02090050 CITY OF CUPERTINO
BUILDING DIVISION pE CONTRACTOR'INFORMA N:
Bl� �1 D DDRFSS: PERMIT NO.
MAXINE DR ALLEN SIGNS INC 02090050
�., i V5M6U. 11LEN AND LILLIAN 1982 STONE AVE APPLICAff/16`1 A5002
(408) 280-6500
PHONE: SANITARY NO. 11 CONTROL NO.
�0O ARCHITECTIENGINEER: z - BUILDING PERMIT INFO
as- BLDG ELEcf PLUMB MECH
�yH
LICENSEDCONTRACnOR'S DECLARATION 7 Dp $C�Q(��i
oZ_+o I herebynna70 ).f wham licenseeunder and provisionsof@aprc+9(eommecense INSTALL ONE WOOIJObGReUUNLDnS IGN
FNtm with Scction]OWIof Division 3ofw Business and Profadoa coda and my license
<a as
sun
full force anP effect. d�.s f— �p p /�
R.0 c.D Das lmenu C L Conuvnor ✓J F I Y�A L Ire
3�'• ARCNITECrS DECLAMTI N
t h g I undersand hY plans shall W used u public rtcoNs
dpc Licensed Professional NOV 2 5 2002
OWNER-BUILDER DECLARATION
1 hereby affirm Char I am exempt from be Contractor's License Law for the $500
t z a following reason.(Section 70]13,Business and Pmfmions Code:Any city or county
IF O which requires a permit to construct alter.improve.dcmol ish,or repair any swcwte BUILDING
�u3m .priorte its issuances also requites rhe applicantfa such permitmnlaasigmd sixtoment - - pr,rsg -
dWu+iiilidn4Hpunuinliuthev;visionsorteCon=tno Liccmelaw(Chaptu9 .....��2`ONL't�{Jr�l(�s.{p 4. .. . Valuation
(commencing withSttGon7")of Division J of the Busi�caaw Pcofcssions Corel �)„ s sx:... i.'1i.'Y.-"�.'+�l
or that he it emmpt therefrom' be basis for be alleged ucmptiod.Any violation
of Seedun703I S by any applicant for a permit subjecaw applicant to•civil penalty
,of not mare than five hundreddoum (5500). 101ARNM00ATION Occupancy Type
❑Laaownerunhapmpany,,,rte-y employees wish wages nttheir sale compensation, 103 - UFER
-will da Ne'work,and Ne umcturc isnot intondw or'offerttl'f°r'sale(Sec.70asf - 104 - REBAR Required Inspections
'Busineis and Professions Cade:The Conuacror's License law does rot apply m a q p
owner propeny Who Wilds or improves or thereon,and who does such work himself 105 - ANCHOR BOLTS I
through his awn employees.provided that such improvements art use intended or
.Broca ror Tale.If.nowe.eP,the htilding or improvement is sold within one year of 3 04 - ROUGH ELECTRICAL::.
completion.be owncr-W ilder will have be burden of proving thin he did not Wild or
improve for purpose of sale.). 505 - FINAL ELECTRICAL
...----. --.. _ . .. 514. FINAL--PUBLIC WORKS - -construct
on u owher of thc P(Sec.7 am Businessa conuaning with licensed Contractors
m -
_ _ construes the project(Sec.7061,owner o ander,w ions Codc:)The improves
the t ( ,• �.
License Law dna not apply m an owner of property who Wilds m improves Merton,
_sod who contracts focsuch projects wiN,a contrmtur(a)lje•naM
_ - euna,omesra Lieuoenae law. . _. .. . ..._; . .
0 l am exempt under See. - .BB P C for thizreason
Owner Date
WORKER'S COMPENSATION DECLARATION
L 1• - 1 hereby aRrm under p mit,of perjury one of w following d la du -
'0 1 have and will maintaina Certificate of Consent to self-insure for Workm's
Compensation, as provided for by Section 37M of the Labor Code, for the
_ performance of the woh for which this permit is issued.
