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02110094 (4) CITY OF CUPE RTINO - ` � ' ' "' w BUILDING DIVISION PERMIT :CONT�RACTORINF.ORMATION: I+m ES EN CREEK BLVD CAL-NEON SIGN vERMrrN02110094 I0YsBR4E:PROPERTIES 1577 ALMADEN RD APPLICAT!PgSYB194TY2002 orZONE: —74-0-8—T2 8 9-18 8 3 SANITARY NO.r r CONTROL NO. ARCHITECTaiNGINEER: BUILDING PERMIT INTO BLDG ELECT PLUMB MECH I� t� 1-00 LICENSED CONTRACTOR'S DECLARATION �U IWrcby affirm that l am licensee under provisions of Chapter 9(commencing SIGN Job Description <i withScclion 7lkM)pt(Divisi�n Jn(NC Business anup rofassid ps Cd,,e undmyliccnxuis in lull tome ane y,�,(,� E'�� License Glc �S f� TL Lic.N IN���® F�f'w Dale Cunlmnor ARCHITECTS DC;CLA N DEC 2 6 2002 a4< I understand my plans xhull W u.,oJ as pathic record., dOyU uRiBw Licensed prolessionul F u'0, OWNER-BUILDER DECLARATION w i S I hereby affirm Ihat I amxempt from the Contractor's License Law for the BUILDING $1100 m a no Ikdlowing reason.(Section 7(131.3 CBusiness and Profession,Code:Any city eeoounty 6 which requires equir a permit 111 emistmo,alter,improve,demoli h.nr repair any x11di poor to its issuance,also requires the applicant for such permit to a signed statement r-?a that he is licenud pursuant to the provisions of dm Contractur's license law(CWpter 9 3,*91a8I0Q1@A@© Valuation a€0 (commencing with Section lgsp of Division 3 of the 6uslnessimd Poilessions Code)or Our he is exempt these rem and the basis for she alleged eaemption.Any violation of Section 7131.5 by any applicant for a Permit subjects Bit applicant to a civil penalty ofPNN Occupancy Type not more man five hundred dollar.($50(d. 103 — UFER ❑ I.as owner of the properly,or my employees with wages as their Rule compensalion. 184 REBA will Jo Ne work,and the structure is not intended oroffered for sale(Sec.704,1.Business and Professions Code:The Convector's License law does not apply to an owner of 105 — ANCHOR R�f1rloSInspections property who builds or improves thereon,and who does such work himsclror through his n employees.promded that such improvements arc not intended or offered for sale.B. 304 — ROUGH ELECTRICAL however.Ne building or improvement is sold within one year of completion.the owner- 505 - FINAL ELECTRICAL builder will have the burden of proving that W did not Wild or improve for peryese of sale.). 514 - FINAL PUBLIC WORKS 1,as ownef of On property,am exeluaively contracting with littnsed contractors to construct the project(Sec.7X0,Business and Professions Code:)The Contractor's Li- cense Law docs not apply to an owner of property who Wilds or improves thereon,and who contracts for such projects with a comracomot)licensee pursuant o the Contractor's Licese Law. El I am exempt under Sec. ,B&PC for this reason wner Dam WORKER'S COMPENSATION DECLARATION I hereby affirm under Penalty of perjury or of On following dcclaratita: 1 have and will mainmtn a Canificne of Consent o self-insure for Worker's Crudites- Ruder,as provided for by Section 3710)of By,labor Cod,for the performance of the work for which his permit is issued. ❑I have and will maintain Workers Compensation Insurance,as required by Section 37110of the labor Code,for the Performance of the work for which this permit is issued. My WorkeLs mpeasa In donna canner and Policy numberare: 7 O artier. Policy No.:J& /14.3 CER 'A EOF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section recd not W completed if tW Penult is for one hundred dollars(SILO) or Lem.) 1 certify that in the periimmance of the work for which this permit is lamed.I shell not employ any person in any manner so as to Mcome subjeetfn the Workcrs'Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making this Cent Gcale of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Cod,you muss C)Z forlhwilh comply with such provisions or this permit shall W deemed mocked. ZO CONSTRUCTION LENDING AGENCY t-+tz, I hereby attirm Nat there is a construction lending agency lot the performance of m 7 thc work for which this permilis issued(Sec.30)7,Civ.C.) W a Under's Name P. Lender's AJdnss V Q I cenify Out 1 have read this application and suite that the above information is LL H correct.I agree to comply with all city snit county oNtnances and stale laws relating it) 0 V building conswclinn and hereby amhorim representatives of Nis city to enter upon the W aWve-mentioned property for inspection purposes. Fa (Wc)agree to save.indemni fy and keep harmless the City of Cupertino against y Iiabi lilies,juJgmems.costs and expenses which may in any way accrue egaifrstsiid City V Z in consequence of she granting of this Permit. .. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. Re-roofs Signatureof ApplicaDam HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupant marcor handle harardous material ;is defined by the Cupertino Municipal cipal CnJc,Chapter 4,13,and the Ilcalth and safety Gale.SeNon 255320)" All roofs shall be inspected prior to any roofing material being installed. ❑Ycs 0N Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, 1 agree to remove emil briardous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection. District? C3 yes 0N I have mad the ha ardour materials requirements under Chapter 6,95 of Be Califon ria l lcahh&Safe u.Sections 255115.25533 and 25534.1 understand had if Ne building docs nm cuncm a Imam,mat t+s my mspumibillly m notify IM dxcup in Nc mgniremc u'I iaaaary_racemE"cafacean' Sig natureofApplicant Date owner nn anmarimd ascot (/t/� /Date All roof coverings to be Class "B"or better