02030009 CITY OF CUPERTINO " ' I '!•, ,n
BUILDING DIVISION PERMIT CO NTRACTOR'INFORiGIATIO :
e.
BUILDING ADDRESS:
PERMIT N0.
10745 S DE ANZA BLVD ALLEN SIGNS INC 02030009
OWNER'S NAME: APPLICATION SUB DATE
MARIDON BRIAN TURSTEE 1982 STONE AVE 03/04/2002
i HONE: SANITARY NO. CONTROL NO.
(408) 280-6500
O EEO ARCHITEC(ENGINEER: BUILDING PERMIT INFO
U to BLDG ELECT PLUMB MECH
�« r-7
6 H 2 LICENSED CONTRACTOR'S DECLARATION
jZ_o Ihereby aRrmthat Iamlicensed under provisions ofChapner9(commencing Job Description
„t: with Se,ion]000 ofDivision3oftheBusinesxadProfeuionsCde, dm Berea` SIGN (INDIRIDUAL CHANNED LETTER)
m y L is full farce and efiea ,- Y
?O U License Clas—�;� Lit.X SS
Data O'
DECLARATION 3 a 0 ARCHITECTS ARATION
y g 1 understvtd my picas shall be used as puNic rtconds
3¢O o 4c<nscd Professional
•6 R R� OWNER-BUILDER DECLARATION
I hereby affirm that:am exempt from the Contractor's License law for the
C£Z a following reason.(&.as.7031.5.Business ad Pmfessions Code:Any city or county'
K a xhich requires a permit to construct.alter,improve,demolish,or repair arty suuca m h
aim P^ w, al q_rcul pphcantfor such perrmuo filcnngned suwmem. $2000
Jut LG 1 hsed p rs antro dm p ions of the Conwam s LIcrn law(Chapter 9 _ _ ppt, pp•��,,�,u,A` ,k� - "'- '---
3' 1 d 0. a�ea .
(caro , g with Section]0(10) f Division 3of,heBoameaand Professions Cde) 1'/• IVU ' r Valuation
w that he rs exempt therefrom and rM1e basis for the alleged exemptipn.Any vialmn,rid, '1/ `
ofSecdon]0313 by any applirnnifor a penrdt subjccu Ne epplica,to a civil penalty a'
!afnmmarethanBvahuodreddollars(55M)' PN18,m e� !- Occupancy Type
❑I.ar owneronhe n,arm emmeeawimwa exec:tneirmole<om 304 - ROIIU'H ELECTR CAL'
will do the work,and he sutraum'ispno[intended of olrercd for sale(Be,.7Ui4, SGS F
Business and Professions Code:The Comracwr's License law dos not apply to an Required Inspections '
owner o(pro veny Who builds or improves thereon,and who does such work himself
.,or though his own emplo3ces.Provided that such improvcmenu are not intended or
mferd far sale.If.however.the building or improvement na sold within an<year of �n �t
-i.p.scifor the owner-builder will have the bvdcn of proving than he did not build or
improve for purpose of ale.).
LED
_._.. ._. - . . d. --. __ . . .-- .. ...
❑L a awoer of thePraia,n y d Prof ion, license)conve<torno
Y.am esdusivd y .. ..._... ._.__ _ . .-
<onswa the project(Sec.]004,Business and Pro(wions Cd<:]The Contamor s MAR.1 9 002 •• `
License law dos not apply to an owner of pmpeny who builds or improves thereon, i
:. .and who cotrazu for such projects with a contra ours)licensed pursuant to the. . i.._.
Convector's License law.
❑l am exempt under Sec. ,B'&P C for this mason BUILDING -
_ Owner' - Data
"WORKER'S COMPENSATION DECLARATION
1 hertby off tm under penalty of perjury one of the following declarations:
L/I I have ane will maintain a Certificate of Consent w self.insum for Workar's
m
> Copemtime. " Provided for by Section 3700 of ,he Labor Cone. for the
rma
perfonce of the Work far which Nis pemdt is issued.
❑1 have and will murrain Workers Compensation I...omcc as required by Section
3700 of the Labor Code,for the perrormence of Ne work for which Nis permit is
houed.Mywrolmes Compenimio Inxamount carrier and Policy number are:
Cam<r.`S .tQ i'Iw✓LD Policy No.:
CERTIFICATION OF EKEMP ION EROM WORKERS',"
COMPENSATION INSURANCE a ' � •' - "' •' '�' - `
(This minion need not be complemd ifth<permit is for one hundred dollars I
W)or less.) - s
1 cavity that in the perfomunce of the wore for which this permit is issued,1 _ ---' •*� _
shall no,employ any Person in any manner so as to become subject to the Workers
ConKno ed laws of California Data
' '
Applicant
NOTICETOAPPLICANT:If,after melting thu Cenrficam ofE - --
becomesub«tto,heWorker'sCom nation err Code,you
most "- -- - - -
OZ 1 pe provisions o k dLabor Code,you mus
Q forthwith comply wish such provisions or this permit shall be eeemcd revoked.
