02100167CITY OF CUPERTINO
BUILDING DIVISION PE - T
CONTRACTOR.INF(iR
BUII.151TVIRESSTEVENS CREEK BLVD
ALLEN SIGNS INC
PERMITNO2100167
01546 AT ART
1982 STONE AVE
APPLICATITVYlPArR2OO2
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PH L:
4 O S 2 B O- 6 S O O
SANITARY NO. CONTROL NO.
ARCHITECI'rENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECII
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION
llrr,,hh nn
I herby affirm Nat 1 am IiaTned under provisions of Chapter 9 (commencin5
SIGN - - I ND I V CHANip1ii,TTER
wit Section 7001)) or Division 3 of the B Tana s and limitations Code, and my license is
.
in fullforteamd.ffe t.
License I s Lic, x
Dar pz, Conlraelor
ARCHITECTS DECLARATION V'
I understand my plans shall Is, used as public mewls
Lara d Professional
OWNERIBUILDER DECLARATION
I hereby affirm that I am czcmpl (rem the Convenors License law for the
$1500
following ..on. (Section 7031.5. Buion
Business and Professions Codes: Any city or county
which requires a permit in, construct. alter, improve, demolish, or repair any structure
PHOT 10 its issuance, also requires the applicam for such pamitto Me a signed statement
that W is licensed pontoon, to to previsions of the Contractor's License Law (Chapter 9
3Sb6BEffld)BA@®
Valuation
(commw,cing with Section 7") of Rwision 3 of the Business and Professions Code) or
Nat he Is exempt therefrom and the basis for the alleged esemption. Any violation of
I UAPNN
Occupancy
p y Type
Section 7031.5 by any applicant for a permit mbjccu Na applicant o a civil penally of
no, mart tan Eve hundred deltas (isoo>.
103 — UFER
I, az owner of the property, or my employes with wegas a theh sole compensation
is
±64 REBA
R89rndnspections
will do the work. and ✓r swawm is not intended or offered forsake (Sic. 7046, Business
and Pmressmns Code: The COnuacmro License law does not apply Ir an owner of
property who buildsor improves thereon, and who doessuch work himself or through his
own employes, provided that such improvements are not intended or offered for sale If.
105 - ANCHOR
304 — ROUGH ELECTRICAL
however. Ne building or improvement is sold whin one year of completion, the owrcry
505 — FINAL ELECTRICAL
builder will have the burden of proving Nat he did nor build or improve for propitious of
sale').
514 - FINAL PUBLIC WORKS
0 1, as owner of be property, am exclusively convecting with licensed con.. m
comma the project (Sm. 7W. Business and Profestioa Code:) The Contractors Li -
are law does no, apply m an owner of property who builds or improves domain. and,
who contracts for such projects wit a contractor(s) licevad pursuant o the Comvacmra
License Law.
❑ 1 un exempt under Sec. . B & P C for this reason
ner Dale
WORKER'S COMPENSATION DECLARATION
1 herby affirm under Penalty of perjury one of to following decimations:
Q I have and will maintain a Cenifiata of Consent to sel6imurt for Workers Compere
It as provided for by Section 7'!00 of the labor Code, for the perfonmanee of tk
work for which this Perri, is issued.
1 have and will maintain Workers Compensation laurana. az required by Section
37 ofthelabor Code.forth.pwfwmanecof Newoft(orwhichtispwmitisinmd.
y Workers Com ewtion lmur .artier and Palicy number art:
My,
Carrier. Policy No.:337iOLCg705 Z
CERTIFf ATE TEXEMPf1ON FROM WORKERS'
COMPENSATION INSURANCE
(this section need oat he completed if the permit is rotor. hundred doll. (SIO()
Or less.)
1 eenify Ihst in the kafwmance of the work for which Nis Permit is issued, l Mail not
employ any p (ken in my manner SO as in became subject to the Worloas CompettladOn
Laws of California. Date
Applicant
NOTICE TO APPLICANT: IL after making Nis Coni fcate of Exemption, you should
become subject to Its, Worker's Compensation provisions of the Labor Code, you most
foMwith comply wit such provisions or to, permi, limit be earned revekcd.
