07110059 CITY OF CUPERTINOw s .�ask.a";me
BUILDING DIVISION PERMIT CONTR'CT"T.OR IN'F'URMATIOIV . ;
PERMITNO.
BGILtTD;tGNffEs� DE ANZA BLVD #175 GLEASON SIGNS 07110059
W NER'S NAME: PERMIT ISSUE DATE
HUNTER PROPERTIES 521 E MAIN ST 02/15/2008
HONE: SANITARY NO. CONTROL NO.
(559) 625-4092
ARCHIIEC(ENGINEER: BUILDING PERMIT INFO
BLDGO ELECTO PLUMB MECHO
30 o LICENSED CONTRACTOR'S DECLARATION Job Description
U I lereby afarm that 1 am licensed under previsions of Chapter 9(commencing
^_ wimS.tion)OM))of0ivision7ofdeBuainessandProfcasiaaCode,aedmyliccrmsais REMOVE (E) SIGN. REPLACE WITH NEW ILLUMINATING
n full forte and erc
28z uean�c7�L-. A Z CHANNEL, SIGN.' -
Dabe Contracsar .404
G ARCH1MC-S OECLA '
G 1 understand my plans Nall W used as public records
7w� Licensed Porfcaional
ho OWNER-BUILDER DECLARATION
9 i S I hereby affirm that I am exempt from Ne ConuenaYs License Law for the
D o following teason.(Section 7031.5,BUSlocss and Imieeaiom Code:My city an county
$ which tequlres a permit to convect,also.improve.demolish,or repair any saucture
prior m its isaus ee.soon requires tie applicant forsoch permit m Bk a signed YatemCm
£ Nat he ulimacd pursuant to me pmviaimu of time Conuactars Lamrmsa law(Chapter9 3q.Ft. Floor Area $5500 Valuation
m(�9 (commencing with Section 7000)of Division of tie Business and Professions Codc)car
Q
that he is exempt therefrom and the basis for the alleged exemption.My violation of
Section 7051.5 by any applima for a permit subjects the applicant to a civil penalty of
rat mart Nn ave hundred dollars(50 35918058 Afji Number Occupancy Type
❑1,as owner of tW property,an my employees with wages as their sole compensation,
will do time wmkand the structure is conamrnded or offered farsde(Sec.7044,Business Required Inspections
and Pmfesala
oa Code:The Contractor's Lievmu Law dons rom Ct apply an owner or q p
progeny who Wildaurimpre.thcmr.and wW doasuch workle uuelf mtlumith his
own employers,provided Nat such improvements see not Intended moffoeL fmass.If,
however.time building or improvement is sold within one year of mmple ion,the owner-
Wllder will have dee EuNen of proving that he did mu build or improve for purposes of
ule.j.
❑1,a awry of the property,am exclusively contracting wide licensed canuacton le
common me preject(See.7044,Business and Professions Cede:)The Conuscmra U.
cease Taw does not apply to an owner of property wW W ilds or impruvas thereon,and.
who contracts for leach projects with a conuacmrt0 licensed p.m.,is the Conuacmfa
Licence Law.
❑Iamaemptundn See ,B&PCformismason
our
Data
WORKER'S COMPENSATION DECLARATION
1 hereby afro under Penalty of perjury erc of the following dttsntiow
71 I have and will maintain a Certifiws of Consent be salf-lasum for WankersCompen-
cation,a provided for by SeNnn 37M of the labor Code,for the performanee of the .
wank for which this permit u Issued.
❑I have send will maintain Workers Compensation Inmrana,as requited by Seeman m _
3'1110 of the Labour Code,for the performance of the work fmwhieb this permit s beho l
My Worker Co Pen on Date c tori.and Palig numbs am:
Curler.�Pali y Na.: 178 XI4077
CERTIFICATE-OF F EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thsscmion need mtbccomplc sad if the Permit is Intend hundred dollars(5100)
or leu)
I emery that in me prom...of me wmlt for which this permit u issued.I shall nut
employ any person in say manner an a be become subject be the Works'Compensation
Laws of Caiifamia.Das
Applicant
NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should
become subject M de Wurster.Compensation previsions of me lahm Cede%you mw
O frmwilh comply with such Provisions or this permit shill W learned rewkc 1,
Z� CONSTRUCTION LENDING AGENCY
EI emebyefm mswmc
rat them acodn.lending agency for the Pcromanot of
> the wart fur which this permit is issued(Sec.7119'1,Clv.C.)
dQ Lenders Name
Z Lenders Address
U C 1 Notify that 1 haw ne d this appllcuian and two tiW tie Aw.mmma0on Is
D, E roma I agree m comply with all city and county oNinanaa and stale laws misting be
C S� Wilding conwstion,and hereby authorise mpmaensli u of this city to enter upon me
Lid ahme-mentioned pmperty for inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino against �J
y fiabilitica,judgmenta,cam and apeses whine may In any way accuse agaiaiseid City
U'Z In cumegmnce of me[renting of ths permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
S UL.ATIONS.
O Re-roofs
Si um of A0plicingContramber 4 Da
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will tie applicant or future building occupant Yom or handle hazardous material
u de0ned by the Cupertino Municipal Code.Chapter 9.11,and the Health and 59e11
41 otic.Section 15531(.)? All roofs shall be inspected prior to any roofing material being installed.
[IYas a
Will Nc applicant or f tum Wilding amPxnt tax equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
crit hazardous air conumianu as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes No
I haw mad the haardtwsmasdals requirements unCtr Chapterb.95 ofthe giifer•
niaH.Ith&SafctyC d.Scavom15505,25533and5534.lunkc dthalfthe Wilding
does per currently have a anent,Met it u my mapomaibany to notify the occupant of me
te Immc whichmw metpriormiasuancaofoCcnifeesof panty Signature of Applicant Date
re athari dmgem te All roof coverings to be Class"B"or better