06070088 CITY OF CUPERTINO 9 'ad>�t x��' `°• �'`��
BUILDING DIVISION PERMIT �NTRACTOR INIORMATION
Ss xty Lr�,
BUILDING ADDRESS: ALLEN SIGNS INC PERMIT NO.06070088
20735
R'S NAME: PERMIT ISSUE DATE
OWNE
PERFECT DENTAL 1982 STONE AVE 07 /141/2006
E:
SANITARY NO. CONTROL NO.
(408) 280-6500
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDGELECT PLUMB MECH
0 t 0 0
oo LICENSED CONTRACTOR'SDECLARATION Job Description
:ZFC I hemby affirm that 1 Am Iimused under previsions of Chapter 9(commcneing
W with Smtion 700u)of Division 3 of the Business and Professit,n"Code.and my licease i5
>>„ imm0mre ad if .. r t NEW GREEN ILLUMINATED SIGN
p vJ z Limit Lk.As 15
F Date Contraeter _
ARCHITECTS DECLARATION
51-1 1 undersand my plans shall he used As public records
ayU
cod Licensed Professional
S OWNER-BUILDER De ubc Co mixt
i 0 ION
I hcrchy M.that 11. exempt(sum the fonts rs :Any C Law for the
p O following reason.(Saito 103 1.5,Business and .,de tv Code:Any city or county
i m which uquirc5 a pwmit m constnct,alter.impmvm,demolish,at repair any structure $4000
a Z 6 prior An its issomm c,alit,nation.do applieam for Such Permit to Ne a signed auNment
-s mat he is licensed pursuant othe provisions ofdoConuactursLicense Law(Chapter 9 Sq.Ft.Floor Area Valuation
uH$ (commencing with Section 71300)Mf Division]of the Business and Profcssiav Code)ser
— that he is exempt therefrom and the basis for the allcgW exrmiddem.Any violation of
Section 7031.5 by any appli.1 for a permit Subjects the applicant to a civil penalty of er Occupancy Type
not mart than five hundred dollars($5001
❑I.uowtter of the ryopeny,amy employers wit,wguu the'tr ask cmnpevadon,
will do the work and Ne atvctum is not intended or aRered forsale(Sec.7094,Business n
and Pmfasskv Code:The Commutes Dave law dna not apply m an Owner Of Requii _Bre. eotions
pmpeny who bufldsaimpovuthimprendwM10 dassahende hiterfresduough his
ownee,.thas,ldi.gpircnridedthassuchimpmvemun arcnot intendedinterferes for side.IL
however.the building Orden of pmut is cold within ore year ofW wcdan,Nepme of
builder will have tie burden o[proving that M did Out build w improve Iw purpox of
oak,. AUG
1,as owner of the property,am exclusively contracting with licensed contractors to Owl
orso... ZO06
construct the project(Sec.7044,Business and Professions Code:)The COntmcturs Li. b
who contracts
law coca not apply a an owner of proper(who Words p ter impmw thcreom and. (}Ja
whence La ufor sah pmjearts with aeonmmorts)Ilartud pursuant to the Gntractors (U�//(/(/�i q,q�
0
License Law. lY{1[ll .
❑lam ucmpt under See .B&PCfw this won U
Owner. Date
WORKER'S COMPENSATION DECLARATION
I hemby aBum under porosity of perjury rn of the following dmlafations:
❑Ihave and will maintain aCcrGEeateofcoven1wu16iesumforWordoesCompen-
utimn,As provided for by Section 3700 of the Labor Code.for the perfonorom of the
work for which this permit is owed.
1 have and will maintain Workers Compensation Insurance,As myvimd by Section
]700 of the Labor Code.for the performance of de work I.which this permit is Issued.
My Wo s c. pe esad btmsruuz mrriw end Polity number are: -
Catrier. il�� �vt$u2tnce Cp-Policy No.:��x34(�ICI
CERTIFICATE OF EXEMPTION IROM WORKERS'
COMPENSATION INSURANCE
Missmdon need not he completed if Tfr permit is for one hundred dollars(5100)
or leu)
I matify that in thc performance of the work for which this Permit is issued.)shall not
employ any person in any manncrso as to become subject in the Workers Compensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If.After making this Certificate of Exemption,you should
become subject to The Wmrmes Compensation provisions of dm Labor Cork,you must
.JO foMwult comply with such provisions or this Permit AM]M deemed revoked.
Z
[-a r^ CONSTRUCTION LENDING AGENCY
Ihereby affirm that them is construction lending agency far the performance of
a > One,work fur which this permit u issued(Sec.309-(,civ.C)
14 0 Landers Name
14
D z Lenders Add.
V Q 1 certify that 1 have read this applicasion and sue that the Men information is
U.t-^ correct,l agree To comply with all city and county ordinances and suite laws relating to
C C.J building construction,and hereby Whoris representatku of this city To enter upon The
W ahovc-ms.judgdpmperty(And expcuouenses purposes.
F-i a (We)agree to save,indemnify and kap harmless the City of Cupertino again",
N liamosequerim f thoconning cxpcnseninit, may in any way attrue Against said City
V Z A APPLICANT
of the granting of this permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Dale
SOI N�GUUTIONS.
vE-��� _714/06 Re-roofs
Signature of Appli.11COnuxtw Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant stem orhandlc havardous material
u defined by the Cupertino Municipal Cade.Chapter 9.13.and de Health and Safety
Code,Section es �No
25332(.)?
r-1 Yes All roofs shall be inspected prior to any roofing material being installed.
Y
If a roof is installed without first obtainingan inspection,I agree to remove
Will the applicant ser sutura building occupant eau equipment or Mara which P g
emit iet? air cwumivnu u dchne0 by the Bay Area Air Quality Management all new materials for inspection.
Disnict? JJ
[]Y. 1[INu
I have rem)the harardmu materials reepiremena under Ompur 6.95 of the Carlo,.
-is Hmhh&Safety Code,Sections 25505,25533 and 25534.1 undersand thmifde Wilding
dose not mormily have a enan,that it is my msptnsihility Or nudfy One ocpacnupant Of the
mg Iswhichmunebemet our us rCD Signature of Applicant Date
K;7 7(71 6 All roof coverings to be Class "B"or better
wm,or aathwircil.,ar t Dote. .