02100142 (2) CITY OF CUPEKI'INO
nun.DING DIVISION PERMIT CONTRACTOR INFORMATION: 1'
BUB.2I&r,s9t411SST EVENS CREEK BLVD CAL-NEON SIGN PERMFFN(02100142
ER+EALLAN G AND MARIAN 1577 ALMADEN RD APPLWATTO// yy /tTY2002
PHONE (408) 289-1883 SANITARY NO, CONTROL NO.
ARCHLITCTIENGINEER: BUIMING PERMIT INFO
BLDG ELECT PLUMB MUCH
0 0 o
OO I.ICF.NSED CONTRACTOR'S DECLARATION hI,p y�gg
rcF I hereby affirm Nm
al I am licensed under provisions of Chapter 9(cnmcrciag SIGNS--CHANNEL oL �t
le with Seelioq 7kXBof Division 3nINe Bu in and P12(71 C,W dmyliccnse is
n fulland eflt C
00'v�4 Dade¢ C ac
oZ—� Uatu Co`1LF
As shall N,use las no reTION
a 1 understand my plans shall M used as)ll(hGc records
It oaU
uXi3 - I.ivemcd Pmlcssiomm
al
FLL�j OWNER-BUILDER DECLARATION
ce r 1 hereby alfirm that I am exempt from the Contractor's License Law for the $1250
at o O following reason.(Section 7031.5.Business and Proresocas Code:Any city or county
anX'm which requires a Penni,In constracl.alter.improve.demolish,or repair any structure
w'm prior bits issuanee.also requires the applicant forsuch Permit o rile asigned Statement
that he is licensed pursuanns the provisions of the Contractors Liccnc Law Whapter9 3SSJO.T"6A10k Valuation
e=$ (commencing with Section7LXXB of Division 3 of the Business and Professions Code)Or
a 3— that he is exempt,hchefrom and for basis for the alleged exemption.Any violation of
Second 7031.5 by any applicant for a Permit subjects the applicant to acivil penally of PN-N Occupancy Type
not some than five hundred dollars(S!500). 103 — UFER
I.as owner of the Mori of my employees with wages as their sole comperafion.
will du the work,and the structure is not intended Lir offered for sale(See 7W,Business 1 04 — REBA
and Profess ons Code:The Contractors Licen=c Uaw docs no,apply,o an owner of 10 5 - ANCHOR R rc inspections
property who builds or improves thereon.and who does such work himself or through his
own employees.provided that such improvements are not intended or offered for sale.If. 304 — ROUGH ELECTRICAL
however.Ne building or improvement is sold within one year or completion.the owner.
hurt&,will nave the burden of Moving Nal he did not Hood or improve for purpose of 505 - FINAL ELECTRICAL
sate.). 514 - FINAL PUBLIC WF"NALE0
I,as be,M the prnpenY,am exclusively contracting with licensed cantranons it,
construct the pmjea(Sec.TNa.Business and Professions Code:3 The Contractor's Li-
cometawdoesnotapplytoanownerufprupertywhoWildsorimprovesMerton.and NOV 2 2 '2002
who contracts for such projects wit a contractor(s)licensed pursuant to Ne Contractor's
License I.aw.
I am exempt under See .B g,P C for this reason
46 net Dale BUILDING
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty M perjury one of thea following declarations:
I have and will maintain&Ceniftca¢of Consort it) cl6insum for Worker's Compete
station,u provided for by Section 3700 of Ne Utmor CnJe.for the performance of the
work fur which Nis permit is issued.
1 have and will maintain Worker's Compensation Insurance,m required by Section
3]IXl of Nc lzbor CsWe.fur NC Pertormarmc of Nc wor far wnieh this permit is issued.
My rker's Compcnsmuml urencc canter I ymmhJc)a/(c
Poll Nn: ((J//11 `oO
CE0 tC TEOF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
mins section need not he completed if the permit is Inronc hundred dollars(S 100)
n los)
1 certify that in the performance of the work for which this Permit is issued,I shall no,
employ any person in any manner n,as to become subject h,the Workers Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Ccni lica,e of Exemption,you should
Become,objet,m the Worker's Compensation previsions of the"hor Cade.you most
OO forthwith comply with such provisions or Nis permit shall he directed revoked.
z N CONS'LRUCI'ION LEN DING AGENCY
p1 hereby affirm that there is a construction lending agency for the performanceof
24 > the work for which this Permit is issued(Sec.JIM],Co,C.)
CLIul QLeadcr's NO
:D z u Jcr's Address
U O 1 certify that I have read this application and state that the above information is
4. h correct.1 agree las comply with all city and county ordinances and ,are laws relating to
OU building construction.and hereby announce representatives te
Of Nis City enr also the
aMve-mentioned property for inspection purposes.
�•' (We)agree m save,indemnify and keep harmless the City of CuPeninu against /k
liabilities judgment.ursu and cnpcnsesw ich may in any way accrue against said City
U z in consequcncen he arcing of lhisPe Il/ y�1v/
APPLICANT ANDS AND" LL COMPLY WITH ALL N-P INT Issued by: Dale
SOURCE RE U.A NS, r0 / j
I !/ Re-roofs
signs, ear p r Ile
b
HAZARDOUS MA RIALS DISCLOSU RE Type of Roof
Will the applicant or future building occupant storeor handle h ardours material
s defined by the Cupertino Municipal Code.Chapter 9.12,and the health and Safety
Oe.Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
ED Yes 0N
Will thea licantOffuturebuildin sal useequipment ordeviceswhicn If a roof is installe without first obtaining an inspection,I agree to remove
Pp d by the
limitict? us air tt,maminanlslisJCIincJbytheBay Area Air QualityManagement all new maters rinspection.
District?
❑Yes t]Nn
Ihave Trod the hvnNousom rials reyuircmenksunJerCM1upterfi.95nl Neculdinn
11MO&SWe ism., 2. 15.25533and25531.1undconan Nvif the huilding
J9u�,litcurren atenarn. it is eapenibllity,ti dfy the oactilanl Jin
"I cats, d miss racen,ricam" Signature pplicant Dale
V _ � iG
•- ,e All roof coverings to be Class "B" or bolter
O%nmor cdagen,