BLD-2020-2081BUILDING PERMIT
CUPERTINO
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING ADDRESS: 10480 S DE ANZA BLVD Cupertino
APN: 369 40 014
PERMIT NO: BLD-2020-2081
OWNER'S NAME:
PHONE:
CONTRACTOR: COAST SIGN INCORPORATED, 1500 W EMBASSY STREET ANAHEIM
CONTRACTOR PHONE:
DATE ISSUED 12/18/2020 7:43:57 AM
ISSUED BY: haleym
VALUATION: $6000
JOB DESCRIPTION
MONUMENT SIGN - (28 SF)
CATHATY BANK - INSTALL (1) ILLUMINATED
LICENSED CONTRACTOR DECLARATION
provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full
CONTRACTOR:
LICENSED
C45
LICENSED
EXP
03/31/2022
I hereby
force
I hereby
COAST SIGN INCORPORATED
CLASS:
ELECTRICAL SIGNS
NO: 654238
DATE:
affirm that I am licensed under the
and effect.
affirm under penatiy of perjury one
I have and will maintain a certificate
for which this permit is issued.
I have and will maintain Worker's Compensation
I certify that in the performance of the
laws of California. If, after
with such provisions or this permit
of the following three
of consent to self -insure
Insurance,
work for which this
making this certificate
shall be deemed revoked.
declarations:
for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the
work
as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's
of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith
V
issued.
Compensation
comply
HAZARDOUS MATERIALS DISCLOSURE
requirements under
9.12 and the Health
Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance
I have read the hazardous materials
the Cupertino Municipal Code, Chapter
V
with
equipment
Municipal
& Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use
as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino
Sections 25505, 25533, and 25534.
or devices which emit hazardous air contaminants
Code, Chapter 9.12 and the Health & Safety Code,
EPA LEAD -SAFE DISCLOSURE
Renovator will be responsible for this project.
Firm Certification No:
Firm is required for this project.
An EPA Lead -Safe Certified
Firm Name:
No EPA Lead -Safe Certified
Certified
V
CONSTRUCTION LENDING AGENCY
there is a construction lending agency for the performance of the work which this permit is issued (Section 3097, Civil Code).
Lender's Address:
I hereby
Yes
affirm
under penalty of perjury that
No
V
Lender's
Name:
APPLICATION CERTIFICATION
and
representatives
against liabilities,
will comply
state that the above
of this city
judgements, costs,
with all non -point source
--#
I have read this application
and hereby authorize
the City of Cupertino
understands and
Every permit issued shall become invalid unless the work on the site authorized by such permit is commenced within 365 days after its issuance, or if the work authorized on the site by such permit is suspended or abandoned for a period
of 365 days after the time the work is commenced.