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CITY OF CUPERTINO77777777777777
DIVISION PERMIT
PERMIT
Co.*
BUILDING
BUILDING ADDRESS:
EVERSHINE
PERMIT NO.06050208 6OS0208
19626 STEVENS CREEK BLVD
� W NER'S NAME:
PERMIT ISSUE DATE
EVERSHINE
Pr jNE:
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG EO PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of Ute Business and Professions Code, and my license is
in full force and effect.
INSTALLING AN ILLUMINATING SIGN WITH NEON
License Class Contractor Date oacar
ARROW SIGN CO. WILL BE FAXING A BL APPLICATION
ARCHrrECTS DECLARATION
I understand my plans shall he used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License Law for the
following reason. (Section 7031.5, Business and Professions Code: Any city or county
which requires a permit to construct, alter. improve, demolish, or repair any structure
prior to its issuance, also requires the applicant for such permit to file a signed statement
License Caw 9
Sq. Ft. Floor Area
Valuati$B 0 0 0
that he is licensed pursuant to the provisions of the Contractor's (Chapter
(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
that he is exempt therefrom and the basis for the alleged exemption. Any violation of
APN Number
Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars ($500).
36906009.00
❑ I, as owner of the property, or my employees with wages as their sole compensation,
Required Inspections
q I)
will do the work and the structure is not intended or offered for sale (Sec. 7044, Business
and Professions Code: The Contractor's License Law does 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 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
t
sale..
as owner of the property, am exclusively contracting with licensed contracto
construct the project (Sec. 7044, Business and Professions Code:) The Contractor'sors utto
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
1 ._
License Law.
❑ I amexempt/ Sec B & P C for this reason
f Dale
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
i
❑ I 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
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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 Workers Compensation Insurance carrier and Policy number are:
Carrier. Polity No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section treed not be completed if the permit is far 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 in as a hccorpe subject to the Workcrs Compensation
Laws of Calif -
Applies t /r
NOTICE PLICANT: If, after making'Mil Certificate of Exemption, you should
become subject to the Worker's Compensation provisions of the Labor Code, you must
forthwith comply with such provisions or this permit shall be deemed revoked.
' CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
the work for which this permit is issued (Sec. 3097, Civ. C.)
Lender's Name
Lender's Address
I certify that I have read this application and state that the above information is
' correct. 1 agree to comply with all city and county ordinances and state laws relating to
building concoction, and hereby authorim representatives of this city to enter upon the
? above-mentioned properly for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of Cupertino against
liabilities, judgments, costs and expenses which may in any way scenic against said City
' inconsequence of the granting of this permit.
y APPLICANT UNDERST DS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date - & ey vL
SOUR GULATIO %
(/ orf 06
Re -roofs
Si ure of Applicant/Contractor Date
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will the applicant or future building occupantstorc or handle hazardous material
as defined by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety
^,de, Section 25532(a)?
Yes gNo
All roofs shall be inspected prior to any roofing material being installed.
C]
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management
all new materials for inspection.
District?
64.
❑Yes
I have mad 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 pons hility a notify the occupant of the
requirements which musIbe nor to o Certificate of Occupancy.
Signature of Applicant Date
S fib
All roof coverings to be Class "B" or better
O r or authorized agent Date