00110136 CITY OF CUPERTINO
BUU.UINC.DIVISION PERMIT CONTRACTOR INFORMATION:
RUILDING AUD 1:S..S PERMIT NO.
1.t 1.=3 N WOLFE RD NORTHWEST SIGNS 011. 1.01;�Er
OWNER'S NAME: APPLICATION SUIT UPPP
WESTLAND PROJECTS N V 325 WASHINGTON ST 11/'�9/200Q1
• PHONE SANITARY NO. CONTROL NO.
(831) 469-8208
CO p ARCHI'rEc1'7ENGINEEIL BUILDING,PERMIT INFO
BLDG 171 Ecr PWA1B I
!.1ECI
Q u I•j 1=1 - - �J 1=
. o LlC13NSBDCONnd)R•SOHCLnRAnON 9 Job Description
z
O z� I hereby Odost that 1 am licensednsedunder p sed P I.of.,Code 9(commencing _
Fyc-w all seobornaxo onnvis�oa3nrme Braxmd,,a,iid Panm.xionx cna - 1,ny ha,t.a ELECTRIC SIGN
m f is in Lia ias,and effect. rj �3sWr
z w 6 License Clmx (� Lic.p_
3 a F Ua¢ SDECLAr
AR,hall basin DECLARATION
1 understand my plans shall to used u.public rentrdv
FINA 5
i a p sp Iicvnal Pmfnsinnul
OWNER-BUILDER he C.n'I'ION
m m I hereby.Bir taut I v1.exempt fromth the Contlncmr's LiA nc law for the n 00 1
C> following reason.(9actina 7031 L. t aloax and I,,deal... Coda:star city or county
O
which requires a peril,n construct
neer.in,pnrvs,danollxh,o,'rcpnir any,aacla,e lJ
i m pno I I ante It.,all ,M1 pylic If hpe till fl g Ina,emem
that he is fivelowdp rel to the provisions of thec t unis Licanst,L (Chauvr9 Sq. Ft. Floor { y Valu•It
(I b 011.9 7000) FD' „i 3,,l I il .lcx II ',os
60c) 1�.�i $�� �
or that he i.exanpt Iearefram and the nasi.Inr Ihc ullcged exctnpoon.Any riola,ion
of Section 7031.5 by any applicant for a permit.objects the applicant h,a civil penally
m'and an e than Ma hmdral dollars($S(X)). A PN Number Occupancy Type
❑La.owl"sr of the pmr,cly.or myentpinyee.with wngc>an mansole compensation. 31620037. 00
will do the work,anti the structure is not intended or offered for sale(Sec.Il94.
ua.ine.,a„dIsnd—ill,Col.rFile C....mcto„ Li.ra.alawdor,as,applyIII;at Required Inspections
r of prepeny,Who hold, I,impmves,haram.a ad who mx.".wlch work himseR 101 — FOUNDATION
or through his own etndoyees.provided that such impmvcmen,are not intended or
offered for-sale If,howeecr.me balding or improvemci;is sold wflhin ona year of 1.03 — I.IFE R
imnndetion,the—ner.nurlder will have the burden of moving dist Its did not build It
prove Forpurf•,.eIf.]a.). 104 — REBAR
❑I.a,..was,1.r the property.Ina cxdmlvsl,canaafag all aeaxoil aotnrnemr.m 1.05 — ANCHOR BOLTS
Limuracl the poll(Sea.70.11,dismiss,and I'mlosinns Case: The Contractor:
cense Law does and apply to an mwnet of pmpeny who)muds or improve.thereon. 304 — ROUGH ELECTRICAL
cmwantor`uce�w,far-6 pmjaax wile at coatmetna-sl aeei,.aa pmmual”to he 505 — FINAL ELECTRICAI_
0 l um esarna made,See. .B&PC ht, his ma"'" 51.4 — FINAL PUBLIC WORKS
Owner Date
WORKER'S C(MPENSA'r1ON DECLARATION
• t here1.
by v111 ..colic,penally of perjury one of be lldlowing dccamaion.-
ElI have and will maimafn a Ccnilicare Lir Consent to self-insure for Worker'.
