02030029CITY OF CUPERTINO .
BUILDING DIVISION
" X ' -- "' -
:' CONTRACTOR INFORMATION:'
PERMIT
+
BUILDING ADDRESS:
PERMIT NO.
10889 S BLANEY AVE
ALLEN SIGNS INC
02030029
OWNER'S NAME:
APPLICATION SUB DATE
PACIFIC RIM PARK, LLC
1982 STONE AVE
03/08/2002
PHONE:
SANITARY N0. CONTROL NO.
(408)280-6500
zo ARCHITECT/ENGINEER:
BUIIDINGPERMITINFO
BLDG ELECT PLUMB MECH
i LICENSED CONTRACTOR'S DECLARATION
1 hereby thn that 1 am licensed under provisions of Chapter 9 (commencing
]a
Job Description
I3
❑
m wi.hsection]000)ofDivisionJoftheBusincssandProfessionsCode,andmr canoe
",a,
InffOFC and [RKL
erO 5656
SIGN.( ILLUMINATED INDIVIDUAL
u«nae cls
CHANNEL LETTER )
Com
are 2 S DECLARATION
y ARChallW
SOGO BAKERY FINA ED
mSDECLAic card
.1 und<manv my plus shall be used as public rtcords
o Lmen dProfeaai.nal
:rre. OWNER -BUILDER DECLARATION
MAR 1 9 2002
1 hereby .(firm that I Ia. Lew form,
from the Contractor'sessiooe Any
I.S.exempt
c
< following reason. (section ]031Business and Professions Code: Any city or
❑ which requites a permit to mnsmcL alcor, improve, demolish, or repair m swaum
tructoy
far
m _ prior m its caaurae_also, rcquirrs theapplicirm such pimtiuo fl ... i ad,mumml.
- thai11C,tihchaedpursuaftraft'Ifo`isiamoftheConamemesLicenseLaw(Chapam9
(mmmentio Division3oftheBµsinessaMProfesslons
S Ft:FloorArea,, -----------
9.'f+
gwMSKtion]000)Of Cod,)
or that he is exempt theicfrom'and the basis for the dcmptibd.
+ .: - k ;• .[ion
k " • 'I" ' "' C -'v ' • ' 1„l 18 U
all(ged Any violation
-of Section 9031:5 by any applicvn, for a pennit subjects the applicant to o civil penalty
re m
tof not moan eve hundred dollars (5500).
p,pj.� �N,�
3 6 93 § l) U �b�0 Occupancy Type
❑ 1. as owner of me property. or my employees with wages es their sole compensation,
will do the xMrk; and-me"swcmte is not intendedor Offered' for sale (See 7044,
'Business add Professions Cale: The Contractor's License Law does not apply to an
101 - FOUNDATtMired Inspections
owner of propsny Who builds or improves thereon, end who docs such work himself
Or In gis his awn employees. provided that such imp_mye:pents art not intended or
ofreid Tarsale. IC however, rise Ivihsir -- - -iovement is sold - within one
garimp w
10,3... - UF.ER.
- -- . _.. ---.. _ ._ ..... _.. ... .... . ... ..... _,-.:__.;.-
v=d, of
+completion, the owner -builder will have the burden of proving N he aid not build or
104 - REBARet
improve for purpose of sale.).
__..........._._. _...._.--_..
105 - ANCHOR BOLTS
prox r r gwitn r,m:<a aanaa,wrs h;�
❑Las owner Pojee 0044. exclusive( cProfirn
- consumer the pmlea (sec. 7060. Business vise Profession. Cade:) The Cvnuaaor's
--.. __-... .... .._.
304 - ROUGH ELECTRICAL ' , ._ .. .... .
License taw does nor apply.. an owner of property who builds or improve. thereon,
,: ,and.whis contracts for such projects. with a mucme orts).licensed.pursuam to.the...
505 — FINAL ELECTRICAL-
-..
