01110087 CI nuOF UON
PERTNO
BUILDING OPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10883 N WOLFE RD ALLEN SIGNS INC 01110087
OWNER'S NAME: APPLICATION SUB DATE
AWL DIGITAL SOURCE 1982 STONE AVE 11/19/2001
PHONE, (408) 280-6500 SANITARY NO. CONTROL NO.
OO ARCHITEC(ENGINEER: BUILDING PERMIT INFO
to- BLDG ELECT PLUMB MECH
v a IJ LJ I---J L:]
y= LICENSED CONTRACTOR'S DECLARATION Job Description
z= 1 hereby affirm roam I am licensed under provisions of Chapter 9l commencing P
u,tm wimSmion7(=)ofDivision 3oftheBu.sinessand Professions Code.and myrcansc NEW SIGN.
e m Y: is in full force and e[kct. '�
csw'a Lima C `— Lir.g 56R C ng p
S 3 0. Dna Comranor F'G @9 A, L E
RCHITLCT'S DECLARATION
t-O 1 under.and my plans sM1all be used as public iamods
2 np LicensedPmfeasiaael AUG 2 7 2002
e
'K
OWNER-BUILDER DECLARATION
w=or
I ryemby.Sect thin 1a.1. exempt(rum the Cssions oat License Law for the
z 0 meowing meta.permit
t 7onstr Business and improve.
de Professions Code:Any carr s county $5 0 0 0
W30 which q M n c t o he.ntfh conal to
p ysuucmrt BUILDING
W Pmen ¢ also q theapplicant
sofo rypermdtoflea FWnean,cm arri So�g Egj�-r p� - __ ._.........._ . ....._..._.. ._
mmutiCt,License
(a. nm,hullgw,tSee) n170f )ofDsviso 3mfmnpsin"andp if tnsCde) Vf5 US3:=U av �t +'.{ l;s `a: Valuation
or that he a exempt thcrcfmm and the bass for the allege)exempihan.Any violation
of Section 7031.5 by eny applicant for a permit subjects the applicantax civil penalty
of no(more than five hundred donna($can. 10 CPNDATION " Occupancy Type
FMN
❑I,as owner of the properly,.,my employees with wages as their sale ema,ma ion.
will do'the'work.and the aowtum is nm intended or offeredmr' for'sale'(Sm.'711a4,' Ins "
Business and Professions Code:The Commcs License Law does nor apply to as 10 3 - UFER Required Inspections `
r of,ropeny who builds or improves thermn.and who does such work himself
m through
«medforhis own employees, building
Our mpr improvement
art not intended or 104 __- REBAR
cRartd ion,the.IC howeee,the building or improvement is that within nate Y build
of —--- --- -_ - -
completion,the owner-buildcrwill tmvcma burden of proving the he did not build or 105 - ANCHOR BOLTS •"' '•
improveforpurpotcofaale.). 106 - SEWER & WATER
ax�rimucither-nnhe carl adPircrrgwhnoe:)ncommcatro 202 - UNDERFLOOR PLUMBING-
(D r.r
License low a«s`ntappplytoan owner of ProNny who builds o;li no Contractor's 203 - UNDERFLOOR MECHANICAL' '
and wha,cormarts for such project:with a.conuamor(a),IlennsW pursuant to the. ._ —_. .. '2 04 = 'UNDERFLOOR' FRAME-
Commences License law:.
❑1a exempt under See B'A P C for this ax.. 205 - UNDERFLOOR IN8ftATION
owner ' Date 301 - ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION 302 - TUB & OR SHOWER
Ihereby arftmunder parraltyofp9uryoneanhefolimingd«lambons: 303 - ROUGH MECHANICAL
0 1 have and will maintain a cenifcate of Conacm'm self-inaume for workers 304 _ ROUGH ELECTRICAL
Compensation, as provided for by Section 37W of the Labor Code, for the
perform n ce m me work funwhich mit per,h n issaal. 305 FRAME
XI time d n maim W l Cgmp oce q d by sect 306 HOLDOWNS
mailed Myw kers Co pe 1' InsurancecomerendPolicy umber vet 307 — INSULATION
3 W by
N Lebo CW 0 thperfoma f d o k ro M1 ch N pc is
Cam Policy N �3Zwor�052; 3 08 :SHEETROCK.'.: , , , „_� . . •; '
IP,I ,CLRTIFl �QMPOF ENSATIONNON
SURANCE'ORKERS a, ' r•` ^ s'1109' '- ' EXTERIOR LATH'
. :(chi.".tetiddeeWn„tl,<anmpla,Wirmepermaisroronanunatadaonara 370:x;= ',.INTERIOR-'LATH
rsloo3 one�t.) 311 - SCRATCH COAT
1 cert fY N t in N pert rm nee of the ork f r hich mm pe l'
31'3' -' ROOF NAIL.
