09030042 CITY OF CUPERTINO
BUILDING DIVISION PERNIIT � I� � ►T .
BUILDING ADDRESS: PERMIT NO.
20900 STEVENS CREEK BLVD SIGN DEVELOPM T I09030042
OWNER'S NAME: T7��r77 iT77 T' PERMIT ISSUE DATE
-7AT�/s/rTJ�utt6�F'c21366 W 96T NINTH S
.LONE: SAN AW1W. CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
REFACE 2 MONUMENT SIGNS BO EO PLS MD
900 LICENSED CONTRACTOR'S DECLARATION REPLAC:i EXISTING INT]jb&Mcription
W I hereby affirm that I am licensed under provisions of Chapter 9(commencing
Z i2 with Section 7000)of Division the Business and Professio Co and m nse is
" y in full fora and effect "l/
v�z License Class Lam•R
LQ Date Contractor 06
ARCHITECI'S DECLA
di I understand my plans shall be used as public records
�qU
prn Licensed Professional
n<� OWNER-BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractors License Law for the
00 following mason.(Section 7031.5,Business and Professions Code:Any city or county
t m Pi which requires a permit to construct.alter,improve,demolish,or repair any structure
Z
In 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 9 Sq.Ft.Floor Area Valuation
i-- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
y 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 APN Number Occupancy Type
not more than five hundred dollars(5500).
0 1,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 Contractors 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.).
0 1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044.Business and Professions Code:)The Contractors 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 Contractors
License Law.
0 I am exempt under Sec .B&P C for this mason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
0 1 have and will maintain a Certificate of Consent to self-insure for Workers Compen-
sation,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
have and will maintain Workers Compensation Insurance,as required by Section
700 of the Labor Code,for the performance of the work for which this permit is issued.
My Workqs Compensation Insurance carrier and Policy number
�a��e�
Cartier. Bcy No.:
CERTIFICATE OF EXE ON FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars($100)
or Icss.)
I certify that in the performance of the work for which this permit is issued,1 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
Qforthwith comply with such provisions or this permit shall be deemed revoked.
Z 2CONSTRUCTION LENDING AGENCY
Fr rA I hereby affirm that there is a construction lending agency for the performance of
tYi> the work for which this permit is issued(Sec.3097,Civ.C.)
W A L.endces Name
a z Lcndees Address
U 0 1 certify that I have read this application and stare that the above information is
fJr correct.I agree to comply with all city and county ordinances and state laws relating to
0 V building construction,and hereby authorize representatives of this city to enter upon the
W above-mentioned property for inspection purposes
(We)agree to save,indemnify and keep harmless the City of Cupertino against
�rA 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
0-4 APPLICA UNDERST NDS AN IL COMPLY WITH L NOL01V-POINT Issued by.
SOU R U TION
Re-roofs
Sign f Applicant/Contractor Da
le HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal 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.
❑Yes
Will the applicant or future building occupant use equipment or devices which
If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new IT aterials for inspection.
District?
0 Yes h �Q,�y
1 have mad the az5r/dous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Codc,Sections 25505,25533 and 25534.1 undcrsmd that if the building
does not currently ave a nant,that it is my responsibility m notify the cupant of the
rcyuircm whi m met riorreissuanccof certificatcorocen an _ Signature of Applicant Date
Owner or autho agent
Da All roof coverings to be Class'n"or better