_- 01 have ant will maintain Worker's Compensation Insurance as required by Section
37W of be Labor Coda,for Ne performance of w wink far which this permit is
'aucdM Worker' Com nsati n nsumnce artie-r aaprW Policy number am: --
Cvcnec• 'Policy No.:
CEMnMC IONO EKEMPTION FROM WORKERS'• ky 'r t '•,! - 1
COMPENSATION INSURANCE
a Mil action need not be dnmpincJ if the permit is for one hundred dollars '
15100)or laa.l
I certify but in the performance of the work for which Nis permit is issued,1
shall h t employ a pets n'n a once so as to sub'em te the Workers'
) n am
on"
of li �r 'a¢ A�.
APPlicant . . . .. --. _ .. - ...
NOTICE TO APPLICANT, [v�pg Nix previsions
sof th Labor on.youumulst '
bec°mch comply
i Fork aCohpcma,ion provisions11 the Labor C°dc,you must
0 "
forthwith comply wM sac provtsiona.,,his permit shall be deemed revoked.
4 . .. .hereby . O __. . _. .. - .. . .. ... ... .. _ .... .. . . -
VJ 'CONSTRUCTION is a coNLENDING AGENCY
e 1work for
which but there is s construction lending agency for be performance
r.a
of the work for which this permit is issued(Sec.J09].Civ,C.)
��Q r Lrnder'x Name .• •'-' _ .- .-
Lc als",Acidness
U 0II I cenify that 1 have read this application and state that the above information is
O-F correct.I agree w comply with all city and county ordinances and auto laws relating `
C.) to Wilding construction and hereby authorize representatives of this city to rater upon
�_Wthe above-mentioned property for inspection purposes.. _
t{r (We) g,ce ve,indemnify and kr
keep harmless the City of Cupertino agmnn
F4 Vii moliabilities,judgments,costs and expenses which may in any way acerae against said
U.Z City in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POLNT Issued Date
SOURREGCLATIONS. ys
Signor ofApplicenUCanrmcmr i.- '- , Date Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
edII the applicant or Pomrc banding occupant stere 2,hvdle hawdoa marrrid Type of Roof.. - - ... -_. .. - - _ - -
a da.Sed io the 32fid' Municipal Code.Chapter 9.13,and w Healed ant Safety ,
Code:Section 25532(e)?',+... � '•. � t. ' . '.A.»'i ? '-. .: .. . . .. ..
❑Ya• All roofs shall.be inspected.prior.to any-roofing,material.being.installed.. ..
Will the applicant or fusion,Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection;I agree to remove
emit hazardous air cor amicunts as denied by w Bay Arca Air Quality M m.,erm r,
District, all newmaterialsfor inspection. Applicant understands and will comply with
.0 Ya' all non-point source regulations.
.1 have and the hazardous materials requirements ude,aaper 6.95 of be
California Health A Safety Code.Sections 25505,M533 and 25534.1 umbennnd Nat -
if the Wilding does nes currently have a anon Nat it is my rtsponsibilily as notify the ,
occupant of the rcquir mems Is Is muse be met prior m isxuan<of Cenificmte of
:. °"°p" Signature of Applicant_ -.. Date
0., roraut¢sew' m Date roof coverings to be Class"B"or better
OFFICE
D f
O
� m
D �
r' m
D
T (�
r m
I
1 A �
5q z m
D
R T
m 3
Ra A
m W
n A
m ;, m w ^ cN m a A z
m
Z
pp � S T
6-0"TO THE TOP c
O 1. 4� xx�L�rP�r OFTHE SIGN
C� a
z o F
D D N
m 9 Z
A N R
D_ � o
a $ Z
0
u3i
I..
(D
o C7
S
R
a O
C) [�
O v
7Q
V1
1
N
O
O
N
CPtn
cm
y y
ct �� o � f � N
v ^. = m
n. p o p o� —
VI N N O' O• �. T N' � LLL
CIO
� aoo
a� V avail
�� 00
`CITY OF CUPERTINO °° S�
SIGN
CUPERTINO PERMIT APPLICATION FORM
APN# �Z( - Date: �`326 -02-05,7
Building Address:
0 IDn.
Owner's Name: Phone#:
Contractor: 'i U License#:
A(leA soms, Inc-
Contact'. IPhone#:
91 W�hedq L8---)-to-(oSvD
Applicant/Coritracto :
ui in Permit Info:
Bldg Elect Plumb Mech
Job ascription: / /
esidential: 11YLQ ovd a4 S, .. omrneccial
Sq.Ft. Floor Area: $/Sq.Ft.:
Architect/Engineer: Valuation,
• Type of Construction: Occupcy Gr�ou
Qty. if
Applicable Fee ID Fee Description Fee Group
BENERGY Energy BUILIDNG
BPERMFEE Bldg Permit-Fees BUILIDNG
BPLANCHK Plan Check Fee BUILIDNG
BSEISMICOM Seismic Commercial BUILIDNG
EPERMITFEE Elect Permit Issuance ELECTRICAL
BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL
BREMSIGNS Rmdl Sings,Marquee ELECTRICAL
BUSLIC Business License BUILIDNG
� 6zZ
CI BuD NG DIIVIISSIIONNO
BUILDING CONTRACTOR INFORMATION:
e311t DiN Al MAXINE DR ALLEN SIGNS INC PERMIT NO.
IffMUd'A�ILEN AND LILLIAN 1982 STONE AVE APPLICAIIQN�SIj���z002
'HONE: SANITARY
`ANO, V CONTROL NO.
(408) 280-6500
o re O
w-
ARCHITECT/ENGINEFR BUILDING PERMIT INFO
8 BLDG ELECT' PLUMB MECH
a u
f'i¢a
czy Z LICENSED CONTRACTOR'S DECLARATION II
'='o Ihereby oRmmthat lamlicensed under provisions ofChapter 9(commencing INSTALL ONE WOODob e6c (ionSIGN
Iwe with Section 90004 of Division Softhe Business and Rofessions Code.and my license ll
a m S is in full force and effect.l!rOT6
dre w License Clany�� L�^f,� Lic.g J
o a Da¢ `f/•t/O[ Conlrucmr
S DELI TI N
I understand my plans shall Ise maid as Public mcoNs
aN
at
.0 Licensed pcol'essined
OWNER-BUILDER DECLARATION
so I hereby affirm that I am exempt from the Contractors Liana Law for the
C?s- following reason.(Section 7031.5.Business and Professions Code:Any city or county $500
$S 7 which requires a perinit to construct,alter,improve,demolish,or repair any amucture
to pd., L,issuance,alsoq s theri,fictim Basuch permtua flea signed stat< et - - --- - -- - -
---------
thathe ii Ioenmdp ams t to&i picOismas of me Contractors License Law(Chapte 9 �. r, -'325310 t0�PPF@ Valuation
r
(core eas ithSeeuo 7008) fD ton3oftheBusiiie. adPmressmn,Curl 0l x.-�.- •an, a.'1a.'.�
or that he s exempt therefrom m
and the basis for the alleged eneptmd.Any violation I
or Section 7031.5 by any applicant for a permitsubject,the applicant to a civil penalty
of not marc than five hundred dollars($500), 101ARN(N®OhMATION 'r:::.'.:•: ':D Occupancy Type
O L as Owner arms property.or try,employees with wages as their sale compensation, 103 - UFER
-%ill'do the work.and the slm<tim isnot intended or'offered"for'sale(Sec.7011,- 104 - REBAR Re aired Ins actions" ''•"
`Busibeis and Piofessions Code:The Contractor's Licerve Law does not apply to an q p -
owner of property who breach Or improves the... ad who does such work himself 105 - ANCHOR BOLTS
or through his own employees.provided that such improvements are now intended or, ,_- -.-.__- _ - _
i offerer fdr sale lL nowevcr,the building onmprovemem is sold within one year of 3 0 4-'=-'-ROUGH--ELECTRICAL•;, i',-��;- ,
completion,the owner-builder will have the burden ofproving that he did not build or 505 - FINAL ELECTRICAL
improve puryoa o )
--. - - - ---- - - - --- --51-4-- F3NAL---PUBLIC-WORKS
❑Ia_-.nnof- mavely contracting with licensed rommorsm
_ eP-- ya -na
onswct ----f.-: -.L--
- --------
the project(Sec.7044,Business:red Professions Cudea The Contractors slit V: It
License Law does not apply to an owner of property who builds or improves thereon,
rl: andwho contrecn for-such projmts.with.a contmcturid.licemat pursuanLto.ie.
Contractors;License Law. ----------- _-
plantcxcmptunderSec: _, .B ti P C for this reason
_- - ..
