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08010061,2z g ;WU Qt<<7 'N..t :00 ?$� j�s �z zC CITY OF CUPERTINO BUILDING DIVISION PERMIT TOR �tC�P�`TE'11• • . BUILDING STEVENS CRK BLVD ALLEN SIGNS INC 08010061 NO. CONTROL NO. (408)280-6500 ARCHirEC 1ENGiNEM BURRING PERMrr INFO BLDG ELECT PLUMB - MECH 0 0 0 0 LICENSED CONTRACTOR'S DECLARATION Job Description 1 hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Sec lion 7000) ofl)ivisioo 3 of the Business and Professions Code. and my license is - INDIVIDUAL CHANNEL LETTER SIGN in full force and effect 4 License Contractor ARCHITECTS DECI-AR ON 1 understand my plans shall he used as public records Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractors License Law for the - - following reason- (Section 7031.5, Business and Professions Code: Any City or County which requires a permit to construct- alter. improve- demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to file a signed statement he is licensed to the of the Contractors License Caw (chapter 9 Sq. Ft. Floor Area Valuation that pursuant provisions Section 7000) of Division 3 of the Business and Professions Code) or 2 0 0 0 (commencing with that be is exempt therefrom and the basis for the alleged exemption- Any violation of 316 2 6 0 9 0 Number Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (SSWo ❑ L as owner of the property. or my employees with wages as their sole compensation, Required Inspections will do the work, and the structure is not intended or offered for sale (Sec. 70", Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work huasdf or through his own employees, provided that such improvements are not intended or offered for Sale. If. - - - however, the building or improvement is sold within one year of completium, the owner - builder will have the burden of proving that he did not build or improve for purpose of sale.). ❑ L as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 70". Business and Professions Code:) The Contactors Li- _ tense Law does not apply to an owner of property who builds or improves thereon, and. who contracts for such projects with a contractor(s) licensed pursuant to the contactors I icerue Law. ❑ I ram exempt under Sec. . B & P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm ender penalty of perjury one of the following declarations: ❑ I have and will maintain a Certificate of Consent to self -insure for Workers Compen- sation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 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 this permit is twitted. ' carrier INSURANCE (Chia section need tot he completed if the permit is forone hundred dollars ($I00) or less.) �. I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in any manner so as to become subject to the Worlrerd Compensation Taws of California. Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Worker's Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the wont for which this permit is issued (Sec. 3097, Civ. C) ' Lenders Name , Lenders Address I certify that I have read this application and state that the above information is - correcL I agree to comply with all city and county ordinances and state laws relating to binding construction, and hereby authoria representatives of this city to enter upon the above -mentioned pmpeny for inspection purposes (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may in any way accrue against said City in consequence of the granting of this permiL APPLICANT UNDERST NDS A WILL COMPLY WITH ALL NON -POINT Issued by: Date - SOURCE REG ( Re -roofs Type of Roof Signature of ApillicirakontrifelotV Date HAKARPOUS MATERIALS DISCLOSURE Will the applicant turc building occupant store or handle hazardous material as Wined by the Cupertino Municipal Code. Chapter 9.1Z and the Health and Safety Code, Section 25532(a)? ❑ Yea (Ti�No 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 building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management - all new materials for inspection. District? ❑ Yes J��/-�� No 1 have raced thehanrdou4 materials requirements under Chapter G95 of the Califor- - nia Health & Safety Code, Smiom 25505, 25533 and 25534. I undcrnand that if the building .. does not torte ty ha a tenant. that it is my responsibility to notify the occupant of the n:quircmcn "