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08040210CITY OF CUPERTINOr xa•,gmr x A ;.�,.y��_•i�'g�s� vacs ' >`/iax7 - BUILDINGDIVISION PERMIT -1— IT" BUILDItdGialZQRES$:TEVENS CREEK BLVD 1Rs4NA2SMEE; S COAST SIGN 08040210 PBRMrr ISSUE DATE CALI ANNA M ET AL 1500 W EMBASSY ST 04/29/2008 PHONE: SANITARY NO. CONTROL NO. (714)520-9144 ARCHITECTIENGINEER: BUILDING PERMIT INFO "o 0 0 0 LICENSED CONTRACTOR'S DECLARATION 1 horeby Nn 1 Droned under Chapter 9 lob Description afncm am provisions or (commencing' with Section 701M)ofDAidon 3 the Business and ProWmand fes Cada my litems is is INSTL ONE SET OF ILLMNT'D WALL LETTERS Lof in full fameLioumiclw�s..eJR� fr4J� Lb., Dam 4ISJTEConE I CL �i ARCHITECTS DECLARA - de m pl 1 unnunJ my ea shall he wmtl u public records _ Licensed Professional OWNER -BUILDER DECLARATION _ 1 hereby a1Rrm that I am exempt from mat Contruror's License Law for the following reaan. (Section IID 1.5, Business and Prehssiom Cade: Any city or county which requimn a pcmit m cowruct, alcor, improve, dcm.ImA. at repair any structure polar b its issuance, also requires Ne applicant for such permit to rile a signed statemenl tem he is licensed pursuant to the provisional of die Comtrectare license law(Chapm 9 Sq. Ft. Floor AreaValuation (commencing with Section 71100) of Division 3 of Ne Business and Profusions Codeor $3400) and he b exempt Nerefmm and Ne bub for ate alleged esempuon. Any violNan of Became 1031.5 by any, applicant for a permit subjects the applicant to a civil Penally of Number Occupancy e IYP rot sort Nan five hundred dollars (5500). 3 7 5 01014 .� P y ❑ 1, u ower of Nr pmpmy, m my amployees wih wagca u Weir sole compc=Oon, Curerarotintendedoraw do Tarsale(Sal. 7011, mineof and do Predicted.. and h Cade:rt case: The Cmtrector's uemss Law does not apply Required Inspections property W andwho da osuchworkhtmxlfed rouN his com erty who r ugh is uch awn mplayees, pmsg ss, providedimprovements f mol(ertd fm We If, that such imprewmants ort not ear however, the building or Improvement4hat within am year of comps,for the owner. or I ofo builder will have ate bards of proving that he did rot build or improve for purpose of of tile.). , ❑ 1, as water of the property. am ueluovely caroming with licensed mntracton In convect Ne peojem (Sea 70", Business and Professions Code) The ConbacbrY Lt. comes Law, does not apply in an owner of property who buiMs or Isepmvu Ihemom. cad, who Contracts for such projects with a contractor(a) limned personal m the ContramaYa License Law. ❑lam uampl antler Sea ,B&PC fm Nu moan r Dao WORKER'S COMPENSATION DECLARATION 1 hereby anis under penally of perjury on of the following declmtion: ❑ I have and will connote ItCenificale or Consort m self -Mum fm Wafer's Compen• inion, u provided far by Secuan 3700 of the Labor Cade. far Na performance of the ' work for which this Permit is iavad. ❑ I ban and will maintain Warkmfs Compensation lamnnec, as squired by Section 3700 of the Labor Code, for the performance ofthe work for which this permit is issocd. ' My Worlme Campenauan lam and Policy ny ram:- �niu Catlee •I POIIcy No.: G �-rj SISI CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE • r1Tb Minn need notbacomphud ]film pomtt Is foram, hundred doom (SIM) or leu) 1 certify, that in the perform seen of the wok far which this petmh is leaved, I shall not employ any penton in any manors u It become subject in Use Warken' Campemadon Laws of California. Dam Applied NOTICE TO APPLICANT: IL after making thin Conincae, of Eacmpuan, you should became subject m the Worker's Compensation prevision of the Labor Cade. you mw faMwith comply with such provision or Nb NMiuholl M domed revoked. CONSTRUCTION LENDING AGENCY 1 hemby sfNm hat dom ba const random lending agency for Ne Performance a the work for which Nb permit Is iumd (Sec. 3097, Civ. C.) Lender's Name ' Under's Add. 1 certify that 1 have read this application and sum that the above information is Imre 1. l agree as comply with all city and county collimates and sum Isco mbling to building construction, and hereby euthmiae representatives of this city to enter upon Ile, abmo-menuoned property for inspection purposes (We) agree to save. indemnify Nd knop hm ckom Ne City of Coleman against Ibbiliaes, Judgments, casts and expenses which may in anyway mane again. aid City in consequence of the granting of this permit. APPLICANT UNDERST...