S 296344
a
APPLICANT -TO -FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
CITY OF CUITY-XHNO BUILDING - ELNC-1'RICAL
VIiRMIT NO.
IIUILDING DIVISION APPLICATION/PERMIT PLUMBING -MECHANICAL
BUILDING PROJECT IDFN'I IFICXI DON
FB111LIRNJ ADDRP_Sti:
SANITARY NO.
A PLICATION SURMITTAh DATE
I �r
OW NERSN 1 / PIJUN}i�' zb
�/C(IL
CONTRACI'O 'S NAME '/ s� LIC NO'.
CI1 Fns✓
NIC
❑
CON 'I'It01.IT
'GIIITG /ENGIWiIiN: EJC NO:
ADDRESS:
oeox
CON1ACr: PHONE:
BUILDING PERMFIINFO
❑ Consultant Fees Paid by Applicant (Initial)
ItlOG I?LIiC'1" Pl.l
❑hrJ-y ❑IMB 1-1
LICENSEDLCONTRACfOR'S DECLARATION
1 hereby affirm mal 1 am licensed under provisions of chapter 9 (commencing
QTY. ELECTRIC PERMIT FEE
JOE DESCRIPTION
PEIt MIT ISSIJANC,1?
withSccl'mn]0)0)of Dlvionm3of III H-111ceand Pnfesxions Cadaand my liwnse iv
in tial Bn'cc and dT e
,at
RESIDENTIAL,
❑SPD\41, ❑KITCHEN RIEMOUIiI.
APPLIANCES - RESIDENTIAI,
License Clan+ Ec.a
Dam Gnmractm
[]ADDITIONElPLUM BING RE. PITH
URAL
❑M1IULTI-UNIT ❑MODIFIATIO
MODIFICATION
RCIIITIs,noc DEC. A
I nndarsmnd Iny pros shall he used ns puhlle ra'ards
PANELS
(1,1020"AMPS
❑IN'I'1?RFOId ❑ Cl IIMNEY ItEPAIR
IMPROVI?MENT El SWIMMING foils
❑BATH RESIODELIREPAIR ❑ DEMOLITION
❑ OTHER
Licenenl Pirolaseional
OWNER -BUILDER DECe Co.,.ION
I hereby offnn mm 1 am exempt from the Camr I.meme use fnr tic
s c Any 1, or county
following Iwson. (Section ]0315. Ru+ine, and Pmfteod
201-1IX0AMPS
UVIiR IO(O AMI'.S
SIGNS ELECTRICAL eZ '� '0
which rc ldires a permit to construct, ager, irpmve, dcil H,Jt. n re r any strn'to'd
SI'I?CIALCIRCUI'I'IMISC.
prionnhn lssunncc,uRo rcynireslheupplicnmfor such nim .slgnedsmmme"I
I
Incl hC is liccn+ld purnuanl lO lM10 pmvisinns o[thC Conl ac 's LicemClsw(Chnptr9
TIME MEIER OR NILE INST
COMMERCIAL'
(caan... ngwith $eninn ]000)of DivisismJoflhel d Professions Cale)or
that he is exempt Ih,daum and the basis for Ibe a e, exemption. Any violaion of
Sectio ]1131.5 by an applicant fnr a per 't su I the nppllcoln In n anvil penalty ut
not nurcc Ihun live oared dollars (S51aU.
❑ I,usownerafd pnsperty,annyemplo I ages as their sale compensation.
wdldolm,,ni' . dthestrclureisnolinten donsll'crtdfor sale (See ]tH4, Rusinps
❑ NEW BLDG/ADDITION ❑ DEMOLITION
❑TENANT ❑ FOOD SERVICE?
YIMI'ItOVEh �/�
OL)I'I1I'.R l'V
POWER DEVIC17S
SW I M M I NO COOL IJ.LC'I Edd
OUCLE1'S- SWITCHES - FIXTURES
and Rnfcesinna ale: The Carom rr's Lim Law does not apply to an owner of
pmprny who h Ids or improves Ihm a, and who does such work hinrralf or through
his own wail cc,provided trot such' Tmvemwln xre not intended ur uttered for
NEW RESIDENT Al. ELECT SQ ITP.
SQ. PI'. FLOOR AREA
S/SQ. ITE'.
sale. ll', noes, r, the nnilAil o intpnrvem it is sold wllhin one ycarol' completion, the
wnc,limilder burden of proving that he did not build or improve for put.
pose of ruled.
