06010159 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION°#a'4n�g
an `x'iee' �i ',»
BUILDING ADDRESS: ALLEN SIGNS INC PERMIT N0.06010159
OWNER'S NAME: PERM)T ISSUE DATE
NATURAL BEAUTY Se SLIMMING 1982 STONE AVE - 01/27/2006
E: SANITARY N0, CONTROL NO.
(408) 280-6500
ARCHnECDENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
of r% F v roes o
�Op LICENSED CONTRACTORS DECLARATION
M
H
1 hereby affirm Nat 1 am Beamde
ed unr S Dns of Chapter 9(commencing Job Description
- with Scouon 70(10)of Division3of da Builnessand Profmaimm Code,and mylicense is
mm�foreeandeReg. SIGN--INDIVID. CHANNEL LETTER f
;�=q Liana/Class? wt- ." �` FID �' 2006
' 7 Date 4S� T S DECor
'07W3 ARCHITELTSDEIIt ATION �V� V
¢ I undersand my plans Hill W used ss puMie recoils r
Licensed Pvfcssional � DING OWNER-BUILDER DECLARATION
i<z 1 hereby af0mn that I am exempt from Oct Contramor's License law for the
p O following mason.(Section 7031.5.Business and Pmressinm Code:Any city Or county
.9 which requires a permit to construct,alter,improve,demolish,or repair any structure $2000
_iy prior to its issuance,also requires Ne applicant for such permit to Ole a signed summcro
EiG
that he is licensed pursuant to the provisions of the Contractor's UccnaLaw(Chapter 9 Sq.Ft. Floor Area Valuation
zHgt (commencing with Section?000)of Division 3 of the Business and Profession Code)of
-
that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by airy applicant for a permit subjects the applicant to a civil penalty of
not more than Ow hundred dollars(SS03A r Occupancy Type
wi L as o wart, the f1mpoy or m notimendedyos with wages ss ale(See compensation.
will Prritework.ands: awmurtis loci Licence
Lw do f not a(Sec.7044,owner
Business
and entywh bis Code:The asther on,License law does not apply lf an mwner of Required Inspections
own employ ,provirimpotesch Improvements
riassuchwork himalfof through his
own cmployces,provided that such improvements are ne year cded m offered for ale.If,
builder,Ne Wilding or improvementisat within oneyearofcompletion.Neownr-
builder will have the burden or proving Net he did not Wild Of improve for purpose of
a1cJ.
D I,as owner of Ne property,am exclusively contracting with licensed conuacwrs on
mahout the project(Sec.7004,Businev and Prefetions Code:)The Comuacmr's U.
cense law docs not apply m an owner of property who Wilds or improves thereon,and
who contracts for such projects with a conusctur(a)licensed pursuant in the Conuacto's
License Law.
D l am exempt under Sec ,B&P C for this mann
caner Date
WORKERS COMPENSATION DECLARATION
1 hereby affirm under penally of perjury one of the following drlarations:
I hs.e and will maintain•Cefdfinm of Covent reset(-insure for WortctsConpcn-
fation,as provided for by Section 37W of the Later Code,for the performance of the
work for which this permit is issuN.
D 1 have and will maintain Worker's Compensation Imuran¢,as required by Section
37W of Ne labor Code,for Nd performance of the wants for which Nis permit Is issued.
My Worker's Compensation Insurance artier and Policy number am:
Carrier. 913!n Policy No.: /-I
CERTIFICATEOFEXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu action recd not becompleal if IW permit is foronc hundred dollars($100)
ser less)
1 certify Nat in the Performance,of to work for which this Permit is issued,1 shall not
employ any Person in any manner so as In become subject in the WarkcW Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If,after making this Ccnificam of Exemption,you should
become subject a the Worker's Compcvatian pmvisiam of the Latour Code,you mutt
.J z forthwith comply with such provisions or this permit Nall he rimmed revoked.
z O CONSTRUCTION LENDING AGENCY
[-+ I hereby afrim Nat there is a comwction lending agency for the randcomanco of
IY the work for which this permit is issued(See.3097,Civ.C.)
W Q Lendcrs Name
7 z Lender's Address
U C) I certify Nn I have fend this application and sum that Our above informadu r is
U.r correct-I agree to comply wit all city and aunty ordinanms and freta laws relating in
0U Wilding construction.and hereby authofnn representatives of this city m color upon the
r Wabove mentioned property for impecdon purpoaa .
r92. (We,)agrt to ave,indemnify and keep harmless Ne City of Cupcnino against
y Liabilities,judgments.costs and expenses which may in any way mane against said City
U z in consequence of the granting of this permit.
" APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date 1,-2-
SOUR E GU ATIO
t-7 Re-roofs
Signaz re ppr mnttaeto Dam
AZl.RDOUS MATERIALS DISCLOSURE Type of Roof
Will dr I ant or rut=building occupant store or handle harsrdoos material
as dclined by Ne uptumno Municipal Code.Chapter 9.12.and Ne Health and Safety
Cock.Section 25532(a)?
DYa No All roofs shall be inspected prior to any roofing material being installed.
WILL the applicant of furore Wilding crup...ties equipment te devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit havardro s it contaminants as dcEncd by the Bay Area Air Quality Management all new materials for inspection.
District? `/
Dy. A1No
I have mad the hvarNrvmamrials rears mments undo Chapmnti.95 of the Califor-
niaHealN&SaretyCedc.Sumems 25505,25533 and25534.1 understand NatifOrc Wilding
dem.1 commid,haw a moan.Our It it my mspamihilily b notify the atxup.,of the
mgmrem uuWmel Iaiananaaoanireaseofata cy. Signature ofApplicant Date
Owner or samori od seg t �7„a All roof coverings to be Class "B”or better
CITY OF CUPERTINO
BUILDING DIVISION PERn' CONTTI2ACTORWINFOR ., ON-'„_7
BUILDING ADDRESS: ALLEN SIGNS INC PERMIT NO.O 6 O 10 15 9
20670 STEVENS CRK BLVD
OWNER'S NAME: PERMTT LSSUEDATE
NATURAL BEAUTY & SLIMMING 1982 STONE AVE - 01/27/2006
E: SANITARY NO. CONTROL NO.
(408) 280-6500
ARCHITECfrENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
_op LICENSED CONTRACTOR'S DECLARATION Job Description
� pp 1 hereby affirm bar 1 am licensed under provisions or Chapter 9(commencing
ZW with Section 7")of Division 3 ofthe Businem and Profcssiuns Cade,and my license is
^`oUn m(oil once,andeffecy_ <- �"" 7 SIGN--INDIVID. CHANNEL LETTER
p,t2? License Qass Lic.k
n F n Dam Cunlractor
' ARCHITECTS DECLARATION
5yan
a 1 understand my plans shall he used as public records
U.
e G G Licensed Professional
g OWNER-BUILDER DECLARATION
iy I hemhy trip.that I am exempt from the Contractor's License Law for the
p pOH fallowing reason.(Section 7031.5,Business and Professions Code:Any city or county /
K m LL which mqui=a petioli lit consumer,aIle(.Improve,demolish,or mpan any aLrUCLU e $2000
y¢a
prior o its issuance,also inquires(be applicant for such Permit o file a signed statement
a that he is licensed pursuant to the provisions of be Contractor's License Law(Chap¢19 Sq.Ft.Floor Area Valuation
xFG (mm in toeing with Section 7")M Division 3 of the Business a ad Professions Conic)Us Ce
y dial hen exempt therefrom and be basis for die alleged eumption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of r Occupancy Type
ant mm a than five hundred dollars
1,ss owner of the property,or my employcu with wages as heir wlc compensation,
will do be wmrk.and d¢aWtlum is not Intended or ORCRd fmrsale(Set.7OM,Business Required Inspections
and Professions Code:The Contractor's License Law does not apply to an owner of 9 P
prmpeny who builds or improves tenon,and who does such work himself or through his
own cmployca,provided Nat such improvementsam nor intended oraRemd formic.If.
however,the building or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that he did not build or impmw for purpose of
sale.).
❑1,as Owner of die property,am aclusively eonlneting with licensed con acrors to
consumer the pmject(Sec.704,1.Business and Professions Code:)The Cormacon's Li-
ccme Law does not apply in an owner of propeny.whO builds or improves thetemn,and,
who contracts for such pmjcm with a convacmr(s)licansed pursuant m be Comment's
License Law.
Ell am exempt under Seo .B&PC for this..on
Owner Dam
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of be following declarations:
IUs c and will maintain a Cenifrcam Of Consent in self-insumfor Worker's Compen-
sation,as provided for by Section 37W of be labor Code,for the performance of the
work for which this permit is issued.
❑I have and will maintain Worker's Compensation Insurance,as required by Section
37W of be labor Code,for the performance of be work for which this permit is issued.
My Worker's Compensation Insurance artier and Policy number are:
Carrier, b!zJ1-n FiYS Policy No:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
This section need not he completed lithe permit is fortune hundred dollars($100)
or less.)
_I terrify that in be performance Of rhe work for which this permit is issued I shall not
employ any person in any manner,so as to bmcomc subject m the Workers'Campewtion
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:IL after making this Ceniricatc of Exemption,you should
become subject to be Worker's Compensation previsions of be Labor Code,you must
.J z forthwith comply with such provisions Or this permit shall W dimmed mvmked.
