03030158CITY OF CUPERTINO
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BUILDING DIVISION - PERMIT
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BUILDINGA DRESS: _
PERMIT NO. t
JSJ ELECTRIAL DISPLAY'
OWNEi'&SQ5 STEVENSCREEK BLVD
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PERMIT ISSU6ft8 0 15 8.-
4.59 INDUSTRIAL WY
SANITARY OL NO.
7077475595,
AR CHiTEcvsNGINEER:
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BUILDING PERMIT INFO
BLDO ELEC. PLUMB MISCH
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LICENSED CONTRACT'OR'S DECLARATION.
1 hereby Affirm Nat 1 nolicensed under previsions of Chapter 9 (commencing
Job Description
wiLhs.,ion]0(1q)of Divldon3oflhc BusinmmjPiotessiomC dc, and my tic mach;
in full force E((erY' J— 7
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License CI Ci Lic. p
Dam — comrnt
REVISION --SIGN DETAIL--I'N HOUSE USE ONLY
AC SDEC
NO NEW' -PERMIT ISSUED, ORIG.#03030041
Iundce nd my plans Ntll be aedap creep
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Licensed Professional
OWNER -BUILDER DECLARATION
I herebyesu ,(Sere that 1 exempt from Ne Contractors Law for the
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following meson. (section ](13L5, Business and Professions Code: AnY ci1Y m county
1. e: Any
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which cturs
L alter narnt
nr mash any awment
• pools m consUiMS
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ranw, h Permit t
its issuance. th t
statement
Prior to its l used p rsualsnt to the the applicant the Co permit a m s sig, Law
that bels licensed pursuant 70th) of
Sq. F[. Floor Area' Valuation
(commencing on 7000) of Division of teBusinssand Profession Code) or
Scdfromadth D asisfrmtheeged
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he exempt exemption.AnymACodc7
Nat he iw exempt therefrom mtl the Lula far the alleged exemption. Any rlohGm of
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Section 7831.5 by any applicant for a permit subjects the applicant to a civil penalty of
APN Number
OccU Type.
not more Nan five hundred dollars (5500).
Pn y
❑ I, as owner or the property, or my employees with wage as their sole compenutlon.
will do the work, and Ne swnusn is not intended or offered fat sale (Sm. 7044, Business
and Professions Cade: The Committee License Law does not apply to an owner of
Required Inspections
property who builds orimptovu thereon, andwho doeasuch work lamselforthrough his
own employees, provided that such improvements are nothu nded proffered foradc. If.
.101 – FOUNDATION ,.
however, the building or lmprevement is sold within one yen ofcompletion, the owner-
- - 103 – UFEI2'
builder will have the burden of proving but he did not build or Improve for purpose of
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wale.).
104 - REBAR'
❑ I. Aa owner of the property, am exclusively connecting with licensed contractors to
105 ANCHOR BOLTS -
construct the project (Sec. 7044, Business and Profession Cade:) The Contractors U.
came, Law does not apply to in owner of pu,any who Wilds or Improves themon, ad
304, –-ROUGH ELECTRICAL'
Who convects for such projects with a conuaomrcn licensed pursuant to the Contractors
Ltcerue Law.
,505 — FINAL. ELECTRICAL -
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El Ima as mptunderSec.. ,BAPCl5maidsmnon
- 514 7- FINAL PUBLIC WORKS
Owner Date
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WORKER'S COMPENSATION DECLARATION
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I hereby affirm under penalty of perjury oro of the following declarations:
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L] I hew and will maintain a Certificate ofCanent to self-Insum for Worker's Cheaper.
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wation, M provided for by Section 3700 of the Labor Code, for the performance of tM
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work for which this permit to issued,
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❑ 1 have and will maintain Worker's Compensation Insurance, in required by Section
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3700 of the labor Code. for the performanaofthewor "which this permit is issued.
M Workcr'a Com &natio no ad ad Punic n
CERTIFICATE OFEXEMPION FROM WORKERS'COMPENSATION
INSURANCE
Intonation need pot W mmplcud ifihe permit afaone hundred dollars nio)
or 103.7'
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1 candy that in the performance of the work for which this Permit is Issued, I &hall not
employ any person In any marmoso 0 an become subject to Ne Workers'Comparendon
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Lem of Celif.ram. Date
Applicant
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NOTICE TO APPLICANT: IL after making this Certificate of Exemption, you should
become subjem he the Worker's Compensation provision of the seam Cade, you mat
forthwith comply with such provisions or this Permit shall be deemed revoked.
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'. CONSTRUCTION LENDING AGENCY
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I hereby affirm that them is a construction lending agency far the Performance of
the work for which this permit Is Issued (Sec. 31191, Civ. C.)
Censer's Namc
Lender's Address -
1 eeAe that 1 hew thisapplicationand slam Net the above Information is
with
corm. agree to comply wad all city and county ordinances
anend rete lows mining he
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or
cnifionectiaq and hereby aahonm representatives of this clay a enter u��n Ne
r Upon
!/
4howng
or
shove-ms,judgcd property (mad expenses
xp hies purposes.
- (We) agree uo sew, indemnify and keep humless the City of Cupenlno against
may In any wayaccme again&nuid City
Incon0esunce Of the
In consequence of the of this
of this
permit.
permits.
APPLI U ND WILL COMPLY WITH ALL NON -POINT
Issued by: ' Date
R T ^/
Re -roofs -
Type of Roof
Sign um of pylic C Actor –Dela
//� .ARDDUS MATERIALS DISCLOSURE
ill the applicam m fulum building occupsm store orhandle havudous maim al
as defined by the Cupertino Municipal Code, Chapter 9.12, and the Hcelth and Safety
Coda, section zss3z(a)7cycs � �`
All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or forum building acupam esu equipment or devic0 which
If a roof is installed without first obtaining P g an ins ection, I agree to remove
ersrdna air contaminants as dcfincJ by the Be, Arta Air Quality Management
all new materials for inspection. -
District?
❑Yea XNo
i
I have read the Woodousmaterials requirements under Chapwr6.95 lithe Califor.
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nice Health&safely aon25505,25533mdM534. 1 meets nd that lffle building
does nota a a a at Il is my espotahility at real [be p0uPm1Mthe
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rcyuirt nawat n at so a aCertificate of c ry. a
ignature of Applicant Date ,
All roof coverings to be Class "B" or better
e r a a rets Daa
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