05020087 CITY OF CUPERTINO r,"-�,ilnll
BUILDING DIVISION PE _ T dC,ONTRAC R INF 04R,P.TION:,
BUILDING ADDRESS: ALLEN SIGNS INC PERMIT,05020087
OWNER'S NAME: PERMIT WOE DATE
OGI-SAN
IN ZONE: SANITARY NO. CONTROL NO.
(408) 280-6500
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
O D O
no0 LICENSED CONTRACTOR'S DECLARATION Job Description
m❑ I hereby affirm that I am licensed under provisions of Chapter 9(commencing p
co with Section 70110)nr Diviaian Sof Ne Rusimass,nd Prides-cions Cade,and in,livens is /7�`/f,-')
�n in full force and<Bcgt. (` f y (` !
Sq3 Liama.Clox r -tlC Lica 3'SZ-�5:�'% SIGN
n'i w Dam TS DECLARATION ARCHITECTS DECLARATION
�i a I undersand my plans Mha11 he uud as public menrds
al
B u.
Licensed Profcssiunel
`Og OWNER BUILDER DECLARATION 134
<y 1 Archy alarm Nat I am exempt from Mor Contractor's License Law for the
0 o fallowing moon.(Section 7031.5,Business and Professions Code:Any city or county
'e m which mquires a permit to construct,ober,improve,demolish,or repair any structure Q
Fly prior us its issuance,also frquirar the applicant for such permit to file a signed statement
-c MatkislianMcdPurmanitotbeprovisionsofMeCan.,.,',Lim.Law(Chapter9 Sq. Ft. Floor Area Valuation
.FG (commencing with Section TIDO)of Division 3 or the Business and Professions Code)or
i
Out he is exempt therefrom and Bre basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a peraitsubjccrs the applicant to a civil penalty of 36fiRNlNtffilbe0 0 Occupancy Type
not marc than five hundred dollars(SSW).
❑1.m owner of the psapcny,or my employ...with wages m their sole compensation,
will do Me work.and NeaWCWR is not intended.,Offered far sale(Sec.70dd,Business Required Ins actions
and Professions Code The Contractor's Liamee Law docs not apply to an owner of q p
properly who builds or improves thereon,and who dos such work himself or through his
Own employees,provided that such improvements arc not intended ormRerod for sale.if,
however,Ne building or improvement is sold within one year of completion.the owner-
builder will have the burden of proving Out he did not build or improve for purpose of
sale.).
I]1,as owner of the property.am exclusively comforting with licensed contractors to
construct Ne project(Sec.704,1,Business and Professions Code:)The Commucta s Li
cense Law dors not apply to an owner of property who builds or improves the¢on,and
who conartts for such projects with a contaacmr(s)licensed pursuanuo the Commit
Laos.law.
,
❑1 am exempt undo Sec. .0 df P C for this reason
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of Ne following dedaral rt
❑1 haw and will maintain aCcrtificam crematoria to relf-insure for WorkcrsCompas-
sation,as provided for by Section 3700 of the Labor Code.for the performance of the
work for which this permit is issued.
�Wf 1 have and will maintain Workerpens
Worker's Compensation Insuranss o, required by Section
BTW of Ne hbor Code,for the performance of lite work for which this permit is issued
My Workeer cmmpereatulon Insurance,a nber and Policy num her aa:
carrier: ✓ i�[4VI'Q - /s'. Policy No.:
ERTIFICATEOFEKEMONFROMWORKERS'
,
COM F,INSURANCE
This section Ford not he completed Hiles permit is formic hundred dollars(Slf )
or less.) • ,
I coni ry that in the performance of Ne work for which this permit is issued,I Mall not
employ any person in any manner or as to become subject o the Workers Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Cerificalo of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code.you must
.J0,forthwith comply with such provisions nr this permit shall M deemed revnkcd.
z CONSTRUCTION LENDING AGENCY
F"^' 1a xMirm that More is a construction lending agency for the perfurmorm of
0.a. the work fur which this permit is issued(So,.3097.Civ.C.)