Z'O CONSTRUCTION LENDING AGENCY
[-. I hcmby afrum that them is a comuunion lending agency for the Performance of
a be work for which this Permit is issued(Sec.3097,Civ,C.)
WCE A Lcodcr's Name
=,Z Lender's Address
V O I certify that I have read this application and state that be above information is
V, F-' correct.l agree to comply with all city and county ordinances and sure laws relating to
O V building construction,and hereby aubmire representatives of this city to enter Upon the
N W� above-mcndonad property for inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cupcnino against
r N Iiabilities,judCments,cods and expenses which may in any way acerae against said City
t,)z in consequence of the granting Of this permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURE GULATIO
V2'>16Re-roofs
Signal rc App i /Contractor Date
pl ARDD MATERIALS DISCLOSURE Typo Of R
OOF
Wthamser boom building
occupant storm or handle hazardous material
as defined by the Cupertino Municipal Code.Chapter 9.12.and the Health and Safety
cmum.Schon 25632(1)7
❑Yes � All roofs shall be inspected prior to any roofing material being
Will mea licant or future
building
Ifg
.a roof is installed without first obtaining an inspection,I agree to remove
OP g occupant use equipment or devices which
mit hazardous air contaminants as defined by true Bay Arca Air Quality Management all new materials for inspection.
Diwin7
❑Ycs ANO
I have read the harardous materials mquimmenn under Chapter 6.95 o(the Califory
nia Heellh&Wrly Code,Scluens 25505.25533 and 25534.1 undroacr d that ifthe building
does not torte dy I, ¢nam,bar its is my responsibility O noury the occupant or dic
mquimm' len matxmmp tmiaamammenraceni0camurOcem army Signature ofApplican[ Dale
Owner ser autnori'.ed aF ���>am All roof coverings to be Class "B"or better
• i
�, CITY OF CUPERTINO lS
SIGN 0
a
•CUPEkTINO PERMIT APPLICATION FORM
APN# 3SoDate: X
` � o Z� 7106
Building Address:
~0(O S e fJ P.e -Bid,
Owner's Name: Y Phone #:
In S lM/'✓1 i/1
Contractor: U License #:
I S. Inc 83 Sia
Contact: Phone #:
{<i l Li rl
Applicant/Contractor:
Building Permit Info:
Bldg Elect Plumb Mech
Job Description: /
Residential: T }A6 S! Commercial:
Sq.Ft. Floor Area: $/Sq.Ft.:
Architect/Engineer: Cost of Project:
211LD•—
Type of Construction: Occupancy Group:
Qty. if
A lic ble Fee ID Fee Description Fee Group
BENERGY Ener y BUILIDNG
BPERMFEE Bldg Permit Fees BUILIDNG
/' BPLANCHK Plan Check Fee BUILIDNG
BSEISMICOM Seismic Commercial BUILIDNG
IBREMSITGNS
PERMIFEE Elect Permit Issuance ELECTRICAL
REMSIGNAD Rmdl Signs Add Branch ELECTRICAL
Rmdl Signs, Marquee ELECTRICAL
BUSLIC Business License BUILIDNG
� S- 2-
CITY OF CUPERTINO
m 2 of 2 PERMIT RECEIPT OPERATOR: conniew
COPY # 3
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35908020 . 00
DATE ISSUED. . . . . . . : 01/27/2006
RECEIPT # . . . . . . . . . : 32983
REFERENCE ID # . . . : 06010159
SITE ADDRESS . . . . . : 20670 STEVENS CRK BLVD
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : NATURAL BEAUTY & SLIMMING
ADDRESS . . . . . . . . . . .
CITY/STATE/ZIP . . . : CA
RECEIVED FROM . . . . : KIMBERLY LIN
CONTRACTOR . . . . . . . : ALLEN LIN LIC # 22174
COMPANY . . . . . . . . . . : ALLEN SIGNS INC
ADDRESS . . . . . . . . . . : 1982 STONE AVE
CITY/STATE/ZIP . . . : SAN JOSE, CA 95129
TELEPHONE . . . . . . . . : (408) 280-6500
�EE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- - ---------
BENERGY PERMIT FEE 1 . 00 34 . 86 0 . 00 34 . 86 0 . 00
BPLANCHK PERMIT FEE 1 . 00 83 . 16 0 . 00 83 . 16 0 . 00
EPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
BSEISMICOM VALUATION 2, 000 . 00 0 . 63 0 . 00 0 . 63 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 157 . 02 0 . 00 157 . 02 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
OTHER 314 . 04 VISA
TOTAL RECEIPT 314 . 04
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL
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