02070014 . BUIL OF
ERTDIVISION. PERMIT CONTRACTOR INFORMATION:
BUILDING ADDR�SS: PERMIT NO.
20568/770 STEVENS CREEK BLVD CAL-NEON SIGN 02070014
'IV
VMM IZOPERTIES 1577 ALMADEN RD APPLICATIISV7 IODTFy2002
(408) 289-1883
PHONE: SANITARY NO. CONTROL NO.
O O ARCHITECGENGINEER: BUILDING PERMIT INFO
m u— BLDG ELECT PLUMB MECH
LICENSED COM'RACIOR'S DECLARATION
Ihereb tBmsthat lamlicensed under
prosinn>nfChapter 9bJob Description
nmmcnang
SIGN.
wimseede)mrDmia;tnnheBusmes,a Pn,rcynnsCodeyhaense (11 NOS . )
s s bt nm errem
:C m a License Cnmael — r-D It�3ALFE®
i+ ,t; RCHITECr'S DE ARAI'ION
C 4 1 under stand my plans shall Is,used as public records
ao LicensedProlc,%innn NOV 2 2 2002
OWNER-BUILDER DECLARATION
I hereby afOrm the 1 am exempt Wm the Cwumc or's License Law for the
= h Iollux;ng rtzam,(Section 7031.5.Business and Pmfcssion.,Code:Any lily tar countye� p��m i/i"
Much wch requon
ire a Firm,et cstruct,alley,imprme,demolish,w rtn swmrc
paany cBV ti�p6iR�l
ca prior to its issua[ce.also requires the applicant for such permit to file a signed%lawmen[ COI/YT'
a. that he is licensedpdnuaitnotheprovisiunsoftheCommctor''sLicenseLaw(Chapter9 S Ft.,
(commencing with Section 7000)of Division l of the But nca and Prmeoinns Code) <l' tFloor Area Valuation
t t, �
or mat he i,exempt therefrom and the bail for the alleged exemption.Any violation 3 5 9 68'0'0 5 .'o 0
of Section 7031.5 by any applicant fora permit whims the applicant to a civil penalty
of an,num than five hundred douan($500), APN Number Occupancy Type
❑Lass rollhe pmpeny.n ny ema ple,cwhh wages a,their tole compensation, 101 — FOUNDATION
will do the work,end the'.aruowe N tint intended ,,lined Ins sale(see.7044, 103 - UFER Required Inspections
Business ad Professions Crude:The Comrac 's License Wm
w does ant apply an q p
owner of property Who builds or improve,thereon,and who docs such work himself 104 - REBAR
or Ih:ough his own employees.provided that such improvements are not intended or
offered for sok.If,however,the building or improvement is sold within one yew of 105 - ANCHOR BOLTS
iompleti(n the ownerfbu[i`dcr will have the burden of praying that he did not Wildon 304 - ROUGH ELECTRICAL
mprme patpna m
01,as owner of the propcny.am ceclosively contracting with licensed contracmn to 505 - FINAL ELECTRICAL — - - -
construct the project(See.7634.Bu%lness and Professions Code:)Tin,Contractors 514 - FINAL PUBLIC WORKS
License Low does not apply to an owner of properly who builds or improves[hereon,
and who contracts for such projects with a conmemrfs)licensed punuam to the . .
Commcmr's License Law.
01 am exempt under Sec. .B&P C for this¢axon -
�wncr Doc
WORKER'S COMPENSATION DECLARATION
I hereby wfinn under Penalty of perjury one of the following dcclaations:
0 1 have and will maintain a Certificate of Consent to self-insure for Worker's
Compensation, as provided for by Section 37W of the labor Code, for the
perform nee of the work for which this permit is issued,
01 have and va Is maintain worker's Compensation Insurance,as rtqu bol by Section
l7W mf the or Code,fa the performance of[he work for which this fermis-is
t iuued.M :em's Com notion Insumn rzict a 4b 7 Z re:
CERTIFICATION OP E%EMI'T� FROM WORKERS', '� t f• _ s ',. t :) S t
COMPENSATIONTTTNSURANCE
(This section need not be completed it the permit is for one hundred dollars -
(SI00)mIcss.)
'1 certify that in the performance of the work for which this permit is issued,1 i. •-
shall no[employ any person in any manner m as to become subject to the Workers "
Comm,smion Lows of California.Date
Applicant
NOTICE TO APPLICANT:If.wu,,making this Cci ifiewe of Excmptioa,you should
0 Q ttmpe
become subject the Worker's Consation provisions of the Wbor Codc,you must
forthwith comply with shah pookimts or Ihi.,pecoul shall be demned revoked.
Z
CONSTRUCT ION LENDING AGENCY
a .> 1 hereM1y u0itm that[here is n ummnminn lending agency for[he perfmrmanen
W of the work for which Nis permiYis issued(See 1(197:Civ.Ci)
5 Q Lender.,Name
= -
Z Lcndei'i AJdreo
U I certify that I have read this ap ilicmion and stare that the above inf rommum is
cnrrvei.1 agree to comply with all city and county ordinances and%late laws relating L
0U to building conxunctiomand hereby omhorim[epresemaule,of this city,.cncerup.a a
r � the abovememianed perfectly for inspection purposes. _
fy (We)agree
ma ,indemnify and keep harmlessthe City of Cupertino against
h' liabilities judgmc sts end ex secs which may in any way aceta against said
U Z Ciryinronuqu c the 8rantin8 finis son.
APPLICAN H'I COMPLY WRHA >4- d�
1' �ed by: Date'
nmwe n icwdrC marmr we Re-roofs
HAZARDOUS MATERIALS DISCLOSURE'
Will the applicant m future Wilding occupant store or handle ho solous material Type of Roofas defined by the Cupcnino KMtCod' e.Chafer911,endth<HohhandSafetyCode.Seaian25512fa �t . .o ' 'I;:t ` All roofs shall beinspected priorto anyroofing materialbeing installed.will she alicant tariItingmcupien u,e equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
�it h mous air contaminants as defined by the Bay Area Air Quality Management
_ Denierall new materials for inspection. Applicant understands and will comply with
oyes 71Z all non-point source regulations.
�-� 1 have read th ha ous materials requirements under Chapter 6.95 of the
Gllfoown HwpM1 fcty Code,Sect-nnx 25505,15531 and 75531.1 understand that
I Mebuild,ugd Icul- Iyhay wnant.[h at l[i.s n responsibility to notify c
occupant of t remema which saw W tact prior to issuance of a Cetlific of
- °c up...cy., 7 i nature of Applicant Date
owns [;reed agent time/
All roof coverings to be Class "B"or better
.. . OFFICE