08050162COTEVENS
BUILDING.DIYISION PERMIT
CREEK BLVD
;_��VNIERISHHIINXIEI
TBD — TO BE DETERMINED
08050162
,PERMIT
ISSUE DATE
L.P.
06/11/2008
PHONE:
SANITARY NO. CONTROL NO.
ARCHTIECT7ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION
Been 9
lob Description
p
1 thereby affirm that I am (commenting
Bu under pmvisms of ; Colo.
with Sectrceand )ofDivivonJnfdW Business and! Prm(cssov Code.andmylkcnwu
ADD 1 SET 36" BAY AREA BRIDAL,1 SET 24" BAY AREA
in con rota and area
a 2 o nes Cl r -tar Lm.a
BRIDAL ON RACEWAY& 2 SETS 24" PAN CHANL LTR ON
Date ����
ARCHITECTS DECLAR ON
RACEVv NEW 'THINGS WEST". A K SIGNS & DESIGN INC.
understand my plans shall be used ss public records
�L
ucenaedA�aioo
OW NER.BUILDER DECLARATION
I hereby affirm that m 1 aexempt from the Contractors License law for the
following on. (Section 103 1.5, Business and Pofcsmarn Code: Any city or county
which requires a permit W eonswtt al Wr, improve, demnll h, or rtFair any structureprior
W its issuance. also require the applica , for such Permit to file a signed statement
that he is liccnwd pursuant to oho Provisions of Ne Conuaturi lice. Law (Chapter 9
Sq. Ft. Floor Area
Valuation
(commencing with Savor ]000) of Division 7 of Ne Business and Professions Cull) or
�
$13 0 0 0
$13000
that he u exempt thmcfom and the basis for the alleged eemption Any viomion of
Section 7031.5 by any applicant per a permit subjects the applicant W a civil penalty of
36906009 AR�Number
OCCU am nCyType
mart than five hundred dm11ars(1000).
I,uowna of Ne pmperty.mmY employee wiN wgne Nov vele cempewdnn,
will do We work. and the sructure is not intended tar offered for sale (Sec. ]014, Businessand Fatback. Code: The Commam. amnes LiLaw Mees ret apply W an owner of
Required Inspections
property who Wilda a improves Nerean. andwhodaessucll workhimxlf aWaugh his
own employees, provided thaeuch improvements are not intended aro@rml forsake If.
however. We Wilding or improvement u sold within oro year of completion, the owner.
builder will have the burden of proving that Im did rot Wild or Improve for purpose of
axle.).
0 1, as owm of the propent,.m mtoludvely contracting wit licensed conu usims W
construct the posed (See. 7014. l usi•... and Professors Code:) The Conuacaer's U.
«nae law does not apply W an names of property who Wilds or impmvn thereon, and,
who contracts for such projects wild a=wua=mr(s) licensed pursuant W the Convactofs
Lic.. Law.
0 lam eempt under Sec , B B P C for this mason
Date
WORKER'S COMPENSATION DECLARATION
I hereby damn under penalty of perjury arc of the following declarations,
1 haw and will sudmain a Canifca eof on., W aslf-irsurt for Wench Compen-
W an, as provided for by S.etion 5700 of the Labor Gude, for We pork anwa of the
wore, for which this permit is issoved.
0 1 have and will maintain Workers Compensation Insurance, as taloned by Section
77W of the labor Codc. for the performance of the work for which Ws pcamil u issued.
--
My Workens Compewtion Warms. gassier and Policy mother am:
Carica. Peliq No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(This wcslon need not W camplaWd irthe permit is foronc hundred dollar ($I00)
or less.)
I certify Won in the perform. of the, work for which this perm. u issued. l shall nm
employ any person in any mai ."W banner, b,.t,. We WoMss' Compeva0on
laws of Cmifo Dare il�I'a
ata
Appli'
NOT[
NODCE TO APP IL a0cr making this mf, Letter on, you should
Occurs, subject a Wod ovsioncaW
Worh ra Cmnpcmuot provisions of de Isba Cade, you roup
y it
forthwith comply with such pmvisatu a Nu permit shall W tleemed rewkcd.
CONSTRUCTION LENDING AGENCY
1 hemhy -Tom that Wenn is a cmunmemn lending agorae, for the performance of
dm work for which this permit is meed (See. 3077, Civ. Q
Lenders None
'
Lenders Addrm
L certify Nat I have rad this application and auk that Ne sinew information is
correct I agree W comply with N city and county aNinxnaa and sure laws relating W
Wilding construction, and hereby aurhodn mpreenmivor of thts city to cndr up m de
a Ww-menuontd popery for inspection purpswhich
(We) agree to save, indemnify and kap humlees the City of Cupertino gaie,
ms
nce of hsgoad and expense which may in any way acme agmen said City
in consequence
A consequence of the granting of this permit,
�5fJf UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date l
�e
SOUR
SOURf7aaFr.ULAT70N5.
TT�..---
Re -roofs
�
SignatureOfA��p""ll�r
pliclud/ContraciorDate
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
W111 de ap"n amw future Wilding occupant come "hood"'bavrdoe material
.fined by the Cupertino Municipal Cade. ChapWr 9.13, and Be Health and Safety
. Section 25571(.)?
❑Ye CEPIlk
All roofs shall be inspected prior to any roofing material being installed.
Will theeapplicant or future Wilding ogre comp
6 papa tax mem or which
If a roof is installed -without first obtainingan inspection, I agree to remove
Mina
emit ha'rsmnus air contaminants ss defined by the Bry Area Air Quality Management
all new materials for inspection.
Disarict?
❑Yea _,Z]No
I have read! the haumousmaerialsrtquiremcw under ChapWr695 of the Califory
ria Health urSafety Cede. Secdae 25505.125537 and25574. L thnifuh
Mae ata currently haw a benoel out is i W rdlyunderstand
W teary the of But
of of NC
1p�
poam,,occupant
a cety
re m mdwnmhmutb metpoor W ssma cenr.Ca OCWa a psu .
issuance
nee
Signature of Applicant Date
. All roof coverings to be Class "A" or better
Owner or aurharlsd agent D,m