04060097 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CON'I•RAGTOR INFO1.tMATION
,*.'.i,-� 5°'.;b
BUILDING ADDRESS: PRO SIGNS, INC PERMIT NO 04060097
OWNER'S NAME: PERMITL$UEDATB
SARATO
E; SANITARY O. CONTROL NO.
408
ARCHITEC(ENGINEER: - BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
�ap LICENSED CONTRACTOR'S DECLARATION
1 Wntby M.that 1 em licensed under provisions of Chapter 9(commcheing Job Description
with tioa7")of Division]of the Buxuxut:O Protestant.Code.md my license is
n mfall f ndenect. �4Z W I SIGN
n:i� License au Lic.N
q Date Contractor
7W ARCHITECTS DEEM ON
y � ndesstamdmyplana alWlWwW as CMA c records
U
G Licensed Professional
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Conm ctols License Law for the
0 0 following moon.(Section 7131.5,Business and Pm(euiuns Cale:My city or county
n$� which requires a Permit to construct.alter,improve,demolish,or repair any structure nno
Fzr prior m its too.=.also requires the applicant for such Permit to file signed statement
That he islicensed pursuant to tie provisions of the Corrector's I-ce=Law(Chapter 9 Sq. Ft. Floor Area Valuation
$ (commencing with Section 70D0)or Division J of the Business and Professors Code)or
that he is exempt therefrom and the basis for the alleged exemption.My violation of
Section 7071.5 by any appiice.t for a permit subjects the applicant o a civil penalty of 3 "crO 0 Occupancy Type
not mem Nan R.hundred drlWa(5500). .
❑I,u owner Gillet propt ty,w my eoployas with shallow thch role compcwdon,
will do the work end the structure B not intended w.Rcud formic(Sec.701/,Business Required Inspections
and Pm(essioru Cade:The Com eretrfs License Law don nor apply to an owner of -'w 9 P
property who Wilds orimproves dum on.andwho dwsaah work himulf ser through his
own employees,provided Oil such improvemenuue notimended oroOered forde.if. s�
however,de building or improvement is sold wild.one year of compktion,the owner- rj
builder will have the burden of moving the he did not build or Improve for purpose of ''7
sale.).
❑1,as owner of the property,am exclusively contracting with licensed contnnon l
construct dIC project(SCC.7Bad,Business Nd rry Professions CML]TI¢Cemreebrf U.
Genu law docs not apply a an owner of property who Wilda or improv.Centra,axed,
whence Lacts(onuch projects with aconrssmr(q licensed punwntmthe Conuadoh
Liana Law
❑1 the exempt under Set. .B&P C for this reran
13071.1'
er Dau
WORKER'S COMPENSATION DECLARATION
1 hereby affhm under peony of perjury one of the renewing declearwta:
have and will maintain a Certifiak of Consent to aclf-im n.fa Worker'aCompen-
n,o provided for by Section 5700 of the lahor Code,for the performance of ted
for which lb permit is issued.
Mw end will maintain Wortrfs Compcwron Insuance,o required by Saran
le labor Code,for the performance of the work for which lis permit la issued.rtrr's Compensation Insurance carrier and Policy number ate:
er. ry N�s� r
b ZD
CERTIFICATE OFEXEMPTION MWORKERS'
COMPENSATION INSURANCE
(Thissexhon need not W completed Iftie permit is forme hundred dollsopil )
nr less.)
1 anify that In the performance of the work for which this permit is issued,I sledI not
employ any person in any manner an as to become subject to the Workers Compensation .
Le.of California.Date
Applicant
NOTICE TO APPLICANT:IL afar making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you meet
vJ2
forthwith comply withsuch provision or this Permit hall W seemed revoked.
Z O CONSTRUCTION LENDING AGENCY
[—� IWreby affirm that them is I construction lendinsasney for do merfwmencca
the work for which this permit is Wood sec.5097,Civ,C.)
Is10 Lamdc/a Name
0. z Lander:Addroo
V Q 1 anify let I have read this application orb state the de shove Information u
WE correct,I agree to comply with all city and county ordinances and auk laws milting to
O building comrvction,and hereby mthorie,mpmxnutives of this city to enter upon the
.hove-mentioned p.,ny for ina,cron pugrrses
gy (We)agree,to on,indemnify and kap harmless the City or CupcOno against
L.1 liabilities,judgments,coats and expenses which may in my my acme agaiml said City
U 7 in conugancc of the starting of this permit.
•^r APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date ex
SOURCE REGULATIONS.
Re-roofs
Snatureof AppliaMConuanor Dau
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future Wilding occupant more or handle heallous material
o defined by ted Cupemno Municipal Cate.Chapter 9.12,anC le Hall and Safety
Cole.Section 255)2(¢)? All roofs shall be inspected prior to any roofing material being installed.
❑Yrs `�No
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it haxardnm air eonteminanu as clamed by the Bay Ara Air Quality Management all new materials for inspection.
Trio?
'c
VN.
I have mad the hma wsmaMdalsmquimmenaunder .Chapter G95ofle Califor.
nia HcalO&SafetyCale,Secmm21505.25557u 25554.1umlen thmifthe Wilding
does not currently have a tenant.Oat it is my responsibility to nudity the occupant or the
mquimosonswhich rouuWmet pr miasanceofsCerrfiateofOccupancy. Signature of Applicant Date
(�. lt -oi'
cow authrrirtJ egenl Data All roof coverings to be Class"B"or better