08040042 BUILDING DIVISION PERMIT CON.TRd1.-ORI�N U fi d,
BmLOU{p/sIp3TCLELLAN RD TBD - TO BE DETERMINED P08040042
NER'S NtSAUME;MC PERMn ME DATE
41 JEHOVAHS WITNESSES CUPERTINO 04/07/2008
PHONE SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB - MECH
0 0 0 0
�oo LICENSED CONTRACTOR'S DECLARATION lob Description
V 1 Wroby affrm Nn 1 am licensed under provisions of Chapter 9(oummcreing
with Section 7")ofDiviAion 3of1he Business and Profession!Cnde.and my license is BLDG OF A MONUMENT SIGN. BUS LIC IS CLEARED,OK
in full force and effect.
2g- LicenseClua Lie. FOR
9
Dole.contracts,ARCHr1ECTSDECLARATION INSPECTIONS (PG)
p I turnaround my plans"I he used u public record!
6u
1: Licensed Professional
OWNER-BUILDER DECLARATION
5 I hereby affirm that I am mempt from the Canuactofs License Law far the
Cc, follow off remon.(Sad.703 L5,Smoras and Pmfeuiom Cade:Any city or county
$�` which requires a permit to corers ct,tour.improve.demollah,or mpdr any suuctum
Prior so its issuance.tan requiresft.pplieant for much Permit 1.fileasipned aoctral
p < last he is licensed pursuant to the provisions oflMCommuter's LuemcLaw(Chapler9 Sq.Ft. Floor Area $789 Valuation
Y 9
(command,with Section 7000)af Division 3o the Busincesand Professions Code)or
that be is mempt th.mfrom and du haste for the alleged mempeom Any violation of
Semon 7031.5 by any appOcanLfer a permit subjects the applicant to civil penalty or Number Occupancy Type
not mom than R.hundred dollars(5300). 3 rJ 9�2 017:U'V�
❑I'm owner ofthe property.army employees with wages as their out compensation.
Will do thew.L and th.moneture Is not intended or offered broad.(Sec.70,44,1usinels Required Inspections
and Professions Cade:The Contractor'!License Law does not apply u an...or of q p
property who Wilds orimproves thereon,and whodoessuch work himselfordowlin his
ownemployme,provided Nat such improvements are not imaded confuted fortune.If.
however.the building or improvement is sold within ova year of am pu0on.the ownery
builder will have the burden of proving that he did net build or improve for purpose of
' isle.
1,u awhar of the Progeny I 'wly comvamng with licensed conuacun m
comment the mica(Sx 7014,Buu m a Taf Cade:)Tha Comtsam'.U.
cem]e Law does not apply b an of p y Ild!ar VIIpmK!tlen9n.Nd,
who comsat for such Fork noun req d l tractor's
Lim.law. �"
❑1 un exempt undo ar
nor Dau ,•
WORK CO PENSATIONDECLARATLO
1 hareby affirm under penalty of perjury one of the following arad...
❑1u'veam will mainulns Cenifrcam.rc.menlbsel6inaumfor Wof e.Compen-
notion,as provided for by Soman 37x0 of the Labor Code.for W performance of the
work:for which this permit is Word.
❑I have am will maintain Worker's Compensation Insurance,as mbuimd by Seaton
3700 ofthe Labor Cade.for the Performance ofthe work for which this permit is Issued
My Worker'!Compensation Insurance carrier uhd Policy number art:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS•
COMPENSATION INSURANCE
Clhislecurn need rot W completed ff the permit Is forom hundred dollus($100)
carless)
1 cerdfy Wit in the pc arcs of wort f bait Nis
employ any perseI ncr b 'cello
Owe of Califaml
APplicent
NGnCE A sMr i j mption yav out
become sat oh !Compc ti rovliiom her Cade,you must
.JO fordwith comply such pre, . Nil pmrmitandl seed mwk.d.
CONSTRUCTION LENDING AGENCY
[r I hatohy affen thou then is a construction lending agency for the performance of
iY, ? the work for which thin permit Is bound(Sec.3097,Civ.C.)
1+7 QIIsnanda"Nun. ,
,�gl� z das Add.
U O 1 certify that I Mw mad this application sad suis that the show information m
IL (•' comma.I spa to comply with W city and county ordinances and sum laws totaling In
V building conmucoon.and ketoby authorize representstirm ofthts city to murupon to
I� sho ' nod progeny fofinsRctm purpoaa
Iy agree w mw,indemnify and kap humus the City of Cuperdno against
:v N JAPJLIAW
' igmcnt.cosu and.aperues which In anywayumvegdmtuld city
V ceofdoScan g of this PermiL !/ �'y UNDERST ! S AND WILL MP l TH ALL N N P INT Issued by: Date 7 /"z—
U ADO .
Re-roofs i
Si HAA USMATERIALSO OSURE Dt Type of Roof
Will mappllcan or furore building occupan tom or handle hanrdom material
fined the Cupertino Mu ''pal Cade.Chapter 9.11,and the Hcdth and Safety
a.See` 75537(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑ m Na
Will th.applicant or fawn ilding occupant iso cyuipmenl or devices which If a roof is installed without first obtaining an inspection,I agree to remove
.mit h„amnar or conundrums defined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑ u
mad the hazerdms require u under Chapter A95 of the Califon
kN SafchyC Sau .75533 534.1 thatifthe building
not my be a lrn.L it my h noufy the mapsnt of do
m .0 afoca Signature of Applicant Date
e ' m 'sdAFm I xDate All roof coverings to be Class sena,or better