07070262 CITY OF CUPERTINO ` '
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BUILDING DIVISION PERMIT G�- ��'��`����� '
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PERMIT NO.
BUILDING ADDRESS:
10423 S DE ANZA BLVD UNITED SIGN SYSTEMS 07070262 .
PERMIT LSSUE DATE
QWNER'S NAME: ,
CALI EDWARD S TRUSTEE 5201 PENTECOST DR 10/02/2007
SANITARY NO. CONTROL NO.
NE:
(209) 543-1320
BUtCDING PERM11'INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
� 0 0 �
i p Q LICENSED CONTRACTOR oEC�nRano►v Job Description
; V� I hcrcby aCfirtn that I arn liccnscd unckr provisions oC Chaptcr 9(commcncing
; z� with Scction 7000) o( Division 3 of ihc Busincs.c and Profcssions Code and my liccnsc is REMOVE ( E� ALBERT S ONS S I GNS W I TH NEW I LLUM LUC KY
i� z Liceox C e snd eftecc ��. � ���� j S I GN S �i� D RE " AC E MONLTMENT S I GN
• p Datc ' Conuactor �
: � � ARCH[TECI'S DECLARATION
i� a l undcrstand my plans shall bc used as pu6lic records
)yU
� 0 y Licenscd ProCessional
: y � OWNER-BUILDER DECLARATION
'�' 1 hcrcby alTrm �hat 1 am czcmpt trum �Ac ConUaaor's Liccnsc Law for thc
� p O (ollowing rcason. (Scction 7031.5, Busincss and Profcssions Codc: Any city or county
�,°, � which rcquims a pcnnit ro consiruct, aiter, improvc, dcmoli.eh, ar repair any suuctum
rior to iLt issuancc, alsu rcquires thc applicant for such permit to fitc a signecl su�mcnt Valuation
'. ? r � 5 q. Ft. Floor Area
a i h a t h c i s l i c c n s c d p u r s u a n l � o thc provisions ot ihc Contraclur s Liccnse Law (Chaptcr 9 � 7 5 O O
� t �(commencing with Scction 7000) of Division 3 0[ �hc Busincss �nd Profcssions Codc) ur
��� that he is ozempt Nerefrom and the basis Cor the alicgcd eumption. Any violauon of
Section 7031.5 by a�ry applicant tor a pefmit subjecu ihe applicant to a civil penaity of Number Oeeupaney Type
not morc than 6vc hundrcd dollars (SS00). 3 S 9 �. r I O 1���
❑ I, u owncr of ttie propccty, or my cmployces with wages as �heir solc compensation,
wilt do U�c work, and the st�uaure is not intenGed or affeced forsalc (Set. 7044. Business Required Inspections
and Professions Cadc: The Conuactor's Lianse Law does �wt apply to an ownu of
propeny who builds or improves �hercon, and who daes such work himself or ihmugh his
own empioyces, provided that such improvemen�s are not iniended ar ottered for sala U.
however, the building or improvement is sold within one year of compledon. �he owner
builder will have the burdu� o[ proving �hat he did no� build ar impcovc tor purpose of
salc.).
� 1, as owner o[ the propeny, am exclusively convacting with littnsed rnnvxtors a
construct �he project (Sec. 7044. Business and Professions CodeJ The Contractors Li-
ccnse Law docs not apply Io an owner of propeny who builds or impraves Wereon, and .
who conuacu Cor such projects with a contractor(s) licensed pursusnt w the Contractar's
L'uense Law.
❑ I am exempt under See. . 8 8e P C far this reason
Owner Daie
WORKER'S COMPENSATION DECLARATION
I hereby afl'irm under penalty o[ perjury one of the follawing declaraGons:
�] I hsve and will maintain a CeniGcam of Consent to self-inswe for Workers Canpen-
sation, az provided for by Section 3700 of the [abor Code, for the pedarmaMe of �hc
work tor which Wis pertnit is issued.
❑ I havc and will maintain Workcr's Compensadon Insurana, as required by Scctian ,
3700 of thc Labor Codc. Cor thc performancc of Uu work far which �is pecmit is issued.
My Worku n Insurance cacricr and Policy number am:
Camer./Vl�t.. �t�' Pal'�cyNo.:�
ERTIFICATE OF EXEMPRON FROM WORKERS'
COMPENSAT[ON INSURANCE
(This sectian necd not bc completeJ if �he permit is for anc hundred daltacs (S 100)
orlcssJ
I cenify that in thc performancc of thc work for which �his permit is issucd, I shall not
employ any person in any manncr so as a bccomc subject iu the Workcrs' Compenudon
Laws of Cali(ornia. Datc
Applicant
NOTICE TO APPUCAM: If, af�cr making �his Ccrii�catc o( Excmption, yau should
become subjcct to thc Workcr's Compcnsadon provisions of thc La6or Cadc. you must
� O fanhwith comply with such provisions or this pecmit shall Ac deemed Rwoked.
z "" CONSTRUCTION LENDING AGENCY
[� ►�-� I hcreby a(lirtn �hat thcre is a constcuctinn Icnding agc�y [or ihc perfortnancc af
�., �✓ ihc work (ar which Wis permit is issued (Scc. 3097, Civ. C.) ,
W Q Lcndcr's Namc
� z Lcndtt's Address
U � I cenity that 1 havc rcad this application and siatc U�at thc above informatiun is
w ►-� cortcct. I agrce ta comply with all city and county onlinances and sute Iaws cclating to
� U building conswction, and hcrcby authori�e rcprurnutivcs of this city to cntcr u�n thc
� W above-mentioncd properly (or inspection purposes.
� a (Wc) agrce to save, indcmnify and keep hacmless ihc City o[ Cupertino agains�
�„ � liabilitiu, judgmcnts, costs and cxpcnscs which may in any way accruc againsl said City
(� ,'� in consequence aC the grantin f ihis permit.
►'� APPLICANT UNDERSTA AND WILL COMPLY WITH ALL NON-POINT Issued by: Date / �����
SOURCE R ---` `
%D Re-roofs
Signaturc of Appli UCon tor �a� T e of R � �f
HAZARDOUS MATERIALS D[SCLOSURE YP
�ll tl�c applicant or futurc building occupant store or handlc harardous matcrial
as dcRncd by Ihe Cupertino Municipal Codc. Chaptcr 9.12. and the Health and SaCcty
Codc. Scction 25532(a)? All roofs : hall be inspected prior to any roofing material being installed.
❑ Ycs ❑ No .
Will �he applicant or fuwrc building ottupant use equipment or Jevices which
If a roof i: installed without first obtaining an inspection, I agree to remove
cmi� harardous air coataminan�s as dcfincd by the Bay Arca Air QualitY Managcmcn� all new m; iterials for inspec 4l0�1.
Disvict?
❑ Ycs ❑ N�
I havc read the ha�ardous maicrials ceyuiremcn�s undcrChap�cr 6.95 af thc Califor-
niaHcalih&SafctyCodc,Scctionc25505,25533and25534.1undcrs�indthatiCihc buiWing
docs not currently have a �cn l Ihat it is my responsibility m notify Ihe a:cupan� of ihe
rcy�� h�ch m met prior to issuance of a Ccrtifica�c of Oc r• S ignature �f Appl icant Da[e
� /e / O All roof coverings to be Class "B" or better
Owncr or ari . agcnt Datc