06030121 CITY OF CUPERTINO -
BUILDING DIVISION PERMIT .CONTRA�TORINF�ORM, I,ON
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BUILDING ADDRESS: MINA TREE SIGNS PERMITND'06030121
23000 HOMESTEAD RD
ERS NAME: PERMIT ISSUE DATE
JAYNE HAM 1233 E RONALD ST 04/10/2006
PRONE: SANITARY NO. CONTROL NO.
(209) 941-2921
ARCHREC(ENGINEER: BUILDING PERMIT INFO
BO EO PLO MEOCH
LICENSED CONTRACTOR'S DECLARATION Job Description
I U 1 bereby+form IMI I sen licensed under Provisions of Chapter 9(commencing
with Secdan 7")afDiviAon 3.1'the Business and Professions Code.ad my Ii.c.is
infanforceandefee.C_ S Lmg -)9q q57(' 2 ILLUM WALL SIGNS11 MONUMCH LLUM
0 Z License ns
3F— Dem conuadr y SIGN-WELLS FARGO BANK
NAtED
ARCHITECTS DECLARATION iNC MINA-TREE SIGNS PAID FOR BL
4 I understand my plans shall be used as public records
APR RV 2006
s C C Licensed Pmfeaeonal
s OWNER-BUILDER DECLARATION
i N 1 hemhy atnrm that I am exempt from the Contractor's License law for use
p O following wan.(Section]ID 1.5,Business and Professions Code:Any city or countyski III nikla
S! which sequlros a permit w eonsrue4 alms Improve.demmtsh,or mpaif any uroaum
_zi paLheits=nwdpm rtquiroslmasioe.ffofeuchpersnitmfileeaug (chmmem
F C thatbeucenwit pursuant 7000)00)of Division
sinco lianaelsmuC ode)9 Sq.Ft.Floor Area I 1
Y�3
(commencinghhe
tris with Section]and
iasisfrth alleged
hoomnd Prof ea vi Code)or $19900
—
that he s exempt IMrtfrom and the bash for the alleged eampdom Any violation.f
Student 7031.5 by any applicant for a permit ediccu IM applmant to a civil penalty of APN Number Occupancy Type
not mart dun five hundred dollars($300).
❑1,a owner of the property,or my employea with wages a their sole compenation,
will dO Newark.and the s.bee b not intended a OBcred for mo(Sec.7044,Business Required Inspections
and Pmfeudoms Cade TM Committees License Law damal napply m an Owner of 9 C
property who builds minestrone thereon,and whedoes such work himwr or through his
ewnemplo>ea,Is^viaed this abs impfovemenss art atinuended or.lfertd for sale IL
however,th.building"impre—i is sold within me Feer ofcornphaked.site vwrcr-
Wilder wed have IM bafdan of proving that he did.1 Wild or improve fee purpose of
axle.).
❑1,ea owmr of the propeny am ucl.k,ely contracting with licensed conuacmn m
construct the pmjm(Sec.7044.Business and Professions Code)The Convectors W-
cense Law docs not apply in an Owner of property who builds or improves thereon.and,
who comneu for such projects with asoma ctor(0 licensed pursuant to the Cormacmr's
License Law.
❑l an exemp,under See .B&PC for this meson
Dale
WORKERS COMPENSATION DECLARATION
I hereby affirm under peretty of perjury mm of the(alienating decwadumcc
❑I have and will maintain a CerGOaaaaf Consent to self-insure for WorYers Camper.
.it..,as provided for by Section 37M of the labor Code,fe,the performarcm of the
workforwhich We penult is issued.
M-1 navy and will mainWn Workers Compensation insurance.as moulted by Session
37M of the labor Code.for the performance of Rho work for which this Permit s Issued.
My Wafters Compensation]=me e artier and Policy number art:
Carrier. 5'Tlt E-Fu.v� Policy No.:00coia0--2 06
CERTIFICATE OF EXEMPnON FROM WORKERS'
COMPENSATION INSURANCE
I
Crisis section need notbe complexed Elbe permit u for.nc hundred do0an(3100)
or Tess)
1 comfy then in the performance of Ibe work for which this Permit is issued,)shell not
employ any person in any mander an as m become subject to the Worken'Compco a0on
Laws of aRfamm.Due
Applicant
NOTICE TO APPLICANT:If.after making this Certificam of Exemption,you should
become subject In the Worker's Compensation provisions of the labor Code•you mus
,J O forthwith comply with such provierms Or this Permit Nall be deemed mvoked.
r tiCONSTRUCTION LENDING AGENCY
(—s IMreby air.that mem b a construction lending agency for f performance of
a the work fee which this Permit is tined(Sec.3097.Civ.C.)
Qlender's Name
z lender's Addw
U O I ce tify that 1 have road this application end sum that the above Imormatiun ts
V, F turner.1 agree to comply with all city ad county.Ninances and sok taws refining In
OV building construction,and hemby authorize representatives of this city to enter upon the
H above-mcmiuncd property for inspection purposes.
(We)agree to am.indemnify ad keep barrels.the City of CO strrmo ageism
In
liabilities.judgments,costs and expenses which may In my way accrue against said City
U z in consequence of the sterling of this PcrmlL /
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:, 4
; Date r_10_U G
SOURCE RF�UI.ATIgNS,
�Clp Vb AR-2 [n ee_ �,//0J4 L Re-roofs
Signatum of Applfam/C.nuaclrr Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant.for.building occopats ore orhandle bees dons material
a dcRscd by the Cupenia Municipal Code.Chapter 9.12,and the Health and Safetyde.Section 2+532(.)7 All roofs shall be inspected prior to any roofing material being installed.
Yos
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
emit hamdnm air contaminants a de0ned by Ism Bay Am Air Quality Management all new materials for inspection.
Montt? t
❑Yea
IM1ave load NelwaNwtmamr)ssmqulmmenu undcrCMPmr d.93Ofdm Wifor-
nblkalth&SaielYCede,Sced.25505,25533 and 25534.1 unEcmatd that lfdc bonding
does Out currently hese a mnask that itis my snspomibllity an Iwdfy IM oceupat of do
mgmremen which uabemetPrior m of.Cefdam
Rof f�P�''� Signature of Applicant Date
L o't� �l16 f 0 All roof coverings to be Class"B"or better
Owner or milmdzed agent am _