shah ma plyayp y tobeomeab3ectm thwoil a501 — FINAL ELECTRICAL ENERGY
Compensation Lo or C I tom a Dale n
Applicant " —502---FINAL -PLUMBING ENERGY
NOTICE TO APPLICANT,If.after making this CenificateofExemption.youshould 503 - FINAL MECHANICAL ENERGY
I mmaxhhjm,mthe W'orker's Curnpcmmion provisions ofmc Labor Cole,you'must
OronhwiN'rnmplywhnmmpmviaionsorNispermitshmm
lbeeeectlrtvokW, .- 504 --. FINAL. BUILDING- ENERGY.._..
Ihertb'aR'
°i °'COIVSTRI1cnoN.LENDINCACErvcY, - 505 - FINAL ELECTRICAL,
' " y inn mat mere is'a contraction lending agency for the perfmrwnec
W .., ofth<wbrk Tor which this pem d is isurr ism.3097,civ,ed .; _ 506 - _GAS TEST .. ...-. .. .. .. .__ .
S 0 Lanae Name
......., - ..... .. -..
I<nde .Add - - 507 — FINAL PLUMBING. .
' GQ Icenfythat Ihave mad this application and state that the no t ton is 508 - FINAL MECHANICAL
koro r l.,me to comply ,h all city ane county ordinances ❑state laws lating 509 — FINAL GRADE
Q:[) to building construction, dh by authorizerepresentatives of the city to enter upon
- j„ m the abovemerdonWF!Plxnyfor ox,roctionpurpot;.,, 510 - FINAL PLANNING
f" LL (We)agree to save,indemnify and keep hmmless the City of Cupertino against
In liabilities,judgments.cosi and expenses which may in any way accrue egains.raid 514 - F INA PU I C WORKS
C.J Z City in CANT UNDERSTANDS
of T granting D this prom COMP _
APPLICAM'UNI3ERSTANDS'Ary'�WILL COMPLY N'TTH'ALL'NONrPO1NT'''
souR '1 em N .�; r f Issued by: Date
t
-. Signm re M„mAaPIti onorclor E '
Dae ' Re-roofs
ARDOUS N[ATERIALSDISCLOSUR
pdat or future building uccpam sure m
n rmerial Type of Roofas defined by Ne Cupcn M Pal C Chapter 9.12.and N Health and Safety YP _ k "-• " .. '' "-'"
Cdde S ti n23532(al t •.�•`i ! s 't -, I..
❑Ye. ': , •'�'• J _ All roofs shall be.inspected prior'to any roofing.material being installed.
Will th ppplicamo ruture Wild t eq apirtual or devicei winch If a roof is installed without first obtaining an inspection; I'agree'to remove
emit locrandous air nmandrams as d fne he Bity A .a Air Quality Management
j District? all new materials for inspection. .Applicant understa_ods and will comply with
ora " all non-point source regulations,..
1 ha4e lmraird'uhSe.humdo a calimsl2 rtqu 25533 d 2 Chapt r understood
of me
California Hwhh B:Sa(ct Cnae;Sdtinna 25505,25533 antl 25SJa:.l umWemsmnd thin vi
oesn came yhave atenant,Nat it is my responsibility to notify that'
cupaut of the men, hich and met prior m issuanceof a Certificate of
an anby,: ;,
Signature plicant Date
ne aumoriaeE dgant.- � : time , All roof coverings to be Class "B"or.better
OFFICE .