08010014 CITY OF CUPERTINO �
BUILDING DIVISION pERNIITCONTRA wlgN , RM TIi 1W
ON
BUILDINGA RFSS: PERMIT NO.
109�c1 N WOLFE RD ALLEN SIGNS INC 08010014
OWNER'S NAME: PERMIT L55UE DATE
ROSE RONG 1982 STONE AVE_ 01/03/2008
PHONE: . . I SANITARY NO. CONTROL NO.
(408) 280-6500
CHTI EC(ENGINEER: BUILDING PERMIT INFO
BLDO ELECT mum MECH
sCp LICENSED CONTRACTOR'S DECLARATION O O O
F1 hmcby mobot Nat I are Hennaed under provisions of Chapter 9(commencing Job Description
with Section 7MKo.fDiAda.3.fft9mdnea and Prol ld Code.andmylimnsein INDIVIDUAL CHANNEL LETTER SIGN
N infulose OO
l farce and e �{ bft
n'R3 License Cl
CC Dau Connecter
Q ARCHITECT'S DECLARATION _
ZZ I understand my plans shall Its,used u public recoNa
a
5Q Licensed Pmfeaianal
OWNER-BUILDER mDECLARATION
ZOO h,rthy.(Sero onn I em exempts an d r Convecto o License Law for the
ZOO following reeve..Permit
uncommon.IDJim.s sedc., mons Code:Any city.r mmee
S 3 which mutant.a enteron so re alar.nt Fmve,depermit
t or e a sig eny tatwtem
_Z!~m that beprior to I.
lensed ptlommut res the applicantsuch cmaratmB mfimme Lawdataumem
FF a (comma cingwhtSewwtuthe 00)atDlsioluafthtC.mmctesaLmnsefaw(Chapur9 Sq.Ft. Floor Area Valuation
e5F 'at he
ngwiNSuvone and the
thine Business endon.Anyovi Code)or $250
r3— Nat Section u exempt teerefmm and the burs it be cts on,exemption.AnY l Penau of
.1oue,than five
amainedapplicant for 1001. objects on,applkanuoarnil penalty of �pN�Number Occupancy e
wt mom the rave hundred a.Ba.fSR101. 31605053 .•PfYT P YZYP
❑I.u owner of the property,a my employe.with wages as Nmr vel,compenutien,
will do thework.and thesnumme bn.tlnundcd or offend fonsu(Sec.7f1µB.inra Required Inspections
and Pmfeselons Code The C.namemes Limen Law tion not apply m an owner of 9 P
progeny who builds er lmprows thereon,a nd who dor suchwork himself.,Ihmu{h his
own employe.,prodded that such improvements am not intended ter offered for We If.
however,the building a improvement is old within ere year of mmpkdon the own.
builder,will haw,tie burden of proving that he did rot build Or Improve for purp.e of
aka).
❑1,as ower of the property,am.cl.lv,ly convening with Iiansed conbwten te
co.tmct the project(Sec.7044,Business and Pullwiam Code:)The Coneracues s-
cents Law does not apply m an owner of property who builds or haproves thereon,and,
who conlrwts for such projects with a conuwmRO licensed pun uml to lee Comractor's
Lem m law. -
❑IarnesemplunderSee ,B At PC for this revon
Owner Dau
WORKER'S COMPENSATION DECLARATION
1 hereby afOrm under penalty of perjury ane of the following declarations:
LD 1hamsndw01msinWn•Ce O.u.(Co=niteul(--i.umfa Waker'a Compeer
on,a provided for by Sermon 3700.1 the,lather Code,for W psOlmansnm of the
for which this Permit is issued.
I have and will maintain Workers Compenalmn Insursnm,as,required by Section
37110 of the Labor Code,for the performance of the work for which thin permit is laud, '
My Workers Compensation
^bu m u,easier and Policy number art:
Carrier: �7t� U S PolicyNo.: Ng16_
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(IEb mumu weed Our ccomputed if Ile Permit b foram,hundred Wants;(SIM)
or less.)
I certify Not in she perfamawe of the work for which this permit is issued.I shall not
employ any pecan in anymennar spy lq_yacome subject u the Workers'Compensation
Laws of California.GatAppl ^ rgd�lf,9'�(aTQ�i
NOTICE
NOTICE TO APPLICANT:M :1(. (te me ting n p Cisions of of Exemption,you shoos -
baome subjwt te it Woheh pewtion provisions of the labor Code,you most
.J Q forthwith comply with such provisuan Or this permit shall be domed revoked.
,zr !n CONSTRUCTION LENDING AGENCY
f" I hereby alrnst that Nem its construction lending agency far the performance of
Pi
the work for which this permit b issued(Sec.3097,Cih,C)
0.Q Lenders Name
Z alders Address
U O 1 certify that I have read this appli.non and sum Na the above Information b
0. comma I alta m comply with all city and county atdinancen and mu laws relating to
C) building construction,and hereby othorim rtpteunutivee of Nis city to enter upon the
Cshove-mentioned property for inspcni.n puqusea
(W.)agree to ave,indcmmfy ad keep harmless the City of Cupertino against
ti IA liabilities,judgmenu.cum and expenses which may In my my were against said City r
U z in consequence of the{ranting of Nu XMIL tl
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
SignUmn afAppR.nUCanuwmr Dau
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
WIII tits appticen'a,future building a¢upmptom or handle haemo.mau mind
u deOncd by Uu Cupertino Municipal Code.Chapter 9.12.and the Health and Safety
cmk.meson ss53z(a)7
❑Yes 6Ne All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,.I agree to remove
emit h onedaus air contanomon u dcrined by the Bay Arta Air QusBy Management all new materials for inspection.
cs7 r/
❑Yee R No
I hoe read du hvvd..materials requirements order Chapter 6.95 ofti a Calif.-
nut Health&Safety Code.Sema.23505,25533 am125534.1 understand!thsu If one building
dors ems curtcnal ha a tenenL Nu it u my myuntislity u wtify do oaupat of Ne
ream taw fn mmn rteusuaccofaCcrtifiamotOcmpacy. Signature of Applicant Date
Owner ter vel ori degent
Dam'
All roof coverings to be Class"B"or better