Contractors License Law"
❑lam eaem reneersa. " "''" •'
�`" :B&PCfor
_ ..- LIC' WORKS'--- -._ ....._--.__..
514 - FINAL P _ -..------__..-
P this reason
t.
- Own. ..:,!s. .:n.' Dam' .. �.. .. ..'
WORKER'S COMPENSATION DECLARATION
�I hereby ef0rm under penvby ofpe jury one otthe fallowing dttlamrions:
1 have end will maintain a certificate of Conaen, to'self-insum for Worker's
CvmpeismIran. as provided far by Section 3]00 of me labor Cade, far the
- pcAmmmce of the work for which this permit is issi
p,(1 have and will maintain Worker's Compeninion lesurmce, as mGuired by Section
" " 3]00 of the Labor Code. for the work
pe:iarm a of the fee which this permit is
issued. My W rke s Compcwt Ina 'cam end Pol y n mWr ere
Card PoI ,y Na 3'3Z r�ocroa Wiz'
- -
t CERTIFICATION OF EXEMPTIONhl<OM'.wORKERs I"
, r171 '
._.'.... COMPENSATION INSURANCE..,:.: 1-I' •
.. _.._ ....... ,, .. . .
--,....__.__.."--_...._.-
' section ncN not be romPlaed if the Permit is for one hundred collars
-- ----------
+ -- -- - - ---
10 les
(5100)or orkssJ
..
• 1 termthatthepe f .nee work f issued 1
"- "`-'• • � •+
mth
sit 11 ( lnpl y any
y person any manna - io become subject r me Workers
'Cpmpcwnon
lives f California'. Dare
Applicant
-
N ptio
APPLICANT If, Nor making shit Certificateof
come subject
subjca to theWorkersuch is Compc the U Code, you must
thisi provisions of de, you trust
�become
or
fonhwitn comply with such provisions or this permit shall b, deemed revoked.
a deemed re
'• - ' : CONSTRUCTION LENDING AGENCY ...• •,' ",
.._ - .. .. -_ .. ...._ .. _ _ _
I hereby aRirrr that these is a comtmnion;ending agency for the performance'
I ofthe work for which this permit is issued (Sec. 30. C)
Civ
IUnder'., Name v :.:.... ... .. . ......9];
... .,....:.. L...,.::.:..'.
._.
Lender'. Address '
-
1certify that 1 have read chis epplicnion and lr a met the above infmmalimit is
'
cdma 1 agree to comply wish all city and countyorLinarces and state laws mlating
m building construction, td hereby euthonie repreuntatives
of this city to enter upon
the above-mentioned property for inspection purposes.
(we) agree to save, indemnify and keep harml,se the City of Captions, igelnst
' liabilities. judgments, costs and expenses which may in any way
accrue against said
City in am i,stru a of the Starring of this pemtr:
a.
APPLICANT UNDERSTAAD AND HILL COMPLY WITIf"A OINT
n
1 01,/
Issued
by: atev"
�Immn,
Da;Re-roofsATERIALS DISCLQSURE'':"lding
occupant store or handle hariidbus material
as defined by the Cupertino Municipal Code, Chapter 9.12, and me Health and safety
Type of Roof
Code, Section 255J]lal].,; -. ., ..
Yes
- -
w II the applicant i ! tore Wilding ac p i use equipment or gMiami venin,
d:us arconm - is asd fined by shell yAmaA Qyny Management
All roofs shall be inspected prior to any,roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
,,,
/D'a'm" ❑Y.N
all new materials for inspection. Applicant understands and will comply with
..
all non -point source regulations:'
1 have read me harudom maenads requirements
-Mer Chaper 6.95 of ire
Califomia Health tit Safety Cade: Sections 25505:25533 end 25530. I understand the,
"
if the building docs not currently have a tenant, that it is my responsibility to notifyth0
occupant make requiremern which must be
..
- 3
met priori issuaned f a Certificate of
Occupancy
�-- 3 _
�/
u
,Signature ophcant Date _. .