WQ Lender's Name
LL lender's Address
=).z
U Q 1 certify that 1 have mad this application and rule that the about information is
it, Hcorrect.1 agree to comply with all city and county ordinances and stale laws relating to
QU building contraction,and hereby authorim representatives or this city to color upon the
r W above mentioned property for impecdon pmp rm,
(We)agree to save,indemnify and keep humless the City of Cupertino against
lQ'/) liabi lilies,judgments,costs and Faport which may in any way accme against said City
U Z in consequence of the granting of this permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURJ,,EE RR�E ULAD NS.-
T 71� 2� 0� Re-roofs
Signor reof Appl int conuamr bou,
� HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will thc3pplicant or future building axupant store or handle mosidous material I
as defined by the Cupenur,Municipal Code,Chapter 9.12,and the Health and Safely
cndr.soy�2ss3z(a)7 �4No All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant Use equipment OF devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit haiardnus air contaminants m defined by the Bay Area Air Quality Management all new materials for inspection.
Di uia7 �/
❑Yes NO
I have read the haaaNnus materials requirements under Chapmr6.95 ofthe Califor - ` —
—
iaHmlth&Safely Cade.Scallions 25505.25533 and 25534.1 prompt thaifdc Wilding
docs not ertearly
haw .nam that it is my msponsihility to Firmly the acupanl nr the '� L
mqui do Frehm ,kmetpdortnissumccnfacerdrealomracupanry_ Signature Applicant Dae
` a r �� �� All roof
O.Ar 8fiv,agent Date coverings to be Class "B"or better
-------------
2T-0-
OGI-SAN RAMEN BUILDING SIGN ELEVATION: 10789 S.BLANEY AVE. CITY OF CUTPERTINO STORE FRONTAGE
NEW 56N LOCATION
Q
18'-0' (70A OF STORE FRONTAGE) - -
- - RACEWAY PAINTED SAME COLOR A5e1JILDING �F OGI-SAN RAMEN
-I -O G 1=Mr-SA.N-RA�IV�.E = -
5"THICK INDMDUAL CHANNEL LETTERS,NEON FOR INTERNALLY ILLUMINATION.-
3/4"RED COLOR TRIM-CAP,RETURN PAINTED BRONZE CALOR
LETTER WILL BE RED COLOR
SCALE:1/4"=1'-0" DATE:FEB-08-2005 BUILDING ELEVATION:
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ar.rwXyaMaXamb..x +Tar mw r�.1. ;n,n�,,,drb,s,anp,wulpm,e,en,awcmucmex 107895 BLANEY AVE.
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�EL498/Y80-8500
*4981289-8700
APPROVAL: DATE: PROJECT: All designs&art Works belong to Allen Signs, Inc. Any duplication is prohibited. COPY RIGHT 2005 1982 STONE AVE.
