05030093 CITY OF CUPERTINO
BUILDING DIVISION PER1V1� CONTRACTOR INk'ORMN
BUILDING ADDRESS: ALLEN SIGNS INC PERMRNO05030093
0795, q PLANEY A172
OWNER'S NAME: PERMIT ISSUE DATE
FDENTTqT?y
ONE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
E= 0 0
X00 LICENSED CONTRACTOR'S DECLARATION 706 DeSCTIpI100{��rgl A /Hg p 11^"` li"�1
iWw❑ 1 hereby affirm that 1 am licensed under provisions of Chaprcr 9(commencing tgg/ltd Iltllt\\NV!rygdl/[�N\1(Il Itll��{t1IVby1
with SectionIWO)arDivision 3 ofthc Business and Professions Code.and my liceraw is k0
License
6
in"'If. and effect �' SIGN (INDIVI . CHANNEL LETTER
Lima
Z�' Dam Cl ARCHITECTS DECLARATION ppiRs] n/ rq
Ni a� I understand my plans shall he used as public occur I(I'Y:I` J I `ooaa
JyU
O Licensed hereby Tonal ®�B1 p
OWNER-BUILDER DECLARATION r�IQ�p
1 hereby affirm thut 11. exempt from Nc ConuaaCo License Law for rite
X S o fallowing mason.(Schon]1131.5.Business and ve de au Code:Any city S county
K$ which requires a permit to cnnnmct,altep improve,demolish,m repair any atmdum
Fi< Prior to its issuance,also requires the applicant for such permit to file a signed statement
Exx
that he is licensed Pursuant to the provisions of the Contmcmr's Liccnsc Law(Chapter 9 Sq. Ft. Floor Area Valuation
ret-$ that he
exempt Section]000)the
Division the
the Business and ProfessionsAnviolation
ationof .
y5. Natio is exempt Ncrtfrom and Jut buss for the Objects
the exemption.Any violation of
Section]031.iveany
ndred Carrarantr (apermit subjccuthe applicant maCivil penalty of 36912OI'�LftcrO O Occupancy Type
not mom Nan five hundred df5500). '
0 1,u owner of the prepm,a my employees with wages u their sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.704x,Business
and Precessions Cade:The Contrcmrs License Law does not apply to an owner of Required Inspections
property who builds or improves thereon,and who doessuch work himself or through his
own employees.provided that such improvements are notimmuded or offered forsale.IL
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 Wild or improve for purpose of
0 h as owner of the property,am exclusively contracting with licensed contractors to
construct the preKct(Sec.](ao,Business and Professions Code:)The Contractor's Li-
cense Law does not apply b an owner of property who builds or improvss thereon,and,
who contneu for such projects with a conmetor(s)licensed pursuant o the ContracmFs
tk:enae law.
❑1 am exempt under Sec. .B&P C for this moon
OwnerDate
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under Penalty of perjury ane of the following declamations:
737M
1 hire and will maintain a Certificate of Consentto self-insure for WorkeYsCompcn-
.son,u provided far by Section 3]00 of the labor Code,for Ne performance of the
ork for which this permit is issued.
1 have and will maintain Workers Compensation Insurance,as"hired by Section
of Ne Labor Cade,fa the performance mf the work far which this permit u issued.
y War err Compenstion Insrance carrierand Policy number arsesy: �������articr. Qi hT � Policy No.:(y'5-15
r ERTIFICATE OF E4EMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Ibis section need not he completed if the permit is for mm hundred dollars(SIM)
less.)
I comfy that in the performance of the work for which this permit is issued,I shall not
employ any person in any manner so u to become subject to dm Workeri Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate or Exemption,you should
become subject to the Worker's Compensation previsions of the Labor Coda you must
.J O forthwith Comply with such provisions or Nis permit shall be deemed revoked.
