04030218 (4) CI'T'Y OF CUPEWFINO = k - ""I
BUILDING DIVISION PERI• CO
? NTRACTOR INFORM N
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BUILDING ADDRIM: GOLDEN GATE SIGN CO PERMITNO04030218
10555 RIDGE VIEW CT
NF.R'S NAME: PERMIT ISSUE DATE
HEWLETT PACKARD 711 INDEPENDENT RD 03/24/2004
NE: SANITARY NO. CONTROL NO.
(510) 366-3838
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
:00 LICENSED CONTRACTOR'S DECLARATION Job Description
rd F 1 hereby affirm that I em licensed under provisions of Chapter 9(commencing p
`�' wlMSemion]UMrynfDiviximn 3ofthe Rusinoserp Pryfcs m �, dmylicoucis
"�h in full roree andc c3y (�t0 SIGN
--2 ILIUM MONUMENT
j0Z Llccnu Cls S I-m"
"JJn Dale contractor CHANGE CONTRA. FROM ARROW SIGN TO GOLDEN GATE
i�lARCHITECTS DECLARATION (0 4 14/0 4)
1 underttend my plans shall k used es public records
;,tn Licensed Professional
g OWNER-BUILDER DECLARATION
i 1 hereby affirm that I am exempt from the Contractor's License Law for the
COO following recon.(Seedun 7031.5,Business and Professions Code:Any city or ounty
rd^ which requires a permit to construct,alter,improve,demolish,or repair any struaum
—�
prior it)its issuance,also requires the applicant for such permit to file a signed statement
££ < that he is licensed purmanttothe put,faunsofOnComruwr'aLicense Law(Chapter 9 Sq. Ft. Floor Area Valuation
Y $ (commencing with Section 7")of Division 3 of the Business and Professions Code)or $7000
a that he h exempt therefrom and the basis for the alleged exemption.Any violntlon of
Section 7031.5 by Any applicant for a peril l subjects the applicant to A civil Penally of APN Number Occupancy Type
not more than five hundred half ars(S500k P Y YP
❑Iuowner .and
sheAnchor
c or is employees withwages r theirsole compensNon,
will do the work,Code:The Cure iutots Lia orawdoadred ont pply o in,Business Re uired Inspections
and Professions builds
or lite improves
d amen, rad who Law dace not apply ll in owner of q p
propertywho builds iimprovesthereon,end who dorssuch work himu0or through his
Own employees,provided that such improvements are not intended m peered for the Owner.If.
however.the building or den of proving
is sold within one year of completion,theowner- RED huilticr will have the burden of proving Nat he did not build or improve for purpo �of-
sal�.). s1PI
❑1.as owner of the property,em exclusively contracting with licensed contractor 50�5o
contract the project(Sec.7044,Business and Professions Cori The Contractor's 1:h-T�
come law dos not apply to an owner of properly who Wilds or improves Merton.M
who contracts for such projecu with a contractors)licensed pursuant to the Contractor
License Law. 14
❑tem exempt under See. ,BkPC for this ream18
Data
WORKER'S COMPENSATION DECLARATION
Or 1 herebyof ren under penalty of Perjury Arc of the following dewlaratiome
1 have and will maintain a Certificate or Consent o self-insum for Worker's Cempen-
sotion,a provided for by Section 37M of the labor Code.for the performance of One
we which this pored is issued,
w have And will maintain Worker's Compensation Wunnce,u reburied by Section
J7P7 of the V Wr Code,f a Ne performance of Ne work far which Nis permit is issued.
My Worker's mpensati n surenca carrier And Policy number am: q
Carrier: .tin d Policy No.:o�t POD
CERTI JC ATEOFEXEMP170NFROMWO KERS'
COMPENSATION INSURANCE
(Tho section aced not k completed ifft Permit it(m one hundred dolIm(Slrp)
less.)
1 certify Nm in the performance or the work or which this Permit o issued,I shall not
employ any person in any manner an At to become subject o the Worker'Compensation
Laws of Cal ifomie.Dom
Applicant
NOTICE TO APPLICANT:IL after making this Certificate of Exemption,ynu should
become subject to the Worker's Compensation provisions of the Letter Cole,you must
.J z forthwith comply with such provisions nr this Permit&hall W deemed revoked.
,zO CONSTRUCTION LENDING AGENCY
[—t l hereby Anion Nat there is a construction lending agency lot the performance of
W' Ne work(car which Of.permit is issued(Sea 3(197,Civ.C.)
[T]Q Lender's Name
Z)z Lender's Address
U Q 1 ttni(y that 1 ben read this application and state that the above information is
U. F" Correct.I Agree to comply with d1 city and county ordinances and state laws relating to
QU building construction,and hereby atdhorim repmaenmtivu of this city to enter upon the
a Above Mentioned property for inspection purposes
(We)agree In save,indemnify and keep harmless the City of Cupcnino against
tF.Ih liabilities,judgments.costs and expcnus which may in any way accrue against said City
t.) Z in consequence of the granting of this Permit.
APPL ANT UNDERSTANDS ND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOU ERE ULAT14S � `y O
'T Re-roofs
Signatureof Applicm Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or(mum building occupant r 9,1 or handle Hearduus material
As,defined by the 32(a)?nn Municipal Cuda Chapter 9.11,and the Health and Safety
Code,Section 1853z(a)? rN�L,/ All roofs shall be inspected prior to any roofing material being installed.
40 ❑vu
Will the applicant or future building occupant can equipment ordevica which If a roof is installed without first obtaining an inspection,I agree to remove
Dist District?
m air contaminants Wikfincd by the Bay Arco Air Quality Management all new materials for inspection.
District? �}/y
❑Yes u
Ihave mad the he,amousmmcriao requimmenu under Chepm ti.95 Orion Califnr
M.Health&Snlny Cade,Semlons 25505,15533 And 25534.1 underhand thm if the huildog
does not curemly ham a tenant,that my msp9nsibility w nnul'y tk arupatn of die
require m whiennµtt�kMeipLorp�oeliccofaccrdkawc Da cy. S ignature of Applicant - Date
Owacr Ar aOthan,cd spent GC Date All roof coverings to be Class"B" or better