B-2017-0082CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-0082
10050 N WOLFE RD STE SW2-136 CUPERTINO, CA 95014-2528 (316 20 086)
CORPORATE SIGN
SYSTEMS INC
SANTA CLARA, CA
95050
OWNER'S NAME: I&G DIRECT REAL ESTATE 27 LP
DATE ISSUED: 01/18/2017
OWNER'S PHONE: 408-982-8404
PHONE NO: (408) 292-1600
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class _Q45 Lic. #765078
Contractor CORPORATE SIGN SYSTEMS INC Date 06/30/2017
X BLDG —ELECT _PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
MECH _ RESIDENTIAL X COMMERCIAL
with Section 7000) of Division 3 of the Business & Professions Code and that my
license is in full force and effect.
JOB DESCRIPTION:
SUGARCRM - (I) ILLUMINATED WALL SIGN (1)
I hereby affirm under penalty of perjury one of the following two declarations:
i. I 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.
z. 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
permit is issued.
Sq. Ft Floor Area:
Valuation: $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 20 086
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
PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting of this permit.
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally, the applicant understa' , s and will co ply with all non -point
9.18.
source regulations per, the CuKertin6 Municipa=ja ode, Section
180 DAYS FRO ST CALLE VSPECTION.
Signature J ,` ,/1 a e 01/18/2017
Issued by: MELI ANAME
Date: 01/18/2017
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the
RE -ROOFS:
following two reasons:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
m. I, as owner of the property, or my employees with wages as their sole
installed without first obtaining an inspection, I agree to remove all new materials for
compensation, will do the work, and the structure is not intended or offered for
inspection.
sale (Sec.7044, Business & Professions Code)
2. I, as owner of the property, am exclusively contracting with licensed
Signature of Applicant:
contractors to construct the project (Sec.7044, Business & Professions Code).
Date: 01/18/2017
I hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
1. I 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.
HAZARDOUS MATERIALS DISCLOSURE
2. I have and will maintain Worker's Compensation Insurance, 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 performance of the work for which this
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
permit is issued.
s. I certify that in the performance of the work for which this permit is issued, I
Health & Safety Code, Section 25532(a) should I'store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the
air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California. If, after making this certificate of
niPal Code, Chapter 9.12 and
will maintain compliance with the Cupertino Mui
exemption, I become subject to the Worker's Compensation provisions of the
the Health & Safety Code, Sect ns 2 ,_ 05,x25533, and 25534.
Labor Code, I=must forthwith comply with such provisions or this permit shall
-
be deemed revoked.
Owner or authorized agent: f
APPUCANT CERTIFICATION
Date: 01/18/2017 _;-
I certify that I have read this application and state that the above information is
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance
correct. 1 agree to comply with all city and county ordinances and state laws
of work's for which this permit is issued (Sec. 3097, Civ C.)
relating to building construction, and hereby authorize representatives of this city
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
a DECLARATION
ARCHITECT'S11beused
I understand my plans shall be used as public records.
Code, Section 9.18.
Licensed
Signature Date 01/18/2017
Professional