1. its owner of the pro y am exclusively contracting with licensed contactors to
FOIA
dnanat the pmjml (Sec. 144, Business and Pml'exnio I, Coda) The C'nntroctor, LI.
nsa Lllw ares nut apply u, n era ol'pmperty woo milds or lnlpn,vea dwrron, and
QTY, PLUMBING PERMIT FP.N.
whoa Taws furwch mail swish a conwemr(s) Iienued pasuam IO t he Contravene,
PERMIT ISSUANCE
Idocroc law.
❑ 1 am exempt under Sec. . B & P C tar this recood
AtJ17R- DRAIN A, VEST -\VA'D7R(EA)
Own" Lane
VALUATION
RACK FLOW PRGPI CDEVICE
WORKER'S COMPENSATION DECLARATION
I rc¢by affmn under penolly of rotary one of the fallowing deelwations:
/�
DRAINS-FLOORROURARFA,COND.
J lhuve and will mninminaCenifcaenf Consenno xlf-insure fnr N'nrkers Cnmpen-
as provided for by Section 3]1X) of the Labor Gale, for the performance of the
STORIES
TYPE CONSTRUCTION.ration,
r which this permit it Issued.
FI X'1'0 R IS- PER 'I'ItAI'
htrva and will nwinmin Wnd.cs Cumpeir,nion hisn0lnee, m rrynired by Section
GAS -FA. SYS 'I'HM- I INC, 401TTLEFS
3710 of the Labor Cale. for the performance of the work for which this l,mi is i.swed.
OCC CRUDE
APN
My N'I, y' io yyanr, p
GAS -F.A.SYSTEALOVER 4(IiA)
icy Nicy
Carrier:(% ('((!� tyo Policy No yg/�y�te�y�
CERTIFICATE OF ISXIih ION FRO. ORK:IS -
COMPENSAN ION INSURANCE
GREASFJINDOS"I III, WASTIi IMI FItCEPTOH
BUILDING DIVISION- -IES
('Illisse"ion need not becamplctd ifthe pttmil isforonehundrcd dnllalr [SlnO)
or less.)
GRIiA513 TRAP
-- - -
-—
PLANCIIIECK FEE --
SEWER -SANITARY- STORM IEA. 21X1 PC
Icenifydambe perfonnananfacwork forwhichthi,remit kssued. Ishdl
not employ any pemon in any manner sl as t become subject to the Workers' Comm pe
ENERGY 113E
WATER HEATER W/VENT/ELECI'It I-,--
scion Laws of Coldurniu. Dae
Appllwal
OI lV ; THE
NOTICE 10 APPLICANT, if, Mier making Ibis CerllEcalc at Exemption, you should
beconmsubject to the Workers Compensation provision+ of the Who Coda you must
WAFER SYSTEM/1"RIiATING I e
SO -11-5 FEW
WATER SERVICE I
III, peit shall be deemed revoked.
forthwilh comply with such pmvi,imc ur Ibrm
CONSTRUCT ION LENDING AGENCY
I herebyaffirm t hanhem is a cmuvuelien lconingagency for lfre,rfonnamc of
R 2 2
Aplu' 199
Dam R
>•�
rpt
NI7W RFS1DEN'I'I Al. 14L1011. SQ, ITI'.
the work lbs vdad d' pe tic (Sce. 3107. Co. C.)
kit
Lender's Name—,A
YI
- 'AL:
Lender's Address
TOl'AL: By
4104tElbs4 EFi
I certify that I huvc read this i,,a anion and site That the above achaonaimt i
QfY. MECI IANICA], PERMIT TEE
SEISMIC FEE
correct. I agree to enntply with all city and county ordi ounces tend stat laws relating w
building anssvuciam. and hereby amhorim mprascntmlves of this city m other upon Ire
PERMIT ISSUANCE:
ELECTRIC FEE
dwer-a entioned property for inspection purposes.
(We) agrce to cava indemnity and keep hamdea the City of Cupertino agn to
ACIER OR ADD' TO MECI.
PLUMBING FEE
liobililies,ludgments, encs and experea which may many way accruengainsl said City
airnnmgnanm of IEC gnmlln, of thin pooh.
AIR HANDLING ONI'T(TO 1.111X1 CFM)
MECIIANICAL FEE
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
SOLI Ct REG'. Al' IONS.
