04030217 CITY OF CUPERTINO qt
BUILDING DIVISION PERMIT C6N±TRAGTQR IIVFORMAT;T01�
.;K" Y�L 3* _ rk=BSS'•-^f,'3FY"='
BUILDING ADDRESS: ARROW SIGN CO PERMITND.04030217
ER'S NAME: PERMIT ISSUE DATE
HEWLETT PA
PHONE: � a. \ SANITARY 440. CONTROL NO.
510 533-76 C
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
V s /-"•� BLDO ELECT PLUMB MECH
30'z LICENSED CONTRACTOR'S DECLARATION UEN
/ O O � O
�j 1 busby affirm that 1 ata liaised Mer rov.. of Chapter 9(ammcncing Deesscription�
with S«tion 7MO)oh Division 3ofdm Bug Profeuitu Code.WmYlkammais
mtaurt B«t ��� SIGN--NEW ILLUM MT��
jE6 LlemucC Lle, U
2:.f
Data
Can .,*
ARCHITECTS 0 RATI
understand my plans"I W used As public reenrds
it Liccu.d Professional
OatHER-BUILDER DECLARATION
I hereby.(firm that 1 A.1. exempt from the Canlns Co License Lew for 1M
p�0�
which
handon. (anion 7031.5.1.S,conduct,aincu aM Pm(nsluu Co dc:Any oily«coumy
which its issu a permb to res thealter.improve,demolish,ri repair ed structure
prior miu iensedp pursuant
acquires pr applicant fu Sahpermit toiceseL w(awpter9
<
bad beislleenad Sectio 700(1 provisions Buacmr'aLiansclaw(C7uplcr9 Sq. F[. Floor Areaf. Valuation
thammennttempth nstfran and
Deds for then Busime it Any viCedC)ur
.. dist o is 31.5 b any
and Ne bub for be allcls be exemption.antto Any l penalty
of
S«eon?teas be hundred
red dant for(a permit subjects the Applicant ro e civil puWry W 3 MN6�diVer 0,0 Occupancy Type
oat mon Nen five hundred dollars(5500).
❑1,uownerofthepmpmy.mmympioymwu"mut bmlecampees on.
will do thework and Nesternum Isnotinu ided or offend for.&(Sec,7044,Business
and PafessioAs Code:The Canuacmr's Licerue m Law dnot apply m an awm of - Required Inspections
propeny who builds or Improves thereon,and who dm such work himself ear through his
own employm,provided thatguch Improvements are not intended aro@rtC forale It,
however,be building or improvement is sold within one year of completion,Ne owner-
builder will have the burden of proving thal he did not build or improve for purpose of
Asia.).
❑1,As owner of the prapeny,am ex.lusively,contracting with licensed conuaeb,n to
construct the Indent(Sec.7W.Baines And Profusions Cede)The Contractor's U-
ceae Law dm not apply on in owner of property who builds or improves banned.arM
who contracts for such pmjccm with a canlncuu(s)licensed pursuant an the ConVKtor's
License Law.
❑l am exempt under San, .B&P C for this reesan
Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under pealty or perjury arc or be following declarations:
❑Ihaveendwillmxinuina CeniOauaf Cove.taself-IaurefmWarker'sCmnpen-
ation,As provided for by Section 37W or the Labor Code,fu be performance of the
work for which this permit is Issued.
❑I have and will maintain Worker's Compensation luurana,As required by Section
3700 of ens IAbm Code,for the performance of do work fm which this permit is ism
My Warkces Co¢m�pemV lnrsanm�x canicrand Policy nu beram:
�!'a Q Ft'It^s. Pol No.: (�tkJ�
CERTIFICATE OFEXEMPTIO WORKERS'
COMPENSATION IN ANCE Ot)0.8YS .
IThb anon need not W completed If On,permit is for am hundred dollars(SIM)
or les.)