,
Ownc, Dare
' WORKER'S COMPENSATION DECLARATION r���a ryftr�p
c Ihereby a0irnt under penalty of perjury one of the following declarations
•`F•❑ 1 have and will maintain a Ccr ificaie of Consent to self insure for Worker i CHS"�O''Na,ll
Compenmtiori as provided for by Section 37M of the Lama Code, for the NOV �oo
perforanuh.of tho work for which this permit is issued.
'-- 01 bastard will maintain Worker's Compensatidn Insurance;ss required tiy,Sestion
of the work forwhich th perm f ,p ry p�yro
f the
Cvr ,i t, 'CEci` C f the Performance r;ncac rid Poi y number m: �' 6J��1it�/V4A.e1.c
issued 37W My W kir C a s t on bit g$4A
FIC (ONO E%EMoli PfIONF'JM-O�w� .i7 )N: •,t..a ':
(Th eon nen _____—__ _.._.__.__ .—._ _- ._.------
COMPENSATION
....__
INSURANC_E _
ft t. eennot be nsmpinN'f the Pcrmt is for tine hundred dollars �•'� -`"it t P :. �'!'Ct,'dl'[C' r�L;
(SIM)or less.? ,• '
Irn,tht to lpeformence ofih- kf htrhth perttiti. rwiI -
tiallnt ply - ,pC sat t9QI9q by tt th Wrk s .
Compe t of t �Y-I(-UL
_APP(mant _
'NOTICLTOAPPLICANT t r kt g th C rt f t -f E mpt yo ho id s '
0 0 bice e 1fyt,thcN k C' p t p sof theLM Cad you mua
forthwith complywith p sor this perms shall W deemed weveiked.
w I f -vCONSTRUCrION LENDING AGENCY
I hcccby Rrm tM1 t th construction Ind ng agency for the performance ".l` - ( '
W,> of the work for 'h'hm. permit . issued Ser.3097 Cis'C)
Q ender Nam
L
�.Z Leede Address
V 0 r,1 ccnify that 1 hove Freud this application and sate that the above information is
corien:I,agree t9 comply with mI city and county on inane,and sate laws relating
1. rJ to building construction,and hereby authorize mpmantaives ofthii city somber upon
tgt the aMwcanemionN progeny for inspection putpam.7. ,,
Qs (W) gree to sat tnd6 iib e) and keep harmless the C'ty f C pin a against
4 Z liab la 1 dgm tits.cost, ad expenses which m y in any way fccrua against said
O Z City in comccluence of the g i g of ffirk Permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL INONPOIpTn ISSUedb Date
SOURTICREGULATIONS •^ by
Si,imalre OfAppficroit,Cmdracm, -;,- _:', Dam. ,, Re-roofs
t, HAZARDOUS MATERIALS DISCLOSURE Type Of Roof_
'.
willthe'npplicatn Tubs bolding occupantst 'a,harall baeaNws matenW
a,defined by the Cupertino Mucipol Cal Chapor912 aJthe Health and Safety,Code Secon 255320 ss "' 3 1
![I yes, + be infsfipvac,t;edb1.ppriot r_tIo ja`nL'ky_-A .ro
ofs shall. rroofing.m- ateri-a'l.being,-intts'ta,
lled. _-.._ _
,
em hazardous,Will M pphc larfuture�b riding ecc pa red acq p, t d ccs Inch If a roof is installed'without first obtaining an inspection; 1 8gree't0'rentOVe
td fined by the Bay Area A' Q ItyMunag entI
D t t _ all new materials,for inspection. Applicant understands and will comply with.. BY * all non-point source regulations..., lir.
•', have read the Immden,muieriA,aquimments under Chapter 6.95 of the
1
if the mil ing do He Safety Cale.Sections ard.dr 25533 and 2$534.1 understand that
of rho Wilding does ion currently brei a senate,that it is E0 meponaibilitY ro notify the -- - - - - - - - - j.. -
G cupnnt of the exqui meat)f ich mon be met prior m issuan a of Cenifna of
occur n g PP Da e
Own ror authorized
P
... Signature of Applicant .-_., , .- ,- , _t . .,
�.. __. q .az _ .
cm' Data
All roof coverings to be Class 'B"dr better
. ....._.. .OFFICE-' .... ._ . -