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CITY OF CUPERTINO
CONT.RACTORyINFO&
BUILDING DIVISION PERMI�
3"Q<4+if3ii
BUILDING ADDRESS:
Tinppr'
PARAMOUNT SIGN CONTRACTORS
PERMIT NO.
05040165
PITT,
'R'S NAME:
PERMITISSUEDATE
4
PHONE:
r
SANITARYt
O OL N0.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
O O O O
LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing
with Seation]B(NI)rr Division 3_of NC BusicesnaM Profession Cn c and mylicenu is
in tub mrce,ma err raj.' 3
Lirenaeclas Lia.a
OFFICE DIRECTORY
'
Dam Cumracmr
ARCNITECrS DECLAR
1 undcraund my plain shall be uscd n public rcmmda
Licensed Pofcaiunal
OWNS R -BUILDER DECLARATION
I hcmby affirm that 1 am carotid from the COnbacer s Licenu Law for the
Following reason. (Seeaon 7131.5, Business and Professions Code: Any city or county
which requires a permit to construct, alcor, improve, demolish. or repair any Structure
! prior its issuance. also inquires the applicant for such pandit to file a Signed statement
Ft. Floor Area
Valuau
that the is licensed punuanuo the pmvisioa of the COAUACUA'S Littnu Law (Chapter 9
Sq.
n
m (commencing with Section]IXID) of Division 3 of the Business and Pforasioni Code)or
: that be, is exempt therefrom and Be basis for the alleged rsentpdion. Any violation of
APN Number
Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant tO A civil penalty Of
net,,., Nan fin hundred dollars ($500).
❑ 1, as owner of the property, or my employees with wages a their sale COAramsadon,
Required Inspections
will do Ne work, and Ne structure is not intended or offered for sale (Sec. ]044, Business
and Professions Code: The Comment's License Law does not apply to An owner Of
property who builds or improves demon, and who doessuch workhimself or through his
own cmplOyra, provided that such Improvements ..of IdmMW oroncred for sale If.
for the Owner
builder will hon the burden of proving Nat M1c did nm build or improve fur puryrse of
builder, Htfivbuilding orden of ement po.vo,bar within One yea o, complimprove
sale.).
O 1, as owner of the property, am exclusively contracting with licensed contractors to
D
construct he project (Sec. 7044. Business and Pmfcssions Code:) The Contractor's Lt.
.VC\
cense law does not apply to in owner of propcny who builds or improves dhemon, and
who contracts for such projects with a contractor(s) licensed pursuant o the Cantrac oar's
License Law.
❑ 1 am exempt under Sea . B h P C for this meson
Dale
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under pealry of pcou, ..of the fallowing declamioa:
❑ I have and will maintain a Ccnmcae of Consent to selfdnsum for Workers Compcn.
sarion, As provided for by Section 3700 of the Labor Code, for me pedmmancc Of the
work for which this permit is issued.
❑ 1 have and will maintain Worker's Compensation Insurance, As required by Section
37W of On, Labor Cod, for the performance of me work for which thia permit is issued.
My Wor�k,fa C�ompents(,d Insurance carrier and Policy number am:
Cardcr.'AA'T tilt -Atm Policy No.:l_
CERTIFICATE OF EXEMPTION FROM WORK ERS'
COMPENSATION 114SURANCE
(This section need nor be completed tribe permit is Intone hundred dollars ($100)
ter Irm.)
1 cenify that in the performance o! the work for which this permit is issued. I shall not
employ any pcmon in any manner sat a 10 bmente subject to rbc Worker; Compensation
Laws of California. Date
Applicant
NOTICE TO APPLICANT: IL after making this Centftca¢ of Exemption, you should
became suhject to the Worker's Compensation provisions of the labor Coac, you must
rortfyvitn comply with such provisions or Ibis permit shall M Accrued invoked.
i
CONSTRUCTION LENDING AGENCY
• me than iia construction lending agency for performance of
work which
Be work fm which this permit h issued (Sac. 309], Civ. CJ
Lender's Nsmc
r Lender's Address
,
1 codify that 1 haw read this application and sum that the alien Information is
'
• comma. I agree to comply with all city and county rNinames and state laws relating 10
building eanrooctton, and hereby authmin rcprearmatins of Nis city m corer upon the
almn-mentioned moronity for inspection purposes.
(We) agree to an. indcmni fy and keep harmless the City o(Cupenino against
liabilities, judgments, coats And es nsca which mayin any way orator egainn snit City
to comscqucnce Of the gra a p
of mmid.
APPLIC UND IAND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURC U LO
Re -roofs
Type of Roof
Signature of A lic UPSn tamer Dae
I Z DOLS S MATERIALS DISCLOSU E
WIII the app cat rfmurc building mcupam smrcmhanJle haamilms material
a dcflnrd by the Cupmmmr Municipal Code, Chapter 9, 11, and the Health ad Safety
dc, OY.xrion 15531(x)? ``Nu
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without firs[ obtaining an inspection, I agree to remove
WIII the applicant or future building occupant use equipment or devices which
emit haarduus air croammanm as dcfned by the flay Arca Air Quality Management
all new materials for inspection.
Diavimt?
❑YetNn
1havereadthehanrdnusmaterialsmquirrmmnuunt rChapter6.95rfthe Califon
nix Health a SafetyCOde. Sections 75505.15533 and 35534.1 um'emtand thuifdte building
docs wt cu nrly haarrsaen 4 met it is my responsibility to Wily be Occupant of me
rcyuircm nilimpalx pduraissu.or.ACr.mAmofOccuP rex
Signature of Applicant Date
All roof coverings to be Class "B" or better
Ownet A,.uln ri ag n, o, a
a
�.d
ary of
CUPERTINO
CITY OF CUPERTINO �a
SIGN
PERMIT APPLICATION FORM
APN # 3 6 q�y 1005 0�
Date:
��7OS
Building Address:
/go 02�Z�i &.
Ow is Name:
77 S
Phone #:
4(o8-255- /
C actor:
�1i2A�n unl`T &6A/� ,_S
License #:
.5-
Co ct:
Y-6 M 7P
Phone #:
�l0'1 —19D�
App licant/Contractor:
Seismic Commercial
Building Permit Info:
Bld Elect Plumb Mech
Job Description:
Residential: Commercial:
Sq.Ft. Floor Area:
$/Sq.Ft.:
Architect/Engineer:
Cost of Proje-1-1 _
Type of Construction:
Occupancy Group:
Qty. if
Applicable
Fee ID
Fee Desnrintinn
FPP Rrnnn
BENERGY
Energy
BUILIDNG
BPERMFEE
Bldg Permit Fees
BUILIDNG
BPLANCHK
Plan Check Fee
BUILIDNG
BSEISMICOM
Seismic Commercial
BUILIDNG
EPERMITFEE
Elect Permit Issuance
ELECTRICAL
BREMSIGNAD
Rmdl Signs Add Branch
ELECTRICAL
BREMSIGNS
Rmdl Signs, Marquee
ELECTRICAL
BUSLIC
Business License
BUILIDNG
Project
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