02050181 OF
CI BUILDING mvtsIONNDPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
20200 LUCILLE AVE BAYMARK SIGNS 02050181
OWNER'S NAME: APPLICATION SUB DATE
TRAVEL-CROWE 43528 FREMONT BLVD 05/29/2002
-� PHONE: SANITARY NO. CONTROL NO.
(510) 623-1300
BUILDING PERMIT INFO
IWgGIgu o Cz0C ARCHI'fECT/ENGINEER: BLDG EC
ELECT PLUMB MH
PZE
u LJ
i, LICENSED CONTRACT'OR'S DECLARATION Job Description
oZ= 1 hereby a(flm,that 1 am licensed under provisions of Chapter 9(commencing
F_Fou wi,hSecrion70W)of Division 3of[heBugn(ssand Profesuon.Code,and mylicense SIGNS (1 MON, 2 WALL)
isi�full(orcegnd H t. if}
z Lic- Its,
E:3 u m.�.�_ Canusggqsor
c• O g ' ARCHRECTS RATIO 1
Me ndm aaR bits rtcoNs 1
a.E o O Lice ofeasiond S`a
n 2 OWNER-BUILDER DECLARATION
uat- hereby aRrm he,I am exempt from the Contmeor's License Law far thea 1 1
h z a rono ing reason.(Seadon 7031.5,Business mid Profession,Code:Any;ityru court 4"" I $4000
F O which regwra a permit to construe ala,improve,demali y riiiipu,r44nny shunum _
UU3s�_pn t uusuamm.tlso rtquues the applicancfor such permst ggqsss flleaugtad uatemem - - -" -
es. thath'alcensed pukukn to the provisions of the Cantroctors l'.M se law ighpmr9 /1 Valuation
(amnaarrivjmg with Seemn 7").f Division 3 of the Busilow u�yd Pryfzy..Code)
,h t h s exempt tWscfrom'end are bass for Ne allege)ea �p.Ahy Imbriumy 'T,
-afSnuon 70Jl5 by arty applrcen fare, imbints Neapp] neoe civil peryJry
of nal man,than Five hundred do[on,Ig500). ttPN t��,ry,�� Occupancy Type
101 FOUNDATION
❑hes owner of Ne pmpcny,ur my emplaY¢a with wa,as.,hci tion.
-wiR do Ne work:snd'*a structure Is not intended or arceraci ar'aale(see.70114, 193
- Required Inspections
"
'Business and Professions Code:The Contractor's License Law does not apply to an 104 - REBAR q P
owner of property Who Wilds or improvesthe...,and who dues such work himself
or rhmugh his own employees.provided Net such improvements are not intended or .. . ._. 105 ANCHOR-BOLTS_
- coRrtd'for.stile. wner-Wlderwilllavehebmdnv ofinemusthaathedidnotWildoor 304 — ROUGH ELECTRICAli `'"`"`
'offered for sale owner proving
impmve for purpose of sale.). 505 -- .FINAL ELECTRICAL
L71:ammrarthepropaty.meadusivelycontmeingwirhlicensedcontriciorsto 514 - FINAL PUBLIC WORKS -' •' '
conswct the Project(Sec.744 Business and Professiam CAc:)The Cantnetor',t -
Licer,x law does not apply to an owner of property who builds or impmvn thereon,
-and"who contracu.for_such.projecurwith.0 conweor(s)licensed pursuant to,the --- -- -- — - -'-
Conmector's License Law.
°I am exempt under Sec. 'B&P C fonhis¢axon I
_
0,6ar 0,6aDam
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
Of have and will maintain o Ceniflwm of Consent io selbimua for Worker's
Compensation, a pmvidcd for by Section 37W of the Labor Cade, for the
` 4 - performance of the work for,which this permit is issued.
°1 have and will malmain Worker's Compensation Insurance,as squired by section
- 37W'6f the labor Code,fat the perfannvnbe of the work for which this permit is
issued.My WrkersCompensation Insu a carrier and Policy number are
SA _
at: f. CERTIFICATION oN�FRO ORKERg
- COMPENSATION INSURANCE " "ss
(This section need not be completed of the permit is for one hundred dollars
1g100)or less.),
I certify.,thitt in the pe/formynce f the work for co ch this perof t e Issued,I �
shill 't tion L hey person rr any manner sdas is becomesubject to the Wnrkea
Applicant'
y Dam' '
Compensation utas o o i ornm.
NOome aTO APPLICANT 9f,after ranking this Cano of Exe rt ,on,YOU should -
hecomesubmply it suchprovaons or this permit
shall
theLabormvokc . mus,
j Compensation provisions
- deemed revokN.
.� ofrhe work for which thane is'a const (Seoo nN0iling age ... . . .. .._ - ..._ ... ._. .. ._.— _. __ ..
O forthwith comply with such mu shall be
AGENCYthis
1 hereby hick that thperem srinit s construction(Son lend n agency for the performance
Le der's Name-._. ,.... . -. ... '�
t_Z LenderAddress f ' 5l 't,1
I '
.'
certify that l have rcud,his city
and ion and uacethat ances a shove information mion is
�T+�U sorted.-n co to comply with all city imize county ordinances and scam laws relining
"W to mBuildingcanumeion,andhcrebyuwction representatives of this city,o enter upon
Tai Ne above-mentioned propend for inspection and keep
purposes.
p. (We)agrcemevve;indemnify and keep harmless the city of Cupertino against
F V1 liabilities,ju'gmey`s.cosu and noting of cs which may in any way vccme agoinu said yfrl ,
City in<onsegt RyE of rhe gmming of this permit. L/
_ APPLICAIQ'a fUERS'f.. NOW MPLYN'ITHALLNONPOINTy Issuedb Date
SO' f i , CATIONS. ' Z8 Y•
S a Applican,/Conirmtor Dam Re-roofs
9 .HAZARDOUS
Will um MATERIALS DISCLOS E
ePPliwnl ogfumre Wilding oecupvn,store or handle haiardous material Type of Roof,
a5 defined by the Cupenum Municipal Code,Chapter 9.12,and the Health and Safety
Code.Snton 25532(a)? , . .' tl
°vis° i,y."vAllroofsshall beinspected.pri�oFr.+tod.aSn4 y!-roofing ••;1•' I
material being installed._-_,_,. .-
Willtheapplicantorm m building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
arms hararJon,air c r - m a teed by he Bay Area Air Quality Monegemem
311 new materials for inspection. Applicant understands and will.comply with
all non-point source regulations... .
I have rrad'che ha.Man'mea"'mquimme as under Chapter 6.95 of the
CaLfomia Heath&Safety Cede.Sshumts 25505,25333 end 25534.1 understand that
if the Wilding does eat comemly have o mnsn,thin it is my maponsibilky to notify the - -
accu'an'of rhe remains which mail met prior to Isxvvnce of a Ceniflcme of
Ottupancy.
G S•2 Signature of Applicant Date
or amhorized¢gem, - Data
All roof coverings to be Class"B"or'bettet
OFFICE - . -- - -