070400853 Z
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CITY OF CUPERTINO
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BUILDING DIVISION PEiA
LQIQ _
6U1L I G ➢ ESS:
�1���.5 N WOLFE RD
/
PERMITNO.
0 ��L
07040085
OWNER'S NAME:
PERMIT ISSUE PATE
CUPERTINO SQUARE LLC
1051 45TH AVE
04/24/2007
PHONE:
SANITARY NO. CONTROL NO.
(510)533-7593
ARCHITECTIENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
I hereby licensed Chaplcr
Job Description
affirm that I am under provisions of 9 (commencing
withScct(on70W)ofDivision3ordlcBusinessandProfassionsCodc,andmylicenscis
INSTALLING ILLUMINATING SIGNS ( 12) ARROW
in full race and effect.
License Class Lic. 0
SIGN
Date Contractor
ARCHITECT'S DECLARATION
CO RENEWED B/L ON 4/ 10 / 0 7
I understand my plans shall he mcd as public records
Licensed Professionai
OWNER -BUILDER ➢ECLARATION
I hereby affirm that 1 am exempt from the Canlracloel License Law for the
following reason. (Section 74131.5, Business and Professinns Code: Any city or county
which requires a permit to construct, alter, improve, demolish, or repair any structure
'
prior to its issuance, also requires die applicant For such permit to file a signed statement
that he is licensed pursuant to the provisions of Lite Contractor's License Law (Chaptct 9
Sq. Ft. Floor Area
Valuation
(commencing with Scc6on 7000) of➢ivision 3 of the Business and Professions Code) or
$ 2 3 0 0 0
that he is exempt therefrom and the basis for the alleged exemption, Any violation of
Number
T
Occupancy Type
Section 703L5 by any applicant for a permit subjects the appiican( to a civil penally of
not more than rive hundred dollars 3S00).
316 2 0 0 3 7
[] I, as owner or the property, or my employees with wages as their sole compensation,
- Required Inspections
(1 P
will do the work. and the structure is not intended or offered for sale (Sec.7044. Business
and Pmfessions Code: The Contractors License Law does not apply tm an mwncr of
property who builds or improves thereon, and who does such work himself or through his
1
own employees, provided that such improvements are not intended or offered for sale. If,
however, the building or improvement is sold witht one year of complclion, the owner -
builder will have the burden of proving that he d' not build or improve for purpose of
sale.).
owner or the property. a lusiv y c trotting with licensed contractors to
onstru. the project (Sec. 7(394, in and ofessions Code:) The Contractors Li-
ccnsc Law does not apply an ncr pro, y who builds or impro+rcs (hereon, and .
who cartracts For such p ens ith a on tors) licensed pursuant to the Contractors
License Law.
❑ i am exempt and
(rA `J
Owner Date
W iZ PBNSATION DECLARATI
1O
I hereby limt untie salty of perjury one of the following declarations:
❑ I hsm and will maintain a Cenificare of Consent to self -insure for WoducesCompen-
sation, as provided for by Secsien 3700 of the Labor Code, for the performance of the
wort for which this permit is issued.
❑ I have and will maintain Worker's Compensation Insurance, as required by Section
370D of the Labor Code, for the performance of the work for which this permit is issued.
_
'
My Workers Compensation Insurance carrier and Policy number are:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INS CE
{this section need not be camplc if ih t i; r one hundred dollars (S 100)
or less.)
I comfy tltat in the performance o o C Bch this permit is issued, I shall not
employ any person in any mannc bjecl to Lhc work ' Com nsation
Laws ofCaiifornia. Dose /
Applicant
NOTICE TO APPLICANT: , apdr g n� es to of Fxcmpt(en, you should
become Wor
subject to the ompc t' provisions or the Labor Code, you must
forthwith comply with such provisionss s /rind sh II be deemed rewired.
,
CONSrRD AGENCY
I hereby affirm that [hen: i j o Co nding agency for the Performance of
the work for which this permit i 7, Civ. C.)
'
Ci
Lenders Name
Lendees Address
I unify that I have rra ihi application and stare that the above information is
'
correct. I agree to comply with all city and county rd( sees and stale laws relating to
'rP
building cmnswction, and hereby autho rcpr cot ws of this city to enter uPon the
..
above-mcnooned property for inspec' n pu sits.
(We) egret to save. indem.' y and cp Irss Nc City of Cupertino against
liabililics, judgments, casts and stases is any way accrue against said City
in corsequence of the gm n f this mi
APPLICANT UNDEASTA Dom( OMPLY WITH ALL NON -POINT
Issued by: Date
SOURCE AEGULA770N .
- Z 5
Re -roofs
Signature of Applicant/IL`o clo)S' Date
➢o MATERIALS DISCLOSURE
Type of Roof
Will the applicant or IMum building occupant store or handle hazardous maurial
as defined by the Cupenina unicipil Code, Chapter 9,12. and the Hcalih'and Safely
Cott:, Sccti01 2553i(a)?
All roofs shall be inspected prior to any roofing material being installed.
❑ Yes
rul�
If a roof is installed without first obtaining an inspection, I agree to remove -
Will the applicantobuilding occupant use equipment or dcvicu+rh'sch
cmitha?ardoos aircontaminan as defmcd th ay Air Quality Management
all new materials for inspection.
District?
