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05050131 CITY OF CUPERTINO ;, BUILDING DIVISION PERMIT rdCON,TRACTR11 , ORMATION BUILDING ADDRESS: NORTHWEST SIGNS PERMITNO05050I3I OWNER'S NAME: PERMIT ISSUE DATE BYER PROPERTTFS SNE: SANITARYNO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDGELECT PLUMB MECH 0 0 0 0 urea LICENSED CONTRACTOR'S DECLARATION 00 m❑ I Wroby storm that I am licensed under and Professions Chapter 9(commencing Job Description vein Stetion)BI111)ofDivision Jofthe Business and Profession Codc,and mylicense u o H fll fd IT in uorce an " et 78(ar8 i-i ucamecln.� _4S Lm.. SIGN--ELECT. GROUND SIGN �� Dam _ .'tr.� Canlranor o wet I ARCHITECTS DECLARATION I understand my plans shell W used as public meet& esti /� 3 o t', Licensed Pmfcssionel OWNER-BUILDER DECLARATION a 0 1 hereby reaso affrzm that 1 1. exempt from me Contractors e:Any c law for the ^\ x00 which requires Permit to coJL4 Business and improve, dcoodi Code:Any city structure l/ ym which its ass s a permit re construct,eller,import,h Permit t or repair any strumum t-se that he its issuance.purse ntto tetWvision o foe sucConaretmiuoicens1c ae Law(Chapter 0 that me cameedpSectionmm"pmviviomofthe Comncmfule"rselaw(C Cork) 9 Sq. F[. Floor Area �alua[lon m= that he (CommencingWiththerefor. and Use Divisionr she UCBusineuand Professions CSMn ser y 3� that lie u eaemps therefrom and the bnu far the alleged exemption.Any violation of Section 7031.5 by arty applicant for a permit subjects the applicants to a civil penally of 3B0yBT7*f$t(:r00 Occupancy Type nae mom than live hundred dollen(5500). I,is owner of the properly,or my employees with wages as their sole compensation, will do the work and the structure is not amended or offered foe sale(Ste.704a,Business and Professions Code:The Contractors License Law docs nos apply to an owner of Required Inspections property who builds or improves thereon,and who does such work himself or through his won employ.,provided that such improvements are not intended or offered for sale.If, however,the building or improvement is mid within ane year of(omplml0n,the owner- builder will have the Wrden of proving that he did not Wild or improve for purpose of side.). C)1,as owner of the property,am exclusively contracting with licensed contractors to coneuum the project(Sec.7044,Business and professions Code:)The Cantnaor's Li- music Law does not apply to an owner of property who Wilds or improves daemon,and who contracts for such projec,with a co rracmr(s)licensed pursuant to the Contractor's License Law. I-]I em aemp.under Sac. B&P C for this mann Owner Date _ WORKER'S COMPENSATION DECLARATION 411 1 hereby affirm under penalty of perjury one of the following daslafation: asn❑1 hsve and will maintain Section 37 se of Cartsem Code, for tfor performance Compcm workI as, provided far by Section 3)00 of the labor Code,for the performance of me work for which this permit is issucd. ❑1 have and will maintain Workers Compensation Instance,m required by Section 3700 of the Labor Cow.for dw peff.mrow.of the work for which this permit is issued. My Workers sa'ypJ,I,,,sufanu sari[,and Policy member art: - Cartier. y ore P �v+'1dt Policy Nu: I. g5423S CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE Ends section need not W completed if the Permit is for one hundred dollars(SIM) nt less) 1 nif,mot in the performance of me work for which this permit is izsucd,I shall not employ any person in any manner so as w became Subject o the