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02120018 (2) CITY OF CUPERTINO �.� +� av �- I ✓v %a.�x az BUILDING DIVISION PERMIT 'CONTRACTOR INFORMATION BUIf1O(f).'1309FSS DE ANZA BLVD PERMIT N9ZZZ OOIB OwQgp.sbPE:REAL ESTATE PARTNERSHIP APPLICATIPN2SU�T42OO2 HONE: SANITARY NO./ / CONTROL NO, ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH uoFs00 LICENSED CONTRACTOR'S DECLARATION 0 0 u u 1 hereby afnrm that 1 am licensed under provisions of Chapter 9(commencing SIGN Job Description a with Section 7")of Division 3 Cruse,Busines and Nousnwu Code,a dm license is '`" "`° "` CONTRACTOR: ANDERSON' S SIGN 7 b 0z— -12 LK YF -ysLk.11 ARCHITECTS DE A �OWU Iundcrslanu my peau shallWusedupuh too s LLO� L¢cnsctl Profcasmnal ,5 OWNER-BUILDER DECLARATION ata 0 1 W rcby affirm that 1 1. exempt from the Cwnuaaor's License taw for the C. whicfolloh".lng as a Permit I ID. 1.-1-xs and ve derohn Code:Any city or county s�3 whim requs u a pnmio m Cnutmn,clef,improve,h Pe m it t of repau any stiftnue prior issuance,also the applicant for such 3000 ne pp Permitto q Valuation oNalWulittnsedPursuant mtheo(DisiomoftheContractorsndPro (Chapter 9 S F[. Floor Area � $ Hot he Us (commencing Staffornon and Dasi far the the Bed exemption, An iota Cock)or 35917019 . 00 n,3 that io u exempt Iany applicant li and de Per for Ne alleged c plicant to Any violation of Section than L5 five any applicant for ai[00). subjects the applicant a tivil Penalty Of Type not more than fire humred dwmrs(sSIXs). APN Number OccupancyT ❑I,uwmer of the propcny,wmy employees with wagesutheir sole comperlxadon, 101 — FOUNDATION will do the work,and the suucmre is intended oroffe¢d for We(Sat.7044.Busineas and Professions Code:The Convactofs License Law docs not apply in an owner of 10 4 - REBAR Required Inspections proimproves property who builds or proves thereon,and who doessuch work himself or through his Own employees,provided that such improvements are not intended Orof and for sale.if, 105 — ANCHOR BOLTS however,Ne Wilding or improvement is sold within Ont year of completion,the owner, builder will have the burden of proving that be did not Wild or improve for purpose of 304 — ROUGH ELECTRICAL sal 01. 505 - FINAL ELECTRICAL ❑ stut On roj Be PCUSee 704,ameiness andnly contraPrefeatling with)Theed ariscotorsm 514 - FINAL PUBLIC WORKS Construct a Ne project apply to an Business and Property who Cock:)Theve&ft hr's nd who law dao not apply to an wither of property who Wilds or improves themwn,and whocontractsLaces for such Projects with a conuactor(s)Iiccrue0 pursuam m Be,Conituroh License law. ❑ lamescmplimder Sec. ,B&PCfUBusruron Owner Data WORKER'S COMPENSATION DECLARATION I hereby affirm under penally Of perjury one Of the following declarations: 1 bare and will maintain isCenificae Of Consent to seR imum for Worker's Compmn talion,u provided for by Section 3]00 of de labor Code,fur thma e performance of Be wo for which this permit is issued, I ban and will maintain Workers Compensation Insurance,u required by Section ofthe Labor Code,for the performance of the work for which thu permit is issued. MY- y Worker's nmpe uligp.4uulantt ca rand Policy nu W/u_e Policy NO: tp—�LO 3e� CERT FI ATE OFE : PTION FROM WORKERS' COMPENSATION INSURANCE or icss.)(Thu sedan need not he completed if @e permit is for one hundred dolWa(Sloth I Cenify Ilial In the 1110 -ifte Of 11e wort roe which his permit is issued.I shah not employ any person in any manner so as m Uecome Subject o the Workers'Cwmpenution Laws of California.Data Applicant NOTICE TO APPLICANT:If.after making Nu Certificate of Exemption,you should become subjcet to the,Worker's Compensation provisions of the la Wr Code.you must O O forthwith comply with such provision OI this pcoatshall bo deemed revnked. rz h CONSTRUCTION LENDING AGENCY [--� l hereby alarm that them is a construction lending agewy for the peclumanr of Ix the work for which this permit is houcd(Scc.309],Civ O) aQ Lender's Name .7. z Lender's Address U 0 1 certify that I have read Nis application and sham that the above information is jy f-r concct.1 agree m comply with all city and county ordinances and stale laws relating m 0 U Wildingeonsuucuun.and hereby authndrn representatives of this city m enter upon the D] above icajudncdpropeny fmicpecuonwhich ms H 4 (We)agree to Lave,indemnify and keep hamless the City Of Cupertino against V) flabilinC.iues,judgmena,clssu and Of thisuMO. mayinan V z incw quenceof Negran"ng of this Y`x'y accme against said City permit. AP CANT UNDERSi DS Aqp WILL COMPLY WITH ALL NON- 1 Issued b S k REGVL ION . A Y Dale t_ Signamreo pplicanVC°nuacmfr Re-roofs HAZARDOUS MATERIALS DISCLOSURE "m Type of Roof - Will she applicant urfmu building«cuprd am more or bantllc hazaous materialu dcrt on 25by Ils32(4e Capenin)? 0.M npal Co Codetle.Chapter 9.12,and Ne Health and Safety .Sem5 C]Y. w All roofs shall be inspected prior to any roofing material being installed. Will the+ppht+nt of tum Wildingoccupam usccquipmcntordeviccs which If a roof is installed without first obtaining an inspection,I agree to remove i.n+.ardwni sit ciintairl ¢ defined by the Bay Arca Air Quality Management all new materials for inspection. Yes I have mad Be haca Jon maedalin uimrnenuun@rCMper6.95ofthcCalifof- niaHe &Safety Code.Stedou 25N15,25533 and 25534.1 understand that if the Wilding dins currently have...vitt,that it' my r¢poh¢ibiloy to notify IW wecupanl the my Co which lithe ct prior r uarlcc aCcni Ocam fQcupanry. ©, BignatureofApplicant Date . wrier or th daxd., D, All roof coverings to be Class "B"or better