❑ Yes u
1 have rcad the ha7ard qen Ls under Chapter 6.95ofthe Califor-
'
niaHcafth&Safety Code. 6 5 d25534,1understand ihalirthe building
does not currently have L. t i pnsuibility to notify the occupant of the
mquiremcntswhich m me I arecoraC ' IZVp!6y4
Signature of Applicant Date
All roof coverings to be Class "B" or better
Owner or authuriz ag t Date,
•
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CITY OF CUPERTINO
��•t � �: ,_{ � k ��;. Y �r. T�T�
BUILDING DIVISION PET
lfyTl.TilJ li`[��T�
�.f
5001,10 ADDRESS:
PERMIT NO.
10123 N WOLFE RD
P.S. SERVICES, INC.
07040085
OWNER'S NAME:
PERMTT MUE DATE
LANDMARK PROPERTIES
2820 E GRETTA LN
04/24/2007
PHONE:
SANITARY NO. CONTROL NO.
(714) 683-1120
ARCHITECTIENGINEER:
BUILDING PERMIT INFO
BLDG ELECT mums MECH
LICENSED CCNTRACTOR'S DECLARATION
I hereby licensed Chaptce
Job Description
affirm that I am under provisions of 9 (commencing
with Secfion7000) of Division 3 ofthc Business and Profesflons Code, and my licenscis
INSTALLING ILLUMINATING SIGNS (12) P.S. SERVICES
in full farce and effect.
License Class Lic.o
IS THE NEW CONTRACTOR: ARROW SIGNS DID NOT DO THE
Date Contractor
ARCHITECTS DECLARATION
JOB. .. _
i understand my plans shall be used as public records
Licensed Professional
OWNERBUILDERDECLARATION
I hereby affirm that I am exempt from the Contractaes License Law for the
following reason- (Section 703 LS, Business and Professions Cade: Any city or county
which requires a pemu to construct, alter, improve, demolish. or repair any atnrpure
'
prior to its issuance, also requires the applicam lot such permit to file a signed statement
that he is licensed pursuant to the provisions of the Contractors License Law (Chapter 9
Sq. Ft. Floor Area
Valuation
(commencing with Section 70DO) of Division 3 of the Business and Professinns Cadc) or
$ 2 3 0 0 0
that he is exempt therefrom and the basis for the alleged exemption. Any vialadun of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
�-,l Number
A
Occupancy Type
not more than five hundred dollars (S5W).
3 1 6 2 0 0 3 7
❑ 1, as owner of ttie property, or my employees with wages as their sole compensation,
Required Inspections
will do the work, and the Structure is oat intended Or offered ror sale(Sec. 7044. Business
and Professions Code: The Conuactoes License Law does not apply to an owner of
e q p
property who builds or improves thereon, and who does such work himself or through his
awn employees, provided that such improvements ate not intended or offered for We. If,
however• the building or improvement is sold within one year of mmpietion, die owner -
builder will have the burden of proving that he did riot build or improve for pdgxnc of
sale.).
❑ 1. as owner of the properly. am exclusively contracting with licensed contraerora to
construct the project (Sec 7044. Business and Professions Cade:) The Contractors Li-
cense Law dots not apply to an Owner of property who Wilds or improves thereon, and.
who contracts for such projects with a contraerar(s) licensed pursuant to the contractors
License Law.
❑ I am eacm pt under See. , B & P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of pery'ury One Of the fallowing declarations:
❑ I have and will maintain a Certificate of Consent to self -insure for WorkersCompen-
sation, as provided for by Section 3700 of the Labor Code, for the performance of the
work for which (his permit is issued.
❑ 1 have and will maintain Worker's Compensation Insurance, as required by Section
3700 of the Labor Code, for the performance Of the wort for which this permit is issued
'
My Workers Compensation Insurance carricr and Policy number art:
.
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if ore permit is for one hundred dollars (f 100)
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 mannerm as to became subjeca to the Workar3 Compensation
Laws of California. Date
Applicant _
NOTICE TO APPLICANT: Ir, arier making this Certificate of Exemption, you should
become subject to the Workers Compensation provisions of the labor Code, you most
rOrthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm dial diem is a consuuctian Lending agency far the performance of
the work fur which this permit is issued (Sec, 3097, Civ. C.)
'
Lender's Name
,
Lender's Address
I certify that I have read this application and state thal the above tnfonoafion is
-
correct, l agree to comply with all City and county Ordinances and state laws relating to
building construction, and hereby authorize rcpmscntadvrs of this crty to enter upon the
above-menriuned property for inspection purposes
(We) agree (o save, indemnify and keep harmless the City of Cupertino against
liabilitics.judgmants. costs and expenses which may in any way accrue against said City
in consequence of the granting of this permiL
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCE REGULATIONS.
Re -roofs
Type of Roof
Signature of Appliranr/Conrracyor Date
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant Or future building occupant store orhandle hazardous material
as defined by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safely
.
on25532(a)7
Code,SYes
All roofs shall be inspected prior to any roofing material being installed.
❑ Y❑No
If a roof is installed without first obtaining an inspection, 1 agree to remove
Will the applicant or future building occupant use equipment or devices which
emit bazardous air contaminants as defined by the Bay Area Air Quality Management
all new materials for inspection.
District?
❑ Yes ❑ Nu
Iliart read the hvar&vs materials requimmimis under Chap(" 6.95 of the Califor-
nia Health & Safety Code. Sections 25503, 25533 and 25534.1 understand that if the building
does not currently have a Errant, that it is my responsibility to notify the occupant or the
requirements which must xMet prior loissuance ofaCertificate ofOccupancy.
Signature of Applicant . Date
All roof coverings to be Class " B" or better
'
Owner or authorized agent Date