00120131CITY OF CUPERTINO
CONTRACTOR INFORMATION:
BUILDING DlvtslaN PERMIT
BALD INC, ADDRESS
19744 STEVENS CREF_N,.SLVD
ALLEN SIGNS
PERMIT NO.
001201.31 t
OWNER'S NAME. F'��.-7
APPLICATION SUIT DATE
MARKET PLACE_
1982 STONE AVE
12/21/2000
ONE:
SANITARY NO. CONTROL NO.
(408)280-6500
G ARCHI'HICPAINGINEER:
BUILDING PERMH INFO
O
IfLUG ELECT PLUMB MECfi
jLICENSIiDCONTRACrOR'SOECI,ARATION
Job Description
hcrohy :JOrm rl)haa 1 sen Il,cowal under, pnrvixlnnx of Chane, 9 (cotnmereing
with Sccdan 7SM) orI'mun 3 of the liu,inea, and Pafmsiim' came. and my license
fall force oil free,.
Linens,
SIGN
¢in
Class Lie. e
J De, Connacha
G ARCHI'I'ECI"S DIiCIARATION
,
g I undersand my plmts shall be usd u. p.hire accords
Y Licensed Prote"iannl
O
Of:
he CmdoIOfJ
Red I i ciera.DER
1 heresy law forth,
11. eHasin from he Cssioni
. scaton 1' de ore: Any
Cdc:Any city anorouy
,w,Iha IS,ctiun 703 1.5, 11.
wfollowingich ellen imps .delrinitt rets .ed a crena
O which aqui a parnit Lim, r. li
repairs the it Laa,
peter
Tom b its i.amanro, aLw repairs the tnovisio
S Ft. Floor Area
y'
Valuation
s Licensele
s o theouch
(Chatter 4)
Provisions of ra,mc,,amin,cLl,,ion,
- mmneKhcefaun,Sention70
ode)
Section Iz 0) Di Professions Cdcl
:; Baa
or that heist ,rain (I hasis it the
or that he is,aonht thercfmli and the Innis for the alleged cxnnpnoo Any violationnatty
—
nf na 7031.5 by any npplic forit permit xuhjen, the applicant m a civil penalty
APN Number
Occupancy Type
oll
or nm mare Ivan Rvc nnnaad aiRaa ($srp).
.,)I
3r9aF;aa9. as
❑Laso"Le,of he pepety. or my cmpinyee, win, wages as mensoh,trar.•nandon.
Required Inspections
will do IM1e work. and the %raa¢ I% not Intended or offered for are (see. 7014.
License Law does
Ravines% and Professions Cde:'ITe Contactor. and apply to an
owte Hurl,,,),,rlyWh,)mltdsoriaprovesnhca,)gnaI liot vw,Il,hworkhimself
1.01. -- FOUNDATION
or hhnegh Iii. awn employees. moided n rhe such improvement, arc nil intended nr
improvement ear
offered for fate. IL then Wilding n sold within nue year of
arden
1.03 — LIFEP,
of proving
will have the hnNcn nf,mving Thal M1, did not build or
aarmed. e
nmplctian, 0e (wner-M1uik
.).
mprrwe lir pnr,I„eorxllm.).
104 — REBAR
0 1, as owner of the pro,carlit, am vult,,ively contracting with liernvel contractors to
105 — ANCHOR Sol TS
construct the project (sec. 70,14, un.iras, .,it Prilcx%Ion% Cde:) If, Contactor:.
Ij,,nsc Luw Jd., not apply to an owner at many who heads nr improves diemm,
,04 — ELF- T @ I C • I_
v5 ,
and who contracts for .such project% with u connotations) licensed punuam m the
li„na Law
_ROUGH
505 — FINAL E1. EC R 41_
cnntaclnr.
❑I:on,v,tnpt llamr Sec, .RLR rets, lei, res,,)n
51.4 — FINAL PIJBL i
Owner Dec
llKS
WORKER'S COMPENSAI ION DECLARATION
I hereby atilt In carter penalty nl perjury nuc of the following drdarelans'.
1 have and rill maintain a Certificate of Consent as self -insure far Worker's
Conhpcnxarion, ;is provided tar by Section 37b) of the Lubar Cd,, fir the
,erfornhance of the work for which phis permit is issued.
have and will maintain Worker's Com,w n.ution Inxuance, as required by SL
3 00 of the Labral Code, for the Performance of the work for which this permit i,
-
ismud. My Wd,1w,, Cntnlwn,mion h ancc carrier and Policy numher are
r
S'�E� 33 Z—OL—
Carrier: Policy Nu: JZ
'ERI IP CAI I N (Ih IIXEMIsHON FROM WORKERS'
COMPENSATION INSURANCE
ted if rhe t i, for one madrd dollars
(Thixve m need not be.otn"con
IFI pip or le,,,)�Ih
I certify that in the ,vrfnnnowe of the work for which this permit i, issued. 1
shall nI via,pio, any per any nnn I ,o ea ah become djar to tire Workers
Com,rasmion Law, of C.1doo iu. Date
Applicant
NoricE TO APPLICANT: If, aver raking this Certificate of Exemption, you slarild
bec re object the W..kerLI C..... a,aloa prnvi sof Oa Labor Cale, younn,a
_
forthwith comply with such p,mi ion, or this, .... it shill hadee revoked.
p CONSTRUCTION LENDING AGENCY
'
I hceby anion that Orr, Ix a con,tacrion le fir, agency for IM1e "eriormancd
of the work for which this permit i, issued (See. 3097. Ci, C.)
Lender's Namc
7 Leader'x Andrews _
1
I criff, bar l h d pit, .,head d ,aid drat the mif r 's
nt 16 d ply with all city d h oh cc and sure I mining
J torl
ld b Lam,ameriori,annalh h,,a tl p rl es l his city ao enterpm
J] IM1e leI' al P IS I "I,IranP I
3
y (Wc) agree to save. indemnity andkeep limitless the Cry ofCpartg test
J which may In any way twerre aga nsr id
q ♦
A hidilair,,tal,roarn, crisis u r,,L .
City in cnn..Iucnre of Ilia gaamg of this pans
APPLICANT UNDERSTANDS AND WILT. COMPLY WITH ALL NON -POINT'
Issuedby' �(- %J AA -1 CC, Date
SOURCE REGULATIONS,
Re -roofs
si,nalare,IApowert)Contractnr ])are
HAZARDOUS MATERIALS DISCLOSURE
Will the it'livsm or futile huildni laenfvhat War a handle hearin,un material
Type of Roof
a, defined by the Cr,mr, Municipal Cdc. Cha,¢, 1) 12, and rhe Health and Safety
Cn It. Section 35532000
0}'ei
All roofs shall be inspected.) prior to any roofing material being installed.
Will the applicant or more blilmtng occupant use equipmem or dcstre.which
If a roof is installed without first obtaining an inspection, I agree to remove
nail harardnux an comm nirmas ux def d by l he ltay Aw Air Qmalhy Management
Irma?
all new materials for inspection. Applicant understands and will comply with
0Yr, "°
all non -point source regulations.
read (h, hamrdt... nnMiak m,riminma, under Chtgna 695 of r,
lth&Surety Cd,; 5eaiuns 25505.255?}ImJ 25514.1 undeaund thatrc.
nm curandy Ehmc a hmm�h. the it is InY rc......bditymmaf,re
e require int, vdawh nn1,l be mel prior I.. nuunaeof a Cerrilicee of
"read
Signature t A plicant Dale
All roof coverings to be Class "B” or better
,)ri„III - Dem
V OFFICE