Workefi Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If,aricr making this CcniHeare of Exemption,you should Income mbjcn 10 the Worker's Compensation provision of the Labor Code,you must .,z forthwith comply with such provision of Nis Permit shall W deemed revoked. _ z CONSTRUCTION LENDING AGENCY I hereby a from mat mart iso eanstrucsirn lending ag,my for the pc,for..of CYithe work fur which this permit is issued(Sce.3097,Civ.C.) LUQ Lendcrim, Na a. Lender's Address D V O I cenify that 1 bars mad this application and sum met me aW ve information is Ly H coeeet t agree m comply with all city and county ordinances and sea laws relating to O V building convection,and hereby auehome mprosenutives of this city to enter upon thc r fJ.l above mentioned property for inspection purposes. 0. (We)agree to save,indemnify and keep harmless the City of Cupertino against E" fn liabilities.judgments.cos,and exp"res"s which may in any way ascruc against mid City U in consequence of the gmming of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date O SOURC ��,I1LATIO n // yREGm4 G•ZS-O S Re-roofs X Signature or ApplicantlCanraetorr Dal, HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant of future building occupant tore or handle hafac ous material n dmred by the Cupertino Municipal Code.Chapter 9.12,and 0rc Health and Safety Cade.Section M532(a)) All roofs shall be inspected prior to an roofing material being installed. [3 0 N Will Nc applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove it hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yea 113 No 1 have mad the harar iovs materials requirements under Chapter 6.95 of me Califor. nia Health&Safety Cor,Section 25505.M533 and 25534.1 underwnd mazifine Wilding does not currently have a unapt.that it is my responsibility to nudity me oeeu tint of use reporem or�tyi.,uancco crbdrlcate of Occupancy. Signature of Applicant Date `JQ Owner or outhorimd agent l� �w/� Date All roof coverings to be Class "B"or better CITY OF CUPERTINO BUILDING DIVISION PE T �com: alc'roxrrroUN a .a-d?u"tis. BUILDING ADDRESS: NORTHWEST SIGNS PERMITN005050131 wNER'S NAME: PROPERTIES PERMIT ISSUE DATE RYURPHONE: SANITARY NO. CONTROL NO. BUILDING PERMIT INFO ARCHITEC(ENGINEER: MECH BLDGO ELECTO PLUMS O LICENSED CONTRACTOR'S DECLARATION Job Description F 1Mmby affirm that 1 am licensed under Provisions of Chapter 9(commencing '¢ with SemiO=)of Division 3 ofthe Business and Nofeulum Code.and my licesseis < mmOlnmeande ee 7f(p(gi SIGN--ELECT. GROUND SIGN j Z Lmense Class e ^4 S Lie.g z Dam Comma' NfAwpiT_1 9 ARCHITECTS DECLARATION I understand my plans shall Ac used U public records 0 U LLp Licenwd Professional OWNER-BUILDER DECUBATION I hereby Maso .lino I em exempt from the Cortin,Co e:censeAny C Lew fou the O O following moan.permt(Section 21131.6 Business and w.profession,Calc:Any city or county u�$ which its iu a n permit ro enreatma,pike impront forse,hpermitdemolish, fi c a sir any atruaum prior m its issuena,alsu rryuims Mrc applicant fouuch permit m Olc a tlgncd summenl Valuation ss��< Netha is liansW$ punuamm Nepmvisianofthe Contmweatianm Law(ChaP¢r9 Sq. Ft. Floor Area(commencing with Section?000)of Divhian3ofthe Busiocaaand Prafrssimu Cade)ur that he h exempt Moorman and the basis for the alleged exemption.Any victim on of Section 7031.5 by any applicant for a permit subjects Ne applicant o a civil penalty of 39ETN7 "c:r00 Occupancy Type not come than five hundred dollars(5500), ❑1,as owner of the property,or my employees with