04060048. CITY OF CUPERTINO
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BUILDING DIVISION PERMIT
BUILDING ADDRESS:
PERMIT N004 0 6 0 04 8
R'S NAME:
PERMITISSUEDATE
TORRE AVENUE PROPERTIES
06 '/04/2Q114
NE:
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job DCSCfIptlOn
1 hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing
iN Sxtio] of Diviaion3of the Busineasm Pro�re-sss�iuns Cmn.ml my license is
wrenm aDrtr0 Ips.
JAS 1
2211 NON ILLUMIATED SIGN
Lca
aZ Class Lk.nR tramor
Dare
CONTRACTOR: ILLUMINATED CREATIONS
ARCHITECTS DEC N .ttb►.jCr
DBA]ELLIS & ELLIS SIGN SYSTEMS
understand my plan.hell she used u public mcards
un
Licensed Professional
OWNER -BUILDER DECLARATION
1 hcrehy affirm that I am exempt from Ilse Contractor's License Law for the
following mesa A. (Section 7031.5, Fairness and Profession Code: Any city or county
which mqulma a Permit to Conswct, dtea Improv:, demolish. or midair any structure
prior to its issuance. also matures be applicant for such permit to file a signed statement
Sq. Ft. Floor Area
Valuation
that he is licensed pursuant to the provision of the Conimures License Law (Chapter 9
(commencing with Section 7000) of Division of the Business and Pmessinn Code) or
], 6 0 0
that he t exempt themfmm and the bade for the alleged exemption. Any violation of
APN Number
Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant 10 a Civil penalty 9f
not mare has five hundred dollars (MM).
❑ I. a a ower Aides pmpcny, Or my employees with wages As their sole eompenallon,
36902031.00
Required Inspections
will do the work, end themmau , is not intended oro((ered Torsade (Sec. 7004, Business
and Pmfetrons Code: The Contagious License Law docs not apply to an own, of
easy who su chemon,mNwho h work through his
not ar
oelfar
own yees, pdson d that am i tied for et.If.
thatsuchimprovementin:not ear
ownemployees,ping
ofdmoBered
however, Ne building or improvement t old within one year or the owner-
or
'
omm efor
improve
builder will have the Widen of proving that he did not build or improve far purpose of
iota.).
am exclusively confessions with ti.
01,constas property, amcomintor's
❑ 1. as owner of the pee.
:) Theedomanctelort
weproject (Sec. 704 Pronecting Cade:)Thed Li.
cause law docs not apply m an owner of property who builds or improves themon, and
J
who contracts for such project with a conlnctoKs)licensed pu man! to the Contractor's
License Law.
❑ 1 w exempt under Sec. . B S P C far this mason
Dat
WORKER'S COMPENSATION DECLARATION
I hereby Air. under penalty of perjury arc of the following doclamtion:
ve and will maintain a Certificate of Consent to self-insum for Worker's Campion.
as provided for by Section 3700 ofthe labor Code. for the performance of the
11CM52",
r which this permit is issued.
ve and will maintain Workes Compensation Insurance, n required by Section
we Labor Cod, for we peRormanee of the work for which wia parol is issuedker
s`Cc-^�'e_radon Insurance carrier and Policy number]'Ft ICATE ori Policy `
IR WOR
r10N FR WORKERS'
CERTIFICATE OF S'
SATIO
COMPENSATION INS ANCE
(nds section need not be complex d ifthe permit Is for one hundred dollars (SIM)
or leu.)
1 certify that in the performance of the work for which this permit is lamed, l shall not
employ any person in my manner an As to become subject to the Workers Compensation
Laws of California. Date
Applicant
NOTICE TO APPLICANT: IL after making this CCnnricae of Exemption, you should
biome subject a the Workers Compensation provisions of we Labor Cod, you mum
forthwith comply with such provisions or this parent shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby AT. that there is a constmclinn lending agency far the perfurmmee of
the work for which this permit is issued (Sec. 3091, Civ. C.)
LendYs Name
Lenders Addmse
I certUy that 1 have mad this application and state that the above information is
'
comet. 1 agree to comply with all city and county ordinances and hale laws relating to
building construction, and hereby authorize reprnem aches of this city to enter upon we
above-memioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless Ilse City of Cupertino against
liabilities, judgment, casts and expenses which may in my way same against said City
in consequence of the SM Ling of this
APPLICANT UND DSA WI COMPLY WITH ALL NON -POINT
Issued by: D e
SOU L`A NS.
Re -roofs
Type of Roof
.,1 `O� ,
Y
mag A mmUCan or Data
HAZARD US ATERI DI LOSURE
e
Will the applicant or future bm)OS m ant¢ rc handle maddaus material
defined by the Cupertino Municipal Cod, Cha r 9.1 2, and the Health roti Safety
SectionDye. 25532(x)? �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 we applicant or future building occupant use equipment at devices which
it havankma air contaminants as dOned by the Bay Area Air Quality Management
all new materials for inspection.
Disuicl?
't�No
❑Yes
I have mad Nc hva,dnus materials requirements under Chapter 6.95 of the Califon
ria Hcaltitdr9 c c' 25505.25533md25534.Iundntndthmifthchuilding
Jots n CO. ly bout ran 1 it is my responsibility b notify the occupmt of the
'mm raw h harm At pro fa Cmificne of Geedcy.
Signature of Applicant Date
—O r
All roof coverings to be Class "B" or better
own ar a horivcd age Doe