07110088 CITY OF CUPERTINO ` `
BUILDING DIVISION PERMIT �����������������
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BUILD N A D ESS: PERMIT NO.
��4�� S DE ANZA BLVD PROMOTIONAL SIGNS INC 07110088 .
PERhIIT LS6[JE DATE
...JNER'S NAME:
MARY TRAN 20361 �:ERMANA CIR � 11/15/2007
SANiTARY NO. CONTROL NO.
PHONE:
(949)4�8-1000
BDI[.DING PERMTT INFO
ARCHI'['ECT/ENGINEER:
BLDG ELECT PLUMB MECH
� 0 � �
u p p LiCENSED CON7'RACTOR'S DECLARATTON JOU DCSCI7pU0i1
m ���yy �� �hat I am liccnacd unJcr provisions oC Chapicr 9(c mc '
� z � wi�h Sccdon 7000) af Division 3 of thc Busincss and Profcssions Codc m �ice ' RE PLC FX ST POLE S I GN W/ NEW I LLUM MONMNT
�� y�n tuu �o�ce and en'ec�.G 5 ��. �r � j ? GN � RF:FACE ALL OTHR EXST S IGNS . PROMOTI ONAL PLU S
� v� Z Licenac CI s ConlracWr
' F ' � Da � ARCH[TECI'S DECLARATION C U. PD B S L 1115 0 7.
� I undcrsunJ my plans shall bc uud as public rccords
�U
4 O y Liccnscd Prufcssionai
y e� OWNER-BUfLDER DECLARATION
I hcmby alTirm U�ai I am excmpl Gum ihc Conuactors Liccnsc Law for thc
� p O following rcnson. (Scction 7U31.5, Busincss and Prafcssions Cadc: Any city or county
�$ Pi which rcquiccs a pcimit to conswc4 il�. �Pro�• �molish, or re�mir any swcwrc
y�} prior u� i�s issuancc, also rcquires thc applicant for such permit to filc a signcd stalcment Valuati on
� _ � that he is licensed pursuant to the provisions of the Conuactor's License Law (Chapter 9 Sq. Ft. Floor Area � 1 O O 0 O
y � $ (commcncing wi�h Scction 7000) of Division 3 0( ihc Busincss and Profcssions Codc) or
y �,., that he ia e�canpt the�efrom md We besis [or We allegcd exemption. Any violauon of
Section 703t.5 by say spp�icant tor a Pe�mi� $ubjecu ihe applicant w a civil penalty of N Number Oecupancy Type
not morc ihan five hund�ed dollars (5500)• 3 6 9 3 9 4__.�
❑ I. u owner o[ tlie properey. or my employces with wages az their solc compensaUon.
will do we work and we snuctuee is not intended or ot[eme tor sate (Sa. �oa4, susiness Required Inspections
and Pro[essiorm Cade: The Conuacwr's Lianse Law daes not apP�Y w an owur of
propeny who builds or improves �hercon. and who doos such work himaelf or thmugA hia
own employca, providcd Nat such improvemenu ue not imm�ded w ottered Cor sale. lf.
however, the building or improvemeot is sold wi�hin one year of rnmpledon, the wvner-
bui►dw wiU luve the burdan o[ proving t6at he did not build ar improve [or purpose of
sa1cJ.
� I, as owner of the property, am acclusively convacting with iittnud conuacwrs W
rnnsuvct Uie pcojea (Sec. 7044. Business md Protessions Code:)'1Le Conuxwr's Li-
cense Law does not spply w m wimec of prapenY who builds or improves �hemon. and ,
who convsc�t for such projects wi�h a conuacwr(s) licensed pursuant w �he Convacror's
" ' �enae Law.
am exempt under See. , B de P C for this resson
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty o( perjury one o[ �he following declarations:
❑ I hs+e and will maintein a Ceni6cale of Conaent to xlf-inswe for Warker's Compen-
sation, as provided for 6y Secuon 3700 of ehe labor Code. far �he peiformance of �he
work Cor which this permit is issucd.
I have and will maintain Workc(s Compensation Insurana, as mquired by Scction
3 of the LaEor Codc, for the perfarmmce oC �he work fw which this permit is issued.
My Worke�s Compensation lnsutance cartier and Poliry number�� �'���, 6+ �
- Cartier. WdUSs�11 UND�R W .palicy No.:la/`:�
CEKfIFICA'1'E OF EXEMPI'ION FROM WORKERS'
COMPENSATION iNSURANCE �
(fhu seclion necd not bc completcd if �he permit is far onc hundred dollars (5100)
or Icss.)
1 cenify ihat in ihe performancc af �hc worlc for which �his permit is isqucd, ! shall not
employ any person in any manncr so as w becomc wbject to the Worlccrs' CompensaUon
Laws o[ Califomia Date
Applican�
N077CE TO APPLICAM: If, attcr making ihis CcrtiGcate of Excmpdon, you should
become subjcct to thc Worlccr's Compensetian provisions of ihc (abor Codc, you must
, O foMwi�h comply with such provisions or this permit shall6c dccmed mrokcd.
z "'' CONSTRUCi70N LENDING AGENCY
[� .�-� 1 hcroby alTirtn Uwt thcre is a consuuction knding agcncy for thc perfortnancc o( .
�„ �� work fur which ihis pertnit is issued (Scc. 3097, Civ. C)
W Q Lendcr's Namc
] z Lcnder's Address
V � ► certifY ihat I have read �his application and siste tMat �hc abow in(ortnauun is
w F cortett. l agree to comply with all rity and counry orttinances and suie Iaws mladng to
0 U building consuucdon, and hereby authoria represcnudvcs of �his ciiy w cn�er upon thc
� W aAme-mcntioned pmperty for inspectioa pmposea
a (Wc) agree to save, indemmfy ess ihe City o( Cupertino against
�„H � IiabiiiUa, judgmcnts, cosls ich�a m any way urnc against said Ciry
V z in conseque�cc oC the g g C ihi Date
�"� APPLICANT UND ILL COMPLY WITH ALL NON-P INT Issued by:
SOURCERECU
( � � y �7 Re-roof:
w Signuureo(Ap IicanV n �a� T of Roof
S MATERIALS DISCLOSURE }r�
Will ihc applicant or futurc building occupant storc or handlc ha•rardous matcrial
cfincd by the Cupertino Municipal Codc. Chapicr 9.12, and thc Healih and Safcry
�oa� Scction 25532(a)? All roof. � shall be inspected prior to any roofing material being installed.
� y� �lo
Will ihc applicant or future building accupant usc equipmcnt or deviccs which
If a roof is installed without first obtaining an inspection, I agree to remove
cmil hvardous air conuminan�s az dcfincd by the Bay Acca Air Quality Managcmcn� all new ; naterials for inspecr.ion.
��s����
❑ Ycs �Nu
1 havc rcai U� � na cnu undcr Chap�cr 6.95 of the Califor-
niaFicalih 'ons7S505,25533 534.lundcrstandthatiCthcbuilding
dacs no y h �cnan4 �at it is my ibili�y w noufy occupent nf the
req' cn�s hich _bemetprior ' oCaCcnifica�c w� O g�gnatureofApplicant Date
-"" � All roof coverings to be Class "B" or better
� Owner or ori agcnl D��