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B-2017-1351CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-1351 10815 N WOLFE RD STE 104 CUPERTINO, CA 95014 (316 05 056) PHOENIX SIGNS LLC SAN JOSE, CA 95112 OWNER'S NAME: CUPERTINO VILLAGE LP DATE ISSUED: 08/17/2017 OWNER'S PHONE: 858-248-3134 PHONE NO: (408) 573-9300 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class C-45 Lic. #92480(1 Contractor PHOENIX SIGNS LLC Date 01/31/2019 X BLDG —ELECT —PLUMB MECH RESIDENTIAL X COMMERCIAL 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 farce and effect. JOB DESCRIPTION: POKE WORKS - INSTALL (2) ILLUMINATED WALL SIGNS I hereby affirm under penalty of perjury one of the following two declarations: m. 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. 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 Sq. Ft Floor Area: Valuation: $6560.00 permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above APN Number: Occupancy Type: information is,correct. I agree to comply with all city and county ordinances 316 316 OS 056 A (Tenant Improvements) building construction, and hereby authorize and state laws relating to build 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 understands and will comply with all non -point source ,regulations p r the Cupertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signat Date 08/17/2017 Issued by: Kim Dunbar Date: 08/17/2017 O -BUI ER EC O I hereby affirm that'I am exempt from the Contractor's License Law for one of the RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is following two reasons': m. I, as owner of the property, or my employees with wages as their sole installed without fust 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) z. 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: 08/17/2017 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER t. 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. 3. 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 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety Code, Sec ns 25505, 25533, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall -A-1-le be deemed revoked. Owner or authorized agel" APPLICANT CERTIFICATION Date: 08/17/2017 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 and state laws 74ON LENDING AGENCY I hereby affirm that there i c nstruction lending agency for the performance relating to building construction, and hereby authorize representatives of this city of work's for which this permit 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. 1 understand my plans shall be used as public records. Licensed Signature Date 08/17/2017 Professional