SANJOS$ CA. 95125
® State License#505655
-iyir�s >, bl .�srir
CITY OF CUPERTINO
Oem 1 of 1 PERMIT RECEIPT OPERATOR: conniew
COPY # 3
Sec : Twp : Rng : Sub: Blk: Lot :
APN . . . . . . . . : 36934001 . 00
DATE ISSUED. . . . . . . : 02/14/2005
RECEIPT # • • . . . . . . . : 28580
REFERENCE ID # . . . : 05020087
SITE ADDRESS . . . . . : 10789 BLANEY AVE
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : OGI-SAN RAMEN
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CA
RECEIVED FROM . . . . : K LIN
CONTRACTOR . . . . . . . : ALLEN LIN LIC # 22174
COMPANY . . . . . . . . . . : ALLEN SIGNS INC
ADDRESS . . . . . . . . . . : 1982 STONE AVE
CITY/STATE/ZIP . . . : SAN JOSE, CA 95129
® TELEPHONE . . . . . . . . : (408) 280-6500
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- -- ------ -- - - -- ---- ------- - -- -------- --
BPERMFEE VALUATION 2 , 000 . 00 83 . 16 0 . 00 83 . 16 0 . 00
BENERGY PERMIT FEE 83 . 16 39 . 92 0 . 00 39 . 92 0 . 00
13PLANCHK PERMIT FEE 83 . 16 110 . 98 0 . 00 110 . 98 0 . 00
EPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
BREMSIGNS NO SIGNS/MARQ 1 . 00 23 . 98 0 . 00 23 . 98 0 . 00
BSEISMICOM VALUATION 2 , 000 . 00 0 . 63 0 . 00 0 . 63 0 . 00
-- --------- ----- - ---- ----- - - ---
TOTAL PERMIT 297 . 04 0 . 00 297 . 04 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- -------- - - -- ---------- --------
OTHER 297 . 04 . AMEX
TOTAL RECEIPT 297 . 04
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
--101--- FOUNDATION=-===------------- ==103--- UFER=====___________________
104 REBAR 105 ANCHOR BOLTS
304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL
514 FINAL PUBLIC WORKS
•
CITY OF CUPERTA
SIGN a Z
CIN OF
CUPEkTINO PERMIT APPLICATION FORM
APN# 36q Date: /r5
Building Address:
se S. Bldl2ekj
Owner's Name: Phone#:
ai 7�Sa
Contractd lle S` /1161License#:
Contact: Phone#: Y
I 408-
Applicant/Contract r:
S,�als
B ' ding Permit Inf :
E%ldlett Plumb Mech
JIQLOescription:
Residential: 2chemoSi ommercia
Sq.Ft. Floor Area: S/Sq.Ft.:
Architect/Engineer: Cost of Project:
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
t EPERMITFEE Elect Permit Issuance ELECTRICAL
BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL
BREMSIGNS Rmdl Signs, Marquee ELECTRICAL
BUSLIC Business License BUILIDNG
di
4;- 2-7 / , 0
CITY OF CUPERTINO
BUILDING DIVISION PERMIT �CONTRACTORINFORMAT^ION�_,
BUILDING ADDRESS: ALLEN SIGNS INC PE"" "05020087
10789 RTANRY AVE.
W NER'S NAME: PERMIT ISSUE DATE
OGI-SAN RAMEN 1982 STONE AVE n? /14,/20nc;
NE: SANITARY NO. CONTROL NO.
(408) 280-6500
ARCHITECrIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
y_0, LICENSED CONrRACIOR'S DECLARATION Job Description
wC I meby affirm that I am heaved under provisions of Chapter 9(commcming P
U with Section7q)0)of Division 3 ofthe Buvnommtd pProfessionspC�ode.and my license is
^�� infall maaAnd effegt. �OiS t� SIGN -
incense Chss 'a'� Luc.N
Dao: C.."Acar
EE ARCHITECTST*S DECLARATION
DECLAR
1 undcrstanJ my plans shall be u public TION
�yU
3LL�
Licensed Pmfcuional
=cts OWNER-BUILDER DECLARATION
Cama ON v
0 0 1 hereby.(True Nat 11. exempt from de Cssman;Code:License law for rhe
00 fallowingseason. emits ]031.5,Businassand P.fessiolih.inMy city or county
$ which requires a e.alsa toe tri dc,alter,improsu,demolish.or.pair any structure
F?i
Oat
sficco mpummanoin the thovisiocant farsuch pactors icanse Law(Chmmem
Nat he incinu it purnnntmthe of Division
of the ContsinessAluenselaw(LTaptor9 Sq. Ft. Floor Area Valuation
w. (rot he
exemiNSemiour 70nd of Divieionl oftheegalexemton.Any
Com)of p
i 3� that he u exempt therefrom and too basis for the alleged exemption.Any violation of
Section 7031.5 by airy applicant for a permit subjects the applicant N a civil penalty of 3 6)Q1Nl@ r1be0 0 Occupancy Type
not more than Bore hundred doll.(ssoe). P Y YP
I,as owner of the property,or my employees wish wages as their sole compensation. s
will do the work and the structure is not intended or offered for sale(Sec.7014,Business
and Professions Code:The Contractor's License law does not apply to an owner of Required Inspections
property who buildsorimproves Nercon,and whodoessuch work himulf ordarough his
own employers,provided that such improvements art not intended oroffered formle.If.
