05100158CITY OF CUPERTINO
'C�NTRACTnR N '•
.
BUILDING DIVISION PERM
9¢i
INk'ORM
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BUILDING ADDRESS:
22��OER'S
ALLEN SIGNS INC
PERMIT N0.05100158
NAME:
PERMITLSSUEDATE
LUCKY CUPERTINO
STONE AVE
in/20/2005
PHONE:
_1_982
SANITARY NO. CONTROL N0,
408)280-6500
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
lob Description
I hereby affirm that 1 am licensed under provisions of ChaPmr 9 (commencing
with Section 7") of Division 3 of the Business and Professions Code, and my license is
Loculi force and eff,rct.n
wa
TED CHANNEL LETTER SIGNS
License Clvs i '"
Data O Contractor
CHITECTS DECLARATION
1 uMcrsoanJ my plans shall be used v public records
_Q��
I'Iti 2005
Licensed Pmressiunal i
OWNER -BUILDER DECLARATION Is
I hereby affirm Nat I am exempt from Ne Cmanstur's License Law for tW
following meson. (Section 703 L5, Business and Profusion Cale: Any city or county
which requires a Permit m ennsnuct, &Iter, improve, demolish, or repair afift$4000
pnomo its issuance. also requires the applicant for such permit ro Glc 2.1,
teFlnorArea Valuation
o that he is licensed pursuanttothe provisions OfOnCmanacmrsLianxls IC r
(commencing With Section ?0W)nr Division)nrtheBusincvandPmressians-
. Nal he u exempt therefrom and the basis for Ne alleged exemption. Any violation of
hj�Q Q
Occupancy Type
Section 7031.5 by any applicant for a permit subjccts the applicant to a civil penalty of
nod more than five hundred dollars ($5()0).
❑ 1, u owner of the propcny, rr my employees with wages u 0cir xle compensation,
Required Inspections
will work. and the s
no,lc(Sce.?OM,Business
That's License Law docs not apply to an owner of
Profession.am's Line.
Professions Code: The Co
Con
q P
proand
enywyeesho id es shamen. chaoticuch workhncanedselfos through his
that suhimprovndwho
, rovecis
own intended incanted console IL
own employees, that such imis
r
th building sold within
however,theavetngordenofpmentis year orimproverutprposeo-
athediinotWildne
have the burden of proving Nat he did ono Wild or improve fur purpose of
sale)Twill
sale.).
D 1, as owner of the pfopeny, am exclusively contracting with licensed contractors m
conatmcl the project (Sec. 7pL1, Business and Professions Ca hl The Contractor's Li -
cove law does not apply to an owner of property who Wilds or improves thereon, and
who contracts for such projects with a contractors) lived pursuant to the Contractors
License Law,
❑ 1 am exempt under See. , B St P C for this mason
« Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under Penalty of perjury one of the following d«Iaations:
1 have and will maintain a CeniGcam of Covent to self -insure for WodamesCPmpcn-
sation, as provided for by Section 3100 of the labor Code, per the perfomtattcx of the
work for which this permit is issued.
D 1 have and will maintain Workers Compensation Insurance, as required by Section
3700 of the labor Code, for the performanu of the work for which this Permit is issued.
My Workers[Comp/e—nsationdn�su,—ance carrier and Policy number am: L
Cartier. I /,li' m Vr 5 Policy No.: -QLD
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Dissection need not be comPletod iDbe Permit is for one hundred dollars ($100)
,it Mss)
1 certify Nat in the perrnrmance of the work for which this Permit is issuctl, I shall not
employ any Person in any manner an as m become subject o the WorkersCompensation
Laws of California. Date
Applicant
NOTICE TO APPLICANT: If, after making this Cer ificate of Exemption, you should
become subject to the Worker' Compensation provisions of the Labor CMc, you must
fonhwi in comply with such Provisions or this Permit shall be deemed revoked.
