09060162CITY OF CUPERTINO
PERMIT
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BUILDING DIVISION
t
BUILDING ADDRESS:
PERMIT NO.
10343 N WOLFE RD
CAL —NEON SIGN
09060162
OWNER'S NAME:
PERMIT ISSUE DATE
2099
PHONE:
S CONTROL NO.
(408)289-1883
ARCHI'I7:.C.T/ENGiNEFR:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby arum that I am licensed under provisions of Chapter 9 (commencing
with Section 7000) of DivWon 3 of the Business and Professions Code. and and mylicetao is
in full force and eRecL s
8Qg-7$ • •
ONE DOUBLE SIDEN MONUMENT SIGN— CAL NEON SIGN
License Class N
Date o-[I contractor
RENWD BUS LIC
ARCHrrEC'rS DECLARATION
I understood my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractors License Law fqr the
following reason. (Section 7031.5, Business and Professions Code: Any city ot'epupty
which require a permit to construct, alter. improve, demolish, or repair anystsutiplc
permit
prior to its issuance, also requires the applicant for such pit to file a signedststpato
that he is licensed pursuant to Ibe proviskms of time Contractor's license Law (Chapujr 9
Sq. Ft. Floor Area
Valuation
(commencing with Section 7f100) of Division 3 of the Business and Profcssionp{'o_; or
3 5 0 0
that he is exempt therefrom and the basis for the alleged exemption. Any violidea of
APN Number
Occupancy
pane y Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil pbniliq of
not mom than five hundred dollars (SSOdI
31620055.00
❑ L as owner of the property, or my employers with wages as then sole corgpglia116ra,
Required Inspections
will do the work, and the structure is not intended or offered fors ak (Sec. 7OAd gd ji "
code: Ircensc Lawdoes usrn«
and Professions Tire contractors sot npply to.>a 6
property who builds or improves thereon, and who does such work himaelfpY,djrpygfi•hJa
own employees, provided that such improvements are not intended or offea eta} IC
however, the building or improvement is sold within one year of completipu, the bwmio
builder will have the burden of proving that he did not build or he f9r. y),ryop .9f
sale-).
❑ 1, as owner of the property, am exclusively contacting widt licensed IQ
construct the pmjea (Sec 7044. Business and Professions Code:) The Goat. '... ; U.
tense Law does not apply to an owner of property who builds or improves thenwru ucd .
u who contracts for such projects with a conactor(s) licensed pursuant to the CgniriciarY
License Law.
❑ 1 am exempt under Sec B & P C for aii mason
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury Otte of the following declarations;
❑ 1 have and will maintain a Certificate of Consent to self -insure for Workers Compcn-
satioo, as provided for by Section 3700 of the Labor Code, for the performoirrk•p( the
work for which this permit is issued.
1 have and will maintain Workers Compensation Insurance, as required by.-Sew9n
700 of the Labor Code, for the performance of the wont for which this pennitls-iati—d.
'
My Worker's Compensation Insurance carrier and Policy number am: `�a
Carrier. Policy No.�` w F67 t [=
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Phis section need not be compieted if the permit Is for one hundred dollyjt (g)00)
or less.)
I certify that In the performance of the work for which this permit is issued, I "I a4!
employ any person In any manner so as to become subject to the Wor ers' COLn. jyenysaHoq
Laws of California, Due
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should
become subject to the Workers Compensation provisions of the Labor Code, ygir quest
forthwith comply with such provisions or this permit shall be deemed mvokc&
CONSTRUCTION LENDING AGENCY
1 bemby affirm that dare is a construction lending agency for the pmforajanxof
the work for which this permit is issued (Sec. 3097. Civ. C.)
Lenders Name
,
Lenders Address
1 cerdfy that 1 have read this application and state that the above infwtalEdgn is
correct. ) agree to comply with all city and county ordinances and state laws msktiq to
building construction, and hereby authorize representatives of this city to caicii1Ow die
above -mentioned property for Inspection purposes.
(We) agree to save, indemnify and keep harmless the City of Cuperl(jit agpittl
liabilides,judgments, costs and expenses which may In any way accrue agaiiiltE�6id Otp
%O�
in consequence of the granting of this pernIL
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON,-PpKr
Issued by: Date
SOURCE Bti ONS.
q
Re -roofs
Type of Roof
Signature o Appliant/Contractor a(G
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hazardous matcrial
as defined by the Cupertino Municipal Code. Chapter 9.12. and the Health and 9kr ly
Code. Section 2ss3z(a)7 ❑Yes �N
All roofs shall be inspected prior to any roofing material being installed.
/ \o
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 whloh
emit hvardous air contaminants as defined by the Bay Area Au Quality Management
all new materials for inspection.
Disuia7
❑ Yes 500
1 have mad the harardotts materials requhements under Chapter 6.95 of the Califor-
nia Health & Safety Cock, Sections 25505.25533 and 25534.1 understand thatif the building
does rat currently have a tchant. that it is my responsibility to notify the oavpant of the
requ ch must he met prior to issuance of a Certificate of panty.
Signature of Applicant Date
O
All roof coverings to be Class'%" or better
over
orauthorvcdagcnt Datc