07030136 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:07030136
10900 N BLANEYAVE(316 03 045)
711 INDEPENDENT RD
OAKLAND,CA 94621
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OWNER'S NAME: PG&E DATE ISSUED:04/03/2007
OWNER'S PHONE:(559)347-5137 PHONE NO:None
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT IMO:
License Class CONTRACTOR-SPECIALTY Lic.#
Contractor Date 09/30/2016 _BLDG _ELECT PLUMB
MECH RESIDENT AL COMMERCIA
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
1 MONUMENT SIGN-ILLUMINATED 'OD
I hereby affirm under penalty of perjury one of the following two declarations:
1. I have and will maintain a certificate of consent to self-insure for Worker's NO INSPECTIONS SCHEDULED P ' IT EXPIRED ON
Compensation,as provided for by Section 3700 of the Labor Code,for the 10/03/07 r-y
performance of the work for which this permit is issued.
2. I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of the work for which this MICROFILMED 8/2010 \�/J
permit is issued. -
Sq.Ft Floor Area: :luation:$5000.00
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 APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 316 03 045
representatives of this city to enter upon the above mentioned property for
inspection purposes. (We)agree to save indemnify and keep harmless the •
City of Cupertino against liabilities,judgments,costs,and expenses which PE ' T EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting of this permit.
Additionally,the applicant understands and will comply with all non-point WI IN 180 DAYS OF PERMIT ISSUANCE OR
source regulations per the Cupertino Municipal Code,Section 9.18. 1: i DAYS FROM LAST CALLED INSPECTION.
Signature Date ssued by:Legacy
Date:04/03/2007
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of= e RE-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
1. I,as owner of the property,or my employees with wages as their solei installed without first obtaini_-ng an inspection,I agree to remove all new materials for
compensation,will do the work,and the structure is not intended or,•ffered for inspection.
sale(Sec.7044,Business&Professions Code)
2. I,as owner of the property,am exclusively contracting with lic-`sed Signature of Applicant:
contractors to construct the project(Sec.7044,Business&Pr'.essions Code). Date:
I hereby affirm under penalty of perjury one of the following thr e declarations:
n. I have and will maintain a Certificate of Consent to sel nsure for Worker's ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
Compensation,as provided for by Section 3700 of th'Labor Code,for the
performance of the work for which this permit is i : ed. HAZARDOUS MATERIALS DISCLOSURE
2. I have and will maintain Worker's Compensatio nsurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code,for the perfo c ance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
- 3. I certify that in the performance of the wo for which this permit is issued,I Health&Safety Code,Section 25532(a)should I store or handle hazardous
shall not employ any person in any ma -r so as to become subject to the material. Additionally,should I use equipment or devices which emit hazardous
Worker's Compensation laws of Califs ia. If,after making this certificate of air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the
Labor Code,I must forthwith cod rely with such provisions or this permit shall
the Health&Satf ty Code,Sections 25505,25533,and 25534.
be deemed revoked.
Owner or authorized agent:
APPLICANT CERTIFICATION Date:
I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this per-nit is issued(Sec.3097,Civ C.)
to enter upon the above 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 ARCHITECT'S DECLARATION
Code,Section 9.18. I understand my plans sha I be used as public records.
Signature Date Licensed
Professional