00100154OFFICE
CITY OF CUPERTINO
CONTRACTOR INFORMATION:
BUILDING DIVISION PERMIT
OUILDING AID DRESS:
PERMIT' NO.
1.0201. TORRE AV
STOP SIGNS INC
00100154
OWNER'S NAME:
APPLICATION SUR [)Ariz
I.ThICOI_N CUPERTINO ASSOCIATES
L .3193 BELICK ST 37
10/23/22000
ZONE
-
SANITARY NO. CONTROL NO.
(408)988-7867
ARC111'ILC'I'VENGINHER:
BUILDING 1'ERMI'I' INTO
100
BLDG ELECT PLUMB MECH
H
LICENSED CONrRACTOR'SDECLARATION
Job Description
L herebyvffirm Thal 1 am licensed under provisions of Chapter (eonamm,ing
3 C e
with Scclinn OID0T,"I DiM.... o3 dlhe Bruin... and Prol'c..... t ,Crate, and my liamm
,gam
is in fall fare, and I t Lim. «nG
SIGN
yU
hittmse Cines _%�%�� _`4S
tLL�
Uum,�Z�=OPRCIII'fF,C'1';S DRCLARA'IlON
' O 5
1 undenl:uul my phos shall he used as Public record
OO
Limnwcl Prue... onal
OWNER.BUILDHR DECLARATION
7 "�—' y
1 hereby affirm that 1 am exempt from the Contractor's License Law for the
following n ,, (Section 7031.5, Buri and V fes. rex Code: Any city nr,omay
c S Q
which reyuims a pcnnil u, amN met, altecximpruve demolish.... repair any slrunure
7 3 $
prior in its issuance, also requires the applicant for such pelma to the a signed statement
Sq. FL Floor Area
Valuation
mat he isice nedpantnntmthe prov.shimofthe ContnemrsLimmeLaw (Chapter 9
(cummmnem, with Scctlon 711(X) ofDi,t000 J of the Basin... and P-1111iuns Code)
or that he is exempt therefrom and the bulb, lit the alleged exemption. Any s'iotation
$ 6000
of Sidon 7031.5 by any applicant for a permit subjects the applicant to a civil Penalty
APN Number
Occupancy Type
or sar.r, th.ave hntdrea anlmn $5500).
ra..nt
01, as no net of the pmWny, or my employees with wages as their sole compensation.
? .a 11.9 • 7I
Inspections
will do the work. and the structure i, not intended or otrctm for .ale (See. 7044'
nd Po,fn s Code: 'Ilte contra.....'. Umn..: Law does nor ninny u, a
Required
e q P
owner .ony Who huilds or improve thereon. thereon, and who does such work himself
rof pp
or through his own cionoyas, prn'ided .nal such improvements am not intended or
101. — FOUNDATION
a1Rored lot sale. If. oos,mc me haildin, or impmvenenl is sola with la one y,ar of
UFER
dre mwne,-milder will have doe burden of p... via, that he Jar not build or
1.03 —
inoplefim.
mmmverorpurpn.c....ale.).
1.04 — REBAR
❑1. it, oweco..nneao,ny.a,itar�renivclyconnecting with ranedeortmem"tr105
— ANCHOR BOLT'S
onmmct the project (Sm. 7(W. Ibminess and Professions Code.) The Contractor's
construct
304 — ROUGH ELECTRICAL
who ...lo" lot etch pr..jcclt wino a ...... ructnr(s) li.emcd par uant ,, the
cnd
ontmeor Liccoelaw'' I505
— FINAL EI_ECTRICAI_
01 onas o cxempl under S . R K I' C for this ..,an
51.4 — FINAL PUBLIC WORKS
Owner Date
WORKER'S COMPENSATION UECI.ARATION
I allipuss.. -ng
reby
of
omdfor Wal
of Consent n mLabor for Walker*'
e and will maimm cmfi.m Cmemmeool elf
❑ I have and will maimd a Cby
Si,,1 1700 of the Labor Codc. Ire he
os porkWed lo, by Sc
Conopc.....
f hi I tl .: issued.
oI roue
Kit c f d
011 J 31 int Worker C rept 't I unncc a. y dby Section
sem,
3700 f the I t' d t A. Fell 'n. f the'od I 1 1 t. pernnt is
Co Insurance cam J Policy numbere
issucJ lily Worker's Compensation
oso
/
yC(t
Cnr.icn_�7r. -, sem^ Pricy No.:
O/
CERT"1190 1'IUN Ob I X MP1'[ON FROM WORKERS'
COMPENSAHON INSURANCE
1'Tois seri.... rad not Iw co.nplemd it Ili, Per is for one hundred dollars
($lo() or It
'
I.,nil', That on 'he I'll of of he work lin which .hie pernit ie in.nW,I
shelf not employ any boron in any otm ore, c) as to bc,omc subjccl to the Worker,
Compensation Laws of Calif me Dare
Applinvl
NO[ CE TO APPLICANT: II: anc. making .hid Ccnificum of Exemption, you should
Noone subject 1. the Workdx Compen.mion pmvislovx of the Latin Codeyou inner
OfonLwith
comply with such prov inions or this permit shall he Jamcd revoked. .
Zi
CONS "I RUM ]ON LEN DING AGENCY
Y1
hereby a1Trm that them is a conumcoioo lending agency for the pentomoance
of he work lin which this frond is ironed (Sea 3097, Co,, C.)
z
y Q
Iender's Name
7
Lender's AJdm,,
' O
1,,oily land I hove mod do, application anal Nal, mm the aMwe infommtion is
-sets I tg t m mnoply with all city vad county cardamom, and one laws relining
V
to thinking contraction. and hereby vulhadm mpresenmtims of this city to enter upon
y ;4
the al leo-...,..rnn,d pt'q arty fo. i..ape,tio.i nmpo ,
P.
Ov - ' b 1counly and keep harmless the City of Cnpemou again.N
Vl
JctCit
liabiliti . judgments. costs at mws which may in any way =me against kid
me 6 g n pcnnil.
City ho of 'min
'II
Apl'UCAN'1'UNDIiRSTANI. )MPLYWIT ALL NON.ro1N1'
Issued by: Date
y'
SOURCE REGui MONS.
Re -roofs
1Q�GA=QO
Signamm of Appic dA a Uwe
I , I )IIS Af " IAL .OSURE
still the applican - o I Nom or handle haraNaus.11 nal
Type of Roof
di by moa Cupcnino Mon. o c Chapter 9.11, and the Thahh and Safely
'
Cis
adet Secdoo 255321x1"
o Yes oko
All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or houre building occaj%eit use equ,nical or dcvicce ooth
[fa roof is installed without first obtaining an inspection, I agree to remove
nit h rmommo air contaminants as defined by the nay Area Air Quality management
all new materials for inspection. Applicant understands and will comply with
,ionen
Cl Ye, "'r
all non -point source regulations.
1 have mad the hamNtms materials mmimwnls under Unifier 0.95 of .he
Cali fomin I Icelth& Safey Cost.. Smi to 25505. 2553.1 and 25534. 1 undcroandthat
if.hc bubhavu..cnonl,that it is.ny responsibi li ty moldy t he
cuparl the rm,mmcmenrs whin o W met prior no issuance of a Cendicme of
occupancy'
Signature of Applicant Date
/V 43�u
tB"
All roof coverings to be Class or better
owns..t wmon, me
OFFICE
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