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02110093CITY OF CUPEWI'INO ` --# ' ° � II ""I BUILDING DIVISION PERMIT CONTRACT„OR INFnORMATION nU2)0470&rsSTEVENS CREEK BLVD CAL—NEON SIGN PERmrrN02110093 ow0Y.BR4EPRO PERT I E S 1577 ALMADEN RD APPLICAT IS✓trB9412002 DONE: (408)289-1883 SANITARY NO.CONTROL NO. ARCHITRCT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 00 LICENSED CONIHACfOR'S DECLARATION licensed Chapter 9 Job Description u F I hcmby aifnm Ina,1 am under provisions of (commencing SIGN iwi lh Section 7000) of Division 3 of the Business and Profesaims Code, and my license is �= is ants since and e 'I. 3 Liccnu CI s _ is X Uac '����® 1 -ca ARCHITECrSIDECLARATION'—`-� Iundcrmandmyplanasha0hemudaxpuM1licrccnNs ad< DEC 2 6 2002 iu $G Licensed Professional S OWNER BUILDER DECLARATION I herchy affrm that I am cacmpl item the Contractor's License Law lin the $2100 00 following reason. (Section 703 t.5, Business and Professions Code: Any city M empty BUILDING 2 Y- which requires a petmil to construct, alter, improve, demolish. ar repair any structure vo Z< ed stacfnl prior to it, LRuan., alae or,tiRs the applicant for such permit Io life a sightm licensedpursuanuutheprovisionsoftheContractor'sLicenslrw(Chapter9 33l9Et8fQ&@A@0 Valuation that he is Cp 3 = (commencing Of th section7lgkq of Division 3 of the Business and Professions Cade)to Na, he is cacmpl therefrom and the baso for the alleged exemption. Any violation of IUAPM ),j Occupancy Type Section 703 t,5 by any applicant for a permit subjects the applicant o a civil penalty of no, more than rLi hundred delta. (3500). 103 — UFER ❑ I, as owner of the property, or my employees with wages as theirsnle compensation, 1E)4 REBAR IJS tr�Inspeclions will do the work, and the sauc.m is not inhibited or offered for sale (Sec. 7040, Basins Professions Code: The Contractor's License Law does not apply to an owner of and property who builds or improves thereon, and who does such work himself or through his own employes. provided thm such improvements am m, intended or offered for sale. If. 105 - ANCHOR 304 — ROUGH ELECTRICAL however, Me building orimprovement issold within one year ofcompletion, Meowner. 505 - FINAL ELECTRICAL budder will have the burden of proving that he did not Wild or improve for purpose of able.). 514 - FINAL PUBLIC WORKS ❑ f, as ewer, of the property, am is elmovely eonuacong with B«used ommoam's th consumer the project (Sec. 7Bda, Business and Professions Cods:) The Conuacmr's Li. ecose law does not apply to an owner of property who builds or improves thereon, and who contracts for such pmjecu with a contractors) licensed pursuant to the Contractors Lice a. I,aw. 1 am exempt under Si . B dr PC for this reason woe, Date WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: I bars and will maintain a Cenilcau of Consent to self -mi for Workers Compete ion, as provided for by Section 370]0 of the labor Cade, for the performance of the 137,N) rk for which this Permit is issued. I have and will maintain Worker's Compensation Insurance, as required by Section of the labor Code, for the performance of the work for which this permit is issued. Worker 9 nimio Insmmcc carrier and Policy num raremcr: ; !� O Policy Nu.:6 CERTIFICATEOFEXEMITIONFROMWOR RS' COMPENSATION INSURANCE (This.uction need nut beeompleled if,M permit is foronc hundred doflma (SI W ) less.) 1 cenify that in Inc Performance of the work for which this Permit is issued, 1 shall nn, employ any Person in any manner se, as an haeme subject to the Workeri Compensation lawsof California. Date Applicant NOTICE TO APPLICANT: R. after making Nis Cur ilieate of Exemption, you should become subject to the Worker's Compensation provisions of the labor Calc, you must ' forthwith comply with such provisions or this permit shall M deemed revoked. ),Z, 0 ;= CONSTRUCTION LENDING AGENCY 1 hereby Minor that Here is a conawctinn lending agency lin the Performance of > the work for which this permit is issued (Sec. 3197, Co. CJ Qlender's Name lender s Address ,z C) I certify that l have read this application and once that the about information is Fcorrect. 