CONSTRUCTIONLENDING AGENCY
I hereby Our Nem is Comm
mvorvct3 leading agency for the Perfurmarxe of
whaffirm
the work fur which this pemtit is issued (Sec. 709), Co, CJ
s
Lender's Name
Lenders Addxss
�
1 comfy Nat I have read this application and auto that the above information is
^ cone r. I agree to comply with all city and county ordinances and sate laws existing to
'
building commaction, and hereby addition procsenativv of this city to enter upon On
U shove-mendmied properly for iNP«tlon purposes.
(we) agree to save, indemnify and keep harmless the City of Cupcnino against
liabilities, judgments. costs and expenses which may in any way secs= against said City
in consequence of the grand ng or this Permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: DateSOURCE
AT ONS.
Re -roofs
Type of Roof
MA
Signature fApplicanUC tractor Date
Hp FOCUS MATERIALS DISCLOSURE
Will the applies r future building Occupant store or handle hamnlous material
^s defined by the Cupertino Municipal Code. Chapter 9. 12. and the Health and Safety
Jets Section 25532(a)?
Dyes BU Nu
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building occupant use equipment or devices which
emit ha,ardnns reit coronation. as defined by the Bay Arca Air Quality Management
all new materials for inspection.
Di ... ter, �aJl
D YesNu
1 have mad the haaardnu i materials requiromena under Chapter 6.95 or the Califon
nia Hca W & Weoy Code. Sections 25505.35573 and 25534.1 understand that if the Wilding
Jots not c m y 4mn a tenant Lha it is my feapovibility 0 notify the Occupant of oho
rcyuim' whifimus C,Pigrmisaaatcnrraceni0es¢nrQapany.
SignamreofApplican[ Date
\
All roof coverings to be Class "B" or better
Owner or authorivn agent Date
4
CITY OF
CUPEkTINO
0
CITY OF CUPERTINO
SIGN
PERMIT APPLICATION FORM
061 oo Iii*
APN# 3Coq-4o _ oi-4-
Date: It)�jZ OS
Building Address:
Ia>l I v> I
Owner's Name-
Phone #:
t _
Plan Check Fee
Contractor: k,l
License #:
Contact:Phone
#:
�/�
$ -� OJT.
Applicant/Contractor:
1 S; s
Building Permit Info:
Bldg lett Plumb Mech
Job Description: IcM i
Residential: bi qp �� S
�42. Commercial:
Sq.Ft. Floor Area:
$/Sq.Ft.:
Architect/Engineer:
Cost of Project:
ELECTRICAL
lea "—
Type of Construction:
Occupancy Group:
L kl/
./3
Qty. if
Applicable
Fee ID
Fee Degrrintinn
FAP r_r
BENERGY
Ener
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
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CITY OF CUPERTINO
amu•+� ''•"" +�'-Y'" 3�"'
BUILDING DIVISION
KC 10
BUILDINGADDRESS:
0271 TORRF AVE
ALLEN SIGNS INC
PERMITNOID5100158
HER'S NAME:
PERMIT ISSUE DATE
LUCKY CUPERTINO
1982 STONE AVE
10 /20/200S
ONE:
SANITARY NO. CONTROL NO.
(408)280-6500
ARCHITECVFNGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MICH
0 0 0
LICENSED CONTRACTOR'S DECLARATION
Job Description
1 hereby affirm that 1 ser licensed under provisions of Chapter 9 (cammencin{
p
with Section 7") of Division 3af the Business cert Profeashms Code, sail my license is
infull hone and ea9cL
1.