CONSTRUCTION LENDING AGENCY
I hereby off rte Na, alert is a construction lending agency for the pcaforromm of
,
N. it for which tis permit is issued (Sec. 3097, Civ. CJ
Lenders Name
Ledens Address
I unify Na, l have read this application and sum that to above information is
correct 1 agree to comply wit all city and county ordinances and stem laws relating to
Wilding construction. and herby aulhoHae ropresentatives of this city to enter upon da,
move -mentioned prepcny for inspection pugmses
(We) agree to save, indemnify and kith harmless the City of Cupertino
sts may inany wayeccme against mid City
expenses id City
f
/
inconsequnceof ileo goading thispermit.
inconsequence Of to granting of this ICTr1,IL
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NOPOINT
Issued by: Date
SOURC�FyR('iU UL _ ID/�„/
9C7f.2 Y I q� �U Z
Re -roofs
Signa mo Applice ✓Convector 15m,
AZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will the applicant or future Wilding occupant store or handle hvardoae material
at defined by the CoNnino Municipal Code. Chapter 9. 12. and the Heahh and Safety
Seed.. 25532(a)7
❑Yes )6o
All roofs shall be inspected prior to any roofing material being installed.
0•.
1
If a roof is installed without firs[ obtaining an inspection, I agree to remove
Will the applicant or future building occupant use equipment or devices which
crit hazardous air contaminants as defined by the Bay Arca Air Quality Mmogem.nl
all new materials for inspection.
DistoCL?
XNu
❑Yes
Is ave mad the havardnus materialsrquirtmenu untkr Chapterh93ol Ne Califor-
nia Hcalth & Safety Code, S 'Uom 25505,25533 and 25534.l undenland this if lh. Wilding
does not currently have a tenant that it is my msponstility In madly the oecupsnt of the
mquim e B ire av b. tp,aT to moan«oncertirca'oo cayen .
Signature of Applicant Date
2 oZ
All roof coverings to be Class "B” or better
Owner or au,hori'rc0gem'Date
crrY OF CUPER'11NO
BUILDING DIVISION PERMIT
CONTRAGTOR INFORMATION: +.
nulll9c MBSTEVENS CREEK BLVD
ALLEN SIGNS INC
PERMITNO2100'1}67
IMDUNG AT ART
1982 STONE AVE
APPLICATIl)t yf2)41'/ 2002
"'ONE:
(408)280-6500
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MP-CH
0 0 0 0
LICENSED CONTRACT'OR'S DECLARATION
I hercny arrfm in" gkI am licensed under previsions of Chapter v fcommeneng
with Section 7 » of Doosoin 3 of the Business and Professions Code, and my license is
SIGN— — I NDI V . tlpl
in lull lore, and cle I.
'
License 1Contract.'An S
Dam Cum
NOV 0'7 2002
DIIIk!-Ill
As DECfA ATION
shall uses
1 understand my plans shall M used xs public records
p�
BUILDING
G
Licensed Prolessu nal
OBUILDER DECLARATION
I hereby .(Tete am Law for Inc
ore exempt from the Conhns ru :
$1500
onthat)
Any
reaso a;ncss and Crude: Any city or county
followingreason.3 (Section 703 1.5.
ore. demolish. nr repair any structure
which requires a permit to t. alter, improv. h.
h Permsh,
the Cerement
quires a for monpctor
prior to slcense
3SIg6&i(ID1833AQD
Valuation
pal.uant it) the inion of a Lfileasigned
ndPrseLaw
(that Commisfianvdpuection7othcplDi.;onamTM1theBMuross onsCode)or
(CommencingwifeSection Iladd of Division3 of the and Professions Code) or
and the aper for the allcg,d exemption. Any violation of
Nm he is cxcmpl gedexe
pNN
Occupancy Type
6yaundreddollrs apermit mbjecutheepplicannn.civil Penalty of
any applicant
not sour, man Five hundred dollars (asfx».
not than
103 — UFER
❑ Luowner of the pmpenY•or my cmployaa with wag,. as their tele compensation.
