06120059CITY OF CUPERTINO-
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;,�ilr1'FRr1CTORINFORMA.TION
BUILDINGDIVISION PERMIT
BUILDING ADDRESS:
HENRY'S DESIGN. &( SIGN CO
PERMIT NO. 06120059
19640 ST
OWNER'S NAME:
PERMIT ISUEDATE
EVERSHINE
2018 EVANS IN
I
NE:
SANITARY NO. CONTROL NO.
(408)269-0888
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION
IOU De$CllpnOn
1 Mmby affirm Na,1 am lianwd uncle previsions of Came, 9 (commencing
with Seen.70(X)).f Division 3cflhe Businusand Pwfmion Cole.and my license is
nmllforce and erfeeL
CHANNEL LETTERS ILLUMINATED SIGN "BAY AREA BRID
_
License Class 1- / T Lie. a
Dole aQ 4 Concannr
"NEW THINGS WEST" TOGETHER IN ONE SIGN
ARCHnECTS DECLARATION
I undcrvanJ my plans shall he umJ as public mcnrW
Licensed professional
OWNER -BUILDER DECLARATION
I affirm thatLicense Law for the
11. exempt Inn Nc Contrfessm.o
poen ](131.5, Business and :
maw.. ren Code: Any city or county
which Permit ve de repair wuctum
which t
is a a permit re cn.ewq alms, improve do
Permit i file ed
prior uitsleredlprsurequires Wovisiosof for wehpermitm RlcasLsedwmmcni
its
Sq. Ft. Floor Area
Valuation
that ineingwitPursuanu0the pmvisionsofthe
Division oBusiCtonfoutor',ndProrlaw(CMPmr9
of NCeged mops Pwfmievi Cook) of
hecuore DO)ad
$10000
thathe ringwith
sfr alleged uempdom Any violation of
Nat io is esrmpt mmefrom and the basis for
APN Number
Occupancy Type
Semon by or bj
usto veartyreddollforapermitSubjc<sNeapplicantwacivilpenaltyof
not mom Nw five hundred dation ($500).
Lasrwusrs, the Pmprny,or myotimanceswithwaguas Jm(Sec.7
Required Inspections
Bassi,
is iWns9r .Buri car
will do lhewons he
aro dosul
Cme,and
and out apply 0 sm
cock The Com tees Licenselaw doss out apply lf rt ewer of
q P
m then ms, nd who
propProerty who s thctm who docsrahworkhimselrer ugh hu
eny wM buildsmed
rand
not or for sale.if.
own tat we for
ion.red
year fcomired
Nebuildingor Improvements withinone)serofaproveforNeowna-
however. hee ilding or pr antis id within
s,
builder will Mss the burden of proving Nat he did ret Wild or improve for puryoa of
Wilder will
mleJ.
❑ 1, as owner or the pmpeny, am cacluunly com tact with 0cense! mnoactnrs m
construct Ne project (Sec. ]044. Businm and Prufessiens Code:) The Cmufaelnrs U.
cane law does not apply us m owner of propmy who builds or improves thereon, and
whocontruts for such projects with a coneamer(s) licensed pmmant in do Cuatear es
License law.
❑ 1 am unmet under Sec . B & P C for this moon
nee Dam
WORKER'S COMPENSATION DECLARATION
1 hereby alfine uMer puulty of perjury aro of dm following dmlarations:
❑ and will uctm3700 of Conserv w clf-insum Ter Werke cn-
on. u provided for ance of
fer by Secure
Section 3]00 of dx Labor Cade, for dm Performance of she,
workf r
work for which this permit is issued.
mi
71 1 Mw and will maintain Workers Compensation Inwmnce. u required by Section
37M of the labor Code, for the performance of the work for which this permit is issued.
My Workers Compeua Inseam a caniv and Policy number am:
C Policy No.:
C IFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(ITU mins used not becmnplemd lithe Permit is refuse Wound dollars (5100)
or less.)
1 ocnufy Net in be performance of We work for which his Permit u issued. l shall not
cmplcymy pence. in any mmncrw asmbcmme anbjec%m We Woe rYCumpdon
Laws of Calif a. Dam l�
yf� —�—
Appliam '
NOTICE TO APPLICANT. If, after making this Ccnificate or Eumption. you shouW
became Subject m use Workers Compe.tauon provision urine, rabm Code, you most
comply with such provisions or this permit shell be deemed mmmkcd.
'
CONSRU=ON LENDING AGENCY
' •- --
IherebyaffusnthatNemisaeuntwctimlendingagencyforthePerformance of
work for which Nu permit is issued (See. 3097, Civ. C.)
lenders Name
Lenders Addrm
'
I certify that 1 have read this application and cute that the above information u
'
comet I agree m comply with all city and county ordinances and sum laws relating m
building construction, and hereby autherim mpraenulives or this city to enter upon the
Pwp for inspection
claveti
(We) agree in save, indemnify and keep hamilm Oa City of Cupertino against
es judgments. ort whilhma
csmit. may in any way accmc against said City
inconsacluuecorth.crauindof this
of thegrantingof this permit.
A APPLICANT
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOU CE REGULA
�{
Re -roofs
.zg�&, / 2�' 3 —n e
Signature of ApplicanifContraetor Data
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
WIII We appliaut or future building occupwt sem or Mndlc bavardoes material
u defined by the Cupertino Municipal Cock. Chapter 9.13, and the Health and Safety
. Sceden 2ss3z(a)7
t] Yu ❑ No
All roofs shall be inspected prior to any roofing material being installed.
Will We future building
If a roof is installed without first obtainingan inspection, I agree to remove
P g
applicant or occas ant nae
PP g p yuipment or devices which
emit Mnrdous if driu mimms u deOseJ by the Bay Area Air Quality Management
all new materials for inspection.
District?
p Yes ON.
I have mad We heemi sns m ckrialsmquiremens underCMper 6.95 of Ne Califon
me He.?N& Safety Cede, Section 25505,25533 and25534. 1 understand ihuirthe building
does net Currently Mw: a tenant Nal it b my on crujbility W notify the occupant of the
re mentawhehm meipriar,i,ncear.cmdrRamer«apanry.
Signature of Applicant Date
—c
All roof coverings to be Class 'B" or better
Owner tar mNemcd agent Dam '