ZM CONSTRUCTION LENDING AGENCY
(-t Ibemhy,Rrm Nat them is.conscoulm.lcndingagcmy far the perfurman¢of
the work fur which Nis permit is issued(Sec.309],Civ.C.)
f37 C] Lendcis Namc
O. Lenders Address
U 0 1 cenify that 1 have read this application and sure that the above information is
lL F correct,l agree to comply with all city and county ordinances and sum laws relating to
0 U building comruction,and hereby mNonx mpresenutives of this city to enter upon the
W above-ammumed Imorany for inspection purposes. j
(We)agree to save,indemnify and keep harmless the City or Cupertino against
f0.jl liabilities,judgments,costs and expenses which may in any way accrue against said City
or Re
V Z. APPLICANT UNDERSTANDS AND WILL COMPLY WITH^�ALL NON-POINT Issued by: Date ,3
SOUSC��R�EG�ULATIqNS. ✓ /
( t �t �_ /"'(v� Re-roofs
ppli an omncmr Date
Signature of� HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicam or future building occupantstorc or handle hwardmus material
as defined by the Cupertino Municipal Cade,Chapter 9.12,and the Health and Safety
Code.Suedon 25531(.)? All roofs shall be inspected prior to any roofing material being installed.
El Yea 11�o
Wire me, licam or fmurc building Occupant mace t or devices which If a roof is installed without first obtaining an inspection,I agree to remove
pP s p quipmcn
nth hevardnus air comamiarms as derncd by the Bay Area Air Quality Management all new materials for inspection.
Distrix? ✓
❑Yea
I haw read the harardous materials requirements under Chapter 6.95 of the Cali fon , 3
nia Hwlth&Safxy Cook.Sctvons 25505.25533 and 255M.l undersand tharifthe building DS
Jae not currently have a wham,that it b my respumbility,m notify the occupant of the
regal lwmnmrabcmapdortaissaart¢oraeeNhc,maraapaney Signature of'Ap icon[ Date
owner or author>e ascot Dam All roof coverings to be Class"B" or better
FAMILY DENTISTRY BUILDING SIGN ELEVATION: 10795 S.BLANEY AVE. CITY OF CUPERTINO
Of r I fw.,E C DRY �.
1/i A
24'-0-
STORE FRONTAGE PLOT PLANS
NEW SIGN LOCATION
16-T (70%OF STORE FRONTAGE) {� OJECKM BY
RACEWAY PAINTED - DATE
SAME COLOP.AS BUILDING .. ._. __, ..._
NN�\
a B 9 PLAfir DEPT.
-y-�
5"THICK INDIVIDUAL CHANNEL LETTERS,NEON FOR INTERNALLY ILLUMINATION.
8/4"BRONZE COLOR TRIM-CAP,RETURN PAINTED BRONZE COLOR. -
LETTER WILL BE#2648 BLUE COLOR
SCALE:1/4••=U-0'• DATE:MAR-01-2005 BUILDING ELEVATION:
RECEIVED
MAR 4 2005
' ( FAMILYDENTISTRY
10795 S.BLANEY AVE.
SwnxsreaF CITY OF CUPERTINO
LYYa WOrEb A&meennnAYrANgamnalNktio�eeiNP aimq I
- B.Befrmi�olaleC high MNpeNm9aq RbtlnleYl WaNvrip -
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� tlNndlern alCM btaawry, .inar memaAl. GmA1mMrWaN I,ehWINprAn6pnstloppcmbpobny. - - I
' lenebenr,naLrp boon,
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wMh ipmral WYNeb NRlbf ,yy bbe NhnseN Mavrm 50 R)
brtlon unbNmuYeaMYboaan/ tl>LT 1Snlai noir a IW1bWW lrzirch 12 h nar W.
