04090257 CITY OF CUPERTINO s -' '* •e - ti�"�< • ¢iv s
BUILDING DIVISION PFR CONTRACTOR INFORM�QN *'
eull.DlNC ADDRESS: CAL-NEON SIGN PERMIT°04090257
1052
NEWS NAME: PERMIT ISSUE DATE
ROP ADPBE REST
PHONE: SANITARY NO. CONTROL NO.
(408) 289-1883
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0
tion LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm than 1 am liunud unticr pr vuimm mfCM1apm,9(,mOrmrcm, Job Description
^ with SdcumV00RmDivlsion3of NC Buainev and fu(cssium Cmdi.and my license is .
d
j Zin full rgqryryee and effect. fo'7$7$O SIGN
LiccnsYlnss Lim.B '
k Dam Contractor
ARCHITECTS DECLARVON
�i 1 under an my p
areh2Ire u d as PuhBt records
D a u In 1s4J /
30 LiecnstaPProfcsvional
3 OWNER-BUILDER DECLARATION ,
1 hereby alBnn that 1 am exempt from the Contractors License Law for the
p o following reason.(Section](131.5,Business and Professions Cade:Any City or county
m wM1ich require a Permit m cmiswet,akr,improve,demolish,r.,.it any emuetme
prior m its issuenu,also requires the applicant Forsuch permit m file a signed suimmem
5�< that he n licensed purauamto the powthor of the Co union's Bone Law(Charm,9 Sq. Ft. Floor Area Valuation
z�th (commencing with Section70NB of Division 3 of the B usiness and Propulsions Code)or
i Ras he is exempt therefrom and Ne basis for On alleged exemption.Any violation of
Secdon 7031.5 by any applicant for a permit subjects Re applicant to a civil pcnahy O( 3 Sda11UVL iofbet0 0 Occupancy Type
ey more Can five hundred dollars($500).
❑I.as owner.(,he pmapvsy,or my employm with wage as R it so it compensation.
will do the work,and the structure is not mosmied or offered for sale(See.7044,Business
and Pomealions Code:The Contractors License Law docs not apply to an owner of Required Inspections
property who builds or improves themon,and who docssuch workhimself or Rough his
a
ownemptoyces.he Wiping ori prat suchimprovementsarcnot intendedoroedred for owner.
however,thebuildingaiden mvomen(ishaltwithin one year of completion,the o=of
builder will have to burden of proving than he did not build or impose for pumyose of
salcJ.
0 I,as owner of the Property,am exclusively contracting with licensed contractors to \\\
construct the project(Sec,o an Business and Immersionsbus Code:)Them dommr's Li
ccme law docs not apply c an owner of propct(y who Molds or impmass Corton,and 7
Lwho ksmse Laeu for such projects with a convacmrts)licensed pursuant to the Convactoh
Liun�Lew.
1 exempt unticr Sec. .B&P C for this reason ,
aer Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of Bm following declarations:
❑I have and will maimain a Certificate of Consent to self-insumfor Workers Compen-
vtian,as Provided for by Section 3]00 of the tabor Code,for the performance of the
wart for which this permit is issued.
❑10.
and will maintain Worker's Compensation Insunna,az required by Section
J]CO of the labor Codi.for the performance of the work for which this permit is issued.
My Workers aCyompCtuadon Inwnme carticr d Be umber art:
n-1f o'
MEMO FROMVORKERS'
COMPENSATION INSURANCE
(Thu section nand not becompleed if the permit is formic hundred dollars RHC)
ort .)
1 certify that in Rc performance of the work for which this Permit is issued.I shall not
employ any perso�i man gvjp co c bjoom CC Workri Comperusam
Laws of Califoan 1L9
APP Iic r IN Mn Pd LYn •D Ell —
NOT1CV0 APPLICAT:If,after making this Cenifica a of Exemption,you should
become subject.,he Wmrkcr's COmPensation Previsions of the labor Cock.you mtw
�z forthwith comply with such provisions or this Permit shall be deemed mvoked.
