03100192 CITY OF CUPERTINO
BUILDING DIVISION PERMIT �'C , N; T , WINE , RMATION '
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BUIL DING ADDRESS: ANGEL' S PLASTIC & NEON CO PERMIT N003100192
0525 DE ANZA BLVD
,R'S NAME: 495A MADERA AVE PERMIT ISSUE DATE
YE CARE CENTER 10/27/2003
NE 408) 280-0907 /. SANITARY NO, CONTROL NO.
ARCHITECIENGINEER: .�� BUILDING PERMIT INFO
`. BLDG ELECT PLUMB MECH
100 LICENSED CONTRACTOR'S DECLARATION
Eu 1 lumpy affirm that 1 em licensed under provisions fChapter 9(commencing -Job De prion
foil
Me and
fDivision]of NC Businw anO Profwiuns Code.andmylicenxis
s
m full come and err t. 1 1 11 SIGN VVV
iq License nue Lia.N
�Fp Detc CUnlrecbf pw�
7W ARCHITECTS DECLA ATO r
1 understand my plans hall be used as public memos
� 0 /A
�C r^
Licensed Pm(cssinnal
5 OWNER BUILDER DECLARATION f
-0I 1 hereby.(Sec on 11, exempt from Nc Convenor's Code:Any c Law far the �
o O following mason.perhoiut Zonstr B,ainess and Priimprove,
demolish.
h.urAny tiny or county
5$ which its i ma a Permit re construct,Blur.impmw,h Permit
t m repair ed structure 2900
.Z<
Out he
issuance,also tt I,theres the provisions,
or forthe sucConrunnitto Eleasi Law(Chapter
thmhei+IicenuJPurtuenl uuhe PmvisiorunrNC Camm�uh Liccnu Law(Chapur9 Sq.Ft. Floor Area Valuation
Z€O (commencing with Section 7000)of Division 3 of the Business and Professions Code)or !
`t$ 35918058 . 00
Nm he is exempt therefrom and the basis for Ne alleged exemption.Any violation of
Section 7031.5 by my applium for a permit subjects Ne applicant to a civil penalty of APN Number O pane
not more than five hundred doth.($500). .j Y Type
❑ Las owner of the property,or my employeu with wages u their sole comperwtion,
will do Ne work,and the net..isnot intended oroRemd joints(So.]044,Business Required Inspections
and Pro(wiom Code:The ConcracuYes License law does nor apply la an owner of q p
property who builds or improves thereon,and who doeuuch work himselfor through hit
own emplayw,provided Out such improvements arc not intended or offered for sale.If.
however,the building or improvement is sold within one year of completion.the owner.
builder will have the burden of proving that he did not Wild or improve for puryou of
salt.).
❑1,a t the p of the property..B sin.andely comments,rficus wtlh licensed aonvumn m
construct theproject(Sec.too n Bminwandry,who Wi Co de i Tin Convenor. rad
cense Law dots not apply a sen owner of property who Wilda or improv Norton,and
who c.L. for such projects with acomrumRp licenudpunuanla OF Canvxuis
I
nu Lew.
1 am exempt under Sin. B&P C for this recon
One /
WORKERS COMPENSATION DECLARATION ,�•
1 hereby affirm under penalty of perjury oro of one following decimations:
❑ hove and will maintain a Certificate of Consenno self-insure for Worker'+Comped. ® (�
F
r provided for mi Section 3]00 of the labor Code,fa the Performance of the r�
work for which this permit a cooed.
. ❑1 have 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 Compensation Insurance carrier and Policy number are:
Cartier: Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORK ERS'
COMPENSATION INSURANCE
(ThLL section need not hecompleud If the Permit I+forme hundred della.($100)
or less.)
1 comfy that in the performance of the work for which this Permit h issued,I%hall not
employ any %son irTany mann mina 1p oma Ejuua the WUrkor'Compensmion
Lew9nf Celifo au V
Applicant '
NOT TO APPLICANT;It,after making On CCmficau of Exemption,you should
no
subject to Ne Worker'sCompensation previsions of the Labor CoJc,you must
�z fan ith comply with such provisions OF this Permit Nall W demand revoked.
OCONSTRUCTION LENDING AGENCY
1 herehy affirm Nal Nero isacmrswcfion lending agency for the peamm Ice or
Yr+1 the work rut which this permit is issued(Sec.3097,Civ.C.)
Undoes Name
z Lmder's Addrw
Q I certify that I have roti this application and suis Nat the above information is
comet.1 agree to comply with all city and county on inmces and some laws mining in
building construction,and hereby mah urine representatives of this tiny to enter upon the
W shove-mentioned property for inspection purposes
ti gym (We)agree to now.indemnify and keep hum less Ne City of Cupertino against -
N Iiabllums.judgments,costs and expenses which may in my way&cane against mid City
I.
of the .long of
Z APPLICANT eUNDERSTANDS nAND WILL CO LY WITH ALL NON-POINT Issued by: Date D
SOURCE REGULATIONS. �i'\ f
V Re-roofs
nature of Appli anUCont.cur Da
HAZARDOUS MATERIA DISCLOSURE Type of Roof
Will the applicant or(atom building Occupant smm or handle hanNous material
'bled by the Cupenim Municipal Code,Chapter 9.13.and the Health and Safety
Section 35533(.)] g�J All roofs shall be inspected prior to any roofing material being installed.
❑Yu � U
oe
Will the applicant or future Wilding cupam tax equipment or deuces which If a roof is installed without firs[obtaining an inspection,I agree to remove
emit hazardous air contaminants as Defined by the Bay Area Air Quality Managcmcnl
ct7 all new materials for inspection.
Dinri
❑Yu IF
I have mail the nae res materials requixmcnts under Chapter 6.45ofthe Cali for, /)
niaHUIN&safety Cadc,Sections,23505.25573 anJ25S3C.l unnkrstand thin if OF Wilding L.>> C
Jars net currently how a.nan,,Nat in is my r poombiliny m the occupant a(the
nodly Z
requimmcnts which mum be mel prior Fit in r a cenlfiaa:of Occupancy. nature of Applicant Date
owner ore .rWedagent L All roof cov rings to be Class"B”or better