03100147 CI TY OF CUPEWFINO
BUILDING DIVISION PERMIT CONTRAC COR INTORMATION <s
K,Nom..¢i .i• Y- ,
BUIL DING ADDRESS: CAL-NEON SIGN PERMITNO.03100147
`;711 HOMESTEAD RD
sR'S NAME: 1577 ALMADEN RD PERMITISSUEDATE
FRJ MANAGEMENT
"Eu (408) 289-1883 SANITARY NO. CONTROL NO.
ARCHM-C(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MP.CH
oo LICENSED CONTRACTOR'S DECLARATION
1 mF 1 hereby affirm Nm I am lienscd under provisions of Chapter 9(commencing Job Descrll�Q11
;ZW with Section 7fgllgof Dry'on f Ousin.sand Prufc lmC de,andm liccmcis .�rCe �w��®
in`c^Iorte anppffec �j'�j SIGN--GREAT CLIPS /rat
i Li ClassJ^
=� Date `onlummor DEC 1 9 2003
C TECTS O ATION
i < I undo tend m plans shall W used of public records
iau
'OgLicensed Professional
OWNER-BUILDER DECLARATION BUILDING
<y 1 hereby affirm that 1 am exempt from the Contractor's License Law for she
00 following mason.(Section 9831.5.Business and Pmfcasions Code:Any city or county
i m which requiris a Permit te construct,alter,improve,demolish,or repair any.orecmre
a z
Our sea its issuance,alw requires the applicant for such permit to file a signed arammcm
s0 IhmheisliecusedimrmmuotheprevisionsnftheCnmracwr',Licenselaw(Chapter9 Sq. Ft. Floor Area Valuation
ZF (commencing with Section 7")of Division Sof the Business and Professions Crone)or
3$ that he is exempt therefrom and the duo for dm alleged exemption.Any violation of 32610060 . 00
Section 7831.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not mom than Eve hundred dollars($500).
❑1..owner of the property,or my employees with wages m their sole compensation,
will do the work,and Ne suunum is not intended or offered for sale(Sec.704,1,Business
and Professions Code:The Conlncmr's License law docs not apply to an owner of Required Inspections
property who builds or improves thereon,and who does such work himself orthmugh his
own employe..provided that such improvements are not intended m offered Russia.It.
however,the building or improvement is sold within one year of completion.Ne owner
builder will have the burden of proving that he did not Wild or improve for purpose of
salt.).
I.as owner of the pmly,ar,am exclusively contracting with licensed contractors to
convect the project(Sea 704,1,Business and Professions Code:)no Contractor's Li.
me law docs not apply to an owner of progeny who Wilds or improves thereon,and,
who commem for such projects with a contractor(s)licensed pursuant te the Conwaor's
License law.
Fl I am exempt under Sec. B A P C for this umma
IC37MData
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of Perjury one of the following declanimns:
ave and will maintain a Certificate of Consent to self-insure for Worker's Compen-
,as provided for by Section 37 W of the Labor Code,for Ne performance or the
for which this permit is issued.
have and will mammon Worker's Compensation Insurance,u requited by Senior
of Ne labor Cade,for Ne performance of the work lnr wM1ich Nis permit is issued.
orkcr's ore a esti Insumnce carrier and Policy nu al Polic.y.N,o.: v
CER IFI ATE OF E%EMfTu`Om.�yyd^^dOM WORK RS'
J COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars($IIX))
or Ices.)
1 certify that in she perfurmanec of the work for which this permit is issued,l shall nut
employ any person in any manner an as an become subject to the Wo lmor'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of EaemPtma,you should
become subject to the Worker a Compc madon provisions of Nc labor Code,you must
Z; forthwith comply with such prnvism.to his permit Shall be decmcd mvoked.
ZO CONSTRUCTION LENDING AGENCY
1 Wmby affirm that then is a Construction lending agency for the performance of
1a > the work for which this Permit is issued(Sec.3017,Civ.C.)
IJ Q Lender's Name
1 Lcndcr's Address -
�z
;)p I certify Nu 1 have read Nis application and sono:that the&Wye information is
correct.1 agree to comply with all city and county mdoam es and stale laws relating to
V building convection,and hereby authorim mprenenmtives of this city to enter upon the
NU above-mentioned properly for inspection Purposes.
