06080036 CITY OF CUPERTINO + " c .....
BUILDING DIVISION PERMITWTQ '0�'� 5 _
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BUILDING ADDRESS: SEARS ROEBUCK AND CO PERM11'1,10.06080036
10101 N WOLFR RD
ER'S NAME: PERMIT ISSUE DATE
SEARS ROEBUCK AND CO 08/29/2006
P NE: SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERM"INFO
BLDO ELECT PLUMB MFCH
O O
pp LICENSED CONTRACIDWS DECLARATION lob Description
w 1 hereby.1117.Nn 1 Am licensed mile,pmvid-At of Chapter 9(commencing
:ZE wiLbSccdan70gBafDvWW3eflhcBusircu ofeslo Code.AndmYllecrtse is ,
inrdlrarteme INSTALL 14 ILLUMINATED WALL MOUNTED SIGNS
t$Z Lice Lie.{
97M Contrsemr
pp ARCHITECTS DECLARATION
C< 1 understand my plans shall W used u records; cords
tyU
'tin Licensed professional
3 OWNER.BUILDER DECLARATION
,M 1 hereby affirm Nal I am exempt from the Convenor's License Law far the
.a o following reams(Secti7071.5.Business and Pmfevlum Code:Any ily ar County
$ which requims A permiton m curMmL eller.W prow.demolish,or repair any structure
•Za prior to iu issnamn.also requires the applicant for such Permit m Bk a signed uameacm
<
that he u licensed pursuant to the Pmvtslom of the Commute.U..Law(Chapter 9 S q.Ft.Floor Area Valuation
a (commencing with Sretion W00)of Division J of the Business and Pmfessiom Code)or $5 000
!RE that he is exempt demfmrn and the buil for the alleged eaonia on.My violation of
Section 7071.5 by aro'applicant for a permit Subjects the applicant in e civil penalty of ApN Number Occupancy Type
not mart Nm Bw hundred dollars(5300).
ownark.And
pmpmsy,ar In employes oro wAW u thevmle wmpeua0on,
will da Newark,coat Ne atmna¢btwrs Lmome LAW do famlapply.70An Budwr Required Inspections
And pro(eshoba Cade:The vesm mon.Uceme Law dam cot apply lf an owmr is q p
owntur layms,pmlfimprows themonand who darmchwork Mmffemdlforselt If.
ow ever.thebonding
or i Natmchimprowmenuarene lnuededotoRered for axle,owner.
builder UIbuildinguImprowmant).cold within edidam Wild orcompletion,Ne eof
builder wie haw the burden of proving Nn W tld not Wild or improve for purpose of
sale.).
❑1,AS Owner of Ne Property,am exelurively contracting with licensed mntrantnrs m
comimma the Project(See.70",Business and Pmfesslana Cade)The Conwemr&U• -
ccrue Law does not apply to an owner of property who Wilda or Improves thereon,and
who contrmu for such pmjem with a contractor(s)named pursuant to ere Contractor's
Lleem<Law.
❑1 om exempt under Sen. B B P C for this reason
Data
WORKER'S COMPENSATION DECLARATION
I hereby A(ftoo under Penalty of perjury Out of the following deelaradone
❑1 have and will mainnon a Ccrornme of Comcnt to self-inaure for WorkersCompen-
sation,an provided for by Section 7700 of the Labor Cade,far the performance of 0tc
work for which this permit is United.
❑I haw and will maintain Workers Compensation Imurtuce,an required by Section
370001' bar Code.for Ne pedournma of the wart for which flea permit 13 Idnad.
My Wor Cmp moon l.ummgtusie and Policy pL9&Z9A-7
CA (ia } Paliry No.:1 OL
CERTI CATEOF E7(EM ON FROM WORKERS' _
COMPENSATION INSURANCE
(This scedan need no,W completed line permit is future hundred collare($100)
or less)
I cenih Net in the performance of Nc wart for which this Permit is Wood.l than not
employ my person in my meaner an AS N become subject to Ne Warken'Compemadon
Lam of California.Date
Applicant
NOTICE TO APPLICANT:If,afar making this Ccnificata of Exemption,you douhl
ommon subjm w the Workers Compemedon provisions of the IAWr Cade,you most
UO rmowidt Comply with such no,imme or Nu permit dull W domed mwked.
?► CONSTRUCTION LENDING AGENCY
I hereby aRnm ties Nem u natro
e coctimn lending agency for the performma of
p: > the work for which Nis Permit is Wood(See.5097,Civ.C.)
Win~.
LA
der'.
] z 1<nices Address
U 0 1 cooily Nn I haw read this application And sure that the AWw inform-lion b
U, F comem I egrcc to comply with all city and county ordinances and some laws milting to
O V building comuuction.and hereby amhmim representatives of this city to Omer upnm the
r L51 above-mentioned property for impecdon purposes.
(Wc)agree m taw,indcmmfy and keep hdmleu the City of Cupcnino geinn
(~y liebilities.judgmenta,co.0 andeapenru which mar'in mY'naYacera galnrt did City
U,'Z in consequence or the gTpq&of this Permit.
.. PPLI AM UNDE DS AND WILL COMPLY WITH A NO OINT Issued by: Date c�2R -Ge
AU REGULA N5.
Re-roofs
Signature of Ap i InContmelor M
HAZARDOUS MATERIALS DISCLOSUR Type of Roof
Will the applicant or forum Wllding necupanutore or handle huardaw materiel
As deRned by the Cupertino Mionicip3l Cade.Chapter 9.12.and 0te Health and Safety ,
e.Section 25572M)7All roofs shall be inspected prior to any roofing material being installed.
[3y.
Will IW applicant or future Wilding Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit luvardaua air commim is AS delved by Ore Bay Area Air Quality Management all new materials for inspection.
Dimtct7
❑Yea
I hmc mad Ne hdardous maerids mquimmcnm under Chnpwr6.950(Ne Califon
ria HcalN&S.rcty Cadc,Scc' 25505,23373 and 25374.1 undcrstaed Nullthc building
In urently haw a ant. at It i.mY re.pamihl111Y o notify Ne occupant of Ne
u' nuwhichmwt '
m mWUA.mcc.(.CcrtiOc lOccu ry� Signature of Applicant Date
All roof coverings to be Class"B"or better
owner or authmis a cot Dao'