Z O ECONSTRUCTION LENDING AGENCY
E.71.. I hereby aRrm that then is a construction lending agemy for the Performance of
the work fur which this Permit u issued(Sec.3097,Co,C.)
LO Q Lenders Namc
z Le&,'s Address
C)Q 1 certify Cat I have read this application and stem that the above information is
correct.l agree to comply with all city and county ordinances and suite laws refining to
OO building construction,and hemby audorire mpresenuitivcs of this city to enter upon the
r G abovomcmiomd property for inspection purposes.
(We)agree m save,m mnify and keep harmless the City o(Cupeninm against
Iiabilitiu,judgmenu:eostsan expenseswhic may in any way accrue against said City
V z sW it.
APPLICANTJJNDEgranyrP�mf p110 WI COMPLY WITH ALL NON-POINT Issued by: Date
SOURCER GUL
1 9 at ' Re-roofs
Sgrrm(rc f aHA ARDOUS MATERIAmr
LS DISCLOSURE Data Type Of Roof
Will the applicant or future building uccupanistore or handle hvardous material
az defined by tan Cupertino Municipal Code.Chains,9.12 and the Health and Safety
Code,Section 25532(2)? All roofs shall be inspected prior to any roofing material being installed.
�Ycs
Will the applicant or future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit harardnas air con dminants az crincd by Ne Bay Area Air Quality Managcmcnt all new materials for inspection.
District?
❑Yes Nu
I have mad the butV
qui cm rats under Chapter 6,95 Of the Calif.,.
iias not corm
SafmyIr San 25534.1 understand Rmifthebuilding
dIr4ntIin&S ml Casa smyr 'bility'm nmufy Rc occupantA(Rc
myall. nu fmnmmwls yraccin anmy Signature of Applicant Date
c.� 09-ZX All roof coverings to be Class "B"or better
Owner r gent Data
CITY OF CUPERTINO
gem 1 of 1 PERMIT RECEIPT OPERATOR: conniew
COPY # 3
Sec : Twp: Rng : Sub: Blk: Lot :
APN . . . . . . . . : 35918058 . 00
DATE ISSUED. . . . . . . : 09/24/2004
RECEIPT # . . . . . . . . . : 27176
REFERENCE ID # . . . : 04090257
SITE ADDRESS . . . . . : 10525 DE ANZA BLVD # 100
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . .
OWNER ROP ADPBE RESTAIRAMT
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CA
RECEIVED FROM . . . . : CAL-NEON SIGNS
CONTRACTOR . . . . . . . : KATZ, JOSEPH LIC # 20444
COMPANY . . . . . . . . . . : CAL-NEON SIGN
ADDRESS . . . . . . . . . . : 1012 MORSE AVE, STE #9
CITY/STATE/ZIP . . . : SUNNYVALE, CA 94089
TELEPHONE . . . . . . . .. (408) 289-1883
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
-- - - --- - --- -- -- -- - - ----- - --- - - -----
BPERMFEE VALUATION 2 , 300 . 00 83 . 16 0 . 00 83 . 16 0 . 00
BPLANCHK PERMIT FEE 83 . 16 110 . 98 0 . 00 110 . 98 0 . 00
BENERGY PERMIT FEE 83 . 16 39 . 92 0 . 00 39 . 92 0 . 00
BREMSIGNAD NO. CIRCUITS 1 . 00 4 . 80 0 . 00 4 . 80 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 , 300 . 00 0 . 63 0 . 00 0 . 63 0 . 00
TOTAL PERMIT 301 . 84 0 . 00 301 . 84 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------- - ----- ------------ ------- - - --
OTHER 301 . 84 1576
TOTAL RECEIPT 301 . 84
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 CUPERTINO! cs- -z5-
SIGN 7
*CUPERTINO PERMIT APPLICATION FORM
