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10040010CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10050, 10080 N WOLFE RD CONTRACTOR: EXPRESS SIGNCRAFT PERMIT NO: 10040010 OWNER'S NAME: CUPERTINO FINANCIAL CTR PARTS LLC 375 MERIDIAN AVE DATE ISSUED: 04/02/2010 OWNER'S PHONE: 4085679900 SAN JOSE, CA 95126 PHONE NO: (408) 885-9900 1r LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ //// .��.�/A� //�� ? License C]ass�1�YT� Lic. #_ ����T ` �� REFURBISH FIVE PLANTER BOX SIGNS. REFURBISH ONE (E) SIGN ON WOLFE RD, ADD ONE NEW MONUMENT SIGN ON STEVENS CREEK BLVD. ADD ONE NEW DIRECTORY SIGN %-L M on c Date"l-I I hereby affirm that I a licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions ode a� 19] th Amy license is force a effect. S �full l I hereby affirm under penalvy of perjury one of the following two declarations: Sq. Ft Floor Area: Valuation: $50000 t. I have and will maintain a certificate of consent to self -insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APN Number: 31620086.00 Occupancy Type: 2. 1 have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. PERMIT EXPIRES IF WORK IS NOT STARTED APPLICANT CERTIFICATION WITHIN 180 DAYS OF PERMIT ISSUANCE OR I certify that I have read this application and state that the above information is correct. 1 agree to comply with all city and county ordinances and state laws relating 180 DA FR LAST CALLED INSPECTION. to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save �! indemnify and keep harmless the City of Cupertino against liabilities, judgments, Issued by: Date:^� costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source re lations per th�C.upermfi�noMmunicipal Code, Section 9.18. RE -ROOFS: Signature Date 6 1, 10 All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. ❑ OWNER -BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 1. 1, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIALS DISCLOSURE compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) 2. 1, as owner of the property, am exclusively contracting with licensed contractors to I have read the hazardous materials requirements under Chapter 6.95 of the construct the project (Sec.7044, Business & Professions Code). California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & I hereby affirm under penalty of perjury one of the following three declarations: Safety Code, Section 25532(a) should I store or handle hazardous material. i. I have and will maintain a Certificate of Consent to self -insure for Worker's Additionally, should I use equipment or devices which emit hazardous air Compensation, as provided for by Section 3700 of the Labor Code, for the contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the performance of the work for which this permit is issued. Health & Safety Code, Sections 25505, 25533, and 25534. 2. 1 have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this Own authorized agent: permit is issued. Date. j a. 1 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 Worker's CONSTRUCTION LENDING AGENCY Compensation laws of California. If, after making this certificate of exemption, I I hereby aff ir►n that there is a construction lending agency for the performance of work's become subject to the Worker's Compensation provisions of the Labor Code, 1 for which this permit is issued (Sec. 3097, Civ C.) must forthwith comply with such provisions or this permit shall be deemed Lender's Name revoked. Lender's Address APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is ARCHITECT'S DECLARATION correct. I agree to comply with all city and county ordinances and state laws relating I understand my plans shall be used as public records. to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save Licensed Professional indemnifyand keep harmless the City of Cupertino against liabilities, judgments, P tY P g J gments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date 241O