02110094 CITY OF CUPERTINO - ° - .* r'
BUILDING DIVISION PE&T CONTRACTOR INFOR dONt -
Bul N CREEK BLVD CAL-NEON SIGN PERMITN02110094
WlgYs@RAE:PROPERT IES 1577 ALMADEN RD APPLICATIPli5ftfapTY2002
NONE: 408 -1883 SANITARY NO.
CONTROL NO.
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
I hereby edition
LICENSED
I faro licensed
unORS der provisions
of Clhhaapmr 9(commencing Job Description
m
U with Section700o)mfDivision 3rfthe Buribess andlerofcssi code..nd my home it SIGN
in full in=and cfptf,�
Z License Class
S Lic.M
0z— Dam Conuecmr
ARCHITECTS DELLA
X 5
2 9 I understand my plans snail be used as public records
M
%beWdra
I.,LLO Licensed Professional
OWNER-BUILDER DECLARATION
c� p I hereby effnn IMI I am emmpt from the Ciouamors License Law for the $1100
w—p0 following match,(Section 7031.5.Business and Professions Code:Anyetty or county
a'ro�$�i which requires a Nonni m ennruvet..I.,.Improve.demolish.of oreir any structure
print to its issuance,also mquifes the applicant for such permit m Ole a signed statement
Node islicensed pursuant to the pmvuionsof Ne Contractors License law(Chapter 9 3Yg9E18[F)(Bfd A&9 Valuation
(commencing with Scmio000()of Division3ofts,Blesibesemd Profieso eCodc)m
y $ that he Is eumpt therefrom and the Buis for the alleged eumption.Any violation of
Section 703 L5 by any applicant for a permit subjects the applicant o a civil penally of 1 UPN N Occupancy Type
not mom than Rve hundred dollars($Soo). 103 — UFER
L as owner of the prepcny,or my employees wide wages as their sole compensation, 1:04 REBAR
will the the work.and the swcture is not intended or offered for sale(Sec.7044,Business
and Professions code:The Commodes license Law does net apply an in owner of 105 — ANCHOR I1g@)1tr1d;Inspections
property who Wilds.,improves thereon.aM who doessuch work hiromforthrough his
own employers,provided that such Improvements are not intended or offered for rale.It. 304 — ROUGH ELECTRICAL
however.dee Wilding or improvement is sold within one year of completion.the owner- SOS — FINAL ELECTRICAL
Wilder will ban the Widen of moving that he did not Wild or improve for purpose of
.to) 514 - FINAL PUBLIC WORKS
1,as owner of the property am exclusively contracting wild licensed contractor to
construct the project(Sec.7044.Bulinus and Professions Code:)The Contractors U-
se se Law does not apply to an owner of progeny who Wilds or improv thereon,and.
who contracts for such projects wild a contractuds)licensed pursuant o the Contractors -
License Law.
❑ I am exemptaz
under So, .B&PC for this rton
D,to ��Cl
nen WORKER'S COMPENSATION DECLARATION l�
I I bemby aRnm under penalty of Mduq mm of the:following declarations: ®Cres
❑Iheve and willmunuina CcniOne rfCmnxnuo ulGirurt for Workers Compcn- LU C
cation,as provided for by Section 37W of the Labor Code,for the performance of the �n
work for which this permit is issued. ,�,s, IV
nil p'.��pry�$gss&p
O 1 have and will mountain Workers Compensation huanco.u required by Section ILL ItlVYs'
3700 of de TaorCode,for the perfommna of the work for which this permit is issued.
My Worker's mpema nn In unvec varier end Policynu//m��ber����art:������4
aria: Policy No.:-16/ Ll.
CE AE OF EXEMMON FROM WORKERS'
COMPENSATION INSURANCE
(Mis section flood not be completed if do Permit Is forone hundred dollars($100)
or leu.)
1 certify deal in the penformabea of the.,it for which this permit is issued.I shall not
employ any person in any member so u to become subject to dee Workcs'Companion
Laws of California.Dam
Applicant
NOTICE TO APPUCANT:IL after making this Cendicae of Exemption.you should
become subject to the Worker's Compensation previsions of she Labor Coda,you must
OO forthwith comply wild such provisions of this Permit shall W deemed revoked.
z CONSTRUCTION LENDING AGENCY
[r mom. I hereby affirm that them is a construction lending agency for the performance of
y' 7 the work for which this permit is issued(Sec.3097.Civ.C.)
W Q Lender's Name
P, Lender's Address
U 1 cenify that 1 have read this application and state that the above information is
correct.1 agree to comply with all city and county ordinances and Bute laws mlating to
O U building convection,and hereby autorim reprtunutivea of this city to color upon the
r U.1 above mentioned property for inspection purposes.
(Wes)agree to save,indemnify and hep harmless the City of Cupertino against
Uy liaemse,judgme the coming of
mayinany way acerue apmrtuid Cisy
U z mconuq NT of UNDERSTANDS
Ing of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
Signature cifApploardContractor DateHAZARDO
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or furore Wilding oceupapt amts or handle Health anmaterial
u defined by 0te Cupertino Municipal Cade,Chapter 9.¢,and the Health and Safety
We.Seetion 255320d? All roofs shall be inspected prior to any roofing material being installed.
Oyes ONO
Will de applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
k emit hazardous air conummanu u defined by the Bay Arca Air Quality Management all new materials for inspection.
District?
Oyler ON.
1 ban read the hasafdous materials requirements under Chapter 6.95 of the Califor-
niaHealth
&Sec{�C/fJc.Satinu253115 35533and25534.Iundcrsund Nuif Nc Wilding
docs not curnl e a tenant.this i s my rerpnribilky m notify dm becup t of the
dequiremem s oom aofaty_ flOmfie,eofDbeu/I SignatureofApplicant Date
Owner or authoriced agent (/V� Dam All roof coverings to be Class"B"or better
�I ►��
o % � o
;Z4
I I
IW
13 I J
�
Z
r
C
_ w
—~
L.
L
QtivAiMW vi1ry 30 ryy$ pD
L
00
42
�r
2:
o LA
O > 'L eti+'y,
o ry o
V �g{
C cc
tlgg
` .Y u tO`. � � '.,3l'Iii'*riYTk�"GF.17.•`Sr�RS.'FI i:Z' T..r k � � �tL K�dl v
vt w wt of
c o_ c c n
lul
3cJ iE � '�C o v t� 3 L° V 'p8 oOE � � W mU v C u O '�coO
>