The URL can be used to link to this page

040200151 300 �g HN i.s ;U iG �oc IRE C)� Z n V WG ��2 UC L E U2 4 CITY OF CUPERTINO COA\M14TO�A`I BUILDING DIVISION PEA RA4 ALLEN SIGNS INC BUILDING ADDRESS: PERM IT NO 04020015 INER'S NAME: PERMIT ISSUE DATE PHONE: SANITARY NO. CONTROL NO. ARC!{ITECf/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 LICENSED CONTRACTORS DECLARATION Job Description I hereby ef0rm that I am licensed under provisions of CM1.pmr 9 (commencing with cn n]OfU)of DivisionJof thcOnincsaandP�r tcuitm Codc, and my license is ' mint eanderret. Sd--n,g SIGN --GOLDEN GEMS Deu Commcu �� ARCHITECTS DEC TION 1 undermand my plans snail he used u public rmnrJ& � L r sw / �/ C/O 'cc dPnsressional OWNERAWLDER DE CLARATION I hereby .(firm that 1 am exempt from use Contractor's License Law for the i following mazon. (Suitt 7101.5. Business and ter Code: Any tiny or county ere. de which Permit a@nimprove,dcmritosh. orrepaira signedany structure cines itsisssa re Oc ursuaro in the thovisiosofcant forsuch Compactor micarse aw(Chmmem poor itscense pursuant that licensed purction7 h) theeBuuur,nd Sq, Ft. Floor Area Valuation Professions Cattle) or (commencing with Divisions of the Codc)or of Division 3 vi Nal he u e¢mpt therefrom and the Esso for the alleged caemptlds Any vitlauon of that ho rod( m and the aged ass moon. Any 31�&N- Dlliber00 Occupancy Type Section 1031.5 by any appiicmnfor a permit subjects the applicant no a civil penalty of not more than Eve hundred dollen (5500). ❑ 1, As owner of the property, or my employees with wages as their sole compensation, Rd wired Inspections will do the work. and the structure is nor intended tr afrcred rental. (Sm.]044, B usinev and Pmf.i.. Cede: The Conuaetoes Li.. Law dot .m appy to an owner or q P property who build& or ire proves thereon, and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. IL however, the building or improwmcnt is sold within ons year of completion, the owner. builder will nave the burden of proving that he did not build or improve for purpose of role.). ❑ 1, as owner of Ne property, am exclusively convecting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code:) The Contrsatr. Li. cave law den not apply w an owner of property who Wilds or improves theuan, and who motored for such projects with a conuaetor(s) licensed pursuant to the Contractors License Law. ❑ I am exempt under See. Bsk PC ran this soman ter Dau WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following embodiers; ❑ 1 have and will mainuin a Certificate of Cio sent to sel0lnaum ror Workers Compeer. radon, as Provided for by Section 7100 of the Labor Coda, for Ne perfurmance of the work for which this permit is issued. ❑ 1 have and will maintain Worker'. Compensation Insurance, as required by Section 5700 of the Labor Code. for Ne performance of the work for which this Permit is issued. My Worker. Compensation Insunnae carrier and Policy number art: r. 1 Policy No. ERTIFICATE OFM PjlOyil MWORKERS' COMPENSAT O SU NCE (ThB section need not he completed if the Permit is Bottom hundred dollars (SIM) " or it..) 1 Comfy that in the performance or the work far which this Permit is issued, I shall not employ any Person in any manner ser as to become subject o the Workeri Compevanion Laws of California. Data Applicant NOTICE TO APPLICANT: If, after making this Certificate of Eachiption, you &huuN ti:come subject to the Workers Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall he deemed revoked. ONLENDINGAOENCY j CONSnisa ' I hereby nm Ne there its construction di, agency fordm Performance or which ' damLe work per whim this permit is issued (Sec. JU9], Civ. CJ W7, Lender, Nam. lender,Atldrv•.