06070150 CITY OF CUPERTINO > at '� r
BUILDING DIVISION PERMIT CON," ,
C ,QtJNFORMATION �
BUILDING ADDRESS: CHARLES PANKOW BUILDERS L Mrr NO.06070150
10101 N WOLFE RD
NEWS NAME: PERMIT LSSUEDATE
SEARS ROEBUCK AND CO 2101 WEBSTER ST STE 1500 08/01/2006
NE;
SANRARY NO. CONTROL NO.
(510) 893-5170
ARCHITECrIENGLNEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
top LICENSMCONTRACrOR'SDECLARATION ICT
JObDesDescription
w FF I hereby al<nn that I am de
licensed anchor provisions of Chapter 9(commencing P
zto Lied Sccuhn]g1U)of Division 3afNC Buainw and Profcu um CoM,nnd mylicenR is
"i„ in full forceanderfatt 6 flf+ EXTERIOR MODIFICATION FOR NEW ILLUMINATED SIGNA
rya: LicenseLk.g
:g' Dam 1 Cenuecwr PLASTER & ELECTRICAL IMPROVEMENTS ARE NECESSARY
�jARCHITECTS DECLARATION
I s 6 1 undcom my plans shall W dead as public records
.to
O Licensed Professional
OWNER-BUILDER DECLARATION
i f 1 hcrehy IT,.the I am exempt From Ne Conuanah Liccnw Law for the
:0C following..a.(Section IW 1.5.Busiow and Pmfessioe,Code:My city or county
1_ which requires a Permit in construct,altar.improve.demolish,or repair any s mm ire
prior in its issuance.also requisas the applicant for such Permit o File a signed statement
?< Nat he a licensed purmantmftlbr i mu,Of the Contractors lia<weLaw(CIOPter9 Sq. Ft. Floor Area Va a1t�6000
t�N (commencing with Section 711))of Division 3 of fee Business and Profwiom Coda)or
$ tibe u exempt therefrom and the bub for Ne alleged exemption.Any viohd, of
Was
Section 7071.5 by wryapplicant fora permit subjesu the applicam m a mil penalty of ape•p y+N,�`�},f{N�`7 tuber Occupancy Type
not mom than five hundred dollars(5500). 316 2 0�80 . O O P y yP
❑L,u owmr Of the proper,or.,employ..wish wags u their sole compensation,
will do the woM1 and thembsctum is not intended ofoRered forsake(Sm.]044.Businw
and pmfessiom Cadc:The Contractor's Liccme Law dam not apply to an Owner of Required InspeCt�JJ
property who Wildaorimpmsea domain.andwhodasauch work hieuellwthrough his
own employe,provided that such improvements ase not intended oroRefed for sale If.
however,the building or improvement is sold within ase year of complewas the owner. non
builder will low Ne W Wm or province Nat M ata cot hula or improve f«puryose of
sale.).
❑1.as swam of the proper•am.elmiwly mmacting with licensed coouaemrs in `
coutmct d project(Seco an Bminw aM property
who m Code:)The COnuano.Li- C� ��
whocannotcontacts law dont not apply m an owner of progeny who Wilds re improve Newish,and,
Lice.Lfor such pmjeN with aeMl(Ylnr(a)licensed purSllanl m NC CohnaLrOYr a,�
M lam Law. g p G
❑1 am exempt undo Sec ,B k P C for this won
Data
WORKERS COMPENSATION DECLARATION
r 1 bereby air.under pcialty o(pcqury ism of de following declarations !L 4�
71 1 have and will maintain aCer iOe-ate of Coma.to self-imme for Warkers Compcn- RRR 777"'
ration.as provided for by Section 3700 of the Labor Code.for thm Performance of the .
work for which this permit is issued.
❑1 have and will maintain Worker's Compcmaonn Insurance,.required by Second
7700 o(Ne Labor Code,lar Ne performance Of the work I.which this permit is issued.
My Workear3s C��ompof'sabon Insurance nrtlor and Policy number art:
Carrier. FAL.I(iy Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This rection need not W complctad tithe Permit Is foram hundred dollars(SIM)
or less.)
I mrury that in the perform i ce Of the work for which this permit is cooed.T(hall not
employ any person in any m stacrm as N become subject 10 the Worker'Compemauon
Laws of California.Data
Applicant
NOTICE TO APPLICANT.IL a0cr making this Cenificae of Exemption,you should
become subject ta the Workers Compamauen provisions of the Labor Code you muss
,J O foMwith Comply with such Provisbas or this Permit be deemed rewked.
z ply CONSTRUCTION LENDING AGENCY
[-+ Thereby alErm that Nem b a mostmconn lending agency for the perfurmance of
a the work for which this permit b issued(Sec.3097,Civ.C.)
GQ Lenders Name
D z Lenders Add.
U0 1 certify Nat I have read this application and Onto that the above information u
D. correct.I agree us comply with all city and county ordinances and sate laws misting to
oUbuilding consUection,and hereby authhrine aprescnutives of this city to enter upon the
W abovc-menudgm ntsPeny for cipecdom purposes.
ti CIv liebilio(we)
agree e to costs and orntfy pwm d keep
mMarymn and waylty ay of Cupertino agaims uxd Chty
t]z in conRqueme of the Ineating of this permit. _ l
^ A CANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date G
E REG
_ 6R- ac Re-roofs
n
igore Of cH�A 0wriS MATERIALS DISCLOSURE Date of Roof
Will pli.nt or future Wilding occupant store or handle haardom material
as defined by de Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
.Section 25532(a)T
py. 4 N All roofs shall be inspected prior to any roofing material being installed.
Will dre applicant of future Wilding occupant uta equipment Or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit ha gnu air contaminants as defrncd by Ne Bay Area Air Quality Management all new materials for inspection:
DislnctT
❑Ya XNo
1 have read the hnardnmmamnals requirements undcrCNplerii.95 ofthe Califor-
biaHcalN&Selety Cadc.ScmM;M5115.25533 and 25534,londcramnd Nrtiftho Wilding
does rpt currently ase a coni that is is my reepomihiIby m notify the occupant of Nc
men m pnfmiunncenraCen;ftneofOceupmey. Signature of Applicant Date
Comer nr fad esent 6iPL Dam All roof coverings to be Class'B"or better