06080080 CITY OFCUPERTINO
BUILDING DIVISION PERMIT SCCINTRAC�nR IN 'O M.A,TION
9 ms•
BUILDING ADDRESS: PACIFIC NEON ( PERMIT NO.06080080
20745 STEVENS
OWNER'S NAME: PERMIT ISSUE DATE
TARGET 2939 ACADEMY WAY 08/31/2006
PIMNE;
SANITARY NO. CONTROL NO.
(916) 927-0527
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG EIECT PLUMB MECH
0 0 0 0
oa LICENSED CONTRACTOR'S DECLARATION Job Description
w FF 1 hereby affvm Nat I am licensed under previsions of Chapter 9(commencing P
:2W with Section 7110if of Division 3 arrive Business amid Professions Code.and my license is
i« m full foie arW cff
_� - t0 34 ( RELOCATE EXISTING ELECTRIC MONUMENT SIGN
o Lte.g
f• Dals Convacmr
ARCHITECTS DECLARNTION
l¢< 1 understand my plans shall he used as public reconts
a awU
'pt; Licensed Professional
OWNER-BUILDER DECLARATION
<f I hereby arm Out
I ammucacracmpt feta the ConlracmYs License Law far the
r 00 following reason.(Section 7101.5,Business and Pmfusinns Code:Any city car county
'm(ai welch requires a poamh m corawcL alms bnpmvc,demrl W.car repah any swaum $2400
prior to its issuance.also requires the applicant for such permit to file a signed statement
that he is rumored pursuant to On pmvisiov of the Continuo 's License Law(Chapter 9 Sq.Ft.Floor Area Valuation
i r O Commencing with Section 7000)of Division 3 of the Business and Professions Cade)or
$ Nat he u eumpt therefrom and the basis for the alleged translation.Any violadon or
Section 70315 by any applicant far a permit subjem the applicant to a civil penalty of 3r Occupancy Ype
not mom Nan five hundred dollars(15(10).
❑I,az owner,.the property,a my employees with wager azole(Sec.
compensation,
will do fehe wont ands: he Oust is roti endod License
mawdo offered fs coslo(Sec.to 7W,Business
of
and professional
nywhons Code:The estherc.n.License Law does not apply rf an owner of Required Inspections 1
own
ncrnployc uilNmid thatesdercogandwho doesauchended cma3fwthrougb his
however.the Wilding or improvement ve is id wLsartne earefdmoHcrtd rm saner.
however.the the Wmofproviuuldedidnot Wild of completion,the owed f
builder will have the bother of proving Nat k did et build w improve far purpose of /
sok.). �]
❑1.az owner of the properly,.B su ns,and cumaaciing with )The Communities
m r
cmawct Ne es not (Sec.lou,Business and Professions Cade:)Ile Carhmeons Lid
cense Law docs not apply a an owner of proper(who builds or improves Committees and
who nomads for such projects with a convactogs)IiceuuO pursuant m the ConvdmYs
License 4w.
❑ism uempt under Sec. ,BBPCfor Our reaun
Data
WORKER'S COMPENSATION DECLARATION
I Mreby affirm under pevvy of perjury ane of the following deelaadome
❑I hire and will maintain aCs olicsm or Covent to self-insmre rm Warkefs Compere
sauon,as provided far by Section 3700 of the Labor Cade.nor the performance of dre
work for which this Permit Is lamed.
❑1 bade and will maintain Worker's Compensation Nonose,as not i ired by Section
3700 M the Lahar Cade.fm the performance Critic wart for which this permit as issed.
My Wor sCo pevauan Wet tic carrier and Policy number ase:
Carrier. polityNo.:G
CERTI C A O EXEMPTION FRO WORKERM
COMPENSATION INSURANCE
(This action raid et 4 cemphaid if the permit u two=hundred dollars(5100)
or less.)
I certify that in On performer.of No work far which this permit is issued,l shall not
employ any person many masnum ss an become subject in the Warkeri Cwnponsauon
Lawa of Celifomia Das
Applicant
NOTICE TO APPLICANT:If,spur making this Certificate of Exemption,you should
become subject in the Worker's Compensation provisions of the Labor Code,you must
OfoMwith comply with such provisions or this permit shall he dcemed revoked.
Z CONSTRUCTION LENDING AGENCY
4
(-+ I herebywhich
Out themis motor
30 7,Ch,agency for On pedormantt of
tYi theLe work for which Nu pcamit is iaucd(Sec.309'{Civ.C.)
A Leadca'se,Name
Add. - v
� z tender's Address
U0 1 certify Nat I have read this application and mute this the above information is
D.F correct,l agree to comply with all city and county on ire mils and sells laws relating to
0 building construction,and hereby mmhoore rcpreacmab.0 of the:city to enter upon the
F 0. abovcmcmiuncd property for inspec.......ses.
(we)agree to ave,indemnify and little harmless the City of Cupcnino against
C/) liabilities.judgments.costs and exporter which may in any way acme against said City
UZ in consequence of de gamin Nis permit
APPLICANT UNDERST AND L CO WI ALL NON-POINT Issued by: Date
SOURCE REGULATIO
g � Re-roofs
Signature ofA I'cen onvumr Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the appliam or future building accupet atom or handle hmvdous material
az caped by the Cupertino Municipal Code.Chapter 9.12,and On,Health and Safety
^v)o. Ss
❑Y. inspected
3ua7 All roofs shall be ins ected prior to an roofing material being installed.
sec
Will to applicant or future building occupant uta equipment or devices which If a roof is installed without firs[obtaining an inspection,I agree to remove
cri it W7.ardov air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
Disvict?
❑Yes m
I have sad the haallous materials acquirements undm Chaptm6.95 of Ne Califor-
nia HCabh&Safety Cade,Sections 25505.25533 and 2553<.I undeatand thdiitin building
does oat cu t hoe a ice N y ponsihility to notify the occupant Of on,
requirtm icnm met car to aracwdficatearo / Signature of Applicant Date
All roof coverings to be Class "B"or better
Owner w auNomtd agent Dals'