��jjjjjj��l��1ttt(ttDS AND WILL COMPLY WITH ALL NON -POINT SOURCE RECULATION��7 Issued by:3 Date —j 2� "'�J� Re -roofs ✓ Type of Roof ' sigwere ornppucaHAZAR cwr D.m� HAZARDOUS MATERIALS DISCLOSURE Will the no Taus Wildingmcopant sum ar handle material eNan Ona by Na Cupertino Municipal Cade, Chapur 9.13. and are Health and Safety . Secon 25932(x)? ❑Yu No All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove Will flueapplicant or future building occupant use equipment or devices which emit heaWnu air cmumiu u defined by Ne Bay Arta Air Quality Management all new materials for inspection. District? ❑yin e Ihrvemvlthehvard<memamualsmquimmcnuunJrClupw6.95ofhe Colum- ' nta Hnith&Safety Cade,Sccuan355U5,2593and25531.1unticnund NnifNm building dao rot cumcndy haw a tons, arm it is my mapm adoliry in mufy, the occupant of ho requirements which m mpdmuvjssui of. Ceolrmamrequirements which of�� Signature of Applicant Date fij� All roof coverings to be Class'W` or better Owner or authadxcd spool gate 0z Z CITY OF CUPERTINO BUILDING DIVISION PEP -MIT �� qJk` �� " BUILT�tsU IT ESS: �R4,K STEVENS CREEK BLVD COAST SIGN PERMIT NO. 08040210 OWNER'S NAME: PERMIT ISSUE DATE CALI ANNA M ET AL 1500 W EMBASSY ST 04/29/2008 PHONE: SANrrARY NO, CONTROL NO. (714)520-9144 ARCHrMCr/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH a a 0 0 LICENSED CONTRACTOR'S DECLARATION Chapter Job Description I hereby affirm that 1 am licensed under provisions of 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is INSTL ONE SET OF I LLMNT ' D WALL LETTERS in full force and effect. �d5 `e ' License Class Lie. p Date Contraetnr a ARCHITECTS DECLARATKK I understand my plans shall he used as public records Licensed Professional OWNER -BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the following reason. (Section 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, nr repair any structure prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's license Law (Chapter 9 Sq. Ft. Floor Area Valuation (commencing with Section 7000) of Division 3 of the Business and Professions Cade) or $3400 that he is exempt therefrom and the basis for the alleged exemption. Any violation of Q�j�j Number 3 7 5 01 014 ' Occupancy p y Type Section 7031.5 by arry applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500). .` Ci'(J ❑ I, as owner of the property, or my employees with wages as their sole compensation, Required Inspections will do the work and the structure is not intended or offered for sale (Sec. 7044. Business and Professions Code The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, 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 build or improve for purpose of sale.). ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code:) The Contractors Li- cense law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law. ❑ lam exempt under Sec , B & P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a Certificate of Consent to self -insure for Worker's Compen- sation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ I have and will maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ' My Worker' Compensation surance rice end Polity n mbu am: Fq ! . � Int Cartier. % �+.6 Policy No.: `'T"iy:'J9 CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is forone hundred dollars ($100) nrless.) 