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BUILDING DIVISION PERMIT
BUILDING ADDRESS: PERMIT NO.
20488 STEVENS CREEK BLVD NORTHWEST SIGNS 08030084
Ow UZ PEWArr L95UE DATE
BOARDWALK INVESTMENT GROUP 120 ENCINAL ST 05/21/2008 _
PHOr4aTr' SANITARY NO. CONTROL NO.
(831)469-8208
ARCHITECT/ENGINEER: BURRING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business and Professions Code, and my license is
in full force and effect
License Class Lic. R
Date Contractor
ARCHITECTS DECLARATION
I understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for the
following reason. (Section 7031.5, Business and Professions Code: Any city or county
which requires a permit to construct, alter, improve, demolish, or repair any structure
prior to its issuance, also requires the applicant for such permit to file a signed statement
that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9
(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
that he is exempt therefrom and the basis for the alleged exemption. Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars (5500).
❑ I, as owner of the property, or my employers with wages as their sole compensation,
will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business
and Professions Code: The Contractor's IScense Law does not apply to an owner of
property who builds or improves thereon, and who does such work himself or through his
own employers, provided that such improvements are not intended or offered for sale. If,
however, the building or improvement is sold within one year of completion, the owner -
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
❑ I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec. 7044, Business and Professions Code:) The Contractor's Li.
cense Law does not apply to an owner of property who builds or improves thereon, and.
who fo contracts projects with a contractor(s) licensed pursuant to the Contractor's
License Law
❑ 1 am exe under eci ti , B & P C for this mason
Owner
Dale
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a Certificate of Consent to self -insure for Worker'sCompen-
sation, 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 required by Section
3700 of the Labor Code, for the performance of the work for which this permit is issued.
My Worker's Compensation Insurance carrier and Policy number are:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This sectianotcompleted if the permit isfor one hundred dollars (5100)
or Icss.)I certify that in thof the work for which this permit is issued, I shall not
employ any persor so as to become subject to the WorkeriCompensation
Lawsof '
Applicant
NOTICE TO APPLICANT. , after making this CertirAcIfic o Exemption, you should
become subject to the Worker's Compensation provisions of the Labor Code. you must
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
the work for which this permit is issued (See. 3097, Civ. C.)
Lender's Name
Lender's Address
I certify that I have mad this application and state that the above information is
correct I agree to comply with all city and county ordinances and stale laws relating to
building construction, and hereby authorize 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, ju en costs and expenses which may in anyway accrue against said City
in consequence oC the ranting of this permit.
APPLICANT UND ST AND WILL COMPLY WITH ALL NON -POINT
SOURCEREGUL O
Signatu pplicant/Contractor Datc
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant Stam or handle hazardous material
as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety
Code, Section 25532(a)?
❑Yes
Will the applicant or forum building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management
District?
❑ Yes
1 have read the hazardous materials requirements under Chaplcr 6.95 of the Califor-
niaHea& afctyCodc,Scctions25505,25533 and 25534.1understand that ifthe building
does not cu ntly have a mrr.at, that it is my respon bility to notify the occupant of the
mquireme whir zest be mel prior m issuance nificate o cupancy.
Job Description
RACEWAY FOR RETAIL TENANT SIGN LETTERS
Sq. Ft. Floor Area $12000 Valuation
36953999. lumber Occupancy Type
Required Inspections
Issued by:
Re -roofs
Type of Roof
Date I- ?_ j z r)
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
all new materials for inspection.
Signature of Applicant
Date
All roof coverings to be Class W' or better