APN # 3 J/ loo b v _/S 1 Date: o7 ,e
Building Address: 06 e- AMZ� Alva
/ 2 �. � _* loo
Owner's Name: Rkb A�>oee Phone #:
Z,.T&vcLAST iuE- 255- 4400
Contractor: (I �epYA c' ` License#: i O
Contact: —,� vQe� C-1
\ c� Phone
0&App ►� e 409-
Applicant/Contractor:
licant/Contractor:^
Building Permit Info:
Bldg G�) Plumb Mech
Job Description: II
Residential: TWO C?7,� S Ot� C Commercial:
Sq.Ft. Floor Area: $/Sq.Ft.:
Architect/Engineer: Cost of Project:
� 3
Type of Construction: Occup cyY
Q
A ica le Fee ID Fee Descri tion 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
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18000AL-NEON f.4082898024 WWW.CALNEON.COM PROJECT NAME: Rio Adobe Restaumant SCALE:
•
>c 1012 MORSE AVE.SUITE 9,SUNNYVALE,CA94089 DESIGN: i 6 as I scat
7 -0 WnwcNr NOTICE Q):TING ISM OR=IM UNFOBOSNEO ORAPANG WERBTTED FOR ADDRESS: a nza v . DATE: SALES: a✓� e
:7� s
UM IN CQINECTIW YAIXA PROhti[EIXG RLANNED BY CALMEW SIdB.li 16 X01 upe ino, REVISED: DRAWN BY: an0
TORE BNOWM TOMYONEWTSIDE YWR OROANUAIIW NOR IB Ii TO BE CO ED,
i o REPRODUCED,OR EXHIBITED IN ABY FASHIM. FILENAME: rioaame.pmSHEET O: 0 .
F - • • Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
UPERTINO
Building Department
JOB ADDRESS: PERMIT #
525 S. lac Anza 6\vd
OWNER'S NAME: PHONE # •2 q• l8
GENERAL CONTRACTOR N FAX #
I am not using any subcontract 09•29'•09fSignature 7 �Vate
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum/ Wood
Glass/ Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
t Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile -
46 1
09. 2y 01F
er Contractor Signature Date
CITY OF CUPEMNO
BUILDING DIVISION PERMIT �`°CONTRAGTaR�INFORMATi®
<P-.-
BUILDINGADDRESS: CAL-NEON SIGN PERMITNOO4O9O257
52
ER'S NAME: PERMIT ISSUE DATE
ROP ADPBE REST
E: - SANITARY NO. CONTROL NO.
(408) 289-1883 _
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
iso, LICENSED CONTRACTOR'S DECLARATION Job Description
O
y 1 WaLY affirm that I am Ila¢d under prgviaiov of Clupu:r Y(Commencing p
�Zw with Sanson 0110)mf Division Softhc Buttress feasiurc Code.and my license is .
n<a infullf and effect.
°y,i Lianw ass Lie n - 6'7$']$O SIGN -
n^p DateContractor
ARCHITECT'S DECLARRAATto
�-s IusMc a Y..ms he uxdas Pubmt mcmem .
th'
LL I" Liccns odessim al
+03
OWNER-BUILDERexemptOE DECLARATION
a q 1 hereby.(Sec Net I em exempt from ore Contractor's Co e:Any c law for the j
pO which
following (anti 1 ]1131.5,Business and Professions CndO:Anyciry are aunty
.29 which U issu a e.also re Co...'.halma improve.h Permit
mr repair any structure -
`y—ve that heor itsiensedp pursuant
to the the inion or for such Pcrmiuo rite Low(ed nammcm
Utz that he isliccnudpursuavOmthePmvisinnsofthe CmnwcmriLicenseLew(Chepmr9 Sq. Ft. Floor Area aluahon
are$ (commencing with Section 7rM)of Division 3 of the Business and Professions Com)or
that be is exempt therefrom and the basis for the alleged coseption.Any violation of
Section 7031.5 by any applicant for permit subjects lie applicant to a civil Penalty of _ 3S CIO Occupancy Type
not moa Nan five hundred dolhn S!t[X).
