04040129�;o
�uE
n�mmZ
L�p
f�
J�U
`LL�
os
ata
ZG
0z
z
IA
�z
UO
O U
U
Jz
a
CITY OF CUPERTINO
x'.vSrc
'
BUILDING DIVISION PERMIT�C®NTR°AGT�$INTORMATIQN
BUILDINGADDRESS:
GOLDEN GATE SIGN CO
PERMIT N0v4040129
NER'S NAME:
PERMIT ISSUUE DATE
HEWLETT PACKARD
4
ONE:
SANITARY NO. CONTROL NO.
(510)366-3838
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby affirm that 1 am under provisions Of Chapter 9 (commencingsis
With Section IIllk)) of Division J or the Business and Prufcainnn Cotic, and my license is
fdic Bu
nfull formanderre (536
2 NEW ILLLTM MONUMENT. SIGNS
License Class Lk. p
Dam Contractor
ARCHITECTS DECLARA ION
1 undcrslxnd my phos shall be uaJ ax public records
Licensed Professional // ' 1
OWNER -BUILDER DECLARATION 1!' 1j
I hereby affirm that l am eicmpt Imre the Conliacmr'r, License to I for'M-
>
following reason. (Section ](131.5, ainnscail0 Profess ons Cr�a
tir outy_which requires a permit mtout ellepr4y lath,CItr
812000prior
to ire issuance, also m4Ylmalh pifOal fOr� Il tlQCm�QITho he is liccnud punuammthe P .I n94AtaC( plyy
�Ftoor Area Valuation
(commencing with Section 7000) of ERosinkgfa
--Thal
he k eumpt themfrom and Ne bash for the alleged cumiolation of
3]r$�XTQBr83ef00
Occupancy
P y Type
Section 7031.5 by any applicant for a permit subject, the applic our to a civil penalty of
net mare Nan five hundred dollars ($500).
❑ 1, as owner or the property, or my employees with wages as their talc compensation,
will do the work, and thesuuoum isnot intended oroffemd but sale (Sm. 7044, Business
Required Inspections
and Professions Code: The Convector. License law doll not apply w an owner or
propeny who buildscrimproves maroon. and who docs such work himulf or through his
own employees, provided that such improvements arc not intended or offered for tile.If.
however, the building or improvement is sold within one year of completion, the owner -
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
❑ 1, as owner of the propcny, am exclusively contracting with liccnud Cenmames 10
consuum the project (Sec, 7044, Business and Professions Cade:) The Conmcwri Li.
come Law does not apply to an owner of property who builds or improves Neuron, and,
who contracts for such projects with a eanlracmr(s) licensed pursuant to the Conmclo's
License Lew.
m
I aexempt under See. , B k P C for this reaon
ter Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain aCeniOwk of Conunl to sel6insum for Workeri Compere
sedan, a provided for by Section 3700 of the Labor Code, for the performanec of the
work for which this permit is issued.
I have and will maintain Workeri Com recession Imurance, as expired by Section
37 ofthc labor Code, for Nc performum of Ne work for which this permit is issued.
My Workeri�gpem/ahionsl+mun�nee carrier and Policy number arc:
�3
Came,.. JT (A/gC� rlMEl. Panty No.: �a'A tl"17 �-2s t*
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not Wwrepicled lithe permit is roronc hundred dollars (SIRY)
or less)
I cer(HY Nal in the arromm icir of the work for which this permit is issued. I shall not
employ any person in any manners$r le "n t o the Workers' Compensation
Laws of California. Doc
Applicant
NOTICE TO APPLICANT: If, after ribeflifTefftchrricale of Exemption, you should
-
bccome subject to the Wmkd Compensation previsions of the labor Code. you most
forthwith comply with such provisions or this permit shall he deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby sMom that Neu is a eonsuuctinn lending agency or the perfonnanu of
the work for which this permit Is issued (See 3W7, Civ, C.)
(anticYs Name
Lender's Address
I modify Nal I ban read this application and suck that dre above information is
corrccl. I agree to comply with all city and county ordinances and sum laws relating to
Wilding convection, and hereby aohoriae mpreuntstins of this city to enter upon the
ebovcmemioned property for inspection Purposes.
(We) agree to an, indemnify and keep harmless; the City of Cupertino against
liabilities, judgments, costs and expenses which may in any way acme against mid City
in consequence of the roaming of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH AL NON -POINT
Issued by: Date
S URCE REGULAT
Re -roofs
Type of Roof
, 04-
Snureof ApplicanUConlracmr c
HAZARDOUS MATERIALS DISCLOSURE
Will be applicant or boom building ucC.parostore or handle haardous material
as &Rned by the Cupertino Municipal Code. Chapter 9,12, amI ti¢ HcsIN and Safely
ode.Section zss3z(.17❑Yea �o
All roofs shall be inspected to any roofing material being installed.
prior
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
it hoardous air couturro mit a defined by the Day Arca Air Quality Management
all new materials for inspection.
District? ` u
❑Yes l^JGkpr4
Illaw mad the hasarthms materials requirement under Chapter 6.95 of the Cabral.
nia Hcalthffi Safciy Codc,Sccdoa255U5,25533md25534.1un&nwdthwiflM Wilding
dors not currently haw a knan that it is my responsibility in notify the eccupal of the
mquimmemvwhic mctpdor11yyisau cenraccmReawnraens}P��ey'
Signature of Applicant Date
Qlg
y20
All roof coverings to be Class "B" or better
Owner ser awhodvod mgcm