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04030218 (2) CI'T'Y OF CUPEWFINO = k - ""I BUILDING DIVISION PERI• CO ? NTRACTOR INFORM N a -. 1 ;Tsa,�'%:.$ . t�.•� it v4'€.'` �^.id; BUILDING ADDRIM: GOLDEN GATE SIGN CO PERMITNO04030218 10555 RIDGE VIEW CT NF.R'S NAME: PERMIT ISSUE DATE HEWLETT PACKARD 711 INDEPENDENT RD 03/24/2004 NE: SANITARY NO. CONTROL NO. (510) 366-3838 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 :00 LICENSED CONTRACTOR'S DECLARATION Job Description rd F 1 hereby affirm that I em licensed under provisions of Chapter 9(commencing p `�' wlMSemion]UMrynfDiviximn 3ofthe Rusinoserp Pryfcs m �, dmylicoucis "�h in full roree andc c3y (�t0 SIGN --2 ILIUM MONUMENT j0Z Llccnu Cls S I-m" "JJn Dale contractor CHANGE CONTRA. FROM ARROW SIGN TO GOLDEN GATE i�lARCHITECTS DECLARATION (0 4 14/0 4) 1 underttend my plans shall k used es public records ;,tn Licensed Professional g OWNER-BUILDER DECLARATION i 1 hereby affirm that I am exempt from the Contractor's License Law for the COO following recon.(Seedun 7031.5,Business and Professions Code:Any city or ounty rd^ which requires a permit to construct,alter,improve,demolish,or repair any struaum —� prior it)its issuance,also requires the applicant for such permit to file a signed statement ££ < that he is licensed purmanttothe put,faunsofOnComruwr'aLicense Law(Chapter 9 Sq. Ft. Floor Area Valuation Y $ (commencing with Section 7")of Division 3 of the Business and Professions Code)or $7000 a that he h exempt therefrom and the basis for the alleged exemption.Any violntlon of Section 7031.5 by Any applicant for a peril l subjects the applicant to A civil Penally of APN Number Occupancy Type not more than five hundred half ars(S500k P Y YP ❑Iuowner .and sheAnchor c or is employees withwages r theirsole compensNon, will do the work,Code:The Cure iutots Lia orawdoadred ont pply o in,Business Re uired Inspections and Professions builds or lite improves d amen, rad who Law dace not apply ll in owner of q p propertywho builds iimprovesthereon,end who dorssuch work himu0or through his Own employees,provided that such improvements are not intended m peered for the Owner.If. however.the building or den of proving is sold within one year of completion,theowner- RED huilticr will have the burden of proving Nat he did not build or improve for purpo �of- sal�.). s1PI ❑1.as owner of the property,em exclusively contracting with licensed contractor 50�5o contract the project(Sec.7044,Business and Professions Cori The Contractor's 1:h-T� come law dos not apply to an owner of properly who Wilds or improves Merton.M who contracts for such projecu with a contractors)licensed pursuant to the Contractor License Law. 14 ❑tem exempt under See. ,BkPC for this ream18 Data WORKER'S COMPENSATION DECLARATION Or 1 herebyof ren under penalty of Perjury Arc of the following dewlaratiome 1 have and will maintain a Certificate or Consent o self-insum for Worker's Cempen- sotion,a provided for by Section 37M of the labor Code.for the performance of One we which this pored is issued, w have And will maintain Worker's Compensation Wunnce,u reburied by Section J7P7 of the V Wr Code,f a Ne performance of Ne work far which Nis permit is issued. My Worker's mpensati n surenca carrier And Policy number am: q Carrier: .tin d Policy No.:o�t POD CERTI JC ATEOFEXEMP170NFROMWO KERS' COMPENSATION INSURANCE (Tho section aced not k completed ifft Permit it(m one hundred dolIm(Slrp) less.) 1 certify Nm in the performance or the work or which this Permit o issued,I shall not employ any person in any manner an At to become subject o the Worker'Compensation Laws of Cal ifomie.Dom Applicant NOTICE TO APPLICANT:IL after making this Certificate of Exemption,ynu should become subject to the Worker's Compensation provisions of the Letter Cole,you must .J z forthwith comply with such provisions nr this Permit&hall W deemed revoked. ,zO CONSTRUCTION LENDING AGENCY [—t l hereby Anion Nat there is a construction lending agency lot the performance of W' Ne work(car which Of.permit is issued(Sea 3(197,Civ.C.) [T]Q Lender's Name Z)z Lender's Address U Q 1 ttni(y that 1 ben read this application and state that the above information is U. F" Correct.I Agree to comply with d1 city and county ordinances and state laws relating to QU building construction,and hereby atdhorim repmaenmtivu of this city to enter upon the a Above Mentioned property for inspection purposes (We)agree In save,indemnify and keep harmless the City of Cupcnino against tF.Ih liabilities,judgments.costs and expcnus which may in any way accrue against said City t.) Z in consequence of the granting of this Permit. APPL ANT UNDERSTANDS ND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOU ERE ULAT14S � `y O 'T Re-roofs Signatureof Applicm Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or(mum building occupant r 9,1 or handle Hearduus material As,defined by the 32(a)?nn Municipal Cuda Chapter 9.11,and the Health and Safety Code,Section 1853z(a)? rN�L,/ All roofs shall be inspected prior to any roofing material being installed. 40 ❑vu Will the applicant or future building occupant can equipment ordevica which If a roof is installed without first obtaining an inspection,I agree to remove Dist District? m air contaminants Wikfincd by the Bay Arco Air Quality Management all new materials for inspection. District? �}/y ❑Yes u Ihave mad the he,amousmmcriao requimmenu under Chepm ti.95 Orion Califnr M.Health&Snlny Cade,Semlons 25505,15533 And 25534.1 underhand thm if the huildog does not curemly ham a tenant,that my msp9nsibility w nnul'y tk arupatn of die require m whiennµtt�kMeipLorp�oeliccofaccrdkawc Da cy. S ignature of Applicant - Date Owacr Ar aOthan,cd spent GC Date All roof coverings to be Class"B" or better