080200060z
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CITY OF CUPERTINO
BUILDING DIVISION PERMIT
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BUILTRg,6'kEVENS CREEK BLVD
A —ACTIVE SIGN CO
PERMIT NO.
08020006
PERMIT ISSUE DATE
BYER PROPERTIES
169 MEDFORD AVE
02/01/2008
PHONE:
SANITARY NO. CONTROL NO.
(510)481-8948
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby alarm this I am licensed under provisions of Chapter 9 (carnmendng
withSection7000)ofDivision3cdtkBusinessandProfessionsCode,andmylicenseis
INSTL 1 SET OF LED ILLMNTD CHNL LETTRS "WOLFE
in full force and eft
License Class Ix, t q
CAMERA" & ONE BLAD SIGN . A -ACTIVE RNEWD BSL 2/1/8
Date - C7 Contractor
ARCHITECTS DECLARATION
1 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 mason. (Section 7031.5, Business and Professions Code: Any city or county
,
which requires a permit to cmnsu'ttct. alter, improve. demollah, or repair any structure
prior to its issuance, also requires the applicant for such permit z file a signed statementthat he is licensed pursuant to the provisions of the Contractor's License Law (chapter 9
Sq. Ft. Floof Area
Valuation
(commencing with Section 7000) of Division 3 of the Business and Professitrns Code) or
2 5 0 0
that he is exempt therefrom and the basic for the alleged memption. Any violation of
3 5 9 0 8 018 �) umber
Occupancy
P Y Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civ0 penalty of
not more than five hmdmd dollars (S400).
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❑ I, as owner of the property, or my employees with wages as their sale compensation,
Required Inspections
will do the work• and the structure is not intended or offtued 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 himaelror through his
own employees, provided that such improvements are not intended or offered for sale. If,
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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
concoct the project (Sec 7044, Business and Professions Code:) The Cootraetmrs Li-
cense Law does not apply to an owner or property who builds or improves thereon. and
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who contracts for such projects with a conuactor(s) licensed pursuant to the Contractors
License Law.
I am exempt under Sec , B k P C for this reason
Owner Date
WORKERS COMPENSATION DECLARATION
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I hereby affirm under penalty of perjury one or the following declarations
❑ I have and will maintain a Certificate of Consent to self -insure for Workers Compel-
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sadon, as provided for by Section 3700 of the Labor Code, for the performance or the
work for which this permit is issued
❑ I have and will maintain Workers Compensation Trimmer. as required by Section
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3700 or the Labor Code• for the performance of the work for which this permit is issued
'
My WorkLtsumince carrier and Policy number am:
keersC-o�m�p_ensation
Caries: *11ti— Policy No.: —
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
- (This section raced not be completed lithe permit is for one hundred dollars ($100)
or less-)
I cerufv that In the performme of the work for which this permit is issued, 1 &hail not
employ any person in any manner so as to become subject to the Workers' Compensation
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Laws of California Date
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of 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 mvokccL
CONSTRUC770N LENDING AGENCY
I hereby affirm that there is a eortrimcdon lending agency for the performance of
the work for which this permit is issued (Sec. 3D97, Civ. C:.)
Lenders Name
,
Lenders Address
I certify that I have read this application and state that the above informatiun is
correct. I agree to comply with all city and county orlinaoces and state laws relating to
building construction, and hereby authorize representatives of this city to enter upon the
&hove -mentioned property for inspection purposes.
(We) agree m save, indemnify and keep harmless the City or Cupertino against
liabilities, judgments, costs and expenses which may in any way accrue against said City
incononce of the granting of this permiLUNDERST NDS AND WILL COM Y WITH ALL NON -POINT
Issued by: DateSULA
N _
Re -roofs
Type of Roof
' -o
Signature of Applicant/Conuactor Date
HAZARDOUS DISCLOSURE
Will the applicant or future building occupant store or handle hr®rdous material
as defined by the Cupertino Municipal Code, Chapter 9.12. and the Health and Safety
Code, Section 25532(a)?
All roofs shall be inspected prior to any roofing material being installed.
❑Yes ®No
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 harardous air contaminants as defined by the Bay Area Air Quality Management
all new materials for inspection.
District? \
❑Yes �No
1 have mad the ha rlous marcrials reWimments under Chapicr 6.95 or tine Caliror-
nia Health k SafelyCode, Sections 25505. 25533 and 2S534.1 understand titan If the building
d no unently have tenant. that it a in risibility to notify the occupant of the
uimm rats which inbe met p issu r;ccriricato or Occupancy.
Signature of Applicant Date
. All roof coverings to be Class "B" or better
Owner or at dtorized agent Date