1 agree to comply with all city and county ordinances and sure laws relating to U build ing constriction, and hereby aothmisc repicicntionves of this city to enter upon the W aWve.mentinned property for inspection purryw<s. (We) agree to save. indemnify and keep harmless the City of Cupertino against Nliabilities.judgments, costo and expenses which may in anyway acerae against said Cay ),'Z r. in consequence of the granting of this permit. APPLICANT ON AN AND W L COMPLY WITH AI.1. N Np0 Issued by: Date SOURCE REGU S. / // Re -roofs Signature, of n Cunnactor U HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or fawn huilding rweupam smmc or handle haaandous material as defined by the Cupcnino Municipal Code. Chapter 9,f2, and the licalth and Safety Code.Seelcn 25532(x)'' All roofs shall be inspected prior to an roofing material being installed. p y g mag ❑Vis 0 N If a roof is installed without first obtaining an inspection, I agree to remove Will Inc applicant or lumre building Occupant usecyuipmenua devices which mit harurdnus air contaminants as delined by the Bay Arca Air Quality Management all new mat 1 S for Inspect) Dim,ia7 ❑Yes 0 No Ihavemadlncho dr,materials requirements under Chaprcr 6.95 of the Cali for- nib llealNKSafetycs Sm'.255)5,25533 d255llActudersundthmifine building VVVV docs not varmoul at. that it is mY r rytmibility m naurY IM nCirrom of the requbcmcbts whe set ora nmeau nraempawr' Sign t of Applicant Date All roof coverings to be Class "B” or better ermaml -eagmr am ots� op m,u _ u Tri�a F� py=tG F!20 �3 D Hv.og 00 Xatap� 6 Do �Fp I• L 0 0 z� P>_ a Q 5 Z U_ OU ujU CITY OF CUPERTINO U r4q -• BUILDING DIVISION PE T . CONTRACTORINFO �IQN. BUl E TEVENS CREEK BLVD CAL -NEON SIGN PERMIT N92110093 SYBR+E:PROPERTIES 1577 ALMADEN RD APPLICATIIIIISPi94Tj2002 'HONE:(408)289-1883 SANITARY NO. CONTROL NO. ARCHITECUENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONBACTOR'S DECLARATION Chapter 9 Job Description 1 Immhy afrom Nat I am licemod under provisions of (commencing SIGN with Section 7") of Division 3 of the Business and Professions Code. and my Iicenx is In fu code 1. 3 me CIe LKevc Clew Ic. Y Dam nt - T( ARCH TECTS DECLARATI N 1 understand my or.. shall be used as public memdo Lkenud Professional OWNER -BUILDER DECLARATION 1 hereby affirm Nat I am exempt from the Contractor's License 1sw for the $2100 following Mason. (Section 7031.5. Buslnass and Prefessiom Code: Any city m county which requirea permit w com coact, alter, improve, demolish. or repair any summa prior m its issuance, also requires she applicant for such permit file a signed statement Nat he is licensed pursuant m the provisions of dm Conuacmr's License Law (Chapter 9 39g9Et8M6h@A@0 Valuation (commencing with Station 7000) of Division 3 of the Business and Professions Code) or that he u exempt themfrom and the basis for the alleged exemption. My violation of pN N Occupancy Type Section 7031.5 by any applicant for a permit subjects tie applicant in acivil penalty of not more than five hundred dollan (5500). 