1 certify that in the performance of On work for which this permit is issued.I Shell nm
employ any person to any manner so As an become subject o the Workers'CompcuMon
Laws of California.Dab,
Applicant
NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should
become subject a the Worker's Compensation Provisions of the Labor Cade.you mut
,JO forthwith comply with inch provisions or Nis permit shall be deemed revoked.
% CONSTRUCTION LENDING AGENCY t
F+ I lumby AM.that there is a autrntinn lending agency for the perrmors to of
ai
be wuuk for which this permit b issued(Sec.MY1.Civ.C.)
aQ Lender's Nem.
=z Lenders Add.
U 0 1 acidify that i have rad this application W sum this the above information is
Is.F comet.I agree to comply with all city ad county ordinances and suis laws testing an
0 U building construction.and hereby authorin representatives of this city in now upon the
W alnve-mentioned property for Inspection purposes
D, (We)agree to save.indemnify and kap handles the City of Cupertino against
rice
liabilities,judgments,couu end expenses which may in ay way ancon against aid City ,
fJ,rZ In consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULA -VCM a�
fl� Re-roofsC7 I
igaturt of A,pIiMOC mxc1oA Da
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building uceupatnom or Much,huudou material
As defned by the Corpsman Municipal Cede.Chapter 9.13,and the Health and Safety
Scit
ye.25532(a)? 'J�014o All roofs shall be inspected prior to any roofing material being installed.
Will be applicant or future building occupant Asa equipment or dcrim which If a roof is installed without first obtaining an inspection,I agree to remove
emit haardnus sir contaminants As dcfted by the Bay Arca Air Quality Management all new materials for inspection.
Diauict7
❑Ya -No
1 have reed Ne harndnus..wrists requirements under Chapter 6.95 of the Califor-
niaHealth&SafetyCodc,Scedau 25505.35533 aM 25534.I understand does ifdn building
dm net currently Uve a lament.Nat It u my mupovibility to notify the occupant of be
requlremcnb whi a bemetp br[_r w'tuuvm, fe CcreOceu of Oca ry. Signature of Applicant Date
cr or autharimd egret �T�•ta14 3 u All roof coverings to be Class"B"or better
CITY OP CUPPRTINO ."*
BUILDING DIVISION PLRIt xWON�TRAOTQR INFORM
a
nmLDlrvc ADDRESS: GOLDEN GATE SIGN CO PERMITNO04030217
,.QO RIDGE
NEI,.SNAME: r PERMITMUEDATE
PHONE:
HEWLETT PACKARD 711 INDEPENDENT 24 2004
r
1 - SANITARY N0. CONTROL NO.
(510) 366-3838
i1TECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
rez O Q Q
00 LICENSED u CONTRACTOR'S .I hereby air". -t I a,licensed soda,d,,lmviamns of Charter 9(enm,knktng Job Description
whh Semiun](l(k))nf Diviai°nyiof the B�s and Po17comns ode,end my license is
in mu and rem.( 5 J SIGN--NEW ILLUM MONUMENT
Y�Lic,p
°I"' � ARCHITECTS
°t°r CHANGE CONTRA. FROM ARROW SIGN TO GOLDEN GATE
� � Yundersand my plans shallbemctl asmwrda (04/14/04)
`n
gam Loclfcsnnnal
' OWNER-BUILDER DECLARATION
p 1 hereby-frim,that 1 am exempt from the Conbacors License Law for the
C n O following mason.(Section 7031.5,Business end Professions Cock:Any city or county
which requires a Permit in construct,alter,improve,demolish,or repair any structure
-a prior in its issuance.also re notes the applicant for such Permit o rile a signed statement
Esp Ihalheislicensed pnuoomthe pmvisionsofthe ContractoriLicenscLaw(Chapter 9 Sq. Ft. Floor Area Valuation
yl-$ (c°mnteneing with Section 7")of Division 3oflhe Business and Professions Code)(it $3500
that he is exempt Bedroom and the basis for the alleged exemption.Any violation or
Secuon]W1.5 by any applicant for a permit subjects the applicant to a civil Penalty or ApN Number
not more than Eve hundred dollar,D5W). Occupancy Type
❑ Lss owner of the property,or my employees with wages as their took compensation,
will d0 the work,and the slruclun is not intended or offered for sale(S..]OC4,Business
mo
.ad Professs Code:The Confucian's r's License Law denot apply m,n own,or Required Inspections
property who builds or improves drercon,and who doessuch work bimmlf or though his
Own employees,Provided that such improvements are not intended or offered for sale.IL A
hmvever,fie building or improvement is sold within one year or completion,the owner
but lder will have the burden of proving the he did not build or improve for purpose of
taletr
❑h as owner or the property,am exclusively contracting wish licensed convectors to
construct Latheproject(Sec.o an Owner of
antirty whoi Wilds
Cotler)The Contractor's ad
cane Law dols not apply to an owner of property who builds or improve Thereon,sntl
who se Lactsfor welt projects withncnntr.cl°r(s)licenud pursuant to to CnnlractorY
License Lew.