wage as lack gale compensation, will do Ne work.end Ne atsuaum is not intended or offered for We(See1044,Business Required Ins Ons and Professions Code:The Conbasroe&License Law does not apply m an owner of q property who Wild,or improve thereon,and who does such work howelf or through his owne n'loyces,providW Net auch improvements auction Intended.e.ffmcd fmsale.If. build,, Ne building hand.ovemem ismidedict et year oft prove tn,the Owner- build,, we r- builder will have the burden of proving that he did net build or improve far purpose of ❑1.as owner of the property.am eOCILON ly contracting with licensed comruian an Construct Ne project(Sec.load,Business and Professions Code:)The Conuactoes Lt. 6 came law data not apply to an owner of property who builds or improve thereon,and who contracts for such pri with acomracmr(O licensed pursuant to the Combatant's License Lan lam esmi undo See .B At P C for this mean Owner Dam WORKER'S COMPENSATION DECLARATION I hemby affirm under penalty of perjury oro of the following declarations: ❑I have and will maintain a Certificate of Cansent In self-insure far Workees Compct. salon,as provided far by Section 3100 of Ne Labor Code,for Ne performers of the work for which this permit is issued. ❑1 hale and will maintain Workcfs Compensation Imuran,as required by Section 3100 of the Labor Cade,for Ne pnrcep ee of Ne wart fa which this permit is Weed. My Worker's��ampyenya�don,Iasunna canicr and Policy number am: Cartier. _Mn al` n lrj '14 Policy No.: I g —uos'- CERTIFlCATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (TAB section wed nothe completed If the permit Is farow hundred dmiars($101) or loss) 1 coney Net in Ne performance of the work fa'which this Permit is issued,)shall not employ any perm.In any manwrm u in become subject 1.heworkels'Compensamm Laws of California.Data Applicant NOTICE TO APPLICANT:If,arm,making this Certificate of Exemption,you should bernme subject to Ne Wor aces Compensation provision,of Me Labor Ceik,you must .7. z fo,hwith comply with such provisions of this Permit hall be deemed mated. OCONSTRUCTION LENDING AGENCY . [r I hereby either Na Nen las comavucdm lending agency for the pmronnance of a Ne work for which this permit is bound(Sm.3091,Cih,C.) W Q Lattices Name z Lender's Address V Q 1 cenify that I have mad this application and sum that the above information is W P cones 1 agree to comply with all city and county ordinances and sum lows mlatint In t.J buildingconstruction. toand w,indeyavthand mPmwnmivese this City upeenter ino agadm W .hove-mentioned property for impec ion Purposes . rA (Wo)agme ro cove,indemnify end keep may in m Ne City of Cupertino against y Iiabilidu,Judgments.cants and expenses which may in my way accrue against said City U Z in eansequeme of the granting of this permit. .. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURC REG LATION . ti7ZG'qw-05Re-roofs Signuvreof Ai,plicuoucamn t r Dam HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant Or from Wilding mcupanlatore or handle h.mdous material as defined by Ne Cupertino Municipal Cade,Chapter 9.12,and the Health and Safety •Code.Section 25532(.)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes ON. 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 hanrdnu,air contaminants as defined by the Bay Area Air Qnalhy Management all new materials for inspection. District? ❑Yes No 1 have mad the barmious materials requirements under Chapter 6.95 of the Califon. ma Health @Safely Code,Sections 25505.25533 and 25534.1 understand Not if Nc Wilding does net currently haw a meant,Mut it b my responsibility an nodl'y Me occupem of Ne rcquin'"ffuwhic�hmumbe�q primr�ssuwa_af�JceniBeamafaap,ncy. Signature of Applicant Date �'+ .