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CITY OF CUPERTINO
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BUILDING DIVISION PERMIT
-C,ONTRAC°TQR INF01.tMATI0N
ALLEN SIGNS INC
PERMIT NO 06030055
634 S
J19BIALCINGADDRESS:
R'S NAME:
PERMIT ISSUE DATE
POT STICKER
1982 STONE AVE -
03/10/2006
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E:
SANITARY NO, CONTROL NO.
(408)280-6500
ARCHITECT/ENGINEEH:
BUILDING PERMIT INFO
BLDGELECT PLUMB MECH
0 0 0 0
LICENSED CONfitACIGR'S DECLARATION
lb Description
o
1 Mreby affirm find 1 am licensed under Provisions of Chapter 9 (commencing
with Section 70W) of Division 3 of the Business and Profusions Code, end my license Is
in mu torte mdeffeGy
CHANNEL LETTER SIGN.
Liccnvc laz Lie-.. �a
Us.
Doo r r
ARCHITECTS DECLARATION
I uwlermi d my plans.Nall ix used as public rsecrds
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby air. that I am exempt room Ne Cmusaxim s License Law for the
following mason. (Section 7031.5, Business and Protntsiou Code: Any city or county
which requiresa permit In enmwct, .1w'. improve, demolish. or repair any structure
$5500
Prior hs its issuance, also requires the applicant roe such permit w Ole a signed statement
that he is licensed pursuant o Nc provisions of the Contractors Licenx Law (Chapter 9
Sq. Ft. Floor Area
Valuation
(commencing with Section 7000) of Division 3 of Ne Business and Professions Cade) or
that he is exempt darefrom and the bunds for doe alleged exemption. Any violation of
r
Occupancy Type
Section 7031.5 by any applicant for a permit objects the applicant to a civil penalty of
not moo than five hundred dollar (SSW).
❑ 1.uownerofthepropmy,ormyemploycuwithwageauthelrxleeompenssdon,
will do the work, and utesoucwm is notimmuded oroifered fonale (See. 7099, Business
Required Inspections
and Protcssiou Code: The Contractors Li. Isw does not apply w an owner of
property who buildsurimproves Ihcreon,md whodoes suchwark himulf oruuough his
own employees, provided that such imprevemenu see nos inended.,offered for sola If.
however. the Wilding orimprovement ismid avidin can year of tion,downer-
e
uilder will the burden of proving Ilial he did not build or irnpro improve for purpose of
will N
sale I.
El 1, as ownu M the propeny, am uclaaivcly contracting with Remand cnnuacmn w
coulmcl the proj,a (Sec. 7009, Busincu and Professions Code:) The Comouwra Li -
come Lew docs not apply to an owner of property -who builds or improves d neon, and
who contracts for such projects with a convaclor(s) licensed pursuant to the CanaSlots
Licmtx Lsw.
❑lam aemDt under Sea .B&PC for this reason
D
jWORKER'S
COMPENSATION DECLARATION
1 hereby aRimt under penally of perjury on, of the following declarations
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l ha.e and will maintain a Certificate of Consent to ulBimure for Workers Compcn-
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,.lion, u provided for by Section 3700 of see Labor Code. for Ne performance of the
work for which this permit is issued.
_
❑ 1 have and will maintain Wakeh Compensation Insurance, az writhed by Section
3700 of the Latour Code, for Ne performance of she work for which this permit is iuued.
My Workces Compensation Insurance abler and Policy on rase:
_ O�
Carver: ✓ri'P�l :S Policy No.:
IFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE,
(Thu section need not hecompleted if rte permit Is forane hundred dollars ($100)
ices)
I certify Nm in the performance at the work for which this permit is issued, I shall not
employ any person in my manneru as to become subject to use Workers Compenondon
Isws of califomia. Dale
Apidicam
NOTICE TO APPLICANT: If, after making this Cmifwate of Exemption, you should
become subject on Ne Workets Compcuation provisions of the Labor Code, you most
foMwid comply with men previsions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
1 woulty affirm Nat them is s construction lending ageney for the performame of
Ne work for which this permit is issued (Sec. 3097, Civ. C.)
Lender's Name
Lender's Address
1 cenify than I have read this application and Stae That do above information is
coned I agree W comply with all city and county ordinances and sum laws relating he
building construction, and hereby auNooix mpresenutiven of this city Io enter uPon the
above-mentioned property for inspection purposes
(We) agree in love, Indemnify and keep hamsless the City of Cupertino sperst
Ilabllibes, judgments. costs and expenses which may In my way am= against said City
in conenquenee of Ne granting of this permit.
APPLICANT UN ERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date l 6
SO R GU TIONS. 1
3 f DU
I c)p
Re -roofs t7r4
Type of Roof
Signature, ol'Applican onuacsor Date
H =SMATERIALS DISCLOSURE
Will Nes t or future building occupant stow or handle huudous material
az defined by the, Cupertino Municipal Code, Chapter 9.13, and the Health and Safety
ec
.sden 25532W?
[3 Ya �Nu
All roofs shall be inspected prior to any roofing material being installed.
Will de applicant or future buildingottvpant use equipment or device, which
If a roof is installed without first obtaining an inspection, I agree to remove
- . I w.oh us it conumimms as defined by the Bay Area Air Quality Management
all new materials for inspection.
District?
❑ yes
I have read the huvardnusmalerials requirements underChapwr 6.95 of the Califor-
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niaHealN& SafetyCode, Seedas 25505.75533 mal 25534. 1 undnstaM drat if use building
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Jos not currently have a wnanc dot it is my responsibility w notify the eccupant of the
regal c wlahm be mct pdawissyresonacemeateol cu c%
Signatures pllCanl Date
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All roof coverings to be Class "B" or better
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