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04060262 CITY OF CUPERTINO ''�``' °+ '"i" " `"' f3` - Ruu,DINc Drvlslory .. PERNL CONTRACTOR INFORMA�N Ahaai.y 3 ft- # i+ii ,x` ,,. "� 9s?;iizfi->u OUILDINGADDRESS: SIGN DEVELOPMENT INC PERMITN904060262 1699 PERMIT ISSUE DATE 'NLR'S NAME: VALERO GAS STATION 1366 WEST NTNT14 ST nr / �n/9nn4 PHONE: SANITARY NO. CONTROL NO. 909) 920-5535 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH uoo LICENSED GDNTRALTOR's DECLARATION lob Description 1 hereby affirm That 1 am Pune Bu inti provisions of,Credo. 9(commencing w with Sectio ]OBtpaf that IamI thesed-it ow reasinns Cndeandmylicense is inmum1a��anderren. �7� Z� 7 SIGN--SIGN ALTERNATION j ? Liu Cy+:xA Lic.g / ZFp D�� s��cuntragorJl j"1 pp✓� ARCHDECS DECLARATION W .�r11✓ / ,? `-(_C'�(\' C-s 1 understand my plans shall used as public records 9/ JnU Vc/ N Licensed Professional l OWNER-BUILDER DECLARATION je Z 1 hereby affirm that 1 am exempt from the Contractor's License Law for the a O fallowing More.(Section 1131.3.Business and Professions Code:Any city or county K m which requires a permit in cnnswct.ARM impmve,demolish,or repair any structure ''I m poor to its issuance,also requires the applicant for such permit to plc a signed statement -s< that ho is licensed pursuant the provisions of the Cor's Licensor Law 9 Sq.Ft.Floor Area Valua[Ion ttmrum 0, (rpmmcncing with Section 700B,of Division]of the a usinas and Prorcnians Code)or i — that he u exempt merefmm and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a Permit subjects the applicant to a civil penalty of3 y�NCI7uk*er0 0 Occupancy Type not mom Nan five hundred dollars($500). ❑1,as owner orahe pmpeny.or my employees with wages as tieir xnle compensation, ' will do the work.and the structure is not intended or offered for late(Sec.1044,Business Required Ins ections and Professions Cade:The Commences License Law docs not apply to an owner of 9 P progeny who builds or improves Thereon,and who does such work himself or dlrough his awn employees,provided that such improvements an,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 W did not Wild or improve for P.I.of sale.). ❑1,as owner of Ne progeny,am eaclusively ecoure ing with licensed contractors to construe the project(Sec.70,14.Business and Professions Code:)The Cmirmou ri Li cense law does not apply men owner of pmpeny who Wild,or improves demon,and Who Contracts for such projects with o Contractor(s)licensed pursuant to the Comnctoh License Law. ❑l am tempt under see. ,B&PC far this..on oar Data WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury arc or the following declarations: I have and will maintain a Certificate of Consem to selr-imum for Worker's Comped. sation,as provided for by Section 37W of the labor Cade,for the pamformanm of Ne work for which this permit is issued. 1 have and will maintain Worker's Compensation Insurance,as required by Section 3700 of the Labor rr.Code,for Ne Performance of the warts for which this Permit is issued and Myme'. l�1ytl no r I crPol'Icy PqY ni CERTIFlCATE OFFJCEMPDON FR MWORKERS' . COMPENSATION INSURANCE Tris union need not be completed if the Permit is formic hundrod dallass(3100) In less.) 1 comfy that in the perfmmonce of the work for which this permit is issued,I shall not employ any person in any mannerse,as to become subject in the Workers Compensation Laws of California.Dare Applicant NOTICE TO APPLICANT:If,after making this Ccnipcare of Exemption,You shout] became subject m the Worker's Compeosau an provisions of the labor Cade,you muss .�O forthwith comply with such provisions or this Permit hall revoked. Z CONSTRUCTION LENDING AGENCY [-. 