(Wc)egrce m u i mfy and kec0 harmless the City of Cupcnino against
-' fury Iiabiliues,ji dl ma d gooses which ay in any way same against mid City
Jz in consequence of th as fthispermit.
^� A PUCANT UN A S AND WI COMPLY WJTH ALL NpN-P NT I seed b Date
UR REGU (/
foo
Signature o ican omfatter D
HAZARDOUS MATERIALS DISCLOSURE ype of nor
Will theapplicaln.1 Rome.building occupant on"or handle 1 moduus materi
a,defined by the Cupemmn Muni a1 Code.Chapter 9.13,and the Health and Safety
'C.Swim,25531(4)] All roofs shall be inspected prior to any roofing material being installed.
ElYes No
Will the applies or future Gilding occupant are equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
I,hamrdnus air c onminants defined by the Bay Area Air Duality Management all new materials for inspection.
IYlriel'1
p Yea No
Ihave mad the Nous materiels requirements under Chapter 6.95 of the Califon
au.HcalN& e ,Saumr25515.25537 en 57,1.l understand thea if the Wildon
docs not cu mhove a tenant,Nm' is my fesihility te nattily the aeupans of c
he'ammca w h et d teiaaavm f Cfmamnraoan rj7 'g atu of Applicant Date
owe r I rived agent '!/v °(ate/ All roof coverings to be Class"B" or better
CITY OF CUPERTINO TT
BUILDING DIVISION - PERO
CONTRACTnRJNTORMA N
BUILDING ADDRESS: CAL-NEON SIGN PERMIT"°'03100147
OWNER'S NAME: 1577 ALMADEN RD PERMIT ISSUE DATE
lorE' (408) 289-1883 SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
too LICENSED CONTRACTOR'S DECLARATION O O O CF]
1 w❑ I Wfeby affirm that 1 am licensed under provisions M Chapter 9(commencing Job Description
1aW with Scctiun IIHkl)af Divi.on of BusincavnO Prafcssiu s Co de.an dm license is gm'
.�„ imm�mmeam fir« o SIGN--GREAT CLIPS F 1i ALE®
V O Dau Coa
j�� ` TEcsdi DE records
DEC 1 9 2003
,O U I undo and m plans shall be used as public s -
.aG Liccnscd Pmrcasional
3 OWNER-BUILDER DECLARATION
Conn ON BUILDING
n o 1 hereby affirm on 1 1. exempt from the Contractors License Law for the N
p O fallowingunes A (Section]COLS.Business and improve,
de nm Calc:Any city or county
m which rzyus u a permit to cnnsuad alter,improve,demolish,nr c a signed
ign d umetae
poothat he its issuancc,alsant to Om
theapplicantfor such Contrarmiuoicens,ga (Chapter
.i< (commecingitPurtion 70he pro visions of the Cmtranar'snd ProflawlC Cook)
Sq.Ft. Floor Area Valuation
21-a tow he its(commencing Sereian]WO)theDivisionafar of do, e B staged
eas xeandon.An,vi CWe)err
$ Nat he u exempt tMmlrom and the bazu for th<alleged eumption.Any violation of 32610060 . 00
Section 7071.5 by any applicant for a permit subjects the applicant to a civil Penalty of APN mwNumber Occupancy
a.,Iran Pane Y Type
El 1,u Owner of the property,or my empioyacs with wages az their sole compensation.
will Our du work.and the structurz is not intended or offered for sale(Sec.7044,Business
and Professions Code:The Contractor's License Law dors not apply to an owner of Required Inspections
prepeny,who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements art not intended or offered for sale.If.
Inoeveg Ne building or improvement is sold within one year ofCompletion.due owner-
builder will have the burden of proving that he did not build or improve for purpose of
ulc.).
0 h as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Profession Catk:)The Contractor's Li
cense law does not apply to an owner of property,who Wilds or improves theorem,and
who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's
License law.
