04060251 iCITY OF CUPERTINO _ - - - " 777P71777777777777
BUILDING DIVISION PERMIT �*� ��' '`yg�''�'•+c��i"' - - - -
£
BUILDING ADDRESS: GOLDEN GATE SIGN CO PERMITND04060251
11000 WOT,FR RD
OWNER'S NAME: PERMIT ISSUEDATE
HEWLETT PACKARD
Eo SANITARY NO. CONTROL NO.
(510) 366-3838
ARCHITEC rENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LOP LICENSED CONTRACTOR'S DECLARATION
1 hemby affirm that 1 am fimrrd unde
tsr provisions of Chapter 9(commencing Job Description
with Smd.in 70M)of Division S of me 9usinusu d Professions Code,and my lice.m is
immlimrmandeffectr / b7 REVISION--IN HOUSE USE ONLY
;�� License Chess e'—`I S' Lic.g 10
Dam ` /'Sg�Co. man' NO NEW PERMIT ISSUED/ORIG. #04060172
T RCHnECrS DECLARA ION
1 understand my plans shall he used u public mcnrde
XyU
;0 Licensed Pmfcuianal
S OWNER-BUILDER DECLARATION
1 hcrchy afGnnCP
'but I am exempt from use Correctors License Lew for the C
p0 following mainn(SCedan7031.5,Business and Professions Code:Any city or county
k$� which momism
as
Permit;it conmum,alma improve,demolish,or repair any structure
y prior to its issuance,also mquims the applicant for such permit o file a signed argument
�< that he is licensed pursuant to the previsions of the Commons Liecnu Law(Chaplet 9 Sq.Ft.Floor AreaYaluaton $0
$ (commencing wish Section 0000)of Division 3 of me Business and Professions Code)or r
.- that he is eumpt therefrom and the basis for to,alleged cumption.Any violation of
Section 7031.5 by any applicant for a permit subjects me applicant to a civil penalty of APN Number O p Type
not mom Nen five hundred dollen($500). 31607044 0 0
❑I,u owner ofthe property,m my employees with wages u their sole compensation,
will do Newark end theswmum it not intended m offered forage(Sec.7044,Business
and Professions Code:The Con owtor'a Lueue Law does nal apply to an owner of Required Inspections
property who WiIdaorimproves thereon,and whodoessuch workh ser selforthrough his
own employees,provided that such improvements am not intended oroRemd forule.IL
however.the building or improvement is sold within one year of completion,me owner
builder will have the burden of proving that he did not build or imgrovo for purpose of
sale.).
1,as owner of the property,am exclusively connoting with licensed contractors in
consumer the project(Sec.7044,Business and Profusions Code:)The Cooacur'a Li.
cease Taw docs not apply to an owner of property who builds or improves themon,and
who amounts for such project;with a contractor(a)licensed pursuant to dm Canametoh
License Law.
❑lamexcermander Sec ,B&PCfmihismuon
Owner Date -
WORKER'S COMPENSATION DECLARATION
1 hereby aRrm under penalty of perjury one of the following decla atlons:
1 have and will maintain a Confliction of Consent(a self-insum for WorkcesCompen-
ssim.as provided for by Section 3700 of the labor Code,for the performance of the
work for which this permit is issued.
❑I have and will maintain Worker's Compensation Insurance,as mgmmd by Section
37M of the Labor Code.for dm performance of me work fair which to,permit is issued.
My Worker's Compensation Insurance carrier and Policy number iii;
Cartier: W4V10 FQMan Policy No.:/" Ca65
CERTIFICATE OF EKEMP ION FROM WORKERS'
COMPENSATION INSURANCE
(This sectio need not be completed!film permit is intent hundred dollars(SIM)
or less.)
1 certify that in the performance of to work for which this permit is issued,I shell not
employ any Person in my manner u as an become subject to the Workers Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:IL after making this Cenificare of Exemption,you should
become subject be to Worker's Compensation provisions of me Lath Code,you must
Oforthwith comply with tach provisions or this permit ana[]he deemed revoked.
Z " CONSTRUCTION LENDING AGENCY
t~4 I hembyagleas mar than iso consouctian lcndingagcncy far the perfennimmoof
> me work for which this permit Is issued(Su.3097,Cih,C.)
4 A Lender's Name
z Lender's Address
V Q 1 certify that I have read this application and smus that the above information is
ty f" coned 1 agree to comply
with all airy and county ordinances and into laws raising to
p U building construction,and hereby authrise nprearoma'ives of this city in enter upon the
4St above-mentioned property for inspection purposes.
CL (We)agree to save,indemnify and keep harness the City of Cupertino against
In liabilities,judgments,costs and expenses which may in any way atom against aid City
(„)Z in consequence of me granting of this Permit.
APPLICANT LINDERSTANDFqAND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE NS
sign.w r ]i vcantna 6/340,1 Re-roofs
Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will do applicant or future building Occupant tore or handle hazardous material
as defined by the Cupertino Municipal Code.Chapter 9.12,and the Heaim and Safety
Code,Semon 25532m)? All roofs shall be inspected prior to any roofing material being installed.
E]Yes
Will the applicant or future building accupam use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it havnmous air contaminants as defined by the Bay Ams Air Quality Management all new materials for inspection.
District?
Yes
ard
I have mad the been ismateria]s requirements under Chapterd.95of the Colifnr-
niaHealthdrSafelyCmc,Smmns 5505.75533 and25534.1underund thatiftic Milmng
'.a not cmruimemly have a moan.that it u my responsibility m notify the mxupaim of the
mqmsw ' mu met prior ro issuance of a Certificate of Occupancy. Signature Of Applicant Date
6 3e o Ir All roof coverings to be Class"B"or better
Ow or 15tilbrii,,ed agent Dam