❑I.u owner of the pmper,or my employcm wiW wages as their vele compensation,
willda the work and the swclu a is not intended or offend fonale(Sm.7(Nad,Business
and Prolocutor Code:The Conuattors License Law does but apply to an owrcr of Required Inspections
progeny who builds or improves thereon,and who ones such work himself or through his
Own employees,provided that such improvements are not intended or offered foraale.If.
however,the building or improvement is sold within ane you of comploom.Ne owmer-
builder will have the burden of proving that he did not Wild or improve for purpose of
sale.).
❑I.as owner of the property,am exclusively convening with licensed contractors to
convect the project(Sec.7(31C,Business and Professions Cade:)The Contractor's Li.
come law does not apply ro an owner of proper who Wilds ore improves thereon,and.
who contracts for such projects with a comsazmr(s)licensed pursuant,to bac Committees
Licame Lew.
I am exempt on&,Sec. .B&P C for this more
net Da
WORKERS COMPRNSATION DECLARATION
I hereby egret under Penalty of perjury one of the following declarations:
have and will maintain a Certificate of Cement toselM1insum for Workers Cooped-
as provided for by Section 37W of the Labor Code.for the pcfformance of the
work for which this Permit is issued.
❑T have and will maintain Workers Compettsatimn Insunna,as teyvired by Section
3700 of Ne Labor Code,for the Performance of the work for which this permit is issued.
My Workers Co�nsauonlnsunncccarier d It umber.¢:
ATE PEON FRO ORKERS'
COMPENSATION I117
RANCE r
flhu section need not beemnplemd if the Permit is forom hundred dollar(SIM)
kis.)
1 certify that in the Performance of the work for which this permit is issued,1 shall nut
cmployanylat . mann L• co a bject to the Workmi Compensation
Laws of Califsami ;
APPIieUp CaIist'%; e
NGTIC O APPLICANT:If,alter making this Certificate of Exemption.you should
Nature subject in the Woncer s Compensation provisions of da lalwr Code,you must
.,O forthwith comply with such previsions or this P Mit shall W deemed revoked.
Z CONSTRUCTION LENDING AGENCY
I hereby affirm that then is a convection lending agency for the Pcrumnanco of
f5 the work for which this permit is issued(Sec.3097.Civ.C.)
W QLenders Name _
4• Lender's Address
D Z
U O 1 modify that 1 have rod this application and sou that ore above information is
W(•' Correa I agree to comply with all city and county ordinances and sum laws aiming to
0 building consuumion.and hereby authori opmtennlivna of this city to enter upon the
a above mcnumned property for inspection p rrpoaes
(we)agree to save,ipdqmnify and keep homiest the City of Cupertino against
py liabilities judgments.Cos an expenses whit may in any way sccme against Mid City
U Z APPLIICANT.UNDEgren go IND WIC COMPLY WITH ALL NON-POINT Issued by: Date
SOURCEREGUL
Re-roofs
na rc f env n Dam
HAZARDOUS MATE RIALS DISCLOSURE Type Of Roof
Will the applicant or future iptitling e.Chart nom or hanand t e Hearth
sdSafrmaterial
fined by the 32(.)Cupertino Municipal Cade.Chapmr 9.11,and the Health and Safety
e.Schon 2ss3z(a)?
Yes �Z< All roofs shall be inspected prior to any roofing material being installed.
Will thc applicant or future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
I hiModnus air conuminan�fincd by the Bay Am.Air Quality Management all new materials for inspection.
vicR
❑Yes Nu
I have rein the has
Ard assn a qui nu under Chapter 6.95 of the Califory
714�
Haalth&SafnyCaA!Sccu San 25534.1 undcrsmM thuifdm Wilding
s noteemoll ewer umyr hilityinnOdlytheoccupantnf Ocd�mmcrm tichmu c n mit raCenif¢elcmre=a�ancy. Signature Qf Applicant Date
�nerm gent Dale All roof coverings to be Class"B"or better