All roof coverings to be Class "R" nr hPrfPr
O iter ed get , I Date
...OFFICE
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BIANEY AVENUE
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CITYOF
s prERO NO
BUILDING
CONTRACTOR INFORMATION:
BUILDING ADDRESS:
PERMIT NO.
10889 S BLANEY AVE
ALLEN SIGNS INC
02030029
OWNER'S NAME:
APPLICATION SUB DATE
PACIFIC RIM PARK, LLC
1982 STONE AVE
03/08/2002
-HONE:
SANITARY NO. CONTROL NO.
(408)280-6500
ARCHITELTIENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MF.CH
I I CJ f.__j I_J
LICENSED CONTRACTORS DECLARATION
Job Description
1 loosely affirm that I am licensed under provisions of Chapter 9 (commencing
p
with Section 7001ofDivision 3ofmaBr,ocos Oil Prme„i sCoda.anemylicense
SIGN. ( ILLUMINATED INDIVIDUAL
"'
'a
"Live.'"` 150af
_ Lic..
CHANNEL LETTER)
Date Z ARCHITECT'S DECLARAT,9 1—
SOGO BAKERY
. I understand toy plan., shall be clod as Public rccurds
Licensed Prufexsinwl
OWNER -BUILDER DECLARATION
1 heaby affirm no, 1 nm exempt from the Contmermr's License Law for the
following reason. (Section 703),5. Business and Professions Code: Any city or county
which exclaims a permit to con.ttract, alter. Improve, demolish, or repair any structure
. prior to itsalso notturex due applicant for such Permit to file a signed statement
_
thatrmcing with
pu on the pia of Chet BViresLcensetaw (Chapter,Cod)
(comm die s en ]000) T Division a rt Me Bgs ess and Pforeseions Code)
5 Ft-. Floor Area, V ation
i♦ - j 7 tI' ;' 'e,
or Any violation
tie is exempt therefrom and the basis Portia all gid cacmpnt
t, ry t Y 1 t i p� 4 $ 1 8 d�
'r'
ileo
-of SmionQ03 P.5 by any applicant for s permit subjects the applicant m a civil penalty-
to
;prnptmprtthan Ove hundred dolens (s56n).
Ap
3 6 9 3 4N ]Vllrttbe70ncy= pe
�j jZ}(j (rl U
01, as owner of the propeny, pr my employees with wages as their sole competnaion,
will do'the -vowkf and the-structure'is not intended' or offered' for' sale (Sec. 704,1,'
- - -- -- - - !
'Blotters'and Professions Coda: The Contractors License Low dues not apply man
101 - FOUNDAT � Mgired Inspecti ' • -
owner of propeny Who builds or improves themon, and who does such work himself
or doo. h h a vinyees. prov dee al t h -„p n met t intended
-dtTe '.p _y2
]- 0.3_.._-... LIFER.
d'r ITh-wFver. the budd"ng met Id'within a .f
completion,
completon,the awner-Wlder will have the burden or pmvmg that he did not Wild or
_....____....-.-. _ .___...-. ._. BUILDING (��'p ---------
__ _._
`
104 - REBAR '<'BUILDING '
improve for purpose of sale.).
105 ANCHOR BOLTS
theproperty. am ex sines contracting
exclusively gwnneeenuanpntmnprsm
111. asownerthe
- - -
- 304 ROUGH ELECTRICAL
construct the project (Sec 706a, Business end Professions Code) The Contractor's
pr
License raw does not apply to an owner of property who Wilds °r improves thereon,
� , .'-
5 0 5 — FINAL E LE C TR I CAL'
..and who contracts for such pmjcas. with a. comracmr(s). licensed. pursuant to. the.
_._...__.._ ._
Contractors License law. .., ,t,t.ti _ ;.
... ..
14- _- FINAL -'-PUBLIC WORKS"--
01 a.