1 certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers Compensation provisions of the labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.) Lender's Name Lender's Address 1 certifythat I have read this application and state that the above inrormadun is ' correct I agree to comply with all city and county ordinances and state laws relating to building construction. and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may in any way accrue against said City in consequence of the granting of this permit. APPLICANT UNDERST S AND WILL COMPLY WITH ALL NON -POINT Issued by: Date — Z SOURCE REGULATION j9 Re -roofs �-� Type of Roof Signature of Applicant/Conti-Actor -6 Da HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety Code, seetlanzss3z(a)? q All roofs shall be inspected prior to any roofing material being installed. El Yes No If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? `• ❑ Yes [�40 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health & Safety Code, Sections 25505.25533 and 25534.1 understand that if the building docs not currently have a tenant, that it is my responsibility to notify the occupant of the requirements which mu met prior -to-rssu mf a Certilicatc Orrapart . � Signature of Applicant Date All roof coverings to be Class" `` or better nw.,erhmri rd..emt ift CITY OF CUPEVINO CITY OF CUPERTINO SIGN PERMIT APPLICATION FORM q0 L� 0 �-� 0 APN # Date: 3-75-0( Building Address: �,v�, . Mailing Address (if different from building address): Owner's Name: Phone #: cdu Gay za Contractor: Phone #: Fax #: Contractor License #: Cupertino Business License #: Co 42-V Contact: Phone #: (5��) jqo _ 6+¢( Fax #: Building Permit Info: Bldg Elect Monument ❑ Mounted on BuildingX Residential ❑ Commercials Job Description: Valuation (cost of project): 7� Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the application or if applicable, include in plan set & the sheet index. al"i CITY OF CUPERTINO CITY OF CUPERTINO SIGN FEE SCHEDULE �J Quantity Fee ID Fee Description Fee Group Permit Type 1 SIGNDIRECT Directional B 1SIGN/RF Ground/Roof/Projecting Signs B 1 SIGNMASCK Master Plan Sign Check B 1 SIGNREWRKG Rework of any existing Ground Sign B. 1 SIGNOTHER Other Sign B 1 SIGNREINSP Re -inspection Fee B 1 SIGNWNONEL Wall/Awning Sign, Non- Electric B 1 SIGNWELEC Wall, Electric E IESIGN Sign, Outline Lighting System or Marquee supplied from one branch E 10EAP5 IESIGNADD Additional Branch Circuit on Same Sign, Outline System or Marquee E 10EAP6 1ELCPLNCK Plan Check Fee E EPERMITFEE Electric Permit Fee E / ( BSEISMICOM Seismic Commercial B BSEISMICRE Seismic Residential B / ( TRAVDOC Travel & Documentation B BUSLIC Business License B CITY OF CUPEf�TINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRESS: PERMIT #,,,, s Gam- 6 vol s-,,tY�z OWNER'S NAME: PHONE # 700 76 - 237 GENERAL CONTRACTOR: SIFAX # I am not using any subcontractors: 4 2 Signature Date Please check applicable subcontractors and complete the followinjz information: WOA/16L 4(21q10? Owner/ Contractor Signature Date 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 Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile WOA/16L 4(21q10? Owner/ Contractor Signature Date 1,,i_,,,,,:��i�,, - r Ilr DITJJ I' =ile Edit Actions Details Links Favorites Help hi Pearif ,,ur-, & ,I -i Address x Permit Plumber % 08040210 CUPERTINO Status x C - Closed ISI Unit Master Number patg U, Erdv!,r, Iriorn;��o,r� ICgI Notes Project xl CALI ANNA M ET AL suety Use Default Apply Date " 04/29/2008 Operator Permit Issue Date 04/29/2008 Operator Certificate Issued 08!0412008 Operator Certificate Type CO - CERTIFICATE OF OCCUP Certificate Number Permit x Property Permit Details -- - lir'' 1:`. F -I F1 & ,I -i Address x 19480 STEVENS CREEK BLVD City/State/Zip CUPERTINO 0 APN 37501014.00 ISI Unit 3400' patg U, Erdv!,r, Iriorn;��o,r� 0 patg I Owner Name xl CALI ANNA M ET AL suety Use Default [] Address Home - P. 0. BOX 333 Zoning Applicant Contractor " Defined Fields Permit Type 10EAP5 ISI SIGNS, OUTLINE LIGHTING & MARQ Usage Class x WA ISI NON APPLICABLE Applied Value 3400' SQUARE FT. 0 Calculated Value 01,111 US C-404 Type 437 IQI ALT: NON -RES, NON-HSKPG Permit Form " AUTOPERM - PERMIT Ownership 1 Private Project Size City/State/Zip SAINT HELENA CA 95014 CA 94574 Purpose/Special Conditions INSTL ONE SET OF ILLHNT-D WALL LETTERS FILETED 6/2011 117nAaa n„c-..A T -,� 0 K dy Back Imo; Contractors i' Fees Imo, Plan Reviews r Inspections Print Permit 'Adjustments If ;` Holds IEJ, Copy Permit Close Permit Overrides Supplemental Fields �. �jNotes bl Attachments 'ermit issued 0412912008 Ir anter the purpose or any special conditions for this permit