2 ILLUMINATED CHANNEL LETTER SIGNS
License Clue Idc. M
De¢ O Conaumr
CHnECi-S DECLAR I
I understand my plena shall he uud u public mcmdt
IAIA
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby Coninctoos License Lew for tier
11. exempt from ti
DEC
r
following mann. (Saito 7 onsura Buaiser, and Professions Cade: My city at county
. (Sec on
which mamma a permit to demolishcare any
ct, ale,!, nt
1UU Q
forst h rattail tatmbm
for such Permit b Ric s Signed statement
Prior b iia issuance. also unrest A Sig
thinhelicensed 70th) illons
to the ippon the ConammsaLianselso (ChapterCode)
Sq. F[. Floor Area
Valuation
of
pursuant pro of
p
or DivisionviCMe) of
(commencing with Seton? n3 oftheeged
I{p1k p
Net he V eumPt Nemfrom and Ne ossa for Ne alleged exemptio. Any violation of
exemption. Any
and the basis Any
Section 7031.5 by arty appltam for a permit subjects the applicant b a civil penalty of
�Q Q
it s Q Cupancy Type
not mom Nan five hundred claims ({500}
❑ I,uoworoftepmpony.mmyemploycowlNwaguutheirmlecompenudun,
Required Inspections
mildo the work, and Masttucture is notintnded oroffered forsale(Sm. 7044, Business
sad Profesdmu Coda: The Canuactoh.License Law does not apply b an owner of
e q p
propeny who milldam iso proves connotation! who duck each work himself., through his
awn employee, provided dal such improvements art notintnded mortared fornle. if,
a
h n even the building w Improvement is mid within and year of mmpletion, Ne owner -
builder will have the burden of proving Nat he did ant build or improve fm purpose of
I. N goner of the pmp sty. am exclusively contracting with licensed corrosion in
construct Ne project (Sec. 7014, Business and Professions Code:) The Conaacmr+ U.
come law dose not apply man owner of property who Wilda or improv thea". and.
who contracts for such projects with a Camru7Ur(a) licensed pursuant to Ne Convemora
License law.
❑ I oro tempt under See . B d P C fm this reason
.or Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of Ne following dedications:
Cl 1haw4ndwillm4intinaCeNrimmofConsentbulf-WumforWm sCompen-
ration. as provided for by Section 3700 of Ne Iabm Code, for the performance of tin
work for which this permit is Issued.
❑ I have and will maintain Workers Compensation Insurance, as required by Secdon
37W of the labra Code. for the performance of Ne work for which this permit is lured.
'
My Warlumsaminismution Inmrence Grier and Polity nu ben are:
_
Cartier. /'h S Policy No.: O
CER7IFlCATE OF E%EMPTION FROM WORKERS
COMPENSATION INSURANCE
('This sectian seed Mt M completed Visa mrmit is for. hormom dollars (SIM)
or less.)
1 cavity Nat in the performance of the work for which this permit is issued. l shall act
employ any person In my manor m as in became subject to the Workeri Compeonadan
Lara of Califomia. Date
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption. you should
become subject m the Worker's Compensation phovisiom of Ne labor Code, you must
forthwiih comply with such provisions or this permit Mall W damned mocked.
'
CONSTRUCTION LENDING AGENCY
I hereby affirm that Vert is a constructions lending agency for Ne performance or
the work for which this permit is land (Sec. 3097. Ci, C.)
Lenders Name
,
Lenders Address
I malty Nu 1 have aced this application and sure, that the above information is
correct. ) agree in comply with all city and county ordinances and stat laws alating in
building construction. and hereby auNotin: reprtunutivv of Its city to enter open the
above-mendmlW Property rat inspection purposes.
(We) agree to ave, indemnify and tecp hamlets the City of Cupenim against
liabilities, judgments, oma and expemu which may in my way amore against mid City
In consequence of the Swung of this MMIL
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POI
Issued by: Date -0 a —
SOURCE NS,
Re -roofs
Type of Roof
-0
Sigatura fAppli ticor Data RDOUS MATERIALS DISCLOSURE
will Nr appli rfu. building oceupant moa mlundk hauNous material
as dented by Ne Cupertino Municipal Code. Chapter 9.13, and the Health and Safety
. OYG 25533(])7 AN.
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, l agree to remove
Will the applicant or future building occupant use equipment or devices which
emit haraNnus air conmminants as defined by the Bay Area Air Quality Management
all new materials for inspection.
Dinrid7
❑Yes �No
1 have read the h ... dim. materials requirements undtchape,r 6.95 of the Califor.
nia lmalthk SafdyCodc, Sections 25503,35533 and 25534,1 understood dot ifdt Wilding
dace of c dy ave a e,nu4 that it is my mapomihility b nutil'y tW aceupmt of the
aqui] musLAOcipriorlocuummofaccrancaud roc pan
Signature of Applicant Date
All roof coverings to be Class "B" or better
Owner r antho'>c ]gem Dom