02100126 CITY OF CUPERTINO `�`�%-' - ✓�
BUILDING DIVISION PERMIT CONTRACTORINFORMATION:
B11
l-1,6140sSTEVENS CREEK BLVD ALLEN SIGNS INC PERM]FN®2100126
N:NFOHOME 1982 STONE AVE APPLICAI'Trgg B1D]ITV2002
PHONU (408) 280-6500 SANITARY NO. CONTROL NO.
ARCD TIiCT/ENGINEER: BUILDING PERMITINFO
BLOC ELECT PLUMB MECII
OctO O O O
�{00 LICI?NSI'D COME RACTOR'S DECLARATION y
ire Ithereby antrmthat lamlie coveJunJcr idtaaorenapmr9rnmroea SIGN- -INDIVIDi�$�D ftL LETTER
Z with Section 70(10)of Division 3 of the MZIZC JPrnfccsinns G4e.and my lino.¢is
FOO in fulllitr�Jcffc
cznz LiccnLic
¢CI S — Coma
Oe— Date Or ANN F'NALE®
O < �1 umlcrsumd my planes shall era us d as public records
w LL 0
DEC 0 2
Licensed Yrosaional
OWNER-BUILDER DECLARATION 2002
<$ I hereby anirm that 1 am exempt from the Contractors License Law for the $
a 2000
w—00 following reason.(Section 7831.5.Business and Professions Code:Any city or county b1�'�y�
$ which requires a Permit to construct,alter,improve.demolish,or repair any structure SU v
to
pour b)its issuance.also requires the applicant for such permit o GM a signed statement
1Z-Zz< that he is licensed pursuant to the provisions of the Contractors License law(Chapter 9 39q9I _4Uf®@AIU Valuation
aLFO (commencing with Section 7lMKB of Division 3 of the Business and Professions Codc)or
i $ Nat he is exempt memGm nand the basis for Ne alleged exemption.Any violation of
Section 7031.5 by any applicant far If .it ubjects the applicant to a civil pc mi of UAPN-NthWPqUA UN Occupancy Type
not more than five hundred delta.(S5f10). 103 - UFER -
❑ Las owner ofthe property,or my employees with wages as Nei,able compensation.
will do the work,and the someone is not intended or offered for sale(See.7W.Business
and Professions Cash:The Contractor's License Law does not appy to an owner of 105 - ANCHOR ReVILTJ,14nspections
propeny who builds or irn,mr.thereon,and who Over such work himself.,Omagh his
own empmyecs.provided that such innamsements am nm immrded orofftmd for sale.If. 304 — ROUGH ELECTRICAL
however.the building or improvement is sold within one year of completion,Or,owner- 505 — FINAL ELECTRICAL
builder will baso the burden of proving thm he did not build or improve fur pen.e:<of
sale). 514 - FINAL PUBLIC WORKS
❑ 1.as nwncr.f the propert,am eaclusivcly cuntnering with hermam!ronuactom t.
consumer the project(Sec.7(Wa,Business and Professions Code:)The Contractor's Li-
cense law does not apply to an owner of property who builds or improves themes,and
who conwcu for such projects with a contractor(s)licenses!potation to Ne Contractor's
License Law.
❑1 am cacmpt under Sce. .B&P C for this reason
Dam
WORKER'S COM PI!NSATION DECLARATION
1 hereby alrum under penalty of perjury one of the following declarations:
❑I basic and will maintain a Ceniacam of Conacnt to"If-insure for Worker's ComPem
cation,as provided for by Section 37of)of the labor Civic.fill me Prof.....of the
work for which this permit is issued.
1 have and will maintain Worker's Compensation Insurance,as myvircd by Section
3700 of the labor Coale,for Ne pmformance of Ne work for which this permit is issued.
My Worker' Com tion sumne eaMer and Polity/9 cher am:
r.,��Polic N^. u '
CERTIFICATEOF
COMPENSATION
IN 1WORKERS'
COMPENSATION INSURANCE
Cnos section need am be complrmd if the leourr is for one hundmddollars(510))
a less.)
1 eenify that in the performance of the work for which this Permit is issued,I shall not
employ any person in any manner an as m become Subject o the Workeri Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:IL after making this CeniEcate of Exemption.you shoidd
become subject to the Worker's Compensation provisions of the Labor Code,you must
O z, forthwith comply wl@ sumh provisions or this pernot shall he deemed revoked.
zO CONSTRUCTION LENDING AGENCY
(� I hereby affirm that there is a construction lending agency for the performance of
[Y. > me work for which this permit is imued(Sec.3097.Civ.C.)
Wa Q fender's Name
7 C) LcnJcrss
AJJm
V Q I certify mat 1 have read misapplication and itam that the aWve information is
D. F coreef 1 agree to comply with all city and county ordinances and sum laws relating m
OV building conswction.and hereby authonx mpresentathts of Nil city to enter upon the
shovomcationed property for inspection Imposts.
(We)agree to save,indemnify and keep harmless the City of Caperton against
F' h liabilities.judgments,costs and expenses which may in any way same against said City
J in conecipcnce of the granting of this permit.
r-, APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL PON.POINT Issued by: Dale
SOURCI:RE LATIONS.
70z
Re-roofs
s am co APP ca con ¢nor ate
AZARDOUS MATERIALS DISCLOSURE Type of Roof
Will thea cam or future building occupant store or handle for..d.usmamrial
s deiced by me Cupertino Municipal Cnnc,Charm,t),11,and the(Ratio and Safely
le,Semil.n255320)? All roofs shall be inspected prior to any roofing material being installed.
O Yca _^Nt
Will the applicant or future budding occupant use equipment or devices which If roof is installed without first obtaining an inspection,I agree to remove
chair haeardous air contaminants as detind by the Bay Arca Air Quality Management all new materials for inspection.
DistricR s ' or
❑Yes
1 have read the haravlouamaterials requirements under Chapter(.95 more Califor-
nialksits&Safety Gam,Sccdons25546.25533 and 255:W.1 understand thatif thc building
does not currently have a tenant,that in is my resp nshalo,to notily the occupant or the
or tsw thme" met poor ,,issmanmofaccrimeam"Iactiony. Signature of Applicant Date
l v f All roof coverings to be Class "B" or better
O nm err a ho nctl,gent D tc