06100114 107
CITY OF CUPERTINO
Tdl 'RAQCMAkT�a :
BUILDING DIVISION
PERMIT
BUILDING ADDRESS: PERMIT NO.
AMCOE SIGN COMPANY 06100114
NER'S NAME: PERMIT ISSUE DATE
HARRINGTON PROPERTIES
NE. SANITARY N . 0 CONTROL NO,
ABUILDING PERMIT INFO
RCHITECT/ENGINEER:
BLDG ELECT PLUMB MECH
O p LICENSED CONTRACTOR'S DECLARATION Job Description
I hereby affirm that I am licensed under provisions of Chapter 9(commencing
Z�d with Section 7000)of Division 3 of the Business and Professions Code,and my license is
!may in full force and effect 7� 08'-J�- ADDING ILLUMINATING SIGNAGE - MAILEEN BEAUTY SU
h j2Z License Class_ h�j 5—L'c•
F p Date_j' �' Contractor_(,,r,L-M A Ra A iKep i.
t^,l-5%tw;6 ARCHITECTS DECLARATION
L< I understand my plans shall be used as public records
1qU
W.y Licensed Professional
0.< OWNER-BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for the
3 p O following reason.(Section 7031.5,Business and Professions Code:Any city or county
%m 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
?< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9EEO
Sq.Ft.Floor Area Valuation
II- (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 3AYMN0 dk*r 0 0 Occupancy Type
not more than five hundred dollars(3500).
❑I,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the structure isnot intended oroffered forsale(Sec.7044,Business Required Inspections
and Professions Code:The Contractor's License Law does 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.).
[11.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 Conuactofs
License Law.
I am exempt under Sec B&P C for this reason
l_wner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
Q 1 have and will maintain a Certificate of Consent to self-insure for Workces Compen-
sation,as 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 Worker's Compensation Insurance carrier and Polity number are: G
Cartier. AJOA U 01.1"0`t4WZ M0-5Policy No.: y A k l DI(O'O I uZ
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 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
,J 0 forthwith comply with such provisions or this permit shall be deemed revoked.
z" CONSTRUCTION LENDING AGENCY
HI hereby affirm that there is a construction lending agency for the performance of
p; the work for which this permit is issued(Sec.3097,Civ.C.)
W QLender's Name
az Lender's Address
U O 1 certify that I have read this application and state that the above information is
L4 r-+ correct.1 agree to comply with all city and county ordinances and state laws relating to
Q U building construction,and hereby authorise 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
„Hc 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 (6
-+ APPLICANT UNDERSTANDS AND tLL fZOMPLY WITH ALL NON-POINT Issued by: D�
SOURCE REGULA S.
1. 1 - Re-roofs
Si at ApplicanU o Date
RDOUS MATERIALS DISCLOSURE Type of Roof
Will the ant or future building occupant store or handle hazardous material
defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
odc,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
h ❑Yes �No
Will the applicant or future building occupant use equipment or devices whIf a roof is installed without first obtaining an inspection,I agree to remove
ich
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes %Nu
1 have read the hamrdous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Code,Sections 25505.2553 534.I understand that if thc building
docs not currently have a tenant that it' ponsibility to notify the occupant of the
requirements which be met ance of a Certificate of Occupancy. Signature of Applicant Date
<0-- _ All roof coverings to be Class"B"or better
cr or authors gcnl Date