..'^2iia rp CONSTRUCTION LENDING AGENCY
j f 1 hereby eRrm that there is a conswetion lending agency for the performance
(i7 of work for which this permit is issud(Sec.309],Civ.C.)
A Lathendcr's Name
IandeisAddmss
V 0 1 sanity Nm l have read this application and sum that the eW,a infomutlon is '
0 [..av
coert.I agree to comply with all city and county ordinances and sate laws relating
U 10building carswction.and hereby amharixe representatives alums city to enter up.
>a [r] thea tioned property for inspection purposes,
iA. (We)agree to saee.indemnify and keep harmless the City of C.Pamr.against
h• liabilities,judgments,casts and expenses which may in any way accrue against said
f.i Z City in oneaqucnee of'he granting ofthi,permi, n
ate' APPLICANT UNDE STANDS AND WILL COMPLY WTfHpL1,tiON.POINr 1 ' ��
soogc�gEg,ULkN�� 3/r`a,7{ Issued by: D
Sign rum or App Ill,Dan omra<mr .0 2 Re-roofs
r RDOUS MATERIALS DISCLOSURE '
Will the applicant or future building occmpant store or handle haurdas minimal ,.Type Of ROOF
es def ned by the Cupertino Municipal Code,Chapter 9.12,and the Hdth and Safety
Cde,Section 25532(.)+ / -
❑Yes X'1 No
All roofs shall be inspected.prior to any roofing_material being installed.
wtu me.Ppbranterr Pomre wilding accugnt aae egwpmea or devices wm<n If a roof is installed without first obtaining an inspection,I agree to remove
cmi,Is ardous air conmmmams a fined by the Bay Area Au Quality Management
1O1'T all new materials for inspection. Applicant understands and will comply with
fI ❑Yes -
�,y all non-point source regulations.
5 of the
C.B(orn Neem&Safety Code.Sections125505 25533 and 25534.1 tionkrau d that
iftic building does not currently have a tenant,that i,s my responsibility to nmify the
m
cupaof the requirements which most w met pno,to issuance of a Cenlficam of -L—
an
P
d OoZ Si nature Applicant Date
«aa"a edge^' Date All roof coverings to be Class "B" or better
. � . ... .. .. OFFICE
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MTY OF CUPERTINO 00 Z 63
SIGN
CITY OF
CUPEkTINO PERMIT APPLICATION FORM
APN# Date:
Building Address:
to 4-5 S . !fin Zo Blrl
Owner's Name: Phone#:
Contractor: License#:
�;Vs6�a
Contact: Phone#:
2 o — V�O
Applicant/Contractor:
Si ns Me-
Building Permit Info:
BldgElect Plumb Mech
Job Description: t Vl u "n S,y-n .
Residential: Commercial: ✓ -
Sq.Ft. Floor Area: $/Sq.Ft.:
Architect/Engineer: Valu ion:
ype of Construction: Occup
on
Qty. if
licable Fee ID Fee Description Fee Group
BENERGY Ener 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 Rmd] Sings, Marquee ELECTRICAL
e
BUSLIC Business License
BUILIDNG
CITYBUILDING Dpv SiONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT N0.
10745 S DE ANZA BLVD ALLEN SIGNS INC 02030009
OWNER'S NAME: APPLICATION SUB DATE
MARIDON BRIAN TURSTEE 1982 STONE AVE 03/04/2002
PHONE: SANITARY NO. CONTROL NO.
(408) 280-6500
00 ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
mai T� L L—J I_J
• ,P„i LICENSED CONTRACTOR'S DECLARATION Job Description
Z= 1 hereby affirm that I am liccnad nndcr provisions of Chaprcr 9lcom otmeing P
mL. wimSectior70001ofDivlsmd3ortheBusinessandPmfessionsCade,andmyliceire SIGN (INDIRIDUAL CHANNED LETTER)
z aJ is in full rorecund eBe l_
a License Cls Lic.or S SS
%O n U Dam 0' Comoro, Alleir, S40
LL O fin ARCHITECTS DECLARATION
g 1 understand my plans shrill be reed as Public remrdn
�_ce_0 O Licensed Prulessmnal
ce OWNER-BUILDER DECLARATION
M 1 hereby strum that 1 a empt from the Cumrterm's License Law for the
F? following reason.(Section 7031.5 Business and Professions Code:Any city or county
a,Fo wnrM1 or,mm,apermit tt ' lur,improve,demolish.or repair ysracmrc $2000
priors its an« I q tl pplicant for such permit file g ed orement-
that bulllicensed p R a n the prolusionsofthe,Contractorsad LawyC,Cas) i.'I ,* {„i' �. 'b-A'glff,"_�va ValUflClOn
Isom n-gwhhSche 7m oil
1heba 3 of the Business dc,u diumAnynrCnim ..). .a3 V111,,,ii/ t 11x.1 .A i�l.`v`.
or Na io rs oump31.5 b any err m and the basis for the alleged c pliant to a civil
violni on
ofSection a the.5 , any applicant fora permit subj«ter the applicant m a civil penalty p I��mb��
arnosoweroftheennum,
employees
304 '_ RRtJUGH ELECTR CAL' Occupancy Type
❑1,s owner aftne and
theproperty.rd my employees with wages fe ed f sole armpensmion,
will ne ,and Pro and the.qdc:Thi%'nuftor'sintended en offered hoes not(Sec
to cal
Business and Professions Cuda The Contractor's threo License Law does not apply m an Required Inspections
owner ofn his o y who builds or improves Hereon.and who does such wink himself
or
or though his own cmpluyxes.provided Nat such improvements are not intended or
'
dirtiedforsale.If,howaeerwill ive the urge ofprortn wW within one build of
completion,for the owner-builder will have the burden of proving thin he did not build or . .
