06060042 CITY OF CUPERTINO
BUILDING DIVISION PERMIT
BUILDING ADDRESS:
SIGN DEVELOPMENT INC PERMTNo-06060042
625 N DE ANZA BLVD PERMrrISSUE DATE
'S NAME:
HABIB KHAYYAT 1366 WEST NINTH 06
SANITARY NO. CONTROL NO.
PHONE:
(909) 920-5535
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG EMS PLO MME
CH
{p C LICENSED CONTRACTOR'S DECLARATION Job Description
i UF t hereby affirm that I am licensed under provisions of chapter 9(commencing
Z with Section 7000)of Division 3 of the Business and Professions Code,and my license is INS TALL NEW ILLUMINATED MONUMENT SIGN AND LOGOS
y in full force and effect. C'
Z_ License class Lte# CANOPY
p Date Contractor
F m ARCHITECTS DECLAR IO SIGN DEVELOPMENT INC. RENEWED BL 6/6/06
i� a
< 1 understand my plans shall be used as public records
>yU
o y Licensed Professional
OWNER-BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractors License Law for the
3 a O following reason.(Section 7031.5,Business and Professions Code:Any city or county
%e'(ii which requites a permit to construct alter,improve,demolish,or repair any structure Valuation
- rn prior ro its issuance•also requires the applicant for such permit to file a signed statement S Ft.Floor Area
?< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 q $7000
G t--�$ (commencing with Section 7000)of Division 3 of the Business and Professions Cttde)or
that he is exempt therefrom and the basis for the alleged exemption.Any violation of OCCu aRC T e
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number P Y Yp
not more than five hundred dollars(5500).
I,as owner of the property.or my employees with wages as their sole compensation,
will do the work and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections
and Professions Code:The Contractor's License Law docs not apply to an owner of
property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements are not intended or offered for sales If.
however,the building or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that he did not built or improve for purpose of
sale.).
❑h as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044.Business and Professions Code:)The Contractor's Li-
cense Law does not apply to an owner of property who builds or improves thereon,and,
who contracts for such projects with a contractor(s)licensed pursuant to the contractor's
License Law. B& or this tcatt
am exempt under Sea P C fy
a Date
WORKER'S COMPENSATION DECLARATION 5
I hereby affirm under penalty of perjury one of the following declarations:
1 have and will maintain a Certificate of Consent to self-insure for Worker's Compen-
sation,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
f�I have and will maintain Worker's Compensation Insurance,as required by Section
3700 of the Labor Code,for the performance of the work for which this permit is issued.
My Worker's Compensation Insurance carrier and Policy number are: p
Carrier. Policy No.:1 SEX98 1"20 1
CER 1FICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars($100)
or less)
I certify that in the performance of the work for which this permit is issued,I shall not
employ any person in any manner so as to become subject to the Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the worker's Compensation provisions of the Labor Code,you must
Z forthwith comply with such provisions or this permit.shall be deemed revoked.
Z� CONSTRUCTION LENDING AGENCY
E.t C'n I hereby affirm that there is a construction lending agency for the performance of
tYi> the work for which this permit is issued(Sec.3097,Civ.C.)
W Q Lender's Name
0 Lender's Address
U C)re
I certify that I have ad this application and state that the above information is
correct.I agree to comply with all city and county ordinances and state laws relating to
0 U building construction.and hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes.
a
(We)agree to save.indemnify and keep harmless the City of Cupertino against
Hliabilities,judgments,costs and expenses which may in any way accrue against said City 7
U Z in consequence of the granting of this permit. Date
►" APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:
SOUR RE U 014 /-�
-O G Re-roofs t—--
Sign of Applicant/C tort Date T of Roof
MATERIALS HAZARDOUS DISCLOSURE YPe
Will the applicant or future building occupant store or handle hazardous material
-fined by the Cupertino Municipal Code.Chapter 9.12•and the Health and Safety
Je.Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes PIN.
Will the applicant or future building occupant use equipment or devices which
If a roof is installed without first obtaining an inspection, agree to remove
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes INu
I have mad the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safcty Codc,Sections 25505.25533 and 25534.1 understand that if the building
docs not currently have a tenant,that it is my responsibility to notify the occupant of the Date
requirem is wh'h mast be peior to issuance of a certificate of Occupancy. Signature of Applicant
ri All roof coverings to be Class"B"or better
Date
Owner ol authorixcd agent '