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BUILDING DIVISION PERMIT
CONTRACTQR INFORMATION
BUILDING ADDRESS:
ALLEN SIGNS INC
PERMIT NO. 06030054
19638 STEVENS CREEK BLVD
R'S NAME:
PERMIT L45UEDATE
CUPERTINO FINANCE
1982 STONE AVE -
03/10/2006
SANITARY NO. CONTROL NO.
(408)280-6500
ARCHDECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0
LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby affirm that I am under of 9 (commencingsis
P
u s Code.
of dr, and Professions
with Section 7tW) of Division 3 of the Businm and Pro@ssionx GMC.and my license is
In 0unrorm and er t. 3
CHANNEL LETTER SIGN
License CI
Dete �—Cunlr
EC
ARCHITECTS DECLARA ON
1 undcratand my plana shall W used as public records
'
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby M. that I am exempt from the Cantractals License Isw for the
following reason. (Section 7031.5. Business and Professions Cade: Any city m county
which requires a permit to construct, alter, improve, demnlis h. m repair any structure
$3000
prior m its Issuance, also require.( the applicant for such peornit to rile a signed statement
Nat he is li..d pu mntto the provisions of the Conuutori U.. Low (Chapter 9
Sq. Ft. Floor Area
Valuation
(commencing with Section 7000) of Division 3 of the Business and Professions Coale) or
that lex Is wmpt therefrom and the baso for the alleged ewnption. Any violation of
Section 7031.5 by arty applicant for a permit subjects the applicmt W a civil pc.Ity of
Occupancy Type
not more than five hundred dollars ($50H.r
Las owner of rhe prepeny, or my employes with wage u their sole compensation,
will do the work, and thesuuelure is notin¢nded proffered forsale (Sea 70W, Business
and Professions Code: The Conuachn's Littre Law docs not apply to an owner of
Required Inspections
property who builds m improves thereon, and who does such work hi msel f Or Nm ugh h is
own employees, provided thatsuch improvements are nal intended oroRered fmsale If,
however. the building or improvement is sold within one yea of completion, the owner -
will neve to burden of proving that he did not Wild or improve for purpose of
taker
sale.).
❑ 1, as Owner of she propcny, am exclusively contracting with licensed contractors to
/
Cade:) M Comractor. Li -
and Proicssions,property-who
construct the Project (,ply
O
to n wneBusr of Wilds
whoc hon dors not apply m ts owner of propeny.who Wilds or improvss thereon, and
who contracts for such projects with a contractor(s) licensed pursuant w the Contractor's
Lice. Law.
m exempt unticr ga. ,BkPCforthiaDate
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under petWly of perjury one of to following dcclatrab ns:
ave and will maintain a Certificate of Corte.. self -insure far Workee, Compen-
1'31'1
provided for by Section 3700 of the ISW, Cade. for Ne perfurom. of dhe
for which this permit is issued.
ave and will maintain Wakers CompenWion Ihtwranccas reuired by Section
ofthc labor Code, for the performanre of the work for which this permit is issued.
orker's Cc p-esrw�ton Insu 0. C. er and Policy nu bet art:
-71 Carrier. T-HtofIIP/f-SJ-II�PolicyNo,Z1R')65c)
,
CERTIFICATE OF EK ON FROM WORKERS'
COMPENSATION INSURANCE
mus section mcd Out bemmplemd If the permit uforone hundroldollars(g100)
or less.)
1 unify that in the perrnrmance of the work for which this permit u issued,) shall not
Employ any person in any manner an as M WYOme Ubjecl to the Workers' COmpensaton
Laws of California. Date
Applicant
NOTICE TO APPLICANT. If, after making Nis Certificate of Exemption, you should
become subject to the Worker's Compensation provisions of the Labor CMG, you muse
forthwith comply with each provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY '
1 bereby that there is agency rat the performm¢ of
which sed (Se.constructionlending
the work for which Iris permil is issued (Sec. 309'!, Civ. C.)
Isndcr's Name
1<ndcr'3 Address
I unify that I have read that application ane sate that the about information is
Correct. I agree to comply with all city and county ordinances and sou laws rclating to
construction.building consction. and hereby mobonm representatives Of this city to enter upon ted
above mentioned property for inspection purposes
(We) agree to save, indemnify and keep harmless the City of Cupcnluo against
Iiacome;jMgm which may in any way a<cru sgaitutseid City
anddof
f the this Pe
A PLIC nee of Ne RSTA6 Sthis permit.
APPLIC U, STANDS AND WILL COMPLY WITH A NON -POINT
SOU
Issued by: Date
ATI
EG ATIONS
3
Re -roofs
to
Sign arc of li _ tk sex
onRDOLS
H MATERIALS DISCLOSURE
Type of Roof
Will thea torlot. building Occupant store or handle harudous material
defined by tW Cupertino Municipal Code. Chapter 9.13, and the, Health and Safety
. Sateen 25533(x)?
❑tea No
All roofs shall be inspected prior to an roofing material beim
P P Y g g installed.
Will the appliCmI or fuwre building ..Paul use equipmml ar devise whicb
If a roof is installed without first obtaining an inspection, I agree to remove
t ha.dnta air em:nunmu ss defined by the Bay Area Air Quality Management
all new materials for inspection.
District? \
C] Yea
,
I have read Ne harardous materials requiremena under Chapur 6.95 of the Califm.
-
aiaHeaW6SafctyCodc,SecLease 25505.25533 and 75534.1 undcruvtd that irda Wilding
does not currently have • unant, that it is my respmaibility, the to notify WCupml or the
I J (7
req ire u w eh T mel prior to issuar" Of a Cerdficau of Qc Ulp p cy.
of
Signature pplicant Date
J
All roof coverings to be Class "B" or better
Owner
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CUPEkTINO
CITY OF CUPERTINO
SIGN
PERMIT APPLICATION FORM
APN # 3�0 ?
0 C/
Energy
Date: B / v
Building Address:
BPERMFEE
Bldg Permit Fees
63 —54eyeA
s Cre4 Bl yr a o
BPLANCHK
Owner's Nam
BUILIDNG
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Phone #:
Seismic Commercial
(/W D a47 CC .
Contractor:
Akeyll S10-AS,W,
License #:
g3 s�
Contact:
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Phone #:
m erl
n
D -280- Sao
Applicant/C
ntractor:
/
-BREMSIGNS
Rmdl Signs, Mar uee
Building Permit Info:
Bldg
lett Plumb
Mech
Job Description:
v; (,ha -n ne,�
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Residential:
Commercial:
Sq.Ft. Floor Area:
LIC
$/Sq.Ft.:
Architect/Engineer:
Cost of Project:
Type of Construction:
r
Occupancy Group:
a
Qty. if
ADolicable
Fee m
/
BENERGY
Energy
BUILIDNG~
BPERMFEE
Bldg Permit Fees
BUILIDNG
BPLANCHK
Plan Check Fee
BUILIDNG
%
BSEISMICOM
Seismic Commercial
BUILIDNG
EPERMITFEE
Elect Permit Issuance
ELECTRICAL
BREMSIGNAD
Rmdl Signs Add Branch
ELECTRICAL
/
-BREMSIGNS
Rmdl Signs, Mar uee
ELECTRICAL
LIC
Business License
BUILIDNG
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