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CITY OF CUPERTINO
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BUILDING DIVISION PER
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BUILDING ADDRESS:
ALLEN SIGNS INC
PERMIT'004010075
OWNER'S NAME:
ASSY 14ATR
PERMIT ISSUE DATE
HONE:
SANITARY NO. CONTROL NO.
4
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
' LICENSED CONTRACTORS DECLARATION
lob Description -
P
1 hcmby affirm that I em limn d ndcr provisions of Cbvpur Y (commcndng
with Section 1") of Division J ofthc stand Profcssiune COdv,and ra, head. is
flit ' pdpfir
canoe c'ei_ ossa
SIGN --SASSY HAIR
C r
ARCHITECTS CLARAT ON
1 andersnnJ my plans shall Ise a as public nxorJs
Licensed Pmfcssional
OWNER -BUILDER DECLARATION
I hereby affirm
11. exempt from thus Cnnuvnm•s License Law for IN
. .
meson. (Salton 71n1.5, Business and Any city ser county
on
-
vefcssinm demolish. ar
which re vpermit v@cimports,h swment
poort itsisu Permitsrierepair gany
roto due theapplicant for suchrcrmilmGlaa
re ulm the
poor to its Iensedp
Sq. Ft. Floor Area
Valuation
that he islicensedwit punuans mdse of the Law (Chapter
pursuant Liccnslaons
ser
of Division Business Code) or
(commencing Sectionnand) of Division) or IN BminwvMon.
teat
Any
that he is exempt therefrom and the bats for the alleged exemption. Any violation of
IN
31ATN94t"M0
Occupancy Type
Section 7031.5 by any applicant for a permit suo"IS the Applicant he civil penally of
not mom than Gm hundred dollars
❑ Losownr
pa,urde ar myvmployces withwagmatheirrolec
Required Inspections
.the
(Business
will dothcsoms, andthBusiness
The Conismoti Licendm ave doesffened
of apply, to
and Profession Cade: The Conmmnrs law darn not apply if rt owner
- q P
his
property red who is
doesouchended work or
cyobuildsorimprossachimprve improvements offered for salt. If.
imprommenuannel ear
Ovnemployees,ping
or i proven of completion. Ne owe
builder thebuildingarimprovement psoldwithinone year mprove
or for of
guilder will have the burden of proving that he did not Wild or improve far purpose of
ale.).
❑ 1. as Owner of am property, am exclusively contracting with licensed cenvsrom to
constmer the pmjen (Sec. 7aa, Business and Prefnssiom Cade:) The Contamuse3 LI-
'
came law dans not pply to an owner of property who Wilda or improves Ihemon. and
who contracts for such projects with v convactor(s) licensed pursuant to the Contractors
License law.
D 1 van esemps under Sm. . B & P C for this mason
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
D 1 have and will maintain acenifram of Conant to selhimum for Warle rYCompcn-
satim. As provided for by Section 3700 of the Labor Cade. far the performAme of the
work for which this permit is issued.
'
D I have and will maintain Workers Compensation Insurance, As required by Section
3700 of the Labor Code. for the performance of the work for which Nu permit is Issued.
My Workers Compensation lmunnec e_e icr�and Polic number am:
'
C 'er.' - PX7L—An r, 112, E
RTIFICATE OF EXE FROMWORKERS'
COMPENSA NINSURANCE
(TTls section need A&W completed If be famd,1, fmonc hundred dollars I$ IOD)
Imo.)
1 cenify that in the performance of the work per which this Permit Is issued. 1 shall nut
_
employ any person in any manner so As At become subject to the Workers' Compensation
Laws of California. Date
APGlicont
NOTICE TO APPLICANT: If. after making this Certificate of Exemption, you should
became subject to the Workers Compensation provisions of the Labor Cade, you must
forthwith comply with such provisions or this perm iishall W dccmed ranked.
CONSTRUCTION LENDING AGENCY
1 hereby affirm that Non its construction lending agency for art, performance of
'
the work for which this Permit is issued (Sec. 3097. Civ. C.)
Lenders Name
'
Under's Address
1 certify that I have mad this application and Nm that Inc Above informatlun Is
COMM. I Agree to comply with all city and county ordinances and state laws relating to
building construction, and hereby authorise representatives of thio city to enter upon the
show -mentioned pmTFrty for Inspection parpoYl
(We) agree to ave, indemnify and kccp harmless the City of cupertino against
`-
j IIANIRIMs,judgments. costs and eapcnsi which may in Any way acme against aid City
in consequence of the granting of this Permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
• Issued by: Date
SOUR E2�05
GU ATIO >
Re -roofs
Type of Roof
i u to Appli m/onuNMOr Data,
HAZARDOUS MATERIALS DISCLOSURE
Will the lieant or future building Occupant time or handle hazardous material
As defined by the CuMnino Municipal Code, Chapter 9. 12. and the Health and Safaty
caJe.Seedan25532(a)TAll
V u
roofs shall be inspected prior to any roofing material being installed.
D )N
If a roof is installed without first obtaining an inspection, I agree to remove
Will rhe applicant or future wilding omePant use egmpmem or devices which
mit havardnus air contaminants n defined by the Bay Arca Air Quality Management
all new materials for inspection.
District?
Dyes �No
1hovesend the c2nts7u4n.d1dCJhspmWrb
nialcalth&Saety Ck,s mtimansm2a3uNri5a.ls25533mdurnth.9n5oiffNthe
Wilding
docs not curtently hens a nnenl, thus itis my rtsponihility m ndfy the acupmt of the
mgaine hie a&poor I.iamnmof. Cerdamoffkcpany.
Signature of Applicant Date
All roof coverings to be Class "B" or better
ncr or authO izcda em ,m
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CUPEkj1NO
•
C.
CITY OF CUPERTINI
SIGN
PERMIT APPLICATION FORM
b � p' o0 75'
APN #
Energy
BUILIDNG
Date:
Z-,) 6 1�3
BUILIDNG
9
Building AddrespP,�
BUILIDNG
BSEISMICOM
Owner's Name:
BUILIDNG
Phone #:
0.
0-p_ 60
Contractor:
EPERMrrFEE
Elect Permit Issuance
License #:
BREMSIGNAD
Rmdl Signs Add Branch
ELECTRICAL
6D 56!3s-
6!35Contact:
Contact:
ELECTRICAL
Phone #:
Aimlic t/Contract r:
BUSLIC
Business License
BUILIDNG
BuilPng ermit Info:
Bld
elect
Plumb Mech
Job escription:
esidential:
C
rS ommercial:
Sq.Ft. Floor Area:
$/Sq.Ft.:
Architect/Engineer:
Valuation:
Type of Construction:
Occupancy Gro
Qt
An ic�ble
Fee ID
Fen Dn-rrintinn
FPB r7miin
BENERGY
Energy
BUILIDNG
BPERMFEE
Bldg Permit Fees
BUILIDNG
BPLANCHK
Plan Check Fee
BUILIDNG
BSEISMICOM
Seismic Commercial
BUILIDNG
EPERMrrFEE
Elect Permit Issuance
ELECTRICAL
BREMSIGNAD
Rmdl Signs Add Branch
ELECTRICAL
BREMSIGNS
Rmdl Signs, Marquee
ELECTRICAL
BUSLIC
Business License
BUILIDNG