103 - UFER ❑ I,mmmofthepmpeny.mmyemployemwithwgmsstheksdeeompenmdon. will dothewmit.and Ne strucwmia not intended oraffertd mrsala(sec.70f4. Business And pronasions Code: no Contractors License Law does not apply m an owner or ±E)4 ReBkR pp��OOa�yyj�rryy��Ins ectlODs -iSCJLVIS p pmpvty who builds or improves Merton, end who doessuch work himself Dthmugh his own employees. provided Nal such improvements are ON intended«offered fossae. lL 105 - ANCHOR 304 - ROUGH ELECTRICAL however. the building or improvement is sold within one year ofcomplevon. the owner SOS - FINAL ELECTRICAL Wilder will have the burden of proving Nal he did not Wild or improve for purpose of mk.). 514 - FINAL PUBLIC WORKS ❑ 1, As owner of the property, am exclusively contracting with licensed contractor to construct the projem (See 7014. Business and Professions Code:) The Contractor's Li. term law does not w An owner of property who Wilds or improms thereon, and who contracts fm such Mjecm with a commustor(s) licensed pursuant ID the Convectors LKe. Law. I Am exempt under Sea .B&PC far this rtuon nee Dat WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following daclantiom: �a u5�14"ss ❑ I Mere and will maintain a Certificate ofCownt to self -insure forWorkers Compere ration, As provided far by Section 37M of Ne Labor Code, for He performance of Or Yvoo/g Z work for which this permit is issued. DECs_ 2 L ❑ 1 have and will maintain Workers Compensation Insurance, As required by Section 3700of the Labor Code, for the performance of Ne work for which this permit is issued. My Wmker�'�g�.o��o_amoon lnaomnce artier and Policy num Tart: L a IVG 6O BUILDING U Grticr. J !'sn!� PERU No.: CERTIFICATE OF EXEMPTION FROM WOR RS COMPENSATION INSURANCE (Thuseedon seed not becompleted if nm Permit is ADDED hundred dollan (SHALL or less.) I cenify Nat in she performance of tW work for which this Permit is issued, 1 shall not employ any peman in any manner so As to become subjmuD the Worlo ri Compensation Laws of California. Dem Applicant NOTICE TO APPLICANT: If, after making this Ccnifrcam of Estonian.. you should become subj.t tD dra Worktrq Compensation provisions of the tabor Cak, you mon foMwilh comply with such provisions M Nis permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby a1Erm Nat there is a tonsuuction lending agency I'Dr the Performance of Ne work for which this permit is issued (Sec. 3097, Civ. C.) Lenders Name Lender's Address I cenify Nat 1 have read this application and sum Nal tW sWw inforri is contract, I agree m comply with all city and county oNimnces and sum laws relating w building construction. and hereby authTis, representatives Of this City to enter upon the above-mentioned Propcny for inspecuon purposes. (We) agree in save. indemnify and keep hamsless IIB City of Cupertino agai rat liabilities.judgments, costs and expensm which may in any reymento gainer mid City in consequence of the granting of His permit. UN ANDS AND W L COMPLY WITH ALL N NPO L, Issued by: Date U S. Re -roofs Type of Roof ' n Conommr Drill HAZARDOUS MATERIALS DISCLOSURE 00Y. applicant or future building occupant seam m handle harsrdous m ncrial the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety 25532(.)7 All roofs shall be inspected prior to any roofing material being installed. ON. If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future building occupant use equipment m devices which emit hawdnus air contaminants as defined by the Bay Area Air Quality Management District? al I new ma[ i s for inspec[i ❑Yes C] No Ihavereadth,lb M mamrialsmquimmenrun&rChapmr6.95of Ne Califor- / /� ni.Halth&SafetyC Sec' mn505,25533 d2553s.l wdrrwnd Wtifthe Wilding ` ! V docs not curmmil nL Nat it is my ponsibilily to ratify the nompmt of the mquimmenla whit aI ofa Clitificat, of Occupancy. Sign t of Applicant Date All roof coverings to be Class "B" or better nr,D dagtn, m E w # _ a a Sti-A3H :/ § \ F3 0 0 _$ .! Ig ]§ � ) 1 } })ƒ k ~0 }2£B tƒ i\ u `C k%- V ��{) w k�(K 22�pa� § )o -�a §e9ME2 a. 2�/ba §sm§ft \c F3 0 0