04050161 CITY OF CUPERTINO '1=' t
BUILDING DIVISION PERMIT „"<�NC1tACT' '0 1 't,�. MATIU
BUILDING ADDRESS: ALLEN SIGNS INC PERMIT NO.04050161
20385 STEVENS CREEK PTUT)
OWNER'S NAME: PERMITLSSUEDATE
AT & T WIRELE
E; SANITARY N0. CONTROL NO.
(408) 280-6500
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 a
o p LICENSED CONTRACTOR'S DECLARATION
F1 Mmby that 1 am Ree ued under provisions of Chapmr 9(commencing lob Description
SK2 with
gecGon7 of Division 3 of NC Business and P ons Cade,end my hear.is
ay tmm�mm meercc t — SIGN--INDIVIDUAL CHANNEL LETTER
j Licenu Clw Lin,X
Date Contracto,
! ARCHITECTS DEC ON
Y 1 def d my pWm aNll he used u public Bends
wD Licensed Professional
OWNER-BUILDER DECLARATION
F I hemhy affirm that 1 am exempt fmm do Canuactar's License Law for the
p o following mown.(Section 703 1.5,Business and Pmfessiuu Code:Any city or county
K$ which requires a Permit m consumer.alter,improve,demolish,or mpab my muctum
prior In its issuance,also requires Ne applicant for such Permit to file a signed sutemem
< that he u licensed pursuant she provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation
x1--a (commencing with Section 7")of Division 3 of Ne Business and Profusions Code)or
y $
that he is exempt therefrom and the basis for the alleged taempdan.Any violmlon of
Section 7031.5 by any applicant for a permit subjects be applicant he a civil penally of 3 MN6QM8er 0 0 Occupancy Type
not mom Nen five hundred dollars(5500). Pq
❑I,uowner andah....me,is atinouladmo isped Net on,
will
and dodfausi,and theswmurelsne.LicenseLawrdoes le rv. u a t equied Inspections
and Pm(wions Cade:The Canveown.License Law dao nota m an owns ug
property
mploymuildamimprowamemon. menU=notld who hwoh hi If�oL�lryaid r.
ownem,thebuilding or Netmn imis sold within
notintendetl oIfpfpyldaule.)Tt
builder will
the uimprowmendemld widtinoneyur o(co etlfor the ow r.I. _
builder wi0 have the burden of proving that he did not build u imp for puryof ._
ulcJ. -
❑1.as Owner of the progeny,am exclusively convecting with license contractors to
canswct the pmjcct(Sec.7044,Business and Profusions Code:)The Ca dernmes U. _
cave Law does not apply to an owner of property who builds or improves shemon,and.
who contracts for such projects with aeonuwtm(s)licensed pursuant o the Convector's
License Law.
❑I am exempt under Sec. ,B&P C for this mason
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under Penalty of perjury oro of the following deduations:
I haw and will maintain a Cenifmum ofConsem to self4asure for Workers Compute
sation,u movidoll for by Section 3700 of the Labor Code,far the performantt of me
work for which this permit is issued.
1 have and will maintain Worker's Compensation Insurance,as mquimd by Section
3700 of Ne Ube,Code,for the performance Of the week forwhich this permit I,iauc 1. -
My Worker's Compensation Insurance carrier and Policy number am:
Carver. I 1l > Policy Nm:42=-00C 1(a 32
CERTIFICATE OF E) ' PI30N FROM WORKERS'
COMPENSATION INSURANCE
(Thisseation need nottecomplowd!(the permit Is ho ne hundred dollars(SIM)
mlus.)
1 certify Net in to performance of the work for which this Permit is issued,I shall not
employ any person in my bummer an u m became subject to de Warkeri Compensation
Laws of Calif..!.Due
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject in the Worker's Compensation previsions of the Labor Code,you must
.JO enhwidt comply with such provisions or mis Permit shallbe doemcd revoked.
z^ CONSTRUCTION LENDING AGENCY
Fr 4 1 hnmby of irm mat dem is a construction lending agency for me Performance of
p:7 the work for which this permit is issued(Sec.3097,Cih,C.)
W�Q Unticrs Name
] Z Lenders Address
O Q I coolly,that I haw read this application and sum that the above information is
II. (~ correct 1 agree to comply wish all city and county andhmas and mum laws misting to
QU building convection,and hereby auNorim repcometuiws of this city m enter upon the
LV shove-mendaned Properly for inspection Purposes.
(We)agree to rove,Indemnify sad keep hannleaa me City of Coin: Ina against
y liabilities,judgments.coati and expenses which may in anyway same against=it City
C)'z in consequence of the granting of this Permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
so
§WRe-roofs
HAZARDO
Sigmtureo iaam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant Or future building Occupant stow or handle hamodumslth and Safety u defined by me Cupertino Municipal Code.Chapter 9.12.and the Health and Sefcry
Code,Sectiones
25532(x)? 'Na - All roofs shall be inspected prior to any roofing material being installed.
11
IWill the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
t hanrdous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
Fl Yes XINu
I haw mad the huatdous materials requirements under Chapter 6.95 of de Califor-
nia Health A SafmyCude,Sections 25505,25533 and 25534.1 understand his tribe building � .�/
docs not currently have a mnmt Nm n
at it is my responsibility o ily me occupant of the 2'25
mgai m w nmaa mmpdormiuuaneo[aCeolficateofOccamcy. i Signature o hcant Date
owner or au or'cd agent- - S1216Dam104- All roof coverings to be Class"B”or better
CITY OF CUPERTINO '1=' t
BUILDING DIVISION PERMIT „"<�NC1tACT' '0 1 't,�. MATIU
BUILDING ADDRESS: ALLEN SIGNS INC PERMIT NO.04050161
20385 STEVENS CREEK PTUT)
OWNER'S NAME: PERMITLSSUEDATE
AT & T WIRELE
E; SANITARY N0. CONTROL NO.