= 1 certify thn 1 haw read this application and sure Nan the above information is ' ' comcaT. l agree to comply with all city and county ordinances and sum laws relating to building convection, and hereby amhchm representatives of this city to enter upon the ahow-mentioned property for inspection purposes. (We) agree to Save, indemnify and keep harmless the City of Cupertino against j liabilities, judgmens, costs and expenses which may in any way seine against said City a in eonaegoome, of On gaming of this Permit. v ' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date SO C U ATI S. Re -roofs — D Sm nature of Applin 1/CaARDOr Data AZAROOUS MATERIALS DISCLOSURE Type of Roof. . WIII Nc appb ant or future building occupant store or handle havardous material . as darned by the Cupertino Municipal Code. Chapter 9.12. and the Health and Safety We. Section 25552O7 El )<Nt All roofs shall be inspected prior to an roofingmaterial being installed. If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant Orfuture building rte=.pant t= egaipmem or devices which cmlt hoamdtua at, mmandnants as dcfncd by Inc Bay Arta Air Qualhy Management all new materials for inspection. District] a�x✓,'' Yes . ❑ 10 I have read the hanNnus materials requirement under Chapter 6.95 of the Califon nia HcolO& Safety Code. Sections 25505.25555 and 25574.1 undersund than if one wilding does rot cmmmly have s on -m, Nat it is my deapansihility m and fy Oc occupant of the mq.ire .nnwhmhmvt men priortuimumceofa rd mofactpaney. "Signature of Applicant Dale roof coverings to be Class "B" or better w rma.marhndgena Due u r L W., CUPEI,TINO CITY OF CUPERTINO o 2-0 tq 4S� SIGN PERMIT APPLICATION FORM APN # 316 / 2 ,� 6 � ./ b Date: BUILIDNG Building Address: I Owner's Naa e:1� ( fL Phone #: Contractor: License #: nc. Sa�Gss Contact: Phone #: j Y? l Lt- d- -ZSoo Applicant/Contractor ` YIL. Elect Permit Issuance Building Permit Info: Bldg Elect Plumb Mech Job Description: S,r1 Residential: T Commercial: Sq.Ft. Floor Area: $/Sq.Ft.: Architect/Engineer: Valuation: 2 Q-3 Type of Construction: Occupancy Group: if pWable Fee ID Fee Description Fee Groun BENERGY EnerRv 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 Rmd] Signs, Marquee ELECTRICAL BUSLIC Business License BUILIDNG CITY OF CUPER'I'INO BUILDING DIVISION PERMIT ORANFORMATION gu �4CONTRACT, BUILDING ADDRESS: rc;R qTEATENS CREEK R1 UD ALLEN SIGNS INC PERMIT No 04020015 ER'S NAME: PERMIT ISSUE DATE ONE: SANITARY i CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH t� 0 LICENSED CONTRACTOR'S DECLARATION Job Description P 1 Wreby affirm Nal I am littnxd under prov"a ns of Chapmr 9 (commencing with i n?D(IU)orOivision]ofthe Bmimaand mons Cod.ndnrYlicenxia _ " ful" 7 Arre Li u s `1{- SIGN--GOLDEN GEMS FI NALED DataCumract Comm - ARCHITECTS DEC TION I undcmand my plAo shat W rood a public rccnrds FEB 1 S 2004 a` d PmfcuianAl OWNER-BUILDER DECLARATION Oe, I hereby .('firm that 11. cumpt a Law for the I .. lW Cemons Any BUILDING moon. (Section T s an C : c Business and Pmfde o Code: Any city es county whichfollowingre demolish. repair any which o s r iresism a pmmit m cnnsuueL eller, improve, statement Primu, its issuance, also requires Tru applicant for such permit m filo a alga( aammcm its h Ndrail t file that licenud Auction to fire provision:ofthe Contractor'susinesndproflaw (ChapterCode) Sq. Ft. Floor Area Valuation Section Division or the Business Ction or Net u exempt thcmfrom and the beau Tor Any Any violation of Out he is exempt Add Use r Alleged of cxmant tlff ,e,n �n� 31 213gR16eir OO Occupancy e P Y TYP io be L5ve any applicant for apmmlt subjccu the epplkemmAcivil penally Of Section the to than not more Nan Rve hundred dollars (uoo). ❑ I, As owner or the property, or my employees with wages as their sole compensation, Required