02070110-FPCETY OF CUPERTH*
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SIGN
CITY Of
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o2_07,000
APN #
Date: -7/1 AZ
Building Address:
Owner's Name: I V
Phone ��Op
Contractor: ; 5 `
License #:
Contact:
P one #:
Applicant/Contractor:
5 ewe.
Plan Check Fee
Building Permit Info:
Bld Elect Plumb Mech
o escription: 3y,,�� wh,,v�f 1 60,,,,E
Residential: Commercial:
Sq.Ft. Floor Area:
$ /Sq.Ft.:
Architect/Engineer:
Valuation: j 7700
Type of Construction:
Occupancy Group:
Qty. if
Annlicable
Fee ID
Fee Descrintion
Fee Grout)
q, 1. 57
BENERGY
Energy
BUE,IDNG
r
BPERMFEE
Bldg Permit Fees
BUE.IDNG
BPLANCHK
Plan Check Fee
BUILIDNG
BSEISMICOM
Seismic Commercial
BUILIDNG
EPERMTTFEE
Elect Permit Issuance
ELECTRICAL
BREMSIGNAD
Rmdl Signs Add Branch
ELECTRICAL
BREMSIGNS
Rmdl Sings, Marquee
ELECTRICAL
BUSLIC
Business License
BUILIDNG
q, 1. 57
BUILDING DIVISION PERMIT
BUILDING ADDRESS:
21265 STEVENS CREEK
G`�RN INVESTMENT MANAG.
PHONE:
u 0 Z ARCHITECT/ENGFNEER:
u
(— ZL`
H C C
LICENSED CONTRACTOR'S DECLARATION
o ? 1 hereby affirm that I am licensed under provisions o(Chapter 9 (commencing
F with Secti 7 ) of Division 3 of the Business nd Pro(cssions Cod e• and my license
Y is in full (o nd effect. / SS�S
L < License CI I%`'�J Lic. J
O e Contralto
ARCHITECT'S DEPS10
m 0 1 understand my plans shall be used as public records
u
15 00 Licensed Professional
' X Lf� OWNER- BUILDER DECLARATION
m — rn I hereby affirm that I am exempt from the Contractor's License Law for the
F- Z c following reason. (Section 7031.5. Business and Professions Code: Any city or county
c F_ 0 which requires a permit to construct, alter• improve• demolish, or repair any suuctum
c 3 prior to its issuance, also requires the applicant for such permit to file a signed statement
that he is (icensed pu4uanr to the prhwsions of the Contractors License Law (Chapter 9
(commencing with Section 7000)Lo(Division 3 of the Business and Pro(erssions Code)
or that be h exempt therefrom and the basis for the alleged exemption. Any violation
of Section 703f.5 byany applicant for a permit subjects the applicant to a civil penalty
-of not more than five hundred dollars ($500).
❑ 1, as owner of the property, or my employees with wages as their sole compensation,
will do tb) *'work, and the swbfure1s 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.).
❑ I, as* owner of the•property, am exclusively contracting with licensed contractors to
cons"ct the project (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 contracts for such projects with. a contractor(s) -licensed pursuant to the
Conuactoes License Law.
❑ I am exempt under Sec:. B & P C for this reason
.. Owner Date'
WORKER'S COMPENSATFON DECLARATION
I hereby affirm undo; penalty of perjury one of the following declarations:
r ❑ 1 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.
❑ 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 petrnit is
issaed. My W ets Compens on Insurance carrier d Policy number -are:
kk-U IN it kxuA1 L ll llDm in i� u1 l%qk; If RUIN'
VISIBLE GRAPHICS
15216 BURBANK 5216 BURBANK BLV, SUITE
(818) 787 -0477
PERMIT Nb 2 0 7 0 1 1 0
AJ'RLICATlIA113Si)'BtDA,TFj 2 0 0 2
SANITARY Ll1NO. 1 0 / CONTROL NO.
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
INSTALL 2 AWNIg"CrYfiftNNER
$7800
3 �t7 Elabr�•'. Valuation
10100 N1EQjQJDAT I ON Occupancy Type
103 - UFER
1"-I - 1""""` �,1 Inspectioris
105 - ANCHOR EW
304 - ROUGH ELECTRICAL.
505 - FINAL ELECTRICAL
514 - FINAL PUBLIC WORKS
-leak __ • S Mal: "Pol'c o : (31-,) f- i , . t •,
CERTIFICATION•OF EX ION FROM' WORKERS .
COMPENSATION_INSURANCE... .. ...�._...._ ._ -..
(ntis section need not be completed if the permit is for one hundred dollars
($10 0) or less.)
1 certify that in the, performance of the work for which this permit is issued, 1
shall not employ any person in any manner sous to become Subject to the Workers'
Compensation Laws of Califomia. Date'
Applicant ' '
NOTICE TO APPLICANTr'IL' after making thii Certificate of Exemption, you should
®®become subject to the Worker's Compensation provisions of the Labor Code, you must
forhwlh comply with such provisions or this permit shall be deemed revoked.
V] '''CONSTRUCTION LENDING AGENCY.
"I hereby affirm that there is 's con'saruction lending agency for du perfoir &
o(th'e work for which this'permit is isrsti'ed (Sec: 3097;Civ,. -C.) .
Lender'%NamC.. -.. e ,
Z 4rider s Address •' - , •.
I certify that I have read this application and state that the above information is
(FU cortex. I agree to comply with all city and county ordinances and state laws relating
® .0 to building constmctient and hereby authorize representatives of this city to enter upon
>y :,[� the above-me mioned property for inspection purposes.
� - Ra tW )'•agree io save, indemnify ahE keep' harmless the Cary ti( Cupertaoo against
ry to liabilities, judgments, costs and expenses which may in any way accrue, against said
U Z Cityi id'ionsequence of the'granting of thii permit.
PPLIC-EA EG� 7 TAN'DS,AND _ COh ?PLY WITH A L NON- POLN'T Issued by: Date "
'7 Ip o
NrebfAppli=VContrnct6r' " e Re -roofs
HAZARDOUS MATERIALS DISCLPSURE
Will �}te appOcant'ar future'ba Jding occupant store or handle'fiaiatdoiis material Type of Roof '
as defined by the Cupertino Ku. Code. Chapter 9.12, and the Health and Safety
Code; Section 25532(a)? - '-
❑Yes "" ` ,,, .r
.All roofs shiall be inspected prior to any roofing material being installed.
Will the applicant or lding occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I' agree to remove
emit haw.dous'aii contaminants as defined by the Bay Area Air Quality Management
all new materials for inspection. Applicant understands and will comply with
all non -point source regulations.
./ I
Disthctl
❑_Yes, No 7.
'I have read -the ha2$rdooi materials requirements under Chapter 6.95 of the
Califomia.Health At Safety :Code, Sections 25505, 25533 and-25534. 1 understand that
if the building does not currendy have a tenant: that i( is my responsibiliiy_ to notify the
occupant of the mq ' cots which must be met prior to isspance of a Certificate of
fyccupancy. 02
Owner or authorized agent
Signature of Applicant Date
All roof coverings to be Class tB" or better
OFFICE