B-2016-2461 CITY OF CUPERTINO BUILDING PERMIT
BUILDINGADDRESS: CONTRACTOR: PERMIT NO:B-2016-2461
10601 S DE AlVZA BLUD CIJPERTINO,CA 95014-4451 (359 18 061) II,LUMINART SIGNS
YUBA CITY,CA 95993
OWN�R'S NAME: DATE IS5UED;O8/04/2016
OWIVER'S PHONE: PaONE NO:(408)386-1485
�D 1in T R D� LA1tATI BUILDING PERMIT INFO:
License Class ELECTRICAL SIGNS Lic.#678750
Contractor ILLUMINART SIGNS Date 10/31/2017 X BLDG _ELECT _PLUMB
MECH RESIDENTIAL X COMMERCIAL
I hereby affirm that I am licensed under the provisians of Chapter 9(cammencing — — —
with SecNon 7000)oPDivlsion 3 of the Business&Professions Code and that my
Ilcense is in full force and effect. JOB DE5CRII'TION:
REMOVE&REPLACE 2 NON-ILLUMINATED MONUMENT SIGNS-
I hereby affirm under pevalty of perjury one oFthe fallowing two declarations: DE ANZA PROFESSIONAL CENTSR
i. I have and witl maintain a cer[iftcate oF consent to self-insure for Worker's �
Compensafion,as provided for by Sec6on 3700 of the Labor Code,for the
peiformance of lhe work for which tltis permit is issued.
z I have and will maintain Worker's Compensadon Iusuranee,as provided for by .
Sec[ion 3700 of[he Labor Code,for[he per£oanance of[he work for which this
permitisissued. Sq.FtFloorAroa: Valuation:$11000.00
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above
information is correct. I agree to comply with all city and county ordinances �'N Number: Occupancy Type:
� and state laws relating to building construction,and hereby authorize 359 18 O61
representatives of this city to enter upon the above mentioned property for
inspection purposes. (We)agree to save indemnify and keep harmlass the
City of Cupertino against liabilities,judgments,costs,and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said Ciry in con equence of the granting of this permit. �7�7ITHIN 180 DAY.S OF PERMIT I.�SUANCE �R
Additionally,the applicant unders ds and will comply with all non-polnt
source regulations per he cup no Municipal cade,Section s.1s. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 08/04/20�6 Issued by:MELISSANA�—
Date:08/04i�uio � -_,
O ER-B D� DECLARATIO \
I hereby afiirm that I nm exempt from the Contractor's License Law for one of the RE-ROOFS�
following two reasons: All roofs ahall Ue inapected prior to any roofing material heing installed.If a roof is
i. I,as owncr of Ihc property,or nry employees with wages as their sole �s[alled without first obtaining an inspection,I agree to remove all new materials For
compensation,will do the work,and the shvcture is not inYended or offered for inspection.
sale(Sec.7044,Business&Professions Code)
z. I,as owner of the property,am exclusively con[racting wiHi licensed SignaNre ofApplieant:
contractors to construct the projec[(Sec.7044,Business&ProFessions Code). Date:OS/04/2016
I hcreby affirm under pcnally of perjury one of the following three declarations: pLL ROOP COVCRINGS TO B�CLASS"A"OR RETTER
i. I have and will maintnin a Certifica[e of Consent to self-insure for Worker's
Compeusa[ion,as provided for by Section 3700 of the Iabor Code,for the
performancc of[he work£or which[his permit is issued. HAZARDOUS MATERIALS DISCLOSURE
z. I have and will maintain Worker's Compensation Insurance,as provided for by 1 have rexd the hazardous roaterials requiremeuts un�er Chapter 6.95 ot tLe
Sec[ion 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505�25533,and 25534. I will
pexmi[is issued. maintain compliance with the Cupertina Municipal Cnde,Chapter 912 and the
3. I certify that in the perfonnance of tUe work for which tlils permit is issued,I I3ealth&Safely Code,Section 25532(a)should I store or handle hazardous
shall not employ any person in any manner so as to become subject to the material. Additionally�should I use equipment or devices which emit hazardous
air rontaminants as defiucd 6y the BayArca Air Quality Managemen[Dis[rict I
Worker's Compensafion laws of California. If,after making this certificate of �ro�otain compliance with the Cupertino Municipal ode,Chapter 9.12 and
cxcmpfion,I become subject to the Worker's Compensation provisions of[he the HealtH&Safety Code,
Labor Code,I must Forthwith comply with such provisions or this permit shall
6e deemed rewked. Owner or authorized agent:
APPLICANT CERTIPICATION Date:08l04/2016
I certify that I have read this application and sfate that the above information is o TRU T A E
correct.I agree to comply with all cily and county ordinances and state laws I hereby affirm that there is a const ion lending agency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,Civ C.)
to enter upon the a6ove mentioned property for inspection purposes. (We)agree Lender's Name
to save indemnify and keep harmless the City of Cupertino against liabilities, �
judgments,costs,and expenses which may accrue against said City in Lender's Address
consequence of the granting of this permit. Additionally,the applicant understands
and will comply with all non-point source regulations per the Cupertino Municipal ARCIIITECT'S DECLARATION
Code,Section 9.18. I understand my plans shall be used as public records.
Lfcensed
Signalure Date OSl04/2016 professlonal