06070023 (4) CITY OF CUPERTINO
BUILDING DIVISION PERMIT 'O1VTRr .CTR I1�'k'�1I.i14IA'L�I
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BUILDING ADDRESS: ALLEN SIGNS INC PERMRN0.06070023
10745 S DEANZA BLVD
PFAMTI ISSUE DATE
OWNER'S NAME:
ORECK CLEAN HOME 1982 STONE AVE
SANITARY NO. CONTROL NO.
NE:
(408) 280-6500
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
�� t� 0
±op LICENSED CONTRACTOR'S DECLARATION lob Description
MU 1 hereby affirm Nn!am licensed under provislons of Chapter 9(eommenetng
wish Scx km 1 1k)of0ivlslon 5 of the Buvna.and Profasions Cade.aM my lxense u
inraillI ndeit y. —r INDIVIDUAL CHANNEL LETTER SIGN
p Z License Clas Use.
is
gy=p Dam Convmur
ARCHITECTS DECLARA ON
f 1 understand my plans shall be mud.public mounds;
)R!u
r o Liamed Prnfcssional
OWNER-BUILDER DECLARATION
I hereby aJT m Nat I am exempt from We Convector's License Law for the
O a following moon.(Section 7001.5,Business and Professions Code:Any city or county S O O O
3 B which mquima a permit m conwucL shot.Improve,demolish,or repair any nnmbno
_Z� prior b its issuance.Alan requires the applicant formeh Permit m rile a signed statement Valuation
ES C that he I.licenacd mmumLto the Pmau
visioneofWeContractor'sLicelaw(Chapter9 Sq.Ft.Floor Area
4 (commencing with Section 7000)of Division 3 of the Business and Professions Civic)or
ERR~$ Nat he is exempt therefrom and We basis for to alleged exemption.My violati'en of
Section 7071.5 by any applim,rot a permit wbJccu the applicant r a civil penalty of Occupancy Type
not mom Nan 0w hundred dollars(S500L
❑J,as owner of We propany,Or my employ.-will,wage as Nair tale t ompenmtinn,
will do tiro work,and We atmdum is net ntended or offered ter side(Sec.7044;Business Required Inspections
and Profeslona Cade:The Canmctors Llan.Law doe net apply.an owner of
pmputy who bu i Ida or improves Woman.and who dao aueh work himself or through his
own employer-s,provided Natsuch Improvements are not intended oroRarnd formic.If.
however.Ne building or improvement is sold within a.year of oompletion.the most.
bolder will have the burden of proving that he did not build or improve fa purpose of
.le.). /
❑I,as owner of the propeny.am exclusively convecting with licensed convumm to
comment We,proFet(Sec.7044,Basin.and Profe.lens Cade:)The Contractor's Ll.
came saw rias not apply to an owner of property who builds or improve Werner.and,
who contracts for such projects with a convanmr(s)licensed pursuant to We Co.=.ra e�C/�a� �
Us.Law. Ff?
1 am exempt under gee. .B&P C for this myon
Dean
WORKER'S COMPENSATION DECLARATION
7C37M1 hereby af11on under penalty of perjury One of Ne following doesutiomv dj
I ha.e and will maintain a Cerdnc+u of Consent la self-Imam for Workers Compon- �o
tion,u provided for by Section 77M of We labor Cade,for rite Performance of We
ork for which this permit is issued.
1 have and will maintain Workers Compensation Insurance.u mimared by Section
of rite labs One,far the performance of tite work for which this permit isI ued.
y Workicer'.Compensation Imup=airierend Pali,numbvrtier. rk'��r.15 1/y.5 Po11ry No.: �It`f,L.t L7�
CERTIFICATE OF EXEMPTION PROM WORKERS'
COMPENSATION INSURANCE
(nus seNan need not be completed if Ne Permit is to...lmndmd da0an(SIIX11
or les)
1 certify the,In to parfmmanee of to work fa which did.permit IsIssued,I shall.t
employ any person in my manneran s b become subject r We Waricer Compea.tion
Laws of California.Dam
Applicant
NOTICE TO APPLICANT'.IL after making this Camillus:of Exemption,you should
become subject r the Worker's Compensation provisions or We labor Code,you must
.JOM
rowit,comply with sucha provisions Nu permit still be deemed revoked.Zi h - CONSTRUCTION LENDING AGENCY
F-. 1 hereby ofrimi Nat Ne.is a construction lending agcy far Ne per turmanm of
LY,
We work fm which this permit is leaned(Sec.307.Civ.C.)
W Q tondos Name '
z Lenders Mdmas '
T-)O 1 cord(,Net I haw,mad this applicanion and mute than We show In(mmrvon H
!I. t— coma.I ague to comply with all city and county eminences and sate laws mlating In
O V building conswaion,and hereby authorire representatives of this city to enter upon the
W ahavcin.judgmproperty furtepers.purposes
P,
(WO)agree to save,indemnify and keep harmless tic City of Cupcnino against
liabllidu.Judgmcnu.eosu and upensu which may In my way an.against.id City
V Z incomequcnee of the granting or this permit. Date
�--� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:
SOURCE iEAn NS. Re-roofs
Signa..o Appli UC nv ter ate of Roof
DOUb MATERIALS DISCLOSURE Type
Will Neap Plicate or future building occupant erre Or handle bemoan material
as dcOncd by the Cupertino Municipal Cade.[hapten 9.13,and the Health and Safety
Code,Section 355334)7 All roofs shall be inspected prior to any roofing material being installed.
Ayes X�Nm
Will the applicant or future building occupant use equipment or dcvlcu which If a roof is installed without first obtaining an inspection,I agree to remove
emit Immodous air contaminants as dcfned by We Bay Ams,Air Quality Management allnew materials for inspection.
Dimvlet?
❑yes hyo
1 have mal the haramous materials mquimments under Chapter 6.95 of the Califon
nix Health&Safety(ode,San.35505,35537 and 25534.I utMctsund Nanifiha building
dos not cuncady have a tenant.Net it is my 10pomobility m notify Nc aeupant of Na
mgmtenjcpu}w`hlal'I ua'1xc t;mOrWismanx.f.0 rdrem eraempa.y. Signature of Applicant Date
Dwaer r au a .11lad/cut Dam. All roof coverings to be Class"B"or better
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ATY OF CUPERTINO D 0023
SIGN
`CUPEkTiNO PERMIT APPLICATION FORM
APN# — 7/J J� r Date: ? 710 o
Building Address: �J
0z-,5S S. De zap
Owner's Name: Phone#:
Cle" Home
Contractor: License#:
SW�S Inc. Y
Contact: v Phone#:
beql L;n . -65P D
Applicant/Contract :
hG-
,Building Permit In :
Bldg Elect Plumb Mech
Job Description:
Residential: - - 01"J
Commercial:
Sq.Ft. Floor Area: $/Sq.Ft.:
Architect/Engineer: Cost of Project:
5,000 —.
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