08070021CITY OF CUPERTINO
BUILDING DIVISION PERMIT�7��®`'
"" TTV8 'N': DE ANZA BLVD
1US
.ARROW SIGN CO
PERMIT NO.
08070021 ,
OWNER NAME:
PERMIT ISSUE DATE
SANDHILL PROPERTIES
1051 46TH AVE
07/02/2008
PHONE:
SANITARY NO. CONTROL NO.
(510)533-7693
ARCHITECTIENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
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, an license is
INSTL 2 I LLMNTD DBL—SIDED MNMNT S GNS & 4 SETS OF
in full force and effectC ^i t C
License Class "1.� Le. A f Ll -�" q
NON— I LLNTD LTRS '
Date Contractor�L-d'rf tt9 u � .
ARCHITECTS DECORATION
ARROW SIGN CO. RE —NEWD BUS L I C # 2 2 0 5 3 7/2/8
I understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm That 1 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 consuticl, alter, improve, demolish, or repair any structure
Sq. Ft. Floor Area
Valuation
prior to its issuance, also requires the applicant for such permit to file a signed statement
law 9
' that he is licensed pursuant to the provisions of the Contractors License (Chapter
,- 0000
(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
3263407004 Number
Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars ($500).
❑ I, as owner of the property, or my employees with wages as their sole compensation,
ns Required Inspections
q P
will do the work and the structure is nolintended or offered forsale (Sec. 7044, Business
and Professions Code: The Contractor's License Law does not apply to an owner of
property who builds orimproves thereon, and who does such work himself or through his
own employees, provided that such improvements are not intended oroffered 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,).
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec. 7044, Business and Professions Coft) The Contractor's Li.
tense Law does not apply to an owner of property who builds or improves thereon, and ,
who contracts for such projects with a contractor(s) licensed pursuant to the Conrcactors
License Law.
❑ I am exempt under Sea , B & P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penally of perjury one of the following declarations:
❑ I have and will maintain a Certificate of Consent to self -insure for Worker's Compen-
sation, as provided for by Section 3700 of the Labor Code, for the performance of the
work for which this permit is issued.
❑ L 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 Workers Compensation Insuran carrier and Policy number are:
-.00E?3
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERSW 6
IFNSATION3,NS RAN
/�ie(m��(fhissccl
c o�,corTp�irokchundmddellars($110)
or less.)
I certify that in the performance of the work for which this permit is issued, I shall not
employ any person in any manner so as to become subject to the Workers Compensation
Laws of California. Date
Applicant
NOTICE TO APPLICANT: If, after making this Certificate or Exemption, you should
become subject to the Workers 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 attire that there is a conswctinn lending agency for the performance of
,
>
the work fur which this permit is issued (Sec. 3097, Civ- C.)
Z
Leader's Name
Lender's Address
jI
certify that I have read this application and state that the above information is
correcL I agree to comply with all city and county ordinances and state 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
n
liabilities, judgments, costs and expenses which may in any way accrue against said City
in consequence of the granting off his,permit.
Date
APPLICANT UNDER WNDS A WI 1 OMP Y WITH ALL NON -POINT
Issued by:
SOURCE
Re -roofs
Type of Roof
Signature o pplicanL/Corttractor Date
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Munici ai.Code. Chapter 9.12, and the Health and Safely
Code, section 25532(a)?
*All roofs- shall be inspected prior to any roofing material being installed.
❑ Yes b , o
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants armed by the Bay Area Air Quality Management
all new materials for inspection.
District?
❑Yes Nm
I have read the hazardous materials mquire mcrus un der Chapter 6.95 of the Cali fer-
nia Health &Safety Code, Sections 25505,25533 and 25534. 1 understand that If the building
does noermal a lenan4 that Lt is m responsibility to notify the occupant of the
rcyuirerimet priorlo' ce o(a Certificate of e.pan
Signature of Applicant Date
All roof coverings to be Class'n"' or better
Own -gcnl Date