03020007 (2) CITY OF CUPERTINO 0,30 2 cr-t>o
IWSIGN
• CUPERTINO PERMIT APPLICATION FORM
APN#
3
Date:
SSI o8 0 � � z +t 03
Building Address:
Owner's Name: Phone#:
G4a�\y \Z✓�. est �—inavtc\a� 0� - 346 o`Z8
Contractor: License#:
^� 3
Contact: Phonene#:#:
? Applicant/Contracto
Building Permit Info:
Bld Elect Plumb Mech
Job Description:
Residential: Commercial:
Sq.Ft. Floor Area:
Architect/Engineer: Valuation: ,)
• �l� U
Type of Construction: Occupancy roup:
Qty. if
Applicable Fee ID Fee Description. Fee Group
BENERGY Ener BUILIDNG
BPERMFEE Bld Permit Fees BUILIDNG
BPLANCHK Plan Check Fee BUILIDNG
BSEISMICOM Seismic Commercial BUILIDNG
EPERMITFEE Elect Permit Issuance ELECTRICAL
BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL
BREMSIGNS Rmdl Sings, Marquee ELECTRICAL
BUSLIC Business License BUILIDNG
•
CITY OF CUPERTINOt",pv' ' -
BUILDING DIVISION PERMIT CONTRACTOR=INFORMATION
BU I LDING ADDRESS: SIGNS OF CLAIFORNIA PERMIT NO.
10051 DE ANZA BLVD n1020007
ER'S NAME: 48 GOLF RD. APPLICATION SUB DATE
BEST FINANCIAL 02/04/2003
PHONE: (925) 484-4733 SANITARY NO. CONTROL NO,
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MEOH
000 LICENSED CONTRACTOR'S DECLARATION ]Ob DCSCl1
I hereby uf0rm that I am Ilcenee0 under provisions of Chapter Y(commencing
r�ri X28 with Scninn 7lXXgof Divixinn 3nf NC Buxincsx anJP nlcxsinrm CnJc,onJmyliccnseu isis
in full lircr��n N ffcct.
zogi License Cl.al— E"_e-C�Lic.x , Zj SIGN
F=;� Dale Cnnuac O O �oO]
RCHITE.SDECL IDN JUL O J
2a� meaty shallW�daspublicrccnrds
Tem \ OWNER�RUILDERDECLARATION BUILDING
rc <Y I herchy iffum that 1 am exempt from Ne Contramor's License Law(Or the
ad00 following reason.(Section 7031.5.Business and Pmfessions Code:Any city or county
x$a which requires a permit to construct.alter.improve,demolish,or repair any structure
to—'^ prior to its issuance,also requires the applicant forsuch permit rile a signed statement
��< that he is licensed pursuant to the provisions of lW Comracwr's License Law(Chapter 9 Sq. Fl. Floor Area $2`i "tion
s�$ (commencing with Section 7100)of Division 3 of the Business and Prnfessinns Cotic)or
a
that he is exempt therefrom end the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subject;the applicant us a civil penally of
not more than five hundred dollars(5500). Q Occupancy Type
1,as owner of the property,or my employees with wages m their sole compensation,
will do the words,end the nru3me is not intended or offered for sale(Sec.70,11C,Business TOT. —
C
and Professions Code:The Contractor's License Law does note I to an owner of :red I
propertywho huilds m improves thereon.and who does such work himself or through his 103 — UFER q nspeCt10DS
own employees,provided that such improvements ere not intended or offered for sale.If, 104 — REBAR
however.the building or improvement is sold within one year of completion.Ne owner
builder will have the burden of provingf 105 — ANCHOR BOLTS
That he did not Wild or improve for purpose o
sale.)' 304 - ROUGH ELECTRICAL
❑I,as owner of the propeny.am exclusively contracting with licensed contractors to 505 - FINAL ELECTRICAL
construct the project(Sec.7094.Business and Professions Code:)The Coduactol6 Li
craze law does not apply to an owner of property who Wilde or improves human,and 514 — FINAL PUBLIC WORKS
who contracts;for such projects with a contractors)licensed pursuant o the Contractors
Licence Taw.
1 am exempt under Sm. .B&P C!for Of,reason
e Dade t6 �
\ CO :PEN ATI0N DECLAR
I hereby affirm under penalty of perjury ore of the fol0eingdeclarations:
❑ I have and will maintain a Ceniricate of Cement m wit income for Worker's Com iem
cation.as provided for by Section 37W of the Labor Code,for the performance if the
work for which this permit is issued.
❑I baro and will maintain Worker's Compensation Insurance,as required by Section
37(1(1
of the Labor GWe,for the performance of the..,it for which this Permit is issued.
My Worker's Compensation Insurance cunicrand Policy umher am:
Cartier Poli No _
CERTIFICATE OPEXEMPI'TON ORKERS'
COMPENSATION I
(Dissection need not be completed if tle permit is foroac hundred dollars(S IIs)
or less.)
employ
y Nat in the perI matter IgC uorlyfo�rew;ich Nis Permit is issued.)stall nm
employ any petamt matter act h&l 'bje�cuo the Workcn'Compensatinn
Laws off: TI
Appl'rsrr f
NOTIC r' Co Ccninc of Exemption,you should
Certo subjecttothe Worker's provisions
or this provisions of the ichoresulte.you must
OO forthwith comply with such prnvisiom or this Permit hall ho deemed mvnkcJ.
Z CONSTRUCTION LENDING AGENCY
I hereby affirm thus more is a construction lending agency for the performance of
ai 7 the work lar which this permit is issued(Sec.3W7.Civ.C.)
W Q cornea's Nomc
Z
Lender's Address
1*2
U Q 1 cenify:hal 1 have read this application and amt.that the above information is
t2. coiled I ogres to comply with all city and county ordinances and.nam laws relating e
0fJ hrwa,menns.uction,and herchyauthorimrcpresenlativesnl'this ciry mercerupon the
ahnvc(We)
age to enysave for inspection keep hs.
(Wc)agme to caro,indemnify and keep harmless the City Cupenst s against a
raq liabilities,judgments.ensu and expenses which may in any way accrue against said City
U 7 in consequence of the granting of this permit.
�7 APPLICANT UNDERSTANDS AND WILL COMPLY W17'li LL ONPOINT Issued by: Date
SOURCEGULA IONS.
Re-roofs
SlyaHtppli eon Date
AT.ARO o TERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle hazardous material
of ned by the Cupertino Municipa c.Chapter 9.12,and the Ilcalth and Safety
e.Switch 25532(.)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yez �hy
Will the applicant ur future equipment nr device.which If a roof is installed without first obtaining an inspection,I agree to remove
1.':x
haeardous air utmaminanu aArca Air Quality Management all new materials for inspection.
rict?
❑Yes o
1 have read the hamNo.{materials requirements under Chapwai 95 of the Califor-
Iealth&Safety Code,Soctionv25505,25533 and 25534.:undershoot that ifthe build' g
not cunenlly have a mount.main is my resimmihility to as lily IW oecu�^t the
requiren Is whichmost rome ortost.anceof.Cenmcate c.panX Signature of Applicant Date
gen Da All roof coverings to be Class "B'r or better