Ci a nan.wlao, ;is luuvided for by Section .17(X) of the Lassa Code, for the
pedbrmaaca of the work for wlach,hi,parit is issued.
❑1 have and will maintain Worker's Ct ninavmion Inwraice,as reloircd by Section
37(X)of the Labor Cade,lot 111,pe,tm'mance 1.lIhc walk far which this tannin is
sac 5,My Walk",Comp.uuia i In.wmnee carrier and Policy number are: ,. C
mrie,� + �•X•Gt•nheY No: /I!l3 7 Y•'v
CERI'IIICn'r[ON OF IXHMPIION FROM WORKERS'
COMIENSAI'[ON INSURANCE
(labia sanian need not ha co i"Mad it the peril Is 1'oa ono hundred dollars
($100).1 less.)
I ccnaY mal iu Its pn4urnomcs 1.l Ihc work far which this psnni,is issued,I �V
Moll not aoploy may iscr.nn in any manner at as n,became subject h,sae Workers r
Comrnvlon laws or California.Date
Apilicaut
NOPICC TO API'LICAN 1:if.alter making sats Ccniticac 1.1'Ikcn,p,iun,you should
bacon n
subject ,the Worker%Campcnm,ion pmsislons cl'the Labial Calvm
Calve.You ust
Q O forlhwim comply with such provisions or this permit shall W deemed revoked.
F (ZI CONSTRUc'nON LI1NUIN0 AGENCY
CA I1 hereby alRna that here is a conamOn.lending agency for the perfaraaae
ort he work Inr whist,do,permit is ix sued(Sca.3097.Civ.C.)
P. Q leader's Nunn,
7 1<nder's Addis,
V Q 1 Cady Ian,I have mid Itis uppli,.6t n laid stale unit(Its above Intbrma,ion 1. - -
I.. correct.1 agree Fit enmply with all city and county ordinance%and state laws relating
Q U it,bolding sronswctio.,and hereby umlwma representative,of this city to enter upon
Ihc xbovn mcnnm' nap
l promly Lar m.pcnlaa Purpo,ax,
L (We)agnzu....c.indendly and keep hallex.the City 1.l alclitonFadall -
vrn liabilities,judgmeln,cast.and asps ws which any in any way accrue against said
ei,y in as l —
AI`PLICAMI'UNU' ,ANDS .COMPLY�'1'il,]LI .ONV IN: IStiUCd by: DatC
S( <.cF.RcG //
un
sisin,i� nimlicamTcol"Ia" t — ? Oats Re-roofs
If, I OUS MATERIALS DISCLOSURII
Will meapplicent or future wading rectified stem or handle hvandaw national Type of Roof
.as dcOncd by me Copeman Municipal Codc,Chapter 9.12,and the ila,hh and Safety
Cala.Soon25532(.):'
0 N
All roofs shall be inspected prior to any rooting material being installed.
Will dianppra:,mafuture buddiagacw,amrise arp,lp,oentn1dcvitcswlduh If it roof is installed without first obtaining an inspection, I agree to remove
nail harandou,air aontamini nls a.defined by Ihc Buy Arta Air Quality Manage cut
• Diariae all new materials for inspection. Applicant Understands and will comply with
El Yes [3 No all non-point source regulations.
1 have rend he hesrdous material,mryiremun,s ands,Chapter 6.95 of,1.e
Odifomia Ilcelth k Safc9y Code,Seclion,255115.25533 and 25534.1 mWentand that
II'l,c huilAin, nrrcnly huvuu croon.till"it is illy resp.„ihility 1.t usually ac
anpan man ma,(h nn,pilar m ass 'wifnaa of
°"a ""`y' . Signature of Applicant Date
ownneaauocit qsa /J s, Dote All roof coverings to be Class •`B"or'better
OFFICE