(408) 280-6500
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 a
o p LICENSED CONTRACTOR'S DECLARATION
F1 Mmby that 1 am Ree ued under provisions of Chapmr 9(commencing lob Description
SK2 with
gecGon7 of Division 3 of NC Business and P ons Cade,end my hear.is
ay tmm�mm meercc t — SIGN--INDIVIDUAL CHANNEL LETTER
j Licenu Clw Lin,X
Date Contracto,
! ARCHITECTS DEC ON
Y 1 def d my pWm aNll he used u public Bends
wD Licensed Professional
OWNER-BUILDER DECLARATION
F I hemhy affirm that 1 am exempt fmm do Canuactar's License Law for the
p o following mown.(Section 703 1.5,Business and Pmfessiuu Code:Any city or county
K$ which requires a Permit m consumer.alter,improve,demolish,or mpab my muctum
prior In its issuance,also requires Ne applicant for such Permit to file a signed sutemem
< that he u licensed pursuant she provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation
x1--a (commencing with Section 7")of Division 3 of Ne Business and Profusions Code)or
y $
that he is exempt therefrom and the basis for the alleged taempdan.Any violmlon of
Section 7031.5 by any applicant for a permit subjects be applicant he a civil penally of 3 MN6QM8er 0 0 Occupancy Type
not mom Nen five hundred dollars(5500). Pq
❑I,uowner andah....me,is atinouladmo isped Net on,
will
and dodfausi,and theswmurelsne.LicenseLawrdoes le rv. u a t equied Inspections
and Pm(wions Cade:The Canveown.License Law dao nota m an owns ug
property
mploymuildamimprowamemon. menU=notld who hwoh hi If�oL�lryaid r.
ownem,thebuilding or Netmn imis sold within
notintendetl oIfpfpyldaule.)Tt
builder will
the uimprowmendemld widtinoneyur o(co etlfor the ow r.I. _
builder wi0 have the burden of proving that he did not build u imp for puryof ._
ulcJ. -
❑1.as Owner of the progeny,am exclusively convecting with license contractors to
canswct the pmjcct(Sec.7044,Business and Profusions Code:)The Ca dernmes U. _
cave Law does not apply to an owner of property who builds or improves shemon,and.
who contracts for such projects with aeonuwtm(s)licensed pursuant o the Convector's
License Law.
❑I am exempt under Sec. ,B&P C for this mason
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under Penalty of perjury oro of the following deduations:
I haw and will maintain a Cenifmum ofConsem to self4asure for Workers Compute
sation,u movidoll for by Section 3700 of the Labor Code,far the performantt of me
work for which this permit is issued.
1 have and will maintain Worker's Compensation Insurance,as mquimd by Section
3700 of Ne Ube,Code,for the performance Of the week forwhich this permit I,iauc 1. -
My Worker's Compensation Insurance carrier and Policy number am:
Carver. I 1l > Policy Nm:42=-00C 1(a 32
CERTIFICATE OF E) ' PI30N FROM WORKERS'
COMPENSATION INSURANCE
(Thisseation need nottecomplowd!(the permit Is ho ne hundred dollars(SIM)
mlus.)
1 certify Net in to performance of the work for which this Permit is issued,I shall not
employ any person in my bummer an u m became subject to de Warkeri Compensation
Laws of Calif..!.Due
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject in the Worker's Compensation previsions of the Labor Code,you must
.JO enhwidt comply with such provisions or mis Permit shallbe doemcd revoked.
z^ CONSTRUCTION LENDING AGENCY
Fr 4 1 hnmby of irm mat dem is a construction lending agency for me Performance of
p:7 the work for which this permit is issued(Sec.3097,Cih,C.)
W�Q Unticrs Name
] Z Lenders Address
O Q I coolly,that I haw read this application and sum that the above information is
II. (~ correct 1 agree to comply wish all city and county andhmas and mum laws misting to
QU building convection,and hereby auNorim repcometuiws of this city m enter upon the
LV shove-mendaned Properly for inspection Purposes.
(We)agree to rove,Indemnify sad keep hannleaa me City of Coin: Ina against
y liabilities,judgments.coati and expenses which may in anyway same against=it City
C)'z in consequence of the granting of this Permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
so
§WRe-roofs
HAZARDO
Sigmtureo iaam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant Or future building Occupant stow or handle hamodumslth and Safety u defined by me Cupertino Municipal Code.Chapter 9.12.and the Health and Sefcry
Code,Sectiones
25532(x)? 'Na - All roofs shall be inspected prior to any roofing material being installed.
11
IWill the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
t hanrdous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
Fl Yes XINu
I haw mad the huatdous materials requirements under Chapter 6.95 of de Califor-
nia Health A SafmyCude,Sections 25505,25533 and 25534.1 understand his tribe building � .�/
docs not currently have a mnmt Nm n
at it is my responsibility o ily me occupant of the 2'25
mgai m w nmaa mmpdormiuuaneo[aCeolficateofOccamcy. i Signature o hcant Date
owner or au or'cd agent- - S1216Dam104- All roof coverings to be Class"B”or better