[3I am exempt under Scc. ,B At P C for this mason
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury,one of the fallowing dcchis ions41 :
haw and will maintain a Cenificau of Consent to self-insure rot Worker's Coni
wortu provided far by Section 7]00 of the Labor Code,for the performance c r the
for which this permit is issued.
❑1 have and will maintain Wakef's COMPCrri luurance,u required by Section
77W of the Labor Cade,far the performance of the work far which this permit is issued. L�
My Workee Com cyton Insumnm artier and Palley nu at. �
Ca{ie/: Polity No.: _� L
✓/ CEft IFI ATE OF E(EMPfIO OM WORK S'
COMPENSATION SURANCE
This section nerd not W completed if the Permit is fm one hundred dollafa(S RaB
or less.)
1 certify that is the perf wernme t of Bic work for which this permit is issued.I shall not
employ any person in any manncrsn as to become Subject 10 the Workers'Compensation
Laws of C.lifomi..Data
Applicant
NOTICE TO APPLICANT:If.afar making this Certificate of Eaemption,you should
became subject to the Worker's Compensation provisions of the tabor Code,you must
�O forthwith comply with such provisions or this Permit shall be deemed revoked.�'y CONSTRUCTION LENDING AGENCY
1 hereby dlirm that there is a eartrucdnn kuding agnrty far the Performance of
x� the work far Which this permitisissued(Sec.709],Civ.C.)
Qsander's Name '
Z Lenders Add.,
;J Q 1 certify that 1 haw read this application and sure that the show information is
Fmacer.I agree to comply with all city and county Ordinances and state laws elating to -
V building constructma,and hereby authorise epreacntalives of this city to cnterapon the
a "hove-mentioned property,for inspection pur adi a
-. NO
ify and keep humlcss the City of Cupertino against
h liabilitif and which ay in enY way accrue agmnstaid City
JZ in cifitfthis Permit.A PLSAND W I COMPLYW/TH ALL N N-P NT I seed b Date
URP!/ � OOSignawmaicononraaor p
HAZARDOUS MATERIALS DISCLOSURE 5'ype 0 oaf
Will the applicant or future building accup nt smre of handle havarduus meed
as dcfincd by the CupeZM. al Code.Chapter 9.12.and the Health and Safetycode,seam zss7z(a) All roofs shall be inspected prior to any roofing material being installed.
❑tics Willbe aQplicauilding occupant use equipment ordcvicrs which If a roof is installed without first obtaining an inspection,I agree to remove
t hmardnux air c uminamu definad by the Bay Area Air Quality Management all new materials for inspection.
vin?
❑tics No
l have read thck rduus coned-Is mquiemenu under Chapter 6.95 of the Callfor.
T�qrdirrmmn
Health& a See, 2551D 25577 an 574.1 undcrsund that iftht Wiling _
t
note
ot eu m M1aw a¢mato,that' is my rte iM1ility m notify the eacupant art
w 1lyttu ct n'missuanc fa trip fica¢of Occup y%� n g/ a[u of Applicant Date
me , rivad agrnt p,u All roof coverings to be Class "B"or better
CITY OF CUPERTINO
SIGN
•CUPERTINO PERMIT APPLICATION FORM
APN# 0 / - U Date: lD
Building Address: i
Z06;d
Owner's Name: Phone#:
Contractor: License#:
C/ 1, LP-UA
Contact: vvt) Phone#:
Applicant/Contractor: l/
Building Permit Info:
Bldg Elect Plumb Mech
Job Description:
Residential: Commercial:
Sq.Ft. Floor Area: $/Sq.Ft.:
Architect/Engineer: Valuation: I b b
*Type of Construction: / Occupan Grou
,I
QtY• .f
A 1'c ]e Fee ID Fee Description Fee Group
BENERGY Ener BUILIDNG
BPERMFEE Bld Permit Fees BUILIDNG
1 BPLANCHK Plan Check.Fee BUILIDNG
BSEISMICOM Seismic Commercial BUILIDNG
l
EPERMTI'FEE Elect Permit Issuance ELECTRICAL
BREMSIGNAD Rmdl Si ns Add Branch ELECTRICAL
BREMSIGNS Rmd] Signs, Maz uee ELECTRICAL
BUSLIC Business License BUILIDNG
z 35
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