08060155 BUILDING DIVISION PERMIT kCONTRACTORANFORIVIATI ,
BUIL 1 A RESS: PERMITNO.
�SG1� N WOLFE RD #2020 LUCKY SIGNS 08060155
NER'S NAME: PERMTI ISSUE DAM
CUPERTINO SQUARE 775 N 10TH ST. 06/23/2008
PHONE: SANITARY NO. CONTROL NO.
(408) 298-9153
ARCHRER/ENGINEETt:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
X00 LICENSED CONTRACTOR'S DECLARATION
U I hcrcby grim that I sum licensed under previsions of Chapter 9(commencing lob Description
with Section 7010)of Division 3 of Oa Businvi and Profcuiov Cod .and my he...,. INSTL CHNL LTR SIGN
a�e in full force and effect.
>'p,i Doenseclya Lk.g �� I LUCKY SIGNS RENEWED BUS LIC 6/23/8
Dole
DECLARATION
As mail use DECLARATION
?W� 1 undersunJ my plans dull M used u public rteords _ .
y
k 0: LiconseJ Pmfcssional -
c y 3 OWNER-BUILDER DECLARATION
C 2 1 greasy.(Bron that 1 1. ,attempt faro Uc Contractor's License Law for IIx
D o following reason.(Section 7 o 1m Business and Pr.dam u Calc:Any city of county
m which its issa n permit to sires n apes.minnow.demnlW,m e a sig ed sanctum
I< prior mitsiensedpmantce.adam 10 the
dm apionsof for suchpermit's Tense signedstatement
Eso IhathesbccnsedpursuanuothcpmvisioMofUcConlrocwr'rLimnseLaw(Chapxr9 Sq.Ft.Floor Area Valuation
xJ' (commencing with Section 7000)of Division 3ofthe Business and PmfeomasCOO)or $2000
that he u exempt therefrom and the bus for the alleged exemption.Any violation of
Section 703L5 by any applicant fa a pemdt subjects the applicant to a civil penalty of umber OCCU
act mom than Bw hundred dallam($500). 316 2 0 0 3 7 .� Occupancy Type
❑1.u wmv of Ilio proPerry.m my wployces with wages u the'vaole comPenution,
will do the work and the surname u not Intended vartetend(cowl.(Sar.7044,Business
acrd Professimu Code:The Canlrsaals License Law dao not apply th an owner of Required Inspections
property who sui Ida or improves thvenn,and who does such work himself or through his
own employees,provided that such improsements art not intended aro@red formic.if,
however.this building or Improsemenl issold within oro year of cadple an,the owner,
Wilder will lose the burden of proving that W did mm build Or improve for purpose of
"In.).
❑1.u most of the property am excluiwly convecting with licensed contractors to
construct the project(Sec.7044.Business and Profesvans Code:)The Cmusete's U. .
cuue taw does not appy On an owner of property who builds or imposes thocon,and,
who contracts for such projects with a eonuacmr(s)licensed pun u mi to the Common's
License Law.
❑IamuemptunderSee .B&PClathumasom
Far
Dam
WORKERS COMPENSATION DECLARATION
I hereby affirm under pea d y of pedury arc of the following declaromms:
❑1hawaedwillmaintaina Cctir=mof Co=ntwself-inmmfa Worker's C=m n-
mlion,as provided for by Section 3]00 of the labor Code.for the performance of the
work for which this Permit is issued,
❑1 hale and will maintain Workc(s Compenvuan I.,as rtquirtd by Section
3.700 of the laser Code,for the peRarmance of the work for which this permit is issued.
My WorkeYs Compensation Irmwnntt carrier aid Policy number art:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE "
(Thu section need Out sac completed If Ise Permit is fame hundred dollars(SIM)
or kat)
1 certify,that in the pvfarmencc of Ne wag fu whicM1 Nis pcnit is iniad,l shall not
employ any Person in any mamcrw uwhec c b' orten'Compemtion
Laws of California.D
Applicant
NOTICE TO APPLICANT.IL afar making this Certifieale of Exemption,you rhouW
become mlij."to the Workees CompMkdon proinions of the Latter Cade,you must
.,O forthwith comply with suet provisions m this permit shall be deemed revoked.
z 27 CONSTRUCTION LENDING AGENCY
F+ I lumbyelnren that there is.cousnrction leading agency foe the nerformaac of
G' the work for which this permit u issued(See.3097,Civ.C.)
QUndar's Name
z Lender's Address
V Q 1 ratify that I have read this application and sots that the allose information is
Ly F Corroon 1 W.In comply with all city and county onlinaaces and some laws relating w
0 V building construction.and hereby autholim mpoeimus ws of this city to enter upon the
F aNow-mmum ed propcny for impectim purposes
(We)agree in rove.indrmdily and keep hamtkm the City of Cupertino agutst
y liabilities,jedgmcats,costs and expenses which may in any way sceme against said City
t.);Z in cansegveme of the granting of Our pannit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date -�_2� �C '
SOURCE REGULATION / 4
Smgnalum of AppliCMU OnlracthRe-roofs
r Daw
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or fMuni building aaupantswma paddle Health material
u defiS i by the Cupnino Municipal Code.chapter 9.12,and the Health and Safely
de.0y.sss3z(a)7 No All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or forum Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
OmDisit hu,ct?,rNeu air canuminsnne,,Nu defined by dm Bay Area Air Quality Management all new materials for inspection.0 yes V u c
I haw rtm Use kneum usmauriau requisencema tummChapxr6.95cftheGlifm-
niaHmith k Safcty Cede,Secuoo25M5,25533 and 25534.1 unJcrsund"ifft building
does rote UY haw a seem that uw it ry responsibility notify do occupant of Use
mmaa
regcip w�,ian mastxmll prim imm«
ucis certificate offzcupanay. Signature of Applicant Date
L I�
Owner v mthamcd ager Dale All roof coverings to be Class'%{."or better