06090146 CITY OF CUPERTINO
BUILDING DIVISION PERMIT OW1�!I;+TR &TQR I� '�,
BUILDING ADDRESS: APEX IMAGING & PAINTING PP"MITND'06090146
21855 HOMESTEAD RD
WPERMR'S NAME:
IT 14UE DATE
CONOCO PHILLIPS 2700 N GAREY AVE 09/19/2006
PHONE: -SANITARY NO. CONTROL NO.
(909) 593-9539
ARCHITECT/ENGINEE0.: BUILDING PERMITINFO
BLDG EO PLO MO
30W o LICENSED CONmACTOR'S DECLARATION hob Description
i 1 knobby arcirm this 1 am IkrenatN unties provolone of Chapmr Y(commcndn{
with Section 70010af Dl vol 143of the Buslrcsund ProfmnsI" Cnde.admyliconseh
in roll rortt.red ercea SIGN--MONUMENT/CANOPY FACIA WITH SIGN
3�z Lae as las a Llc.a Y6769-51 76 GAS STATION
Dau T'S DEC
3�
As Shall use DEC O
E I undcnunJ my plana shall M used as public records
1
c sed Licensed Professional
pOWNER-BUILDER DECLARATION
y I hemby affirm that I am exempt from the Cumractars License Law far the
p o following recon.(Section 703 1.5,Business and Protections Calc:Any city or county .
$ which requires a permit to cnnswc4 slur.Improw,demolish,nr repair any structure
-x icy' prior to is issuance.alms squires tire application fersueh permit in file unlined ataemcm VaIU 0000
gin G Nat he is licensed rommornl w the provisions of Be Conuacmra Liam law(Clupur 9 Sq.Ft.Floor Area
(commencing with Section 7000)of Division 3 of Ne Business and Profusions Cook)or
$
but he is commit therefrom and the Was for the alleged exemption.Any violation of
Section 70313 by any applicant for a permit subjects Na appluuuo•civil Penalty o! ppN N�rsler 0 0 Occupancy Type
comm me Bun fire hundred dallas,(3500). 3 2 07 4
0 1,u awm of tie proprny.m my amploym with soaps u tie'u wlcampmuadw,
acid da Newark,ands: he ComumtinLMnse Low and ul apply 70a4,Budrcu Required Inspections
and property
who bis code:The Contramm'.License law dm Out appy fr r L owner is - q P
property who buildsartimproves Thereon,and who doeaouch work h r offered
his
Own emploYm,provided Nm such isprowsuuareatIneMNm leered for cls If.
however,Ne Wilding or iron Of prontssold withinme ildofcosre.parNeowmx-
builder wIB low the burden a!proving W,he did at build o improv fo purpose of
au.).
0 1,as owner of the property,am exclusively contracting with licensed contractors to
construct Lou project(Sec.7040.Business and Pwfeuions Code:)M Conurtmr7 Ll.
1-1 law dm not appy man owner of property who builds or Improm meman,and.
whocantncu for sueh projects with acour acmr(U licensed persons,or Ne Contrnmes
License Law.
❑14m exempt under See .B k P C for Nin recon
r Dau
WORKERS COMPENSATION DECLARATION
1 hereby arm under Penalty of Perjury m of the fallowing dealmdace:
❑1 ham and will maintain a Cenilicamaf Consent to self-Insure for Worker's Compen.
nation,at provided for by Section 3700 of the Labor Code,fm the performance of the
wart for which Nu transit is issued.
0 I low and will maintain Workers Compensation Insunna,a required by section
3700 of the labor Cale,for the performance of the work for which this permit is issued.
My Workers Compensation Insurance carrier and Policy number are:
i
o A9
'_Carrier. � ECLTE.OFiC7 PPnOIINeYFNROMWORERS'
COMPENSATION INSURANCE
: -
rrnis section and net hocompleud if me permit In foronc hundred dollars,(SIM)
or less.)
1 anih that in the perforeaace of the work for which Nis Permit is issued,I"I not
employ any person in ay manner w as or become subject to the Workmt Caopemation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:IL after making this Certificate of Exemption.you should
become subject in the Workers Compemdon provisions of Ne labor Code,you must
oO foMwiN comply withsuch pounuoru or Nu permit shall W decsed revoked.
z CONSTRUCTION LENDING AGENCY
i-v l hemhy affirm Wt tem is a construction lending agency for thc Performance of
G'> the work to,whim No Permit s issued(So,.3097,Co.C.) ..
Landers None
=Z L '.
endeAddress
U O I certify Na I haw mad Nis application and mu that the above information is
U counter,1 agree to comply with all city and county co imued and state laws ndininB to
QU building construction,and hereby aumorim ormetemariws of this city m enter upon the
U ahavcmemiuned property for impaction purposes.
P1, (We)itgree to sew,indemnify and kap harmless the City of Cupertino against
CA liabilities,judgmena,coats and expenses which may in any way accme a&, said City
U Z in consequent of BIN granting of this permit.
APPLICANT UNDE ANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date '(
SOUR NS.
45560oc,w Re-roofs
3I{4tuM1 xppli dCmuacmr Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Be applicant ar future Wilding eccupar,s me or handle basrdous material
dented by the Cupertino Municipal Cade,Chapter 9.11.and the Health and Safety
Section 25531(.)7 All roofs shall be inspected prior to any roofing material being installed.
Dy.
Will Ne applicant o future building accupanl sew equipment or device which If a roof is installed without first obtaining an inspection,I agree to remove
omlt hooamou air conuminwu u Jefiad by the Bay Arta Air Quality Mwagement all new materials for inspection.
DIWIcl7
DYes 01,10-
I
4rI have mad Ne he?"=materials requirements under Chapter 6.95 or Ne Critter.
.is Heal&Safety Code.Seetiam 35505,25533 and 25534.1 understood that ifthe building
J wamna.that i,o my mapoalhilky in MoKy te=upset of the
requlremcrm which me,pdorwissnancuaf.catife,te aracupwq' Signature of Applicant Date
acne r nce scol
All roof coverings to be Class"B"or better
siDau'