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05110106 CITY OF CUPERTINO ''' ' l ` BUILDING DIVISION PF. IT ICONT, INO ADDRESS: PERMITNO.05110106 0 1 S DE PERMIT ISSUE DATE OWNER'S NAME: DOLLINGER PROPERTITES PHONE: SANITARY 10. CONTROL NO, BUILDING PERMIT INFO ARCHITECTIENGINEER: 'BLDG ELECT PLUMB MECH O O O loo LICENSED CONTRACTOR'S DECLARATION Job Description I aJ I t e Ory.farm dust 1 am Ilcemcd under provlelons of Ch lwl 9(commencing with Scedon70nrtai'Divislon3nf Ne Busies 44ProfcsMOm Coe mYticemmis In full fame and affect. SIGN--NEON SIGN (REFERRAL REALTY) License Class Lk.IS 3 p Dam Condumr 7W ARCHITECTS DECLARATION 4 I understand my plans&hall be used an public meards Y U e License)Four mamail bg� OWNER-BUILDER DECLARATION Lem i a I hereby.Inns on 1 em exempt from Sam Codmor C a :A., Lew for Nc 0 o following kaon. panda t 111X3, , the.&and borrow.de oli Code:Any dry ar recome . 9�+ only which requires a pemlo re ares the pplic or susdemolish.,ri e a siany ahaYure 0 Z y Pdor m its issuedce. eters also requires lM applicant far such permit to rilcensesignedw(Cha mcnl Valuation C ren heisdo&Wit Sectims m me Of Diatom of the Canwnessnd Preflawf,Cods)or Sq.FC,Floor Area S (cmnmcming wins SeNmT01X0 of Dividan 3 o the Business and Rofessiom Codc)or thus be Is exempt therefrom and Ne basis for the alleged exemption.Any violation of Saida.7031.5 by m y apPMant fur a permit wbjccu the apPlicut to a 11111 penalty of r Occupancy Type an,muse dusn Bws hmbmd dollars(ASML 0 1,u awser of the pmpwty,w my employees amb wages u their Sole compevadon, anddodmximrs ode:The Con=toLessm LA da not apply to an Owner of e/�uired Inspections Nd do She work Code:The Cad Is am Intended LIRme law dam not apply m 44 aWMf of -a p propertywho builds or impawas N n,andwM donsuch work himselfor Waugh his awn employers,pmvided that ach impmmmenu are Out amended oraQemd foram lr. however.the building or improvement Is Sold within am year of mapledan.the owner- Wilda will haw IM burden of proving that M did ml build m'unproa for purpose of j am.). I.as owner of the pmpmy.are exdusinly contracting with licensed mnuacame he comtmn tin:pmjem(See.7044.Business and Pmfmaions Cade:)The Conuactoe3 Li- Law dam not apply in ao owner of propertywM Wilda or Wipes.thmmn.and, a mnvacts les web pm ieuwid, of emits au JPurammmtheommactse, nm Law. m&cape .eekpc Na W.Umm. Owner m - Da \ KERS COMPENSATION DECLARATION 1 hereby&(runs under penalty of perjury rice of Ne following decimations: 0 1 he.and will meinW aCeniOm s us of Cansam in vif-Wum for Warkofa Campem mins,u provided far by Swann 3700 of Ne Labor Code,for the Performance of de wart for which Nis permit is hued. 0 I haws and will maintain Warkeh CompensW on Insu muse,u required by Section 37M of Ne Labor Cada,fu Na performance of Uus wart lm which this permit is issmd. My Workefa Compensation mwnnce carrier ad Policy mtabu are: Canter. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Thu wmlan reed mi be compthmul Ifde permit is(wane hanNed defers(SIM) or WL) I Vfy Net in me parr of me work for whit counts Sod.I anal1 nm emplwan9persan rwuxttame m,00—C, tr)4"M Compensation / APPllant NOTICE WAPPLICANf.If.after making this CeNnate or aecapdon,you should iceman subject in Ne worker's Compensation previsions of Ne Labor Cade YOU muss O 0 forthwith wor comply with ch Provisions thus Permit mail M demandmwked y CONSTRUCTION LENDING AGENCY In 1bere ,afarm Ne dem ice cmneuuNnn houdingapersy far the performance of p>: v: Ne work fur which Nu permit Is issued(Sec.3097,Ch,.C.) GQ US&,'.Name ' Z Lendeh Add. IJ o I certify thus I haw read this appliadon W sum Nm the.Mora InformWun is ty conext.I agree m comply with all city and county ordinances and stere laws missing to Q building construction,and hereby aumodm rnpmwnudwel of Shia City m enter uPnn Ne W akar.-mcmimed property for inspection pugesce. (We)agree to ave,indcanify and keep harmless the City of Cupenino against �y IA Ilabilides.judgments,tato and expenses which may In any way accrm against aid City t U,ZM, IAnPPLn�u�c of ER ILand" L U IFILL MPLY ITH ALL NON-POINT sued by: Date SOURCER TIONS. F o Re-roofs ' sl r r pp reandCa r - Data HAZARDOUS MATERIALS DISCLOSURE - Type of Roof Will de applicant or future Wilding Occupant sem or handle hao dour material u deamd by W Cupemint Municipal Code.Chapter 9.12.and the HmdW and Safety Code,Selda.25532(x)7 All roofs shall be inspected prior to any roofing material being installed. 0 Yen If a roof is installed without first obtaining an inspection,I agree to remove Will the applicant or future building Occupant use c0forent or dm,lcm which can hu.mdous air contaminants as defined by thc Bay Am Air Quality Management all new materials for inspection. Distnn7 I^ OYu totlu I have need the henmonaamem eb irtmcnyw�crC7upmrti.95afthecalifor. no NkS ; Cadc,Secdons 131my d25514./understand Nmifdm building does ter cu hew a mnmr my each' y m mar de amupant of Je mquireac an faun be me ssuancea ird0cam oafplgGP�cy.�o Signature of Applicant Date L1/ l0 All roof coverings to be Class"B"or better Owner of authomad 3cent Dam _ s � . a CITY O S U ERTINO CUPEkTINO PERMIT APPLICATION FORM APN# Date: 111t 9 p; Building Address: 9 &'D o 11 S. D lA nl zA L Jv / "o (2 Owner's Name: Phone #: Contractor: License #: L/ C.060/e, S / Ivs Contact: -TveV14 ,v- _ fZ-ozaan L' 94—,4. L1`� Phone Applicant/Contractor: T cc,CIO 4- B Permit Info: C'Bldg lect Plumb Mech Job Description. Residential: Commercial: Sq.Ft. Floor Area: $/Sq.Ft.:31 ©� Architect/Engineer: Cost of Project: Type of Construction: Occupancy Group: 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 Signs, Marquee ELECTRICAL BUSLIC Business License BUILIDNG a 77. J�. • YLU'1' VI.AIV, CHUMM BY • CE--� .Tr �I` •Flush Well Mount t .I •Standard 5'Deep Pan Channel Letters. •Double Back Neon for Elecaoblts. \ I NOV PLANNING •Remote Transformers. lmac 1' 1 8 2005 Mo stall 6'Aluminum fletume _ A IbF '. �•.•. x1N Trim Cep Ttlm Cep _ TiSb'VJfe�Aex�ConEUO �. sem U.Elecbo am Neon Tubinp - Raxc a t?T l tmwne.when eeouery 1 61e 3730 rGTO ,y or Eluc blt Pe . N•nTuw `H / Tnrnbrmm In yTnmlpms Wleoe EMC tle Ele OMECM U.LAppr.W 11 Arryllc F.. 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