�ent _ •�%I'''e' "� All roof coverings to be Class"B"or better ` Owner or agent _ Dam 0 W Mc PMI�MMMA -DUST -N R1 ) IA,D SHEET;: CUPEkTINO Assessors Parcel Number: Name of business. Project address. Contact person. � 014 Phone. Fax. �-3 L-1 A 7 1-72 Current use of space. 11 k vvwf�rcto'd Proposed use. Building construction type. Occupancy Group(s) Occupancy Load. • Square footage of remodeled area. Is the building equipped with: .Fire sprinkles? Y -N; Fire alarm system? Y-N Number of floors in the building? On what floor(s) is work being done? Brief description of work. Atow QAAIUa � ' nguns Code editions: 2001 CBC (Y-N)2001 CFC (Y -N)2001 CMC (Y-N) 2001 CPC (Y - N)2001 NEC (Y -N) Effective 11/1/02 Are there any chemicals/hazardous materials to be stored at site? Y - N If above answer is yes, provide a list of materials and quantities. If job is involves food service, provide 3 extra plan sets for Health Department review. Commercial Plan Review Process Work BookPage-11-revised 4/28/04 CITY OF CUPERTIN O Moex� SIGN • CUPERTINO PERMIT APPLICATION FORM APN# Date: �b4 , 37 ZS 5 2� . o� Building Address: ©o Qn� S r fJ0 l C Owner's Name: Pr Phone #: �' r�i�� 331 • y(, , 9ZQ Contractor: q� 1 License#: CLA llor�- Contact: Phone#: Applicant/Contr : MS n1) RAdIA to( Building Permit Info: Bldg Elect Plumb Mech Job Description: Ntw Residential: Commercial: V10 Sl rJ Sq.Ft. Floor Area: $/Sq.Ft.: Architect/Engineer: Cost of Project ,^ • Type of Construction: Occupancy Group: hAki Qty. if Applicable Fee ID Fee Description Fee Group BENERGY Energy BUILIDNG BPERMFEE Bldg Permit Fees BUILIDNG BPLANCHK Plan Check Fee BUILIDNG / BSEISMICOM Seismic Commercial BUILIDNG EPERMITFEE Elect Permit Issuance ELECTRICAL BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Rmdl Signs, Marquee ELECTRICAL BUSLIC Business License BUILIDNG • " 72 9" , t ID 13 Q O < Q 0 O (D Q G N10 I' 4,Yvr �C.,.,I, f.�$t�4 �it4' Cjf"§' ifdyF. 4x ..�� vrn 'n v vY (D W (D ri ey ,A fS£:i� o " o No (Q O CCI)) n < J, `. n (C) O O :ir 1 a 'ft v K+i4q N < O Q A A n 'L 5' "23N, -ta --t o O o, o• D S T w0 ,O O Q 0 'r .i r f r eiN SS n� v APOWS Lh N wu k roI 6 n C /N sal h i t `•G- u � � f0 f0 N ( O S rT , anP r r v u "t tr , f (1 .Wti7•F,a� ��r . N N Q 5 )y l Z) �! k' 1 _ 1• J 0 n ��• Q 0 — e 1 In l:f' i ffv r r1a I. t nW"w k '' 1! rfr'Q1d`5Y� )k'a 3 i3 (QQ t 9a I F r y.A d ('�� A C 2n' Q e-,,titi1: f >yyt. I�, ' v dmrku,4lrA Yy� G, Pd; 'r•, C vQ a O a CL o O Q aQ 7 OL oCA ol ,`. Q J 13! 0 N C) a C .1k a"�11 ' ar,fY JJ I' r L 6r O N � � ID N O I Y U CT G1 A O � � �� •+ ':a ' r' x'< �St z cr`j; 1 i" N '. t 'r .F� �' (n ._ , ' k T (( t s � rt.:r ...� .....J:a........:..�._.....�.Fi...f I I R. $ 0000 ) >Q ` i n `c A m -�{ !� d d nv C n O Q C 2 Q y 3 G7 d 5 fv Q CD 00 c S m n 3 �y O w Z ----- CL n cJ V m Sr o a car s � $ Q o 0o � I . R g - � ,,3 R r ti N 'Pti w u" r• r`t � i r ?, _a .. �' Z y Q, m �c cma 3 m — Q r 0 O D Mode3 I WA Bollinger Road *` H cn x.�tyf3+)�i�ryMlV cn O N p o x > > O m g rn m W n ' f T. tJnnO 0 _ : � � Ff = z cin ' __j(D MN a a V0 U NW O II � � N 3 3 CA) — O (D 2 5 o m CA acq (OL o C 3 > cn OL (� M. n cow m �c x o '0 mCO, o a j N !2 fG N N ,O H 7C OC�j A O m A N `V O' N q D a w N N N Q y (D � o p Q o (D O 0. o Q N 5 � O 3 m m N `a m m x v z 3 Z 3 n oa CD o E