Inspections will do Ne work and Ne structure is not intended or ofrerod fonale (Sec. 7041, Boom. and Pxressiom Code: The Contractors Liceme Law aos not apply to an owner of no property who builds or Oeuon,and who doessuch work himulf or through hit own cenployces, provided that such improvements ad notim anded orofrered forsale. If. however, the building or impervemem is sold within one year of complction. the owner. builder will ban Use burden of proving that be did not Wild or Ienpuw for purpax of sale.). ❑ 1, as owner of the property, am exclusively contracting with licensed convectors to convect the project (Sec. 7D4C, Business and Professions Code:) The Contractor's U came law does not Apply to an owner of property who Wilds or improves Merton, and who contracts for such projects with a contrmmr(a) licensed pursuant On the Conuactoh Licca Law. ❑ I am exempt under See. Bk P C for this moon Date -- ' WORKER'S COMPENSATION DECLARATION 1 bereby.(urns under penalty of perjury am of Ne fallowing declarations: 1 have and will maintain a CeniGeute of Consent to self-insure for Workers Compere inion, a provided for by Section 3TDD of the Labor Code, for Ne performance of the work for whim Nil permit is issued. 1 haw and will maintain Workers Compensation Insurance, a required by Section 3?hr of me labor Code, for On performance of the work for which Nis permit is issued. My Workers Compensation Insurance carrier and Policy number am: L�tg,_1 Policy 11 UERTIFICATE OF EX 0 MWORKERS' COMPENSAT O SU NCE (Thu seedy need not Meomplewd if the permit it foroue hundmd dollen (gip)) or loss) I ecnBy OUR in Use coformaroc of the work for which this Permit is issued, l shall nut employ any Person in ay manner M As to become subject o NC Workers' Compcnsaflen _ Laws or California. Data Applicant . NOTICE TO APPLICANT: If. after making this Certificate of Exemption, you should become subject to the Worker's Compensation previsions of the Labor Code, you most foMwilh comply with such provisions or Nis repoit shall W deemed revoked. CONSTRUCTION LENDING AGENCY , I hereby alydo Nat Ncrc its comlruelinn lending agency for performance of the work For which this Permit is issued (Sec. ANI, Civ. C.) Lender's Name Lender's Address I cenify that I have read (his application and sum that the move information is correct. l agree to comply with all city and county aminaca and stsre laws relating m building convection, and hereby aumonse representatives of this city to enter upon the above-mentioned property for inspection purposes (We) Agree to save, indemnify and keep harmless the City of Cupmtmo against Haiti lidos Indigenous, costs and expenses which may in any any .cense against Mid City in eemegwnce or the granting or this v permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SO C U ATI S. \—:!Z __2 -A Re-roofs , 3� ° St naum o ApPlic (/Comrscmr Data AZARDOUS MATERIALS DISCLOSURE Type Of Roof Will the antor fMuni Wilding lmom2, handle material eppb Health A az defined by the Cupertino Municipal Code. Chapter 9.13, end rbc Health and Safely e. Cirri re. Section 35532(.)? 0Y.a ;�Nn 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 Will the applicant or future baiwing Occupant ax equipment or d vi a which it hamdnm air contaminants o defined by the Bay Area Air Quaity Management all new materials for inspection. iurict? ❑ham''Yes A.l.0 U, w mad the hmam iusmaterials mquimmenu under Chepar 6.45 of the Caliror. nu Health&Safety Code.Secdom35%5.35533.d25534.1undemnndthuifdr Wilding ' dos not currently haw a tartar. tMt it is my mosparomiiny m Amity the AmupMr of Use magtoa whmhmast met odor to m inseaor sofOce.pucy. Signature ofApplicant Date All roof coverings to be Class "B" or better w raraamornea ser, Dare