03030133 (4) CITY OF CUPERTINO >. +��''..'' ^ +R` '
BUILDING DIVISION PERMIT CONT-R' . TOR INFORMA`CION-�
BUILDING ADDRESS: PERMITNO.
CAL=NEON SIGN
OWNEie'S NAMEo 1577 ALMADEN RD
SANITARY ON OL NO.
(408) 289-1.883
ARCHITECTIENGINEER: - BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
O O O O
O o LICENSED CORIRACI'OR'S DECLA ION „
I 1 hereby affirm that 1 em licenud under Pro am
Chapter 9(communing - Job Description _
nU with Sec' r.7 )of Divislon 3ofd oras and Profe m .and.
m full In nd er
>� van_-`?�j��`Lto.• SIGN-1 MONUMANT & 1 'CHANNEL 'Lt( .N LED
Z
Data r .
9 CHIECT ECLARA N
load. tstd my plain shall W u d pa public nomcls
LiermedProf...least JUN 1. 9 2003
OWNER-BUILDER DECLARATION
E I heathy:Giem that 1 a.1. eu sin from the Cssion Ca :A License Law for the ' p�
00
following spar it toc conduct.
alter.and Paeeatnpa Cale:Any city or county cture BUILDING
which regaresnpmmR reanstrocLe'er,nt rormde permit to
orrepaira sig any,Wment
FZSa pkat em.ii. nceaBo requires the
ovishoo.rim,Cohpermi'm ale: Uw(Chned mmenl
HR< (co heI. in mud pursuant to )nf Diatsion3 ftConRacml.nd PmYluw(Chapter Sq.Ft.Floor Area V 100
R Ed he natempth Semonmanditbasisofralhcegeinexemton.Aninne Code,)of �34""
Sec io is exempt thcmfmm and the.pais for the alleged the currant to Any Wohdon of
Section 703 1.5.y any ions fora permit atbkets the Applicant a[lull penally of
not am tion saw namarea domes(s300k 3 ON Vy131ke;0 0 Occupancy Type
❑1,as owner of the property,or my employees with wages pa their into compensation,
.111 do the work and the structure is not Intended orolfemd foruk(Sac.7044,Business 101 FOUNDP � d Inspections
and Prefeulmrs Cade:The Comwcturo s License Law danot apply to an owner of
pmpenywhobuildwrimproes thereon,and who doeuuch work himseforthrough his 103 — UFER
own employees,provided that such Improvements are,notlatended nralfered forsale.If, 104 — REBAR
however.the building or improvement is sold within one year of amplellon,ire owner-
builderwillhawlheburdenofprovingNalhedidnotWildorImproveforpurposeof 105 - ANCHOR BOLTS
ole J.
[:]1,as Owner of the property,am exclusively contractors with licensed conuiscens to 304 - ROUGH ELECTRICAL
common the pnjea(Sce.1144,Business and Prollesul Code:)The Canlewtor'a Lb 505 — FINAL ELECTRICAL
came,law does not apply to an owns of property who Wilds or informs lhefeon.and, S14 — FINAL PUBLIC WORKS
who convects for such projecu with a convaaor(O m �t licensed pumto the Conant
Liana Law.
❑lamesemptundee Sea ,B&PCfaoth..... -
Owner Data
WORKER'S COMPENSATIONDECLARATION -
1 hereby aRnm under penalty of perjury one of the following declandopa:
IPI and will maintain a Certifier.of Consentto self-Inure for WmmesCompcn-
sation,as provlded for by Section 3700 of the Labor Cade,for the Performance of the
work for which this permit is issued, _ -
❑1 haw and will maintain Worker's Compensation Insurance,a rcqulred by Section - -
37WafthelsbarCoda,forthepeff-mv cofthewn far which this permit is Iss^ued.
My Worker's n wnce fierier and Poll num r: T ✓
/ i
C: Pall o.:
CERTIFICA OF EMVCOMPENSATION
INSURANCE WORK S'
' COMPENSATION INSURANCE
(nisacalfm feed not W completed strive Permit is feature,hundroddoll,w(SIM) '
or less.)
1 certify that in the performance of the work for which this permit Is IwucdAi shall nor
employ any person in any matter an u to become subject to de Wo'acre Compcnsadon
Laws of California.Data '
Applicant
NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you should - - -
become subject to the Worker's Compensation provtsiunt of the Labor Code,you must
.JO forthwith comply with such provisimu or this permit hall W doomed mvnked.
VY CONSTRUOTIONLENDINGAOENCY
[-. 1Wrchy:R.Nu ft.I..eomwNnn lending agency for the perfminma of - -
rG> the work for which this Permit Is Issued(Ser.HM,Ci,C.)
W�Q Lender's Normo '
7z Lenders Addresa I '
U 0 1 certify that 1 have read this application and arm that the steam Information is
W f"' correct.I agree to comply with all city and county ordinances and state law misting to
0 C) building construction,and hereby authorlm representatives of this city to enter upon the -
� LkI chow-mentioned property for Inspection purposes '
py (We,)agree to save,Indemnify and keep har.leu the City of Cupertino against
V) Ilabilitia,judgmcnts.ca..a deapemes which may in any say acme against said City -
(JIn conugance of the ren' got this permit
APPLICANT UND S NOS AND WI COMPLY WITH ALL NON-JOINT IsS d by: Date x
SOLI REGUL 0
t/ roofs'
Signore of)dW,WCorIrxcIDr
Data
HAZARDOUS MATERIALS DISCLOSURE pe of Roof
Will the applicant or future building occupant store or handle hwArdout material ,
pa defined by the Cupertino Municip udc.Chapter 9,13,and the Health and Safety -
Code,Section 23373(e)1 All roofs sh
❑Ye all be inspected prio o any roofing material being installed.
Will the applicant or future building Occupant use equipment at devices which If a roof is installe without fir t btaining an inspection,I agree to remove
havardnm air contaminan6 as d ned by the Bey Am Air Quality Management all new mat In r Inspect' '
District?
1ish❑Yes Na
Ihwonculthe W> n.1mawilaismquimmenuunder Cbapwr6.95ofthc Cantor- O
doslmW Rentlyh xunn333it., 3and23334.1in roof dthu Umemll o
Joe,net currently h rent.thea h u ms mihillly m motif the aceupant the
requirements cc f cnificam of 'Curtis ' nor fApplicant Dat
' Owner ursunagent p All roof coverings to be Class "B"or better