04020087 (2) CITY OF CUPERTINO �.�' � '
BUILDING DIVISION
PERMIT 111C CTORaINFORMA.TION.°�
row? "z�,�,t^,: w;'(.. :�. ..R
BuILDINfj%Do "'14020087
BOR'SS NAME: PERMIT LSSUE DATE
ONE: SANITARY N CONTROL NO.
lop
ARCHITECTIENGINEER: BUILDING PERMrrINFO
pp ZZ HLDG EO PLUMB MFCHO
X100 LICENSED CONTRACTOR'S DECLARATION Job Description
F 1 hereby affirm But l am licensed under provision of Chapter 9(commencing p
^ with Section7 )of Divison 3 of the BusinamaMProicaans Code.andmylicenw la
n full fto e
sm p�ma —�s SIGN--PANDA EXPRESS
� (2 ILLUM. WALL SIGNS)
I mrnI anlmy plmsah lI 1- hiRArw , �'---•� CONTRACTOR: ULTRASIGNS
Licensed Pm@ssianel \V/ !It L OWNE I11L965l DECLARATION �1 if I�I hereby affirm that I a� semptfrom thclCotreco?f Ukenfollowing mason. don 7117 . Buainess and gguns oke:A cit Ynr mwly.which uires a rmit ro c w, ml ,mR rN stitictmpdorloilsismame.ao rcquims MappR orwc rTrd�t o6k aaig uj ant
Ilatkis licensed purwanlla the provigons Of Un Contrwtfr alJcevcL r(LTaFter9 �.1 Q.EFloorArea Valuation
(commencing with Section 7000)of Division 3 of BU Business and Profe (`�f.dol IR b asempl theR(rom and the bob fw Ne site{ed esunptlm.Any violedon orI
Section 7051.5 by any applicult for a permit objects the applicant to a civil penalty of APN Number Occupancy Type
not owe than five hundmd dollars WOOL
❑Lssownerof tin property,omyolinumoeswithwa{v as Bnh eek eampBW=
will do the work.mdtlmatwelYR is Wl101e11ded Of ORCRd fO(lek(SCC.78f{.BYPIICY 0 Required Inspections
and Professions Code:The Contractor%License law does act apply M an owner Of q P
property who buildsocimproves dn.on.srd whodmf wlsvnurk hivueltor Wough his
awn employees,providW that such improvements ate nollnteMW or offered forsala if,
however,Ne building or Improvement ie told within one year tof come ini...the owner.
builder will have Ba burden of proving Nat ke did not Wild or improve for purpose of
ole.),
0 I,as owner of the property,am exclusively contracting with licenwd contracors to
construct Ila project.(Sec.7044.Business and Professions Cade:)The Contractor's U. _
cava law does not apply in an owner of proper who Wilds or improv thereon,soul.
whoconuuts for such projects with a comments)licensed pursuant in the Contractors
Lkave Law.
10;011,1,
.B4tPCfarthism cen
Date
WORKERS COMPENSATION DECLARATION
1 hereby air=under penally of perjury ane of the following declarations:
haw and will mainWn a CeNOcate of consemm self-Mute for WortersCompen-
n,m provided fm by Section 1700 of the IaWr Cate,fm Lha perfonmuxe of the
k for which Nis permit b isued.
Mw and will maintain Workers Oomprwtion Insurance.ss requited by Section
of the labor Cade,far dte perfarmance of the work fm which this pcmlitis issued.
��W/qrifle Ca��mpoWyyWedo1n Inwmce noes lloy c.�.�Wffr��aR�:nn Z�ff��GG ''77
c'frper. SOF TI �rA ION FRO.: =
v✓/
CERTIFICATEOFEXEMPTION FROM WWOORKERS'
COMPENSA770N INSURANCE
(This sect need rot W completed tribe permit ts foram hundred dollars({100)
or kers)
1 comity that in the performance of the work for which this permit Is issued.l Nall net
employ any person In my manner w as m become subject in the Worken'Compensaden
Laws Cf California.Date
Applicant
NOTICE TO APPLICANT:If,after making this CcnlRcaw of Faemption,you should
become subject W the Work.'.Compensation provisions of the IaMr Cam,yen muss
.,O forthwith comply with such provisions or this permit mail W doomed revoked.
Z" CONSTRUCTION LENDING AGENCY
F.N., 1W.by alfmn Nu the.is a eonmuction lendingageoey,for the performance of
gY> the wort for which this permit is issued(Sm.3097,Civ.C.)
QLcndcre Nsmc
.7 z Landers Address
U Q 1 certify that I have mad this pplication and tum that the above information is
IL;-+ comcct.I agree in comply with all city and county ordinances and sun laws mining m
C)rV' building construction,and hereby authoriR.presentatives of this city to crow upon flue
W above-mentioned property for inspection Purposes
(We)agree to m..Indemnify and keep barmkm M City of CupcNno against
y liabilities.judgments,costs and expenses which may in my soy wane against said City /
(�7 In consequence of he Swung of this Permik
Fl APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
=LRe-roofs
SiNuure of Applican✓Contrmloe Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof .
Will the applicant or future Wilding occupant awe or handle huudoua material
Rood by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Seed.25532(.)7 tet_ All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building=open,use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
colt les mrdous air contaminants as defined by the Bay Are.Air Quality Management all new materials for inspection.
District?
[3 Yes
I beve mad du,Wasminv materials requirements under pterB.95afthoCalifor-
nlaHvlthkSefcl Cad c.SaUotu75305.25533am125534.1un tau ifue Wilding
dmsrot esuatenant Mtittsmy.gxsnabilhyono upanlofthe
mqulmmc cit mug be mel prior o issuance Of a Ccrdflcate of pmry. Signature of Applicant Date
All roof coverings to be Class"B" or better
Own oro hmiced agent Dote