NinvnraN.n.l 5WIWI= u'ra Mira 11laircha 1-1IBm I
PYlcb—� iFLtlasD,I,eWx,aow. 10001015 inch 1n- 75WT. 11rzb
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I EbnaAe:.rtiq ______ - - NECWa86e0a41. Two hbr ® . '� � Z t
Tm/Ar Tmo r m APPROVED
IN ACCORDANCE WITH THE CITY OF -
••"r T� ! I CUPERTINO CODES AND OiiDWANCEi
1MLW CAA L eewnN�ecway a I
a # _} ' . oranR (AYQl wnubmbxmrrn 4l - DATE
SIGNED s
a.n n wL
iurawbra Ir1n 19s;anesnrr.ft Lee --
Mote IrWbbmnwinmeMs my
MLnuletleany naelnmemecanhirtl n UL�fl � � j � _ Ttlls get of Cw�I9 Ftld S�BCI�K.u'�'•ionS MUST be
LISTED rnpn��.e.e.eena N.rmae.m brmm pnLeiv e4 R CWNILTEDCW�NNELLEITpi
Leib mmY Wwmai.a ebnrbm wrome.oaa•wnmrmaMn.w.wme,mmw... C0N1w smcE y 1 K9pl On the],G,LI.1�P�I.�•�¢I' t!me3 ardd15 Wd8YYlldtO
reowAa oe ter bbonl rm..x.e+raa�me.�.man.wr.-.s,wen mea. �� Blake � dm- "' Of 0016"19 On S" j
gm or Neewa "9 °ry rimae err-rma wrnee'�ar Webb.,mq MIRAI'NO BOOlB AND SLElVR ' +
9x earyr0.i.a e. ELECTWSN SECTION b+..M wna.e m.eew n+bn-A paem tW area
ms.busnynazreeoeow=l•lnax.amomr ebW..F.nrmma oM-te etariarmx rsawmsyu..mrL.�ar ta ' 400Ut wdden permsloo from SB tRRi�IB
!
N ns scar t.
baamabm rcmbmmar wbr. OaO rr. no. City Of CUpaN-A.
The stamp'^9 of this plan and s;pecifice mm
SMALL NOT he paid 10 Pam9 Or ro oe an
approval d Bre 1„Diat'wn Ot any provi m ra
r enY CIN ordinance or Stale Lax _
� rF�408/280-6�u0
M4111111-8790APPROVAL: DATE: PROJECT: All dcoign6 &art works belong to Allen Signs, Inc. Any duplication io prohibited.COPY RIGHT 2005 1982 STONE AVE
SANJOS$ CA. 95125
State License#505655
0 0
r CITY OF CUPERTINO
SIGN /
OF
I&CUPERTINO PERMIT APPLICATION FORM
APN# Date:
3 - 3+ = 001. 3 os
Building Address:
C
Owner's Name: Phone#:
Contractor: License #:
A161 s; Inc
Contact: v Phone#:
App licant/Contractor:
Building Permit Info:
lect Plumb Mech
Job Description:
'Residential: Ly j p f Si Commercial:
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
EPERMITFEE Elect Permit Issuance ELECTRICAL
BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL
BREMSIGNS Rmdl Signs, Marquee ELECTRICAL
BUSLIC Business License BUILIDNG
AWL
U �
� 9�
CITY OF CUPERTINO
BUILDING DIVISION PERMIT �CONTRACTORINFORMATIQN:
aUILDINGADDRESS: ALLEN SIGNS INC PERMIT No05030093
0795 q RT.7\NRY A112
W NER'S NAME: PERMIT ISSUE DATE
FAMILY
ONE: SANITARY NO, CONTROL NO,
CHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECr PLUMB MECH
0 0 0 0
Loa LICENSED CONTRACTOR'S DECLARATION IOb DCSCrIpI100
C 1 Wo by affirm Nall am licensed under provisions of Chapter 9( mencing
m with Section 90(X0 fDivium.Sof NC Busmemitid Professimn Come,indmylicenscis
�„ Infanro.anderm . SIGN (INDIVI . CHANNEL LETTER)
Liceme Class L'e.N
Date�Contr
ARCHf1ECT5 ATION
I u.tlermand my plans shall ha usedM
c rccor
�yV
;oG Licensed Professional` OWNER-BUILDER DECLARATION
I 1 hereby affirm that I am exempt from Ne Convacmr's License Law for the
❑o fallowing mason.(Section 9IA 1.5.Business and Professions Cade:Any city or county
E m which mi,mom a permit to construct alter,improve.dcmohi h,or repair any structure
or 000
—'^ prior in its issuance.also roi ems dte applicant forsuch permit to file a signed statement
�E< that heir licensed pursuant to do,provisions of due Comrxwr'aUmme,Law(Chapter 9 Sq.Ft. Floor Area Valuation
i
Fro (commencingaisxem with donations
n s and th Division 3 the
gaged
ext and Professions Crust)or
y�$ Nal he u exempt thctefmm and IM Ease for the illegcd exemption.Any violation of .a.,a,
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3 fter0((((��A� Occupancy T e
not mom Nan firs hundred doll..($500). ms� yp
❑I,ssowner of the property,ar my employees with wage tithe"v sole campennNon, /f D
will do dm work,and the structure Is not intended aroRered forsak(Sec.7014,Busircssa u.