1 hereby affirm that there is a connmetion lending agency for the Performance of B4 > he work for which This pc mit is issued(see 7097,Civ.C.) Q nd 's Name 0. •Linde z (— U O 1 comfy that I have read this application and sure that the above infamalimn is D.F" Correct.I agree to comply with all city and county ordinances and sure laws relating to QU building ConsWction,and hereby¢uahmne repre{entalocs,of this city to enter upon dlc ahove-mentioned pmpeny for inspection p mpma:s L, (We)agree to sore,indemnify and keep harmless IW City of Cupertino against rd, liabilities,judgments,costs and expenses which may in any way accrue against said City J in consequcncc of the granting of this Permit. ^� APPLICANT YNDERSTADS AND WILL COMPLY WITH ALL N N-P01 T Issued by: Date SOURC RE U ATION& l' + `=-��� •—� f Re-roofs s nalur r pplicant/Commcmr Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building Occupant store or handle ha mous imperial as defined by the Cupertino Municipal Code.Chapter 9.13.and the Health and Safety sale Section15533(a? All roofs shall be inspected prior to any roofing material being installed. 0C �0No Will the applicant of future building occupant use equipment m devices which If a roof is installed without first obtaining an inspection,I agree to remove ' mit hazardous air rnnmmiwnu as JcpneJ by the Bay Arca Air Quality Management all new materials for inspection. Distrix? Y� ❑Yes ( 'Nu 1 have mad the hmarNms materials requirements under chapter 6.95 of thc Califor- nia Health&Safety Code,Sector 155115,35537 and 25574.1 undcrsund Naz if he Wilding i2mnently havC a Ienan4llldt it 11 my ICSpmRSihiily to notify IhC p:CupNt Of IIIc k.whir�ndgaalxmel'p mrmi¢aa re awry catedrayPlicy. / Signature of Applicant Date All roof coverings to be Class "B"or better Owner or aalhmimd agenl r c w 1 U c0 N y C On o s Q 0> o G G co u Od 04 Tza 6LLJ o � o £.9 N �a C'> 6 m 1 OVONNd -2Z 4.L ^ Z C 7 v ..o-.01 /. Vu 1 �@.���1 U m •^E 4 F 9=5 ou0 8 W f0 N7,I.NV'Id U G� * i y i ,V V $ o 2, 0 JI'ItlM9C1IS `� 4 °.IS S V Q V o r � t ZW d J U W W vy.l .Slt �1 �3 a .225 eSVfI DNLLSIXH\\ F- Z n o -Y�1 'J 0 adl-I�a;IH.LS NO 0901 N H �e `e 3 D - ,.I I'.S i p �° v4 NY � O ° ; ✓�p' t,51 F r1 � Z i aF it - Iii 4k1i1�° t�f�ei � 1 NR 3 01 1 SIH lit off" VQ, vj 15 ZQ LJ ;t �, \ / 3 ! ; - ^ ^ ~ it } } [ / . . Q=5 � ^ � L � p> To � u a Z �!P �.q g 0 Z .2 O` 00 ,14 CC) Z Z Z/t .00 OO z u 0 co r7 n C's �u pm Ni ,ea ti c c Q o 0 0 � o o � 2 rco ® rg O rn m C O o 9 b L CWF C,, C G=p U �v J Ulm 6 �Z °' opo o 3s x iw O�U JC KC ¢C W Y•y'S' Ks. o c ��< <� �� s `4`e��lyRa..;.j�+4y� �,1'/ Ns � �z y •,i� ¢ z UFa \ fZ•� o _'cox1- =� 3c m< W JyWI'• ..A $W ~Z 1 4 3"•. 6 ZL 6��J-r�ii yah WC LL C_CO WzWz '•� / •2 •L �JwO EW 6C •e �{yn ANtM1f h4Jl ?_s c t.,�i.f•'��y - w _ c �"F'_�c "a r c �� 6��Y Fry' y6 Z `✓ G La>< Ftp NW xQ w Q us G v V u o Z L J OCJ • o .. .. o z m no w j F F � C J ZI"J F+I VW•CiZW ryF s3 z pop ,�.op sap \ a U � § - �( � \ � .� ) � . Ja � �) �\. � �/ ) § $ / �g �§ � � : CITY OF CUPERTINO 6 ZIM SIGN OCUPEI�TINO PERMIT APPLICATION FORM APN # / / / Date:6 7 O C� v Jn v Building Address: ' 1lr n � I �e Owner's Name: va IQ Phone#: Contractor: _ ((�� ````'' License #: SileXD W�P�/C �(/�L . Contact: Phone 6,0-J 9d 5) gad s s �s A lic /Contractor: / - G!170 Sc,, YY f i t�} Building Permit Info: Bldg Elect Plumb Mech Job Description: Residential: `fi �v Co c 311n 6. 14P.r4?70✓l Sq.Ft. Floor Area: $/Sq.Ft.: Architect/Engineer: Cost of Project; �— Type of Construction: Occupancy Gro Qt -if A l cable Fee ID Fee Description Fee Group BENERGY Energy 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 Rmdl Signs, Marquee ELECTRICAL BUSLIC Business License BUILIDNG CITY OF CUPERTINO BUILDING DIVISION PERMIT CONTRACTORINF©RMA ION 'E BUILDING ADDRESS: SIGN DEVELOPMENT INC PERMIT"x04060262 1699 OWNER'S NAME: PERMIT LSSUE DATE VALERO GAS STATION 1366 WEST NINTH ST oc/3o /2nn4 C: SANITARY NO. CONTROL NO. (909) 920-5535 ARCHITECT/ENGINEER: BUILDING PERMIT INFO till 13 BLDG ELECT PLUMB MECH 0 LOT, LICENSED CONTRACTOR'S DECLARATION y u C I Wreby affirm that I am li¢vcdy"provisions of Chapter 9(commencing Job Desc u �zto with Section 200A.f Division 3 ofthe Bu M professions Code.and my license is « inrullfo defect. SIGN--SIGN ALTERNATION =�o o ` ' �C g V SEP 2 9 2004 '�q'�' c ARCHITECTS�LARA ON a l understand my plans shall W used as public records 0.O� Licensed ProfessionalIN a OWNER-BUILDER DECLARATION y<z I hereby affirm that I am exempt fru.he Ci manoYs License law for the BUILD G z O O fallowing reason.(Section 7031.5.Business and Profesnnns Code:Any city or county K m which oxforx a permit to construct,alter,improve,demolish,or repair any structure 8000 �Iy prior to its issuance.also menuins the applicant for such permit to file a signed statement < Nat he is licensed purcuumb,am rovisimstofbeC.Owwor'sU..U.