❑IomacmptunderStt. B'&PCfor this reason
.., ; i1'1,1,'ll:�l,"1
Owner ,lir Data"
WORKER'S COMPENSATION DECLARATION
I hereby affirm under, pewhy of perjury one,ofthe following declarations:
01 lh vm and will maintain a Cenifciiuc of Consent to self -insure for Worker's
Compensation, as provided for by Section 37W of the Labor Code, for the
performance or the wod,for which ,his, runit is issued. .
;I now and will niainim Worker's Compensation Insurabr<, as required by Section
J 00'oPtne Labor Code, forthe, M -work for
performance the which this permit is
slued My Wallis, Compe t Inium <e carrier ane Policy number art;
y's
.or.. :l Policy No.
'
t CERTIFICATION OF EXEMPTION FROM WOR
COMPENSATION INSURANCE o
tIbi: anion tilled not W2ymMnee ifale Permit is for one nnnarea altuam
`•, .' 'i 'r'.. , ::.:�
fE100)pr lc�s.)
,.
an ntlion.i a - file t��t".uedT
__..-.. .,•.". •�. ,,�
ill.,
shall of employ any pimp any m become subject to Ne Workers -
as. u ct orkers
r t,a>,I
Compensation Laws
Comped. et nLiwe ofCalifornia' Dale
NOTICETO APPLICANTIf flat tm,k ovnfc fE pt you should
"-
ro the Workers s Com ri
,Pere provisions fifth labor Case, You t
becomeis
cosubject
id; 1In
from with comply with such pmvixions or this permit shall W dttmed rtvpk<J.
` ' CONSTRUCTION LENDING AGENCY
h b) that the« sm rivet lend g sgen y f the pc'f rmance'
ofthe kf° ohhi'h ih pe tt s (Sec J09]C' C.)
f
. .. e .' -.-
..
Lenders Nam _ ...
Lentler'a Address ,
certify that l have read this application sand state that he above information is
'
nI
iuest: 1 agree to comply with all city and county,ordinances and state laws misting
Wilding construction: and hereby authoBie repmsdnmtives of this city to enter upon
the above-mcmioned property for inspection purposes.
we) agree to save; indemnify and keep harmless the City of Olpenino igainst
Vate*Wv
liabilities, judgmen«, cons and expenses which may in any way accrue against said
Cit nco
APPLcAN`rUNDERSTA ID tA\DWIILLCOMPLYP'TTHALL Or�T
c L '
h
Issued by:
"is
//Op/'yyD
gURe
'l pp scam °nttactor '. •: tI t Dnl-,
”. H ABOGUS MATERIALS DISCLOSURE t ;', IJ
Re -roofs
. ' Will the ' t f tu« W (ding « pot storerS die hazard ui maledal
asdefnedbytheCpenn
_Type Of ROOF
Municipal Code Chapter912 ❑the Health andSfety
_... --- - - ---• .._._ „
Cade Sect ° 45532(8?", t, f F t -
DY. :.IN I: d`I ,fill i
. Z, t f
I.
-t
roofs.shall be Inspected prior to_any roofing, material being installed.
wh m �pI r «b is g« p t useequp t e sieas which
it f ndo mar t claimed by the Bay A. A, then ty Managcmem
If a roof is in s[alled'without first obtainin an'ins ection; I'agree to remove
g p
ov s t�nn
all new materials for inspection. Applicant understands and will comply with
�t -
all non point source iegulauons. " 1
'
I h ad the h d s t dols q rements under Chapte - 6.95 of due
l -'
Califo a Health & Safety Cad S' uo s 25505:25533 d 25530 1 understand that
(1hc Wilding not c antly a tdant that it yresponsibilityt' notify the
7—D ._.... ._—. _. ._ - _3`"
P, ilrms whi
cedp t of the «quiremenrt titch must tie met p io t issue a f Cert Bate or
' `..-...
- , t -
OccupancY .:n ... ...
_'
Signature o�tj�ppllcant Date
All roof coverings to be Class "B" or better "
o""` m zed ee t ' c,
,
OFFICE' - - --