and Professions Coo:The Contractor's Lianse law docs not apply m an owner of �Regwre21 Irk
` splections
properly who builds or improves thcrcon,and who dmssuch work himselfor through his
own employees.provided door such improsuments are not intended oroRercd for tale.If,
however,the building or impmoessem is sold within one yens ofcomplction,the owner- �,/��� q
builder will have thc burden of proving Nat he did not build or improve for purpose of
sale.). (`
1,as owrcr of the Sec.70y,.B udus and contracting with:)Th ed ana6w. - uz
construct La the project(Sec.]014,Business and property
who
Cotler)The Cs thamon, n 4d6
w
ho contracts
law dots not appy w an owner of property who builds or improves thetegn,and.
Lace for such pmKcu with a contncwrts)licensed pursuant w the CanlncwYs
License law.
am exempt antler Sec. .B d:P C for this reason
�_ Dam
't, WORKERS COMPENSATION DECLARATION
1 hereby all under penalty of perjury one of the following declarations:
have and will maintain a Certificate of Comes,w self-insum for Worker's Camper-
d,as provided for by Section 3]00 of the Labor Cade,for Nc performance of the
for which Nis permit is issued.
have and will maintain Workeri Compensation Insurance,as rcqulmd by Section0 of the labor Cade,for the performance of do,work for which Nis permit is;issad.
My W.,of Compcm"I..I�nm'n canoe,and Policy�mian. �(p5��
t�e,are �(�
Cartier. 1 n1 JUAN Policy Na.:Le`I�a2(A
ERTIFICATEOFE EMPION FROM WORKERS'
COMPENSATION INSURANCE
(This section used not bceamplcted if the permit is far one hundmd dollen lglm)
m hem.)
1 certify Nat in the performance of the work for which this permit is issued.1 ahall not
employ any person in any number so as to become subject to the Workers Compcmation
Laws or California.Date
Applicant
NOTICE TO APPLICANT:IL after making Nis CCNRCaLC of Exemption,you should
become subject to the Worker's Compensation provisions of the labor Code,you must
.J2 roMwid,comply with such provisions or this permit Mall be deemed rcvokcd.
zCONSTRUCTION LENDING AGENCY
't-�'�' 11mmby affirm that Nerc its construction lending agmay for 0m performance of
D: the work for which Nis permit is issued(See.3( 1,Civ.C.)
(y Q Uirder's Namc
z Lender's Address
U Q 1 minify Nat 1 have read this application and sum Na,the above informed..is - /J
0 fes'
correct-l onto to comply with all coy and county ordinances and sum laws miming m
�W building and hcmauthonp rpoeunutorts of Nis city menmr upon the
Y'gL above-(We)a ed gree I.coy for impaction indemnify
akeep for
(•" (Wc)egmeto cove,indemnifyandkith hay in any
way
of against id City
incootles,judgmentsecmaang or thisexpenses
Permit. mayinany way accrue again.scrod City
:) z m cense ANT of D RSTAN or Nis Permit.
? l'1
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH AL NON-POINT Issued by: Dale .J � w
SOU C E LATI S. _ '�
4 L Re-roofs
Signature ofAppli an acm
anar Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or room building occupant note or handle le vete our matenal
m defined by Ne Cupertino Municipal Code.Chapter 9.13.and the Health and Safety
ode,Sc❑cyes 255I3 (a)] �Na All roofs shall be inspected prior to any roofing material being installed.
Will the armfwant or future building occupant use egmpmenlar devices WhichIf a roof is installed without first obtaining an inspection,I agree to remove
u hazardous air contaminants as deflated by the Bay Area Air Quality Management all new materials for inspection.
ria] sss...���
❑Yes IMNo
1 have mad the hmmdous materialsmquimmcnu under Clmpter 6.95 of the Caldi
nix Hcil"SafetyCade.Salons 355)5,25573 and 25534.1unde.m.d that of Ne building }s�
dos rot currently have a tenant that it is my mmonsihility w notify the aevpam or de Y
req.' w ichmu mctpdorwissuarecoraCmafteawofOcapmcy. Signature of p icon[ Date
owner ar mumnrlw ,gent Das All roof coverings to be Class"B"or better