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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