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CITY OF CUPERTINO
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BUILDING DIVISION PERMIT
CON1kACTORINFORMAT'ION '
il3DTIBIT "TPEVENS CREEK BLVD
GOLDEN GATE SIGN CO
PERMIT NO. 03040079
EY K. TURMAN
711 INDEPENDENT RD
PERMIT01[6aAyE� 5 /2003
L
E:
(510)366 -3838
SANITARY NOO, CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
—
0 0
LICENSED CONTRACTOR'S DECLARATION
I hereby 1 9
affirm that am f he Be tie prof ss of, Capnr (crmmense I.
with Section 7llW)nf Diviaion7of NC Bu eM Profcsaiom Code, end mylicense is n ful aM art
License 5
S' v
REID,
Dale vutor -
n.
HITEC S
I ndewnJ mY plans Mall he wcJ public records
Licensed PmfcesioneI
OWNER-BUILDER DECLARATION
I hereby a riimt that I am exempt from the Contractor's License Law for the
following mason. (Section 703 1 A, Business and Prorat inns Code: Any city of county
which requires a permit to construct. alter, improve, demnlleh, or repair any structure
prior to its issuance, also requires the applicant for such Permit to Ole a signed statement
that he is licensed pursuant to the provision of the Conuactur's Liscrue Law (Chapter 9
Sq. Ft. Floor Area $Y�18z6ion
(commencing with Section 7000) of Division 3 of the Business and Profer ions Chic) or
Nat he u exempt therefrom and the bob for the allcgml exemption. Any vialatirn of
Section 7031.5 by arty epplinnt for a permit subjects Out applicant to a civil penalty of
..AA 9g77�aT �i g,�
3 `i 00CY! 0 0
Occupancy Type
net man than five hundred dollars (5500).
Ta.3'k7 !
❑ I, as owner of the property, or my employees with wages as their sale compensation,
will do the work and "d Woman, b not intended or offend fontic(Sec. 70x4, Business
101 - FOUND A€eJdWd Inspections
and Prolmodons Codc: The Contractor's Liana Law does not apply to an owner of
propertywho builds or improves thcrern, and who does such weakhimselfor through his
103 - UFER
ownereploynes, provided that uch improvements an not intended oroffered fnsale.If,
however. the building or improvement is said within are year of completion, the owner -
lO4 — REBAR
builder will hers the burden of proving that W did not build or improve for purpose of
105 — ANCHOR BOLTS
sale.).
0 1.as owner of die property, am exclusively contracting with licenssd common.m
304 - ROUGH ELECTRICAL
contract the project ( Sec. 7044, Business and ProWaions Code:) The Contfactori Li.
SOS — FINAL ELECTRICAL
tense law dues not apply n an owner of property who Wilda ar improve, Onant .and,
who contracts an
for such projects with a contractans) located persons ae the ComnctM1
o
S14 — FINAL PUBLIC WORKS
License Law.
❑ 1 am exempt under Sec. . B & P C for this reoon
Owner Dan
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penally of pe,J., one of the following dedar Lion:
❑ I haw and will maintain a Certificate of Consent o self -insure four Workers Compere
selion, as provided for by Section 7700 of the Labor Cade. for the performance of the
for which Nis permit is issued.
Rwor
have end will main am Worker's Compensation Iouramm. a miuin,d by Section
'
3700 of the labor Cade, for the performance often work for which this permit is issued.
My Worker's Compensation Inuranc t terrier and Policy number am:
Caller. NI Policy
CERTIFICATE OF E)(EM iin0N FRO lyl RKERS't
'
COMPENSATION INSUR CE
(ThaWadmt need lent becampkted If the permit is faone buMrtd dnllua (f IOB7
or Iced
1 mni(y that in the performance of the work for which this permit is issued. I shall not
employ any person in any manner an as b bccame subject to the Workers' Compcwtion
Lawa of California. Data
Applicant
NOTICE TO APPLICANT: lE after making ON Certificate of Exemption. you WhouI5
become Subject m the Wor sm s Compensation provisions of the law CMS, you must
forthwi Lb comply with such provisions or this permit Shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that then its construction lending agency fm the Performance of
the work for which this permit is issued (Sec. 3(141, Civ. C.)
Lender'a Name
la='. Address
I cenify that 1 have read this application and ante that the ahove information is
'
correct. I agree to comply with all city and county ordinances and state laws relating to
Wilding construction, and hereby aulhorin represenmtives of this city to trim upon the
property for iopcNOn purposes.
ahovmmemidgm
(We) agree m aave, indemnify and keep harmless the City of Cupertino against
nt, costs which m
incoment Judgment, i and expenses which may In any way ¢Sena against said City
in consegnenec of the greening of this permit.
7 �
APPLICANT UNDER TANDS ANgq WILL COMPLY WITH ALL NQN•POINT
Issued by: Date
RE�U�L' S.,1A •�W,Q•O�
1YNV1 LF`��r
Re -roofs
b;xw. a(Applican U Dam
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will the applicant or (mum Wilding Occupant era at handle h
eaNUanmaterial
Cupertino Municipal Cade, Chapter 9. 12. and the Health and Safety
ode,
Section io 25
GrdC. 0y.25532(e)7 Na
All roofs shall be inspected prior to any roofing material being installed.
If a roof. is installed without first obtaining an inspection, I agree to remove
Will the applicant c f�n building occupant use equipment or devices which
I hoodoo air conmminanm tarred by the Bay Amu Air Quality Management
all new materials for inspection.
Dia'mt7
❑Yes Nu
1 have man the WraNaus materials requirements under Chapter 6.95 of the Califor.
rile Health &Safety Conn.Seelion 25505.23533 and 25334.1 understood NU if the Wilding
oes not currently ban a serum, that it or my responsibility to notify the aeupant or the
q menu which mu at pdarm tear. Ceniteam ( Occupancy .
�te
Signature of/Applicant Date
All roof coverings to be Class "B" or better
"
or authrriuJ agent