±e4 EE
R� r�¢Inspections
will do the work, and the structure is not intended or offered for sale (Sm. 714A, Business
Code: Th, Cnneoctors License Law doe, not apply to an owner of
and Professions
progeny who milds of improves thereon, and who does such work himself or through his
own employees. provided that such improvements am not intended or offered for We. It,
105 - ANCHOR
304 — ROUGH ELECTRICAL
however. the building or improvement is sold within one year of completion. die owner-
505 — FINAL ELECTRICAL
builder will have the burden of proving Nal he did not build or improve for purpose of
m1,.).
514 - FINAL PUBLIC WORKS
❑ I, as owner of Inc plurality, am exclusively contracting with licensed contactors to
mswet the prghct (see. 704J, Business and Professions Code:) The Contractor's Li-
pec law does not apply to an owner of property who Wilds or improves thereon, and
whocunuaem for such pmjecu with a contractor(s) licensed pursuant o the Contractor's
License Law.
❑ I am exempt under Sec. . B & P C for this reason
cel Dam
WORKER'S COMPENSATION DECLARATION
1 hereby alGrm under penally of perjury one of the following declarations:
O 1 have and will maintain a Ccnificam of Consenuo selbinsure for Worker's Compcm
retool, az provided far by Section 37W of the "We Code. for the Performance of the
work for which th;.s permit is issued.
KI have and will maintain Worker's Compensation Insurance. as required by Section
37 f of Ne Labor Conde, for the Performance of the work for which this perm) is issued.
My Worker's Com en. tin IrEum and Polity Monk, are:
/rcX;tr
Cartier. til Q_ Z
11Pull ONKfdd WORKERS'ri
CERTIFI ATE PEXEMPf10N FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if th, perm's is Lorene hundred dellars ($101)
less.)
1 minify that in the predominance of the work for which thio permit is issued. I shall nor
employ any reform in any manner ttr as to Mcome subject to the Workers Compensation
lLaws of Cithfomia. Date
Applicant
NOTICE TO APPLICANT: II: alter making this Cenilicate of Exemption, you should
become subject to the Worker's Compensation provisions of the Labor Cade, you must
forthwith comply with such provisions M this lennil shall W deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby affirm Thal there is a construction lending agency lar the performance or
the work for which this Permit is issued (Sm. 3097. Civ. C.)
'
Lenders Name
I.cudcr's Address
1 cenify that 1 haw mad this application and time Nat the above information is
contact. 1 agree to comply with all city and county ordinances and state laws relating nr
building construction, and hereby noncom representatives of Iris city to enter upor the
above-mentioned property Int inspection purposes.
(Wc) agree to save, indemnify and keep harmless the City of Cupertino against
liabilities, judgmenm, cox and expenses which may in any way income against mid City
in consequence of the granting of this permit.
APPLICANTUNDERSTANDS AND WILL COMPLY WI'1'll ALL NO -POINT
/
Issued by: Date
SOUR F R
1a l �'
�UL/rl'IOpyJ
STT
Re-roofs
Signal rc n Applicu UCommolor I me
{AZRDOUS MATERIALS DISCLOSU RE
Type of Roof
Will the applicant or future building occupant store or handle hamoduus material
.as defined by Ne Cupertino Municipal Code. Chapter 9.13. and the Health and Safety
,ate. Se,tioo 235321)''� /s
❑Yes
All roofs shall be inspected prior to any roofing material being installed.
XNn
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building occupant use equipment or dcviers which
mil hvurdnav air o0rominan,axdcfired by the Bay Arca Air Quality Management
all new materials for inspection.
DisaicO
)<No
C3 Yes
1 have read the hamohns materials requiremene under Chapter 69 or Ne Cali for
nix Health K Safety Coude. Section, 255115, 35533 and 2551.1 unrkrsund that if ILC building
does but currently haw a tenant, dial it is my responsibility an notify but nc,upanl of the
rc,o;m et.. Ido uslM trariurto;ssuan„orac,nm,afor eupm
Signature of Applicant Dale
02 OZ
All roof coverings to be Class ••B” or better
Own ur authmirsd Ilion Dam