07100021 CIT�' OF CUPERTINO '' ' �, ������T���* ;
BUILDiNG DIV1SlON PERMIT ���� ��
,.,. ,.:;
,;., _ .:
PERMIT fYO.
BUfLD �r�gq���ESN DE ANZA BLVD SIGN DESIGNS, INC 07100021 .
pERMIT ISSUE DATE
?R'S NAME:
CHEVRON USA INC 95700 204 CAMrUS W�'?Y 10/16/2007
SANITARY NO. CONTROL NO.
P"o"E: ( 209 ) 524-4484
BUILDINGPERMifINFO
ARCHITECTIENGINEER: g� EL� PLV�MB M�E�CH
i p o LICENSED CONTRACCOR'S DECLARATION JOb DeSCiIpLlOf1
; m� I hcreby �rm that I am licenscd undcr provisions oC Chap�cr 9(commcncing
: z� with Sccdon 7d00) of Division 3 of ihc Husincss and Profcssians C qdc, and my licensc is INS TALL I NG CANO PY , MONUMENT � & WALL S I GNS �IV
� 6 a in full facce an d c f[
��? Licenu C azs Lic. # STORE
:F � �� ` ARCHITECTSDFCLAR T N & CAR WF.SH RE-FACE ONLY
j a
Q 1 undcrstand my plaes shall tx uscd as public rccords
)yU
' u. y Liccnscd Pmfcssianat
• � a OWNER-BUILDER DECLARATION
� a� 1 hcrcby alTirm that 1 am excmpt (rom thc Contractor's Liccnsc Law for thc
p O following rc.ason. (Scctian 7031.5, Busincss and Profccsions Ca1c: Any city or couniy
<,°, �i which rcquires a pcmiit w caoswct. altcr. improvc. dcmolish. ar rep�ir any suucmcc
�" N prior ui i�s issuancc. also rcquires thc applicant for such permit to filc a signcd statcmcn� c q , Ft. Floor Area Valuation
- z< �ha� hc is liccnscd pursuant lo thc provisions of ihc Conuactur's Lic�cnx Law (Chaptcr 9 $ 8 510
x t x -� �(commcncing with Scction 7000) of Division 3 of lhc Busincss and Profcssions Codc) or
i�.. that he is exempt thcrcfrom and the basis Cor the allegcd exemption. Any violation ot Occupancy Type
Section 7031.5 by a�ry applicant for a peemit subjccu the applican� to a civil pcnalty of 316 2 6 0 9 E �?�l� Number
not more �han five hundred dollars (5500�
❑ i, u owncr oC the property, or my employces witN wages as the[r salc compensation,
will do thc wurk, and the swctme is not intenCcd or oftered farsalc (Sec.7044. Businas Requi; ed Inspections
and fiofessions Code: The Conuactor's License Law does not apply w an owner ot
propeny who 6uilds a improvet thercon, and who does such wort himself or through his
own employces. prm�idcd that such improvemenls are not i��ended ar o[Cered tor sale. If.
however, the building or improvement is sald within oce year of compteaon, the owneo-
buildu will have the burdan oC proving that he did not 6uild or improvc for purpox of
saleJ.
❑ I, as awner of �he property, am ezclusively conuacdng wilh licensed conuactors a
wnstnut the projen (Sec. 7044. Business and ProCessions Code:) Thc Contracmr's Li•
cense Iaw dacs not apply �o an owne� of propeny who builds or improves Uu¢on, and . �
who contracu Cor such projecls with a conuactor(s) Iicensed pursuant to the Convactar's
License Law.
❑ f am ezempt under Sec . B& P C for this rcuon
. Dale _ .. _.
WORKER'S COMPENSAT[ON DECLARA170N
1 Aercby affimi under penalry of perjury one o( tt� following declarations:
❑ I hsoe and will maintain a Cenificate of Consenl to sel6insurc Cor Worker's Campen-
sation, u provided far by Secdon 3700 of [he Labor Code, for the pedortnarkc of thc
work for which ihis pertnit is issucd.
❑ I have and will maintain Worker's Compensation Insurance, as �equired by Section ,
3700 0( the Labor Codc, Cor the performancc ot the work for which this permit is issued.
My Work rs �ompensation Insurance cacricr and Policy number aic:
� .�^ r ��o�--o�',�s
Cartier: `C� � J./� g�/ �R�olicy No.: �
CERTIFICATE OF EXEMPf[ON FROM WORKERS' ,
COMPENSATION INSURANCE
('I1iis sccdon necd no[ hc completcd i( the pertnit is [or anc hundrcd dollus (E100) ,
or Icss.)
I cenify thx� in thc perfortnancc of thc wark for which U�is permi� is issucd, l shall not
enploy any person in any manncr so az w bccomc subject io �he Workcrs' Compensatlon
Laws o( Califomia Datc
Applicant
NOTTCE TO APPLICANT: If, aftcr making this CcrtiGcatc of Excmption, you should
bccome subjcct w �hc Workcr's Compensadon provisions of the Labor Codc, you must
� z (orthwith comply with such provisions or this pccmi� shall bc decmcd Rwokcd.
Z � CONSfRUCT10N LENDING AGENCY
(� r�-. 1 hcre6y afTirm ihat thcre is a consuuction Icnding agency far thc perCortnancc of
p; .� ihc wurk for which I►ils permit ia issucd (Sce. 3097, Civ. C.) ,
W A L.endcr's Namc
� z L,ender's Address
► certi(y �hat I havc rcad this application and siatc that thc above in(ortnatiun is
�� cortect. I agece to comply wiih all ciry and county orJinar�cea and sute laws rcla�ing m
� U building conswction, and hereby authori�e represcntalivcs of U�is ciry to cmcr upon lhc
abovc-mcnuoncd properly (or inspccuon purposes.
� a (Wc) agree to save, indcmni(y and kecp harmlcss thc Ciiy o( Cupertino against
"�� � liabilitiu, judgmcnts, costs and expenscs which may in any way acctuc against said City -
�} z in consequence ot ihe granting of Ihis permiL DBLe �� ��j ��
� APPLICANT U N D E R S T A N D S A N D W I L L C O M P L Y W I T H A L L N O N- P O I N T I s s u e d b y:
SOUR E REGULATION .
�b'0� Re-roofs
Signat of pplicantlCon tor De � T of Roof
H OUS MA7'ER[ALS DISCLOSURE YP
ilI Ihc applicant futurc building occupant store or handlc ha•rardous matcrial
�Icfincd 6y the Cupertino Municipal Codc. Chaplcr 9.12. and the Hcalth and SaCcty
:. Scction 25532(a)? All roofs �hall be inspected prior to any roofing material being instailed.
�y� QNo -
If a roof i� installed without first obtaining an inspection, agree to remove
Wi11 thc applicant or futurc building occupant usc cyuipmcnl or dcvices which
emit harardous air contaminanu az dcfincd by the Bay Area Air Qualiry Managcmcnt all new rr aterials for inspecr.ion.
as�;���
�y� �Nu
I havc mad the hvardcws matcrials rcquircmcnts undcrChapter 6.95 0( the Ca�iforv
nia Hcalih & Safcty Codc, Scctions 25505, 25533 and 25534. f un�rstand that iCthc building
docs no� curtenUy havc a tcnan4 �at i� is my responsibility w notiCy thc occupant nf �hc
rcyuircmen�c wnich musi be met priorw issuance o( a Ceni�ica�c o(OcwpaocY. S1gII3tUie Of APp1tC811i Date
�IM, a�� � �' ��'�� All roof coverings to be Class "B' or better
Ownc or thorizcd agcn� Datc