07020042 CITY OF CUPERTINO
BUILDING DIVISION PERMIT }IMiTI�N:
PERMIT NO.
BUILTr RTIANDLEY DR #108 GRACE SIGNS 07020042
PERMIT ISSUE DATE
OWNER'S NAME:
JIMMY WU 1261 MCDONALD DR 02/08/2007
SANITARY NO. CONTROL NO.
INE:
(510) 207-4907
BUILDING PERMIT INFO
ARCHITECT/ENGINEER:
BLDG ELECT PLUMB MECH
i
00 LICENSED CONTRACTOR'S DECLARATION Job Description
VF. 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing
Z U with Section 7000)of Division 3 of thc Business and Professions Code,and my license is SIGNAGE-BANDLEY CENTER-2 SIGNS GROUND SIGN AND
y in full force and effect.
Z_ License Class Lic a L I , S WA SHU ACADEMY.
E wDate Contractor
a ARCHITECTS DECLARATION
i 1 understand my plans shall he used as public records
)yU
U.h Licensed Professional
G< OWNER-BUILDER DECLARATION
} I hereby affirm that 1 am exempt from the Contractor's License Law for the
CaO O following reason.(Section 7031.5,Business and Professions Code:Any city or county
<m Pi which requires a permit to construct,alter,improve,demolish,or repair any structure
z y prior to its issuance,also requires the applicant for such permit to file a signed statement Valuation
that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area $2500
II--� (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
i that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by arty applicant for a permit subjects The applicant to a civil penalty of APN Number Occupancy Type
not more than five hundred dollars($500). 32633097
❑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 q p
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 sale.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 build or improve for purpose of
�sale.).
!<v/as trwtter 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
Law.
[am exempt under Sec. B&P C for this reason //��
Owner . Date
ORK M
SA ECLARATIONl� /
I hereby alum and penalty of perjury one of the fallowing declarations:
[�I have and will maintain a Certificate of Consent to self-insure for Worker's Compcn-
sation,is provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑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 Warkees Compensation Insurance carrier and Policy number are:
Carrier: Policy No.:
CERTIFICATE 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 Calif Date
Applicant
NOTICE TO AP NT:If, r m ng this Ccrtiflcatc of Exemption,you should
become subject t c Worker's ompc don provisions of the Labor Code,you must
Oforthwith comply with such provisions or this permit shall be deemed revoked.
z'"' CONSTRUCTION LENDING AGENCY
rte. 1 hereby affirm that there is a construction lending agency for the performance of
CY.> the work for which this permit is issued(See.3097,Civ.C.)
a Q Lender's Name
Lender's Address
U 0 1 certify that I have read this application and state that the above information is
IL►" correct.I agree to comply with all city and county ordinances and state laws relating to
0 building construction,and hereby authorise representatives of this city to enter upon the
Uabove-mentioned property for inspection purposes.
Cir (We)agree to save,indemnify and keep harmless the City of Cupertino against
liabilities,judgments,costs and expenses which may in any way accrue against said City
U Z in consequence of the granting of this permit. Date
►-� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:
SOURCE RWqLATIONS.
Re-roofs �2—G
Signature of Aicant/Con r Date
HAZARDOUS MA ALS DISCLOSURE Type of Loof
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Monte' al Code.Chapter 9.12,and the Health and Safety
Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Ycs o
Will the applicant or future b ilding occupant use equipment or devices which
If a roof s installed without first obtaining an inspection,I agree to remove
emit hazardous air contaminants as efined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes o
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Code,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
requiremen which must be m t prior to issuance of a Certificate of Occup ey. Signature of Applicant Date
b All roof coverings to be Class"B"or better
Owner or au Date'