05030201 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFeORMATION
BUILDING ADDRESS: SIGN DEVELOPMENT INC PE""'05030201
OWNER'S NAME: PERMIT ISSUE DATE
/MTK7. T<R7\7.TPT J -166 WEST NINTH 27-
E; SANITARY RT CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
y00 LICENSED CONTRACTOR'S DECLARATION Job Descri tion
❑ I hereby affirm that 1 am licensed under previsions of Chapter 9(commencing p
O W with Seed.. Division Sof the Basin.and Prufessnm Code.end my hot.is r' �T� �
n R!a in full force and efftt
;'y? L«nm � 4 g 2 SIGN--REFACING 2 MONLTNIENTS1./,NEW LWA�LL4 SIGN
Conuazwr `'
RCHITECTS OECLA ATI I
z1 understand my plans shall he used as public ohniras / Z.00�
r
G Licensed Pmfcssionel
`
@ OWNER exempt R DECLARATION
H i F 1 W rchy affirm that I am exempt(mm lrc Committees License law for the f( 1 t( 1
no following mason.(Sadao Tfn 1.5.Business and P (essiuns Code:Any city or counry w I s) I 1
m which requites a permit m ennswm,titer.improve,demolish,nr repair any structure L ` l t, 11 -11_/ 1 11
FZ< poor mils issuance.also realities the applicant forsuch permit to file asignedstamment
that he is licensed pursuant to the previsions of Ne Commtor's License Law(Chapter 9 Sq.Ft. Floor Area Valuation
¢�$ (commencing with Section 7000)of Division 3 of NC B usiness and Profession Code)or
—
that he u exempt therefrom and the basis for the alleged exemption.Any violation of
section 703 L5 by airy applicant for a permit subjects the applicanuo a civil penalty of 3 14J FbV0 0 Occupancy Type
not more Nen rive hundred della.(3500).
❑ Lazownerk,and
progeny,or myotimencee wimwagesazaic(tele compensation,
will dathe tework,and these Comisno's License Law
dfs not (Sec.7014,Business
and arty wh ons cox:The contrmmrs dame Law doe not apply lf an owner of Required Inspections
property who b.prow ed that suthereon,and who..or i h work himselfar hlNmugh his
own employees,provided that imps mid wit are not intended ogled W forthe salkOw.r.
however,the Wilding or den of proving
is mid within one year of mprove for
purpose
Owner.
builder will love the burden of proving Nat W did not Wild or improve for puryose of
sok.).
0 1,as owner of the progeny,am exclusively contracting with licensed contractors to
contract the project(Sec.7054,Business and Professions Cade)The Contractors Li-
cense law docs not pply m an owner of property who Wilds or improve themon,and,
who coned for such pmjecu with a conuactor(s)licensed pursuant to the Contractor's
License La-
0 1 am aempt under Sec. .B&PIC Tor this reazon
Owner Date
WORKER'S COMPENSATION DECLARATION
410 1 hereby min.under penalty of perjury ea of tW following declarations: -
0 than and will maintain aCeniOcareo(Consenuo self-insumfmWorker'sCompen-
smion,as provided for by Section 37M of Ne Labor Cox,for the performance of the
work for which this pomit is issued.
0 1 have and will maintain Wmkcfs Compensation Insurance,as required by Section
3700 of the Labor Code,for the performance of tW wart for which this permit is issued,
My Worker' rasa ion lass ace ' and Policy�n�mbc<r art: O,I
Cartier, Polity No.:\'�SS� _
NRTI� ATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
mus section need not W completed time Permit is formic hundred dollars(SIM)
or kis)
I unify am,in in.performance of the work for which this permit's issued.1091 net
employ any paten in any mmmr as as m Weome subject to tW Workers Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,s(mr making this Ceni ficate of Exemption,you should
become subject to me Workers Compensation previsions of the Labor Code,you muss
.J O foMwilh comply with such provisions or this perm L shall be deemed revoked.
z CONSTRUCTION LENDING AGENCY
Ihcreby allirm
that there is a construction lending agency for the perfurmaece of
t�> Nc work fur which this permit Is issued(Sec.W,Civ.C.)
lg7 Q Lender's Name
0. Z Lender's Address
U O 1 ccnify that 1 have mad this aPplicuioo and sum that tW above information u
ly F conctt I agree m comply with all city and county ordinances and sate laws relating to
O U building construction,and hereby amhori¢representatives of Nis city to enter open dM
GTl above-mentioned property for inspection purposes,
(We)agree to save,indemnify and keep harmless Ne City of Cupertino against
i,I liabilities judgmems,coses and expenses which may in my way accrue againstsaid City
V Z in consequence of the Starting of this permit.
APPLICANT NDERSTANDS AND WILL LY WITH AL NON-POINT Issued by:9 Date
SOURCERE LATIO S.
�i /`�"lZ7pI�IJ-(`J 21l Re-roofs
Signatu of Appl'arycontraz`or I Dat
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building acupmt shore or handle havardous material -
as defined by me Cupertino Municipal Code.Chapter 9.11,and the Health and Safety
Code,Section15533(a)? � 4/3 All roofs shall be inspected prior to any roofing material being installed.
0Ye ` -
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
mit haerxus air contaminants az lc0ncd by the Bay Area Air Quality Management all new materials for inspection.
District?
0 Yes �pno
I have real me hanardous materials requimments under Chapterti.95 oldie Califon
nia Health&Safety Crede,Sections 35515,35533 and 15534.1 understand therifthe Wilding
docs not current ham a ten n4 Nm it is my rnpornam to nndty the acupmt of the
reyuirem - hmustW etpnrmi.naneee a -Tamer capon. Signature of Applicant Date
ownetn amnria gent am All roof coverings to be Class"B"or better