however,the building or improvement is sold within am year of completion.the owner.
builder will have the burden of proving that m did not build or improve for purpose of
sale.). s{'
0 I,as owner of the property,am exclusively contracting with licensed mnuacuns to
construct the project(Sec.7044.Business and Pmfrssions Code:)The Contractors U. //I
ave law does not apply to an owner of psupeny who builds ornant to tharton.and
whence La contracts for such projccu with acontractoRs)liuvedpursuam.the Contnnor's
0 l ann law.
❑ lam exempt undue See. .B&PC for Nis moon
t [Nd
caner Dae
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury am of the following declarations:
0 1 haveand will maintain a CeniRcate of Covent to self-inns.for W.ker'aCompcn-
sation,As provided for by Sation 37M of de labor Code.for the performance of the
work for which but permit is issued.
1 ban and will maintain Worker's Com osadon Insurance,az equired by Section
of the Labor Code,for the perfvmance of the work for which this permit is issued.
My Worker's s ompenrmlon ivunnce,,assim and Policy number ase::
x
Carrier: P � - Policy No.: Oh
ERTIFICATE OF E%EMNFROM WORKERS'
N
COMPENSATT INSURANCE ,
(Thu section need not becomplmed Vince permit Is for one hundred dollars($IIX)
nr Icsa.)
I cenifv that in Na Imform ace of the work for which this permit is issued.I shall not
employ any person in any manner so u in become subject to the Worluri Compensation
Law s of C.ffom A.Dae
Applicant
NGTICE TO APPLICANT.If,after making Nis CmIMOM of Exemption,you should
become subject to Ne Work.s Compensation provisions of the labor Code,you muse
.JO forthwith v Nsh
with comply with suchprovisiois permit all M deemed nwoked.
'Z CONSTRUCTION LENDING AGENCY
�-.� I hereby affirm that theo,is a constsuctinn lending agency for the performance of
fk 7
to work fur which this permit is issued(Sec.3097,Civ.C.)
ft1 lender's Name
Lender's Address
U C I certify that I have mad this application and sum that the above information is
U, P correct.I agree 10 comply with all city and county ordinartas and state laws relating m
DU building construetion,and hereby suNod.representxfivrs of this city.carer upon the
}4 alavc-mismored propcny for inspection purposes
(We)agree.save,indemnify and kap harsnles the City of Cupertino against
f^ rn liabilities,judgments.costs and expenses which may in any way acrnc against said Ci ty
U Z in consequence of the grreating of this permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NO -POINT Issued by: Date
SOUR LATI S._
'22/144/0 Re-roofs
Signm rc of Appl an omon"Or arc
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will de plicao or future building occupamsmrc orhandlc hvardous material
as de fined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
coJc. er z255320),OYrs .`q]1 No All roofs shall be inspected prior to any roofing material being installed.
Will the applicant.1 1.(..Wilding occupant Usecgmpsent a,devices;which If a roof is installed without first obtaining an inspection,I agree to remove
tout hammous air conumivnu As defimd by the Bay Arca Air Quality Management all new materials for inspection.
Dimity? �/ u
❑Yes �y
I have read no,hmameus materials requiretmncc under Chapmr6.95 attire Califon
is Health&Safety Codc,Scetiom 25N15,25533 and x5534.1 understood Nmifthc building \ yr (
does not oc ly have count,Nat it is my responsibility m notify she oreopent of the 4G�
Mqut Oil 'ch memelpdortnissvnecofaecrti0camofOcap cy— Si nattireo Applicant Dae
t
ow r ver aam da d anent Data All roof coverings to be Class"B"or better .