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07100092CITY OF CUFERII.Nv BUILDING DIVISION PERMIT BUILDING ADDRESS: 21682 STEVENS CREEK BLVD R'S NAME: BALJINER DHAHJAL PHONE: ARCHITECT/ENGINEER: p LICENSED CONTRACTOR'S DECLARATION vF 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing z with Section 7000) of Division 3 of the Business and Professions Code, and my license is 91. in full force and effect , a License Class Lic. M 1 p Date Contractor W ARCHITECTS DECLA I N j< I understand my plans shall be used as public records )yU uin Licensed Professional O a OWNER -BUILDER DECLARATION 2�1 1 hereby affirm that 1 am exempt from the Contractor's License Law for the a O following reason. (Section 7031.5, Business and Professions Code: Any city or county u^ 9 which requires a permit to construct, alter, improve, demolish. or repair any structure 14 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 ti F (commencing with Section 7010) of Division 3 of the Business and Professions Code) or i 5 9 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 not more than five hundred dollars (5500). ❑ 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 and Professions Code: The Contractor's License law does not apply to an owner of 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.). ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044. Business and Professions Code:) The Contractor's L- eone 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 Contractor's License law. t1 I am exempt under Sec . B & P C for this reason �z C) z� r-+ W ~ Cl. A z UO u' F~- �U Uz x Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ] I have and will maintain a Certificate of Consent to self -insure for Worker's Compen- ation, as provided for by Section 3700 of the Labor Code. for the performance of the vork for which this permit is issued. -1 I have and will maintain Workers Compensation Insurance, as required by Section 1700 of the Labor Code, for the performance of the work for which this permit is issued. Ny Worker's Co1mpeasatioonn Insurance carrier and Policy number are: :artier. Policy No.: Iy��✓QI `�a� CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($ 100) nr less.) I 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 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 forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.) Lender's Namc Lender's Address I certify that 1 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 to building construction, and hereby authorize representatives of this city to enter upon the ahove-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may in any way accrue against said City in consequence of the granting of this permit. APPLICANT UNDERSTANDSAND ILL COMPLY WITH ALL NON -POINT SOURC REGULATIONS11 ee7. -� 'd Signature o plicant/Con r Date HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building Occupant store or handle hazardous material ieftned by the Cupertino Municipal Code, Chapter 9.12. and the Health and Safety c. Section 25532(a)? ,�,/ C:] Yes t� Will the applicant or future building occupant use equipment or devices whisk emit hazardous air contaminants as defined by the Bay Area Air Quality Managcmeni District? / ❑Yes u 1 have read the hazardous materials requirements under Chapier6.95 of the Califor nia Health & Safety Code, Sections 25505.25533 and 25534.1 understand that if the buildinj does not currently have a tenant. that it is m nsibility m notify the occupant of th requirements which must be met prior ' ance of a Certificate of occupancy. wncror oriv..d agcnt Date PERMIT NO. ACTIVE SIGN CO 07100092 PERMIT ISSUE DATE 1365 E TAYLOR ST. 10/11/2007 SANITARY NO. CONTROL NO. (408) 297-6640 BUILDING PERMIT INFO BLDG ELECT PLUMB Job Description INDIVIDUAL ILLUMINATED PAN CHANNEL LETTER FOR "SUBWAY" ACTIVE FE-NEWD BSL 10/11/07 3571701 Issued by: Re -roofs Type of Roof q. Ft. Floor Area $1400 Required Inspections Type All roofs Shall be inspected prior to any roofing material being installed. If a roof i 3 installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant All roof coverings to be Class "B" or better Date 7Z 0 0 z 0z z0 :D z UO IL E~ - OU U Cir OF CUPERTINO BUILDING DIVISION PERMIT BUILDINGADDRESS: 21682 STEVENS CREEK BLVD OWNER'S NAME: BALJINER DHAHJAL ARCHITECTIENGINEER: LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect License Class l� :�'S Lie # Date Contractor ARCH DECLAff&16N 1 understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION 1 hereby affirm that I am exempt from Elie Contractor's License Law for the following reason. (Section 7031.5, Business and Professions Code: Any city or county Which requires a permit to construct, alter, improve, demolish, or repair any structure 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 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 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 not more than five hundred dollars ($500). ❑ I, as owner of the property, or my employers with wages as theirsole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of 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 said 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.). ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code:) The Contractor's 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. ❑ 1 am exempt under Sec , B & P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a Certificate of Cansent 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. ❑ I have and will maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My Workc�es(,C�o1mmpensation Insurance carrier and Policy number am: Carrier. S[GZe Policy No.: ����✓�f _d� CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (nlis section need not he completed if the permit is for one hundred dollars (5100) or less.) I 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 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 forthwith comply with such provisions or this permit shall be deemed mvoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.) Lenders Name Lender's Address 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 stale laws mlating to building construction, and hereby authorize representatives of this city to enter upon the shove -mentioned properly for inspection purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may in any way accrue against said City in consequence of the granting of this permit. APPLICANT UNDERSTANDS AND ILL COMPLY WITH ALL NON -POINT SOURC5 REGULATIONS. 17 Signature o pplicant/Contractor Date HAZARDOUS MATERIALS DISCLOSURE 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)7 ❑ Yrs Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District? ❑ Yes a I have mad the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health & Safety Code, Sections 25505,25533 and 25534. I understand that if the building an docs not currently have a tent. that it is in esponsibility to notify the occupant of the requirements which must be met prior t ance of a Certificate of Occupancy. ACTIVE SIGN CO 1365 E TAYLOR ST. (408)297-6640 tTION.` .: PERMIT NO. 07100092 PERMIT ISSUE DATE 10/11/2007 SANITARY NO. CONTROL NO. BUILDING PERMIT INFO BLDG ELECT PLUMB MECH Job Description INDIVIDUAL ILLUMINATED PAN CHANNEL LETTER FOR "SUBWAY" ACTIVE RE—NEWD BSL 10/11/07 Sq. Ft. Floor Area$140 0 Valuation 3 57 17 012 q1N Number Occupancy Type Required inspections Issued by: Re -roofs Type of Roof Date 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. Signature of Applicant Date All rnfn` cnverinps to he Class "R" nr hPttPr