05010193CITY OFCUPERTINO°"
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BUILDING DIVISION PERMIT
CON'PRA.CTWRMATIO;
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BUILDING ADDRESS:
ALLEN SIGNS INC
PERMIT NO.
05030193
ER'S NAME:
PERMIT ISSUE DATE
NE:
SANITARY OLNO.
,ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG PLUMB MECH
OELFIC717
LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby ef0on Nal I am licensed Coder pmvidam of Chapter 9 (rommewing
with Section 70IM1) of Division 3 of the Business end Prokssiom Code, and my Ike=la
In full tares eros of t.
Lkeme Yy
Clas Lle. M
SIGN--INDIVIDUAL CHANNEL LETTER
DaWContractor
ARCHITECTS DECLAR TON
1 underm nd my perm Mail be used as public rerordi
Lkenmd ProR. ianal
OWNER-BUILDER DECLARATION
I hereby affirm met I am exempt from dm Commucror's License Lew for the
following mason. (Section 7031.5. Business and Profession Code: Any city or county
which inquires a Permit to crummun. alar. impmw, demolish. or repair any structure
prior W its issuance, elm requires the applicant for each Permit to file a signed moment
Mc ConuacWh lJame Law (Chapter 9
Sq. Ft. Floor Area
Valua on
that he is licensed pursuant to the provisions of
(commenring with Sono 70W) of Division 3 of the Business and Prufessian Code)ar
Nat be is exempt Nemfrore and the Was for the alleged exemption. My violation of
3 [(� 0
E��A�
T
- Occupancy Type
`� I
Semon 7031.5 by any applicant for a permit subjects the appliunt W e civil penalty of
not mom than Rus hundred dollar (5500).
❑ L u owrmr or0m property, m my with wages as their sok cempeneation,
f "' _
f
if 1
P I 1 •Required-lDSpeC ions
otimeyees
willdo thewoh. end theswnure is nolinlended orortcred for sok (Sm,70N,Business
and Profusions Code: The Canu,care Liceme law does not appy W an owner o!
1 \ i' )
propenywho builds orimproses dmWn, end whodoessuch work himselfmthrmgh h4
shmewh Improvements Intended or offered forsake. If.
-_ .. 11� I�� •�
awnemploymes, provided arenot
however, the building or improvement is sold within one year ofcompledon. the owner.
r/
did build improve for of
1 .7I
builds' will have Ne burden of proving that W not or purpose
sok.).
C
❑ 1. as man, or the property am exclmively contracting with licensed cantracmm W
comtrun the project (Sec. 7010, Business and Professions Code:) The Conuacterl LI-
cene law does not apply to in owner of property who builds or improves Marion, and,
who concocts for such pmjecu with a canmcror(s) Rcenred pursuant W the Onam oM1
License taw.
❑ I am exempt under See. , B k P C for this mason
cc Date
WORKER'S COMPENSA71ON DECLARATION
1 hereby arthro under penalty of perjury Om of the fallowing declaration:
❑ I haw and will maintain a Cmificete ofComent W self-Inune far WOUlansCOmpen-
mtion, as provided for by Sacdon 3700 of the Inbar Code, fm the performance of the
work fm which Nb permit is issued.E]1
haw and will maintain Worker's Compecation Imunnce, u required by Section
3700 of the Labor Code, fm the perfarmance of Ne work for which this permit is issued.
y Worker's Com enuti nlnamn u�rtiau/�}d,Poliry rumbas w:
'Y'
Team
Carrier. Mltty tbS
KERS'
I>n FROM WORKERS'
CEIffIFlCATEO M RO
'
COMPENSATION INSURANCE
(This motion wed notbecmnplewd if the permilu forane hundred dollars (SIM)
Or lees.)
I certify that in the performance of the work for which this pemrit ts Woad. I shall mi
employ any person in my manmrso as W bccomesubjen in be Workers'CompemNon
-
Lawn of Cadifurtils Man
Applicant
NOTICE TO APPLICANT: IL afar making this Certificate of Exemption, you should
became subject W the Worker's Compensation previsions of the labor Code, you most
forthwith Comply with each provision or this permit shall be demand revoked.
CONSTRUCTION LENDING AGENCY
I bereby affirm that then is a contraction lending agency fm the Performance of
the murk for which this permit is issued (Sec. 3097. Civ. C.)
Lender's Name
-
Lendee.Addrea
I ceNfy Na I haw mad this application and sus that the above information Is
'
coram. l agree W comply with all city and county ardmance,and sum laws aiming to
Wilding connotation. and bereby authodre representatives of Nis City W enter upon the
above-mentioned pmpeny fm impection purposes
(Wc) agree W ave. indemnify and keep harmless the City of Cupertino againt
a
j liMilWu,judgments, casts and expcmu which may in any way scene Maimtaaid City
in consequence of the granting of this Permit.
APPLICA U DERSTANDS AND WILL COMPLY WITH A L NON-POINT
Issued by: Date
SOURC AT ONS. a
Re-roofs
Signature or Appl' ✓Contractor Daa
NA2ARDOUS MATERIALS SURE
Type of Roof
tstoma
sun plkantor rmum Wueingaavpanlabrcmh,bele hasrdau material
..
as de0ned by the Cupmno Municipal Code, Chapter 9.13, and the Health and Safety
a. Suction 25532(a)7
All roofs shall be inspected prior to any roofing material being installed.
❑Yes �No
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or fuWw building wcupant era equipment or devices which
emit ha>vdnus air conumjnanu as dcRmd by to Bay Area Air Quality Management
all new materials for inspection.
District?
XNo
❑Yes
I hew read the ha>ardnusmamdals mquiremenu under Chapter 6.95 of the Califon
ni,H.I"Safety Cade,SwU=25505,25533and25531.1undcnund Nalfthe Wilding
.
dues ml currently haw a anent, Net II u my reapomihllity W notify the occupant Or the
require c h' must metpiarWiauatec ter, Cerdnnte or puny
Signature of Applicant Date
All roof coverings to be Class "B" or better
owner fount d>1 gent ,te