFER
wilt -do the worst, and the stwcwu is not intended or offered for sale (Sm. 7044:
Busideas and Proat
fesom Code: The Contracmr's License Law dna not appy to an
104 - REBAR Re uired Inspections'
owns of property Who builds or improve Naeon, and who does such work himself
dor through his own employers. provided that such improvements au not intended or
105 - p NCHOR BOLT S
''oHemd for sale. If, however; the building or improvement is sold within one year of
--- "- 304 —' - ROUGH ELECTRICAL-:. --.. _........ _.. .. _ - ..
completion, the owner -Wilder will have the burden of proving that he did not Wild or
improve furpurpowofsale./.
505 - FINAL ELECTRICAL
_. property. ._._...._.__. __.- . ___..._
❑Las owner of the am exclusively centaur' with gcemde on
..........-514 _ FINAL --PUBLIC WORKS.. -- -' '
(Sm7mu's
comwct the projert (Ser. ]BM, Business W Professions Code:) lTe Conrrwmr's
Coro
Licenu taw does not apply to an owner of property who build[ or improves thereon,
,.tied who. contracts for such. Projects with a monacmrfs) licensd. p000not. m the.
Contractor's License law.,
- - —
❑ I am exempt under Sec. , B & P C for this reason
-. .
Owner Daze " N
WORKER'S COMPENSATION DECLARATION
I hereby M. under penalty of perjury one of the following derlantiov:
❑ I have and will maintain a Certificate of Consent to self -insure for Worker's
Compensation, a, provided for by Section 3700 of do, Labor Cade, for the
perfonmanee of the work for which this permit is issued.
❑ t have and will maintain Worker's Compensation laboom e, ss Rqu nal by Section
3700 of the Tabor Code, for the performance of the -work for which this permit is
issued. My Workcer Compematign Insurance carrier and Policy number are:
fid: '•1+.T o/4i--SloHs9 oZ
.
.;..;'.r,,.:,•It,,•,'., _
EXEMy
•CERTIFlCATIO OF EXFMPMTH FROM WORKERS':
'. t 1 - a, s', ..J _. �;'•.: :', .':... _.
COMPENSATION INSURANCE
(This sctiun red not be, completed if the perosit is for one hundred dollarv--
(11 W 1 or less )
• 1 certify Nat in the performance of th work for which this permit is issued, l
'shall
•' -' - '
not employ any person in any manner to as to become subject to the Worker'
'- � 1'•
Compcnution laws of Califemia. Date
Applicant I
. NOTICE To APPLICANT: B. after making Nis Certificate of Eacmpurra you Mould
-
bcomon subject us Ne Workcei Compensation provisions of the Labor Code, you must
foMwitto comply with such provisions or Us pemut shall he deemed revoked.
Chr LENDING AGENCY
h e is leading agency for Ne pm(otmarice
1 hereby affirm thisat Neu is a issued
(Sm
of the work (m which this permit is issue (S«. 3097, Civ. CJ '
C.)
—Lender's Name- _-. _... _. ... ... .... .....
I certify Nat t have read Nis application and state that Ne above imfonwuan is
correct. I ague to comply with all city and county mdinancer and ssam laws relating
to building construction. and hereby amhorim reprcuntarives of this city to enter upon
the above-mentioned property for inspection purposes.
(We) ogres to save, indemnify and keep harmless the City of Cup,m.. against
liabilitin judgments, costs and experts which may in any way accrue against said
�s
City N consqucnu of Ne gn9Yag-af pcmtit. "
APPLICANT '. R A t65 A.YD [LL COMPLY WRH ALL NO '-PO NT
souac�R l
� I
Issued by; v V
g 2
Date
igmmre of ApplicanAZARD for Da
MATERWSDISCLOSUREWill
the applicant or future building occupant store or handle harnrdmu material
derned by Ne Copcnirw Municipal Cee. Chaper 9.12, end dR HcalN ase Sdcryf
'cede,
7Re-rofsHAZARDOUS
Roof ._ .. _ ... ..... . .... . .. �. _. - .. _ ..,..
Section zssJza.. ,. ,.. , ..
ora N Np
'j f :
_ _ All roofs shall be inspected prior.to arlyroofing.material being.installed.
bull theapplicant or ftum, hiing occupant use equipmencordevices which
emit haamdous air cmnaminmm as defined by the Bay Area Air Quality Management
-
If a roof is installed without first obtainin an ins ection; I a ree to remove
g p g
Dian;rt]
- ❑Yes -. III No ..... .._
all new materials for inspection. Applicant understands and will comply with
/
..
all non -point source regulations.
I have Rad the ns .menials under Chapter 6.95 of N<
Safety CM M!i. 33 a 1 understand that
i Lithe win Health &safety Cdc. Seehave
m correctly have a tewnt. Ness it is my msponsibiliry so notify the
a to ant. x. 25xs reed responsibility
m.part of Ido
occupant of N rc rtme rcl st be met prior to issuance of a Certificate of
Occupancy.
/
�IgfId 2,
Signature of Applicant - _. Date .
All roof coverings to be Class "B" or better
own r er antharr: a agent te
OFFICE _ - -- - -
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