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CITY OF CUPERTINO
DIVISION PERMIT
BUILDING
BUILpI6G gQ[2R N
WOLFE RD # 214 8
1NAGM�SE:
ALLEN SIGNS ,INC
PERMIT NO.
08060024
OWNEWS
PERMIT MUE DATE
CUPERTINO SQUARE LLC
1982 STONE AVE
06/04/2008
PHONE:
SANITARY NO. CONTROL NO.
(408)280-6500
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
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, and my license is
INDVDL CHNNL LTR SIGN
in full a Cl and effpa., L Lic. ,
License CIa3s �` ..//
ALLEN SIGNS RENEWD BUS ' LIC 6/4/8
Date fr< Contractor N
ARCHITECTS DECLARATIO
1 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 7131.5, 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 Cor such permit to file a signed statement
Contractor's License Law 9
Sq. Ft. Floor Area
Valuation
that he is licensed pursuant to the provisions of the (Chapter
$2000
(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
316 2 010 0 dumber
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).
,�E�
❑ 1, as owner of the property, or my employees with wages as their sole compensation,
Required Inspections
q
will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business
and Professions Code: The Contractor's License Law does not apply to an owner of
property who builds or improves thereon, and who does such work himself or through his
own employees, 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. 7144, 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 contracts for such projects with a contractor(s) licensed pursuant to the Contractors
License Law.
❑ 1 am exempt under Sec. B & P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
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'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.
11
have and will maintain Worker's Compensation Insurance, as required by Section
3 of the Labor Code, for the performance of the work for which this permit is issued.
My Workeress'-Compensauon Insura�ntc-e carrier and Policy nu�mb'er�am(:
Tas -J S ��
Cartier: f%iii% lo)"s Policy No,: �{�(_L�?
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is foronc hundred dollars ($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 mannerso as to become subject to the Workers' Compensation
Laws of California. Dale
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of 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
1 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.)
Lenders Name
Lenders Address
j 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 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
j liabilities, judgments, costs and expenses which may in any way accrue against said City
' in consequence of the granting of this permit.
7 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALJ NON -POINT
Issued by: Date U�
SOURCE j ATI NS.
r
Re -roofs J/
of Roof
Signature fAppli t/C tractor Date
RDOUS MATERIALS DISCLOSURE
AZType
Will the appiican or future building occupant store or handle hazardous material
as defined by the Cupertino Mum foal 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.
El Yes 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 haz2rdous air contaminants dcftncd by the Bay Area Air Quality Management
all new materials for inspection.
District?
E] Yes No
I haveread the hazardous materials requirements under Chapter 6.95 of the Califor.
nia Health & Safety Code, Sections 25505, 25533 and 25534.1 understand that if the building
—
does not currently have a tenan4 that it is my responsibility to notify the occupant of the
requirerpe-Ls w ich m met priorto issuance of a CenifiPte n apaney.
Signa ure of ppl eat Date
C�
All roof coverings to be Class" .`' or better
Dale -
Ow er/ora )hart .ed agent