❑I am exempt under Sec. ,B&P C for this mason
net Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalq of perjury one of the following declarninns:
;37ffl
have and will maintain.Ceni ream of Consent o mlf-inure for Wmkei s Compete
as provided for by Section 37W of the Latin,Code,for the performance of the
for which thh permit is issued,
ave and will maintain Worker's Compensation Insurance,as required by Section
of the Labor Code,for the performance of Ne work for which this pewil is issued,
orkcrY mpensatin cc canicr and Policy nu2M'/m JDf7-^Da
e g� P c (O R
CERTIFIC OMPE SATIONI N WORKERS'
COMPENSATION INSURANCE
or less.)(This union need not be ermit completed 1f the pis far one hundred dollars IS Bill
I certify that in the performance of the work for which this permit is issued,I shall not
employ any person in any manner an ss In become subject in the Workers'Compensation
Laws or California.Dam
Applicant
NOTICE TO APPLICANT:I[after making this Cenihcam of Exemption,you should
Moine subject to the Worker's Compensation provisions of the Labor Code,you must
.J O Both with comply with such provisions or this Permit shall be deemed ownked.
Z� CONSTRUCTION LENDING AGENCY
f-I I hereby affirm that dleie is a construction lending agency for the Performance Of
LYi ilic work for which this permit Is issued(Sec.3(19],Ci,C.7
Eli Lendrrs Name
D z Lender's Address
V C 1 comfy first 1 have mad this application and mute that the above inform lion is -
W copes.1 agree 10 comply with all city and county ordinances and sore laws relating to
C) building construction,and hereby aohorim representatives of this city to enter upon the
shove-memioncd pmpc cotta
for i expenses
whiposcs.
ryW,
(We)since to save,indemnify and keep harmless the City of Cupertino against
U ten in consequence
nceOr us,the cot¢anti of this eswhtch may in any way eceme against City
U,Z in conxyucncc Ohhc graining of this permit.
^ APPLICANT UN RSi'ANDS AND WILL COMPLY WITH LL NON-POINT Issued by: Date
5 URCE REGUI. 5.
r v ��� Re-roofs
.71 num°t ApFbcaHAZARDO D to
Y HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the a Cu,anl Lir Muni building occupant atom or handle h Health
I material
u defined by the Cupeninn Mum'pal,Code,Chapter 9.12,and the Hcahh and Safety
C,taches 2ssul.n All roofs shall be inspected prior to any roofing material being installed.
Dyes [�Vtt
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
c.it,h.rmdoue air concerto or defined by the Day Area Air Quality Management all new materials for inspection.
rich
0Ycs Vt
I have read the hanmUnus materials requirements under Chapter 6.95 or the Califor-
nia Health&Safety Code,Sections 25505,25533 and 5539.1 understand that if Be holding
does nor curmm y have a mni that it Is y responsibility tun trout Of me
mquimmcm hdn ,Pore 'ssuance°fa CehRC'a or cup cy.
�i4lo _ Signature of Applicant Date
Owner Lr atdhonacd agent DoT— All roof coverings to be Class „B„ or better