B-2018-1083 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1083
21855 HOMESTEAD RD CUPERTINO,CA 95014-0111(320 14 002) PROMOTION PLUS
SIGN CO INC
CANOGA PARK,CA
91304
OWNER'S NAME: DATE ISSUED:06/27/2018
OWNER'S PHONE: PHONE NO:(
LICENSED T DECLARATION BUILDING PERMIT INFO:
License Class C-45 Lic.#853228
Contractor PROMOTION PLUS SIGN CO INC Date 01/31/2019 X BLDG ELECT_PLUMB
I herebyaffirm that I am licensed under the provisions of Chapter 9 —MECH_RESIDENTIAL X COMMERCIAL
p p (commencing
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and ef'f'ect. JOB DESCRIPTION:
76 STATION-SIGNAGE-REMOVE REPLACE(2)CANOPY LOGOS;
I hereby affirm under penalty orperjury one of the following two declarations: REFACE MONUMENT SIGN TO LED;REFACE SECONDARY PRICE
i. t have and will maintain a certificate of consent to self-insure for Worker's SIGN TO LED
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which his permit is issued.
is issued. Sq,Ft Floor Area: Valuation:$12100.00
AYYLICA NT CERTIFICATION
I certify that I have read lhisapplication 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 320 14 002
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
27-2018 Issued by:Kim Dunbar
Date:06/27/2018
OWNER-BUILDER DECLARATION
I hereby affirm(list I am exempt from the Contractor's License Low for one of the RE-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material being installed.To roof is
r. I,as owner ofthe 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(Sce.7044,Business&Professions Code)
z I,as owner ofthe property,am exclusively contracting with licensed Silmature of Applicant
contactors to construct the project(Sec.7044,Business&Professions Code), Date 6-27-2018
I hereby affirm trader penalty of perjury one ofthe following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
r. 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 ofthe work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
i. I have and will maintain Worker's Compensation Insurance,as provided for by I have rend the har-ardous materials requirements under Chapter 6.95 of the
Section 3700 ofthe Labor Code,for the performance ofthe war k for which this California Health&Safety Code,Sections 25505,25533,and 25534.1 will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
s. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(.)should I store or handle hnz.rdi ns
shall no(employ any person in any marine—so neas to become subject to the material.Additionally,should 1 use equipment or devices which emit hazardous
contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of Califomia.If,after making this certificate of will maintnln compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions ofthe the Health&Safety Cade,Sections 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent:
APPLICANT CERTIFICATION Dale:6-27-2018
I certify that I have read this application and state that the above Information is CONSTRl1CTION 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 permit 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. 1 understand my plans shall be used as public records.
SignatureLicensed
Date 6-27-2018
Professional