03070135 (2) CITY OF CUPERTINO V777777° v"'m
s BUILDING DIVISION PERMIT CONTRACT OR INFaQXtMATIUN
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BUILDING ADDRESS: ALLEN SIGNS INC PERMITND03070135
OWNER'S NAME: 1982 STONE AVE PeleMrr kssue DAM
SONE: (408) 280-6500 SANITARY NO. CONTROL NO. ,
CHIIEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
yoz LICENSED CONTRACTOR'S DECLARATION Job Descri tion
1 hemdfiNn de
hy rm 1 am licensed unr provisions of CMpmr 9(commenting p
i with Saturn 700B.f Dividon S of Ne Business and Profession.Cod0.and my license is
in full force end elle
;pz Liceasecl Lk.0 5 55 SIGNS--INDIVIDUAL CHANNEL LETTERS
CIC Data
7 0" Cumracror (GIFT SHOP)
ARCHITECTS it. ATION
< I.m1ma rid my,lahall bem, wed u public..,a,
7�U
MSW Licensed Professional
>.to OWNER-BUILDER DECLARATION
y 1 hereby affirm that I am exempt from the Contractor's License Law or the t
S cO following moan.(Sudan 7031.5,Business and Professions Code:Any city or county
e which mom.a permit In construct.alter,Improve,demolish,no¢pair any structure s
prior to ib Wm.Au,alsu requites the applicant forsuch Permute file a signodstatamml
That he is licensed pursuant m the provisions or the CrnoCM
actnr's License,law(Chapter9 Sq. t. Floe 'Area ValuatgOflQoo
F❑$ (commencing with Section 711(IU)of Division 3 of the Business and Profession
sc)or 4�
3
that he is exempt therefrom and the basis for he alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit objects the applicant to a civil Penalty ofsea ef00 Occupancy Type
not more Nen live hundred delta.(5500).
❑I,As owner of the property,or my employees with wage.as shelraalecampensa0n,
will do the work end the structure is not intended at offered for ale(Sec.7014,Eusioasa
and Perforators Cadc:The Contractor's License Law does not apply to an owner of Required Inspections
property who builds or improwa thermn,and who does such wok himmirorthrough his 101 - FOUNDATION
awn employees,provided that such improvements are not intended m offered forule.If, 103 — UFER
however,the building or improvement is sold within ane year of completion,she owner.
bald.,will neve We home.of proving that w did not wad or harrow far parpo.e ar 104 — REBAR
01.' 105 - ANCHOR BOLTS
❑1,a owner of ct properly am Business
ines andely contracting with licensed nfrom's to
camtroa the pmjoa(py.toaownwr.ouandnywhoom Ca or improCnlnctar's and 304 — ROUGH ELECTRICAL
caneLaw daar suchplro men ithaofpropeny wcemad urs antA ds Conan,and 505 - FINAL ELECTRICAL
who cantraaa for such projects with a rontraear(q license pursuant te the Conmaah
Lusue Law, 514 - FINAL PUBLIC WORKS
0 1 am exempt under Sea, .B k P C for this rerun
Owner Data
WORKERS COMPENSATION DECLARATION
I hereby affirm under penalty of perjury,one of the following deslantians:
have and will maintain a CeniRum of Consent to self-inane for Wmkce.Compcn-
,As provided for by Sedan 3700 of the LAbor Code,far the perfona.ce of the
far which this Permit is issued.
1 have end will maintain Worker's Compensation Insurance.As offirred by Section
of the Lobar Cade,for this,performance or the work for which this permtl is issued.
My Worker's CnmPenutlon lora a carttaand Paligarmax re:
Center. Polity Na.:'S3Z ONPJDOSL
C.tTIFTCATE 0 EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This rector need nal be eompaled illhe fc mil Is fmorm hundred dnfars(SIDE
car If
1 unity that in the perfmmance of the work for which this permit is Issued,l shall not
employ any person in any manner so As In become subject to the Workers'Compenudan
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption.you should
become subject to the Workeh Compensation provisions of the Labor Cnde,you most '
.J O forthwith comply with such provisions or this Permit hall to deemed mwked.
CONSTRUCTION LENDING AGENCY
H (hereby affirm NU there is conssmaian lending agency forth Performance of
ai> the work for which this permit is issued(Sec.3097,Civ.C.)
Igl Q L eadcr'a Name,
C IuZa Address -
U Q 1 unify that I have read this application and mo,that the above information is
ggr F Correa.I agree to comply with all city and county ordinances and stats laws mating to
0 wilding convection,and hereby sudmrim mumommiws of this city to enter upon the
r 4 above-mentioned property far inspection purposes.
F (We,)agree to rave,indemnify and keep harmless the City of Cupertino against
V) liabilities judgments.coats and operates which may In any way ancrw against saidCity
U z his Permit.
APPLICA n"UN ERSTANDSof the granting or IAND WILL COMPLY WITH LL NON-POINT Issued by: Date
sou GU IONS.
X-) Re-roofs
'Sign.(...of OPh �RDOUS MATERIALS DISCLOSURE Data
Type of Roof
Will the p cant or future building weupamnom or handle huamou.mmedal
As defined by Ne penin Municipal Code.Chapter 9.17.and the Health and Safety
Code.Section 75537(.)? 1 All roofs shall be inspected prior to any roofing material being installed.
oya, �Nu
Witt Ne appllun car,fffuuttuure building occupant use ryutoomm or,tvicas which If a roof is installed without first obtaining an inspection,I agree to remove
4 h..dnus air cramminm u defined by the Bay Area Air Quality Management all new materials for inspection.
icl?
❑Yea Nu
I have mad the hundous materials requirements under Chapter 6.95 of the Caltfor.
rata Hcallh 6 SufctyCde Sections 25505,25533 wd25534 I undersand thatifthe wilding I n2
Jaen not cu only has a tenant,that a is my rex onslhilily to notify the occupant of the L t�:J
rcqu' r whi must pprioraissummofa Certificekof cup( Si
Date
0 cr tar au orirc epee 7 7 Dam All roof coverings to be Class "Bra or better
CITY OF CUPERTINO
SIGN
CUPEf�TINO PERMIT APPLICATION FORM
APN# J 0 �7 Date: 7
Building Address:
0
Owner's Name: Phone#:
i/7 /l
Co t License#:
/
Contac : Phone#:
T L✓1 I — �g0—E6Gb
Applicant/Contractor:
l! S, ac JY2 S' e
Building PermitWo:
Bldg Elect Plumb Mech
Job Description:
Residential: T4,4-U1 5 tercial:
Sq.Ft. Floor Area: $/Sq.Ft.:
Architect/Engineer: Valuation:
Type of Construction: Occupancy Group:
Qt . if
A 1' ab Fee ID Fee Description Fee Group
ENERGY Energy BUILIDNG
PERMFEE Bldg 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 Signs,Marquee ELECTRICAL
BUSLIC Business License BUILIDNG
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