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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 // '-�� // 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