-
improve for Puryase of.wleJ.
. .. ._...._._..
Of.as owner of the progeny, oin IY t i 'tri 1 tensede Contractor
to construct the t..,ror,(S 7044 B , d Professions Code)The Comhe. s
License Lax docs n f .pplysic nor of p pony h builds se improves thereon, -
..and who centrist"Licas for. ch Projects with ntmnor(s).l ccnud pdrsuam to'hc .. ..__ ... __ ...___ _... ..
Contractors LrcenderS
❑lam exempt under Sec. ,B&PCfor this reason
MAR OOwner" 'Date
t6 2002
WORKER'S COMPENSATION DECLARATION
I hereby alliin under Penalty of perjury one of the following declarations; U��D9N
❑ 1 have and will maintain a Cenm ificate of Calling self-insure for worker's G
Compensation, u provided for by Section 3700 of the Labor Code, for the
performance of the work for which this Permit is issued.
❑1 have and will maintain worker's Compensation Insurance,as required by Section
_ 37W of the Labor Code,for the Performance of the work for which this permit is
issued My Warkars Cu p t 1 arric carrierand Policy rambw,are
Gta` S Id Q nab Fali No., 33 Z 0000asi
11 _
CERIUM t!
OF EXEMPTION PRUM WORKERS"' 1 t.+. gt{;},t, :{, ,1. . i , ('4 �(t'•�. ,.
COMPENSATION INSURANCE.',- 4 r 1'' Srn.ti s
•
__�
(nil m'can need not be completed"f N permit is far one hundred dollars • l 1' �-��-�-_
151007 or less) " ` '
1 comfy that in the PerformanceN work h this' t uW 1
•Coll not employ any person in any manner to
as to become subject
c''o Ne workers' -
Compcnuuon laws of California.Date
Appli
nt
NOTICE
OTICETO
APPLICANT ,after ourkiag this Certificate Exemption, should
Qbecome subjecto the WorkersC Pesat Provisions the Lebo Coe you o
at0 rorhwh comply with s h pro r this perm'shelf
is,deemed revoked,
CONSTRUCTION loot LENDING AGENCY -
�' •' 1 h work
which that there is s csued(Sec. lending agency C.) for Ne performance
D-z Lender's Address l
o e rk fo which 1h perm t
L Under'.lcenf Nmlha rtdN" alinkSc3d9t rcthm• . . . .__. ..- .. .. - .. .._. _ - .._. ...._ .. - .. . . ..-
oaz
U Y OP the b mfornmian is '
E+ correct I agree 10 comply with all city and county,ordinances and state laws relating
U to building conswction,and hereby authorize'representatives Mthis city to enter upon
p+..W the above-mentioned proPery for inspection purposes.
t-e.46` (We)-gree to save,indemnify and keep harmless the City of Calmat,against
IOliabilities,judgments,costs and eapenses which may in any way inside against said
U.Z City in consequence or the griming of this permit; - •
APPLICANT UNDE STA NDS AND WILL COMPLY WITH SAL NO'%POINT"
SOURc L NS . , 3�„j' Issued by: D 6�/
�t2 oZ
Srgnawrc of PPncan ntractor .., ”. .' . p-r�e Re-roofs
ZARUOUS MATERIALS DISCLOSURE
Will the applicant insurance Wilding occuP t amid or handl hae4rdom m tool _ ..Type Of Roof
as decided by the Cupertino Municipal Code Chaplin 9,12 and theHealth and Safety yp
Cade Set 25532( 1. fhv) ' r d- 4 �' ' s�lh
..
Eyes - �N 's r, t 1't
- All roofs shall be inspected prior to atiy roofing material being installed. _
NII the applicant future Wilding occupant use c quip rde ces which If a roof is initalled without first obtaining an ins ectiori,I agree,to remove
'emit hazardous a contaminants fried by N B.,A ea Ai Q al ty Management g p
chat N all new materials for Inspection. Applicant understands and will comply with
all
non=point source regulations .,, p
I Y .
1 have read the he aardo ma nils req-roman's undo Chapter 6.95 or the
California Health&Safety Cod Sections 25505,25533 and 25534.1-understand that
if Ne budding does not camently have aisnot that it is my responsibility',notify Ne
capon'of the require ems which must be met prior to ojimmce of a Cenificary of 3
ore-p. - °3 Signature o Applicant Date
i,. ..
OZ
Owner or ambo' ddgrm' Date All roof coverings to be Class "B"or better "
. . OFFICE..