07090041 CITY OF CUPERTINO
BUILDING DIVISION PERMIT ` t Q jN-10
PERMIT NO.
BUILDING ADDRESS:
7335 BOLLINGER RD STE C ALLEN SIGNS INC 07090041
PERMIT ISSUE DATE
:R'S NAME.
GRAY SOWARDS 1982 STONE AVE 09/10/2007
SANITARY NO. CONTROL NO.
PHONE:
(408) 280-6500
BUILDING PERMIT INFO
ARCHITECTIENGINEER: BLDG ELECT PLUMB MECH
p p LICENSED CONTRACTOR'S DECLARATION Job Description
yI hereby affirm that I am licensed under provisions of Chapter 9(commencing
UW
z with Section 7000)of Division 3 of the Business and Professions Code,and my license is INDIVIDUAL CHANNEL LETTER AT STORE FRONT;
y in full force and c aft,
�z Licc Ise Lam•# COMMERC--AL
F p Datc Contractor
ARCHITECTS DECLARAT N
i a< I understand my plans shall be used as public records
)qU
U.in Licensed Professional
O< OWNER-BUILDER DECLARATION
1 hereby alum that 1 am exempt from the Contractors License Law for the
in o following reason.(Section 7031.5,Business and Professions Code:Any city or cottony
Pi which requires a permit to construct,alter,improve,demolish,or repair any structure
m prior ut its issuance,also requires the applicant for such permit to file a signed statementFt. Floor Area
Valuation
.
-?e that he is licensed pursuant to the provisions of the Contracuurs License Law(Chapter 9 3Ll
h=• (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $2000
that he is exempt therefrom and the basis for the alleged exemption.Any violati�o of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of [ N Number Occupancy Type
not more than five hundred dollars(5500). 359230113 . V 1
0 I,as owner of the property,or my employees with wages as their sole compensalim,
will do the work and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections
and Professions Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who does such work himself 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 completion,the owner-
builder will have the burden of proving that he did not build or improve for propose Of
sale.).
0 I,as owner of the property.am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Code:)The Contraetars Li-
cense Law docs not apply to an owner of property who builds or improves therein.and.
who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's
License Law.
t am exempt under Sea B&P C for this reason
,r Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
0 I have and will maintain a Certificate of Consent to self-insure for Worker's Compen-
sation,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
0 I have and will maintain Worker's Compensation Insurance,as required by Section
3700 of the Labor Code,for the performance of the work for which this permit is iswed
My Worker's Compensation Insurance carrier and Policy number ark:/
Cartier /WVV_-, n.4 Policy No.. 121�( )_S7��/
—CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred doRms(5100)
or less.)
I certify that in the performance of the work for which this permit is issued.I shall not
employ any person in any manner so as to become subject to the Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you sbmld
become subject to the Worker's Compensation provisions of the Labor Code,ym most
,J 0 forthwith comply with such provisions or this permit shall be dccmcd revoked.
Z)" CONSTRUCTION LENDING AGENCY
Fr ren I hereby affirm that there is a convection lending agency for the performance of
> the work for which this permit is issued(Sec.3097,Civ.C.)
Lxndcls Name
L.cndees Address
U C I certify that I have read this application and state that the above information is
it+a CO CL 1 agree to comply with all city and county ordinances and state laws relating to
0U building construction.and hereby authorize representatives of this city to enter upon o
U ahove-mentioned property for inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
,H cn liabilities,judgments,costs and expenses which may in any way accrue against said City z
U Z in consequence of the granting of this permit. Date Zv<�7,7
►+ APPLICANT UNDERSTANPS AND WILL COMPLY WITH ALL ON-POINT Issued by:
SOURfVktmuir
-.
[o Re-roofs
Sigaat ofApplT of F.00f
US MATERIALS DISCLOSURE ypeWill the apre building occupant store or handle hazardous material
Mined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
0Yes °
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? ` ,
0 Rl Yes No
I have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Code,Sections 25505,25533 and 25534.I understand that if the building
docs not currently ve a rant that it is my responsibility to notify the occupant of the
nquiremcnuw' use meIprioStoissuaaceofaCcrtificatco(Occupancy Signature of Applicant Date
All roof coverings to be Class'B"or better
Owner ora thorizcd a nt Dare