07050279 CITY OF CUPERTINO
BUILDING DIVISION PERMIT 'eTRA I1ERITION�
PERMIT NO.
BU"U IJTIESHOMESTEAD RD AMCOE S-:GN COMPANY 07050279
L L �j PERMIT ISSUE DATE
OWNER'S NAME:
HARRINGTON PROPERTIES 974 COMPIERCIAL ST 05/30/2007
SANITARY NO. CONTROL NO.
NE: (650) 858-1221
BUILDING PERMIT INFO
ARCH1TECr/ENG(NEER: BLDG ELECT PLUMB MECH
0 � 0
p LICENSED CONTRACTOR'S DECLARATION Job Description
m P I 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 ONE 2 ' H 12 ' SIGN CABINET WITH PUSH THRU ACRYLIC
=y in ful�N�Conuaclo
7 LETTERS AND LOGO ILLUMINATED
t ? LicenLic.# .y
p Date i4
F ARCHITECTS DECLARATION
i a< 1 understand my plans shall be used as public records
)yU
u. Licensed Ptufcssional
< OWNER-BUILDER DECLARATION
�} r
1 hereby affirm that 1 am exempt from the Contractors License Law or the
pO following reason.(Section 7031.5,Business and Professions Code:Any city or county
e 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 Valuation
PP P g ;; .Ft.Floor Area $4161
< that he is licensed pursuant to the provisions o(thc Contractor's License Law(Chapter 9 q
e t= (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
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 326-0 MN Number Occupancy Type
not more than five hundred dollars($500).
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.70",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 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.).
I,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 contractoes
License Law.
I am exempt under Sec .B&P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
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.
❑1 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 W4CMERTIF"ICATE
rone carrier and Policy number arc:
L�roricyNo.:�b00is�k, 0( ��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 Workcrs'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 O CONSTRUCTION LENDING AGENCY
Fr C/I I hereby affirm that there is a construction lending agency for the performance of
(S! the work for which this permit is issued(Sec.3097,Civ.C.)
W Q Lendcr's Name
aZ Lender's Address
I certify that 1 have read this application and state that the above information is
O correct.l agree to comply with all city and county ordinances and state laws relating to
U building construction,and hereby authorize representatives of this city to enter upon the
Uabove-mentioned property for inspection purposes.
CL (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 �1/�
U z in co uence ofVSTANDS
f this permit. Date �J— /
►� APPL( NT UNAND WILL COMPLY WITH ALL NON-POINT Issued by:
SOUR EGUh ---
CZ' Re-roofsSignature of plicanor Date T Of F.00f
HAZARDOU ATEtUALS DISCLOSURE Type
Will the applicant or future uildino occupant store or handle hazardous material
as defined by the Cupertino Mum ipal Code.Chapter 9.12,and the Health and Safety
Code,Section 25532(x)? All roofs shall be inspected prior to any roofing material being installed.
0 Yes No
If a roof s 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?
❑Yes 9!Io
I have read the hazardous materials requirements under Chapter 6.95 of the Califor-
!iaHealth&Saf Code,Sectio 25505,25533 and 25534.1 understand"if the building
s not current have a rertant that it is my responsibility to notify the occupant of the
uirements wh must be met rior w issuance of a Certificate of Occupancy, Signature of Appl ieant Date
All roof coverings to be Class"B"or better
ner or authorize age. Date