(Chapmr9 Sq. Ft. Floor Area Valuation QFC (commencing with Section 7")of Division Sof the Business and Professions Cade)tar i that he is exempt duration,and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant.a civil penalty of 36e1Q4u'h*cr0 0 Occupancy Type not mom Nan Five hundred dollars(SSW). - I,az owner of the property,in my employees with wages as their sole compensation. will do Ne work.and the structure is not intended or offered for sale(Sec.7614.Business and Profeadom Code:The Contractors Liame Law dos Out apply in an owner of Required Inspections Property who builds or improves thcran,and who dos such work himself or through his Own employees,provided that Such improvements art not intended oraRved for sale.If. however,we building or impro,cmcnt is said within one year of amplcuon,we owner- builder will have the burden Of proving Nu he did not build or improve for purpos,of snit.). ❑I,as owner of we property,am exclusively contracting with licensed contractors to construct the project(Sec.7044.Business and Professions Cade:)The Contractor's Li. nose law does not apply to an Owner of property who builds or improves thereon,and. who contracts for such projects with a contractor(s)liansed pursuant m the Cmildra a License La ❑I am exempt under Sec. B A P C for this reason , Owner Due WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following decluations: have and will maintain a Ccrtifca.of Comenuo self-insure for Warkcr'sCompen- tion,as provided for by Section 37M of the labor Code.for the performance of the wart for which this permit is issued. 1 have and will maintain Workcls Comperaation Insurance,as teyuired by Section 3000 of use labor Code,for the perfar.snee of the work for which his permit is issued - MyWmke CyampepFs�astion lin dra la c—ajrrier and Pyy�y nuiteraam mer. TUI C- I ✓a Il.{ Policy Pq:�s55S . CERTIFICATE OF EXEMPTION FROA1 WORKERS' COMPENSATION INSURANCE (Thissabitm neednab beats cotdifthe permituformuhundmddollam(SKKs) tar ksa) 1 certify Nat in the performance of the work for which this permit is issued.I shall not employ any person in any manner sa az in become subject to NC Workers Compensation Laws of California.Outc Applicant NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you should WCO.e subject to the Worker's Corn pemmion previsions of the labor Code,you must ,Z forthwith comply with such provisions or this perm i,shall W deemed revoked. Z'O CONSTRUCTION LENDING AGENCY . 'e. I hereby alErrn Nab there is a consorted..lending agency far dm perfomamx of iY the work for which this permit is issued(Sec.709'1,Civ.C.) W�Q Lender's Name =Z fender's Add. V c:) I certify that i have read this application and sow that the above information is Lt. (•-' correct.I agree to amply wit all city and county ordinances and stain laws relating to V building cansoruction,and hereby aut oriae representatives o(fl s city to enter upon the r show Mentioned Property(Or inspection purymca F"y st liabilitiuWjudgmncnts.costs and xpeto save. yases whiicch may in anlwasy waytaccom against mof Cupertino id City U in consequence of the granting of this permit. ^ APPLICANTJVNDERSTAJODS AND WILL CO PLY WITH ALL NQQWN-pot Issued by: DSa e q--�'�1103;` SOU RC E tf ATIONS b/ ( Re-roofs S naur f pylic ✓Contorm o Da HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future Wilding occupant time or handle hxear amen material az defined by the Cupertino Municipal Code.Chapter 9.12,and die Health and Safety Code. E)Y. ss3z(a)' All roofs shall be inspected nor to an roofinrs material being❑Yea )a No P P Y o g installed. Will the applicant of four.building accupam tax equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove t havardnua air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. mricR O Yes rNu I have mad she haraNd.s.uerials requirements under Chapter 6.95 of the Califor- noHealth&Safely Codk,Sceuom 255(15.25533 and 25534.1 indersuM Nuifthe Wilding tlpes not currently have a tcnanL dot a u my responsibility w rwdfy the oauPant of the rdg)r.men�icylm u borne rtes�rgnQ aL,fc xtaara y.� Signature of Applicant Date own— —ni,adag t �.C� J of All roof coverings to be Class"B"or better