AIR HANDLING LIST 10000 CFM)
CONS' I'RUCf10N TAX
�q
gnauuo ofApplicnnl/CbIU.r Haw
I IA9ARDOUS MATERIALS DISCLOSURE
RXI IAUST HOOD IW/DUCT)
HOUSING MITIGATION FIEF
TREATING UNIT (11) 110,00 B'I U)
Wiliduct,licanrin future building"ecupant stancorhandle hay.Nou, mmerial
as defined by the Cupertino Municipal Cale, Chapter 9.12. and the Health and Safety
Code, Section 25532(1)!
1117ATING UNIT (OVER 100,001) II'1'(1)
E3 YO, Nn
a building by the B y A equipment or Mires which
Will Ins air comm tm commitments
til huvardous air ummminanlsmAefned by the Bay Area Air Quality Management
istriaf
0Yc �
�ry1 1'
PAID
Date Ru6"N
VL'N'IlLAT10N IAN [SINGLE RESIU)
ROILIiR- COME (Jifl'OR 101),1X10 BTU)
DIAL:
BOILER- COMP (OVER 1 OLUX) H'fU)
AT IT CONDITIONER
I huvc read the humrdnus mna•Hnlr rcyulroments under Chapter G95 of the Cali
/ ISSUANCE DATE
NEW RESIDENTIAL MECH. SQ. FE
fomia Ilwlth & Safety C - Sections 25505 25533 and 25534. 1 underslad fare hire
III it x ncu 1 avec air On tspnnsibility m notify the occu,ant
2 Z _
nn�r
ofthc sm,tc Is h coloC nifeum of cy.
ISSUED BY: -m
O nwho asci ug 1 `?�
TOTAL:
OFFICE
SIDE
PLOT PLANS
DA'Z'E —14-�;=—f '
1PLA1V`;; _s � DE
(ft --L- 2. —
DATE _L —
I' ffT.
MAY
T -I.
REFACE EXISTING D/F INTERNALLY ILLUMINATED RETAINERLESS MONUMENT SIGN
CABINET -AS IS
FACE -ROUTED.090 ALUMINUM FINISH W/ FINE WHITE M(OTETOMATCHEXISTING.
"JIFFY LUBE" - EMBOSSED LEXAN (TWO LEVELS) AND PUSH THRU_
PAINT STANDARD CORPORATE COLORS RED #485 & WHITE
"QUAKER STATE" - EMBOSSED LE(AN, PAINT FACE GREEN #347 WITH WHITE DRAWS. PUSH THRU-
':' mate M� r z
FRONT, SCALE: 3/41, =1 A - 0"
PHOTOGRAPH, MONUMENT SIGN, NTS
WILL
DETAIL OF SIGN FACE
HEAT1.
Signs Nationtiek
1762 Airport Way S.
Seattle, Washington 98134
Phone: (206)623-3100
Fax: (206)623-1785
10213 NE Marx St.
;REW Portland, Oregon 97220
Phone: (503)408-8510
Fax: (503)408-9576
APR 2 219oe .
yq dLUG.INSPECTIONDEPAH1NICia1
DESIGN: CITY OF CUPERTINO
This is an original design created for
the exclusive use ofthe customer. Until
transfer by sale, all rights reserved and
is not to be reproduced in any manner
without permission from Heath Signs.
CUSTOMER APPROVAL
DATE
BY
LANDLORD APPROVAL
DATE
BY
R E V I 5 1 0 N 5
3/22/99
DATE
V. LENGE'
DRAWN BY
ROGER KORSTAD
SALESPERSON
AS NOTED
SCALE
j Nklube
#2355
19480 STEVENS CREEK 00.
CUPERTINO,CA.
SHEET 1 OF
0
r
0
SIDE FRONT, SCALE: 1/211 = 11- 011
3/4' EMBOSS (OPY
I � �XG%2 /�75 /•U�
I
jiffy lube,
PHOTO ELEV.: REMOVE EXIST. "0 -LUBE" LETTERS AND REPLACE
TO CONSTHOCTION FACTORS. COLORS SHOWN HERE ARE AS CLOSE, AS PRINTING WILL ALLOW. ALWAYS
W
LL
J
rep
Li
ONE NEW UNI -CHANNEL WRAPPED LETTERS, FLUSH MOUNTED, ILLUMINATED
RETURNS -ALUMINUM RETURNS& BAO(S, PAINT PMS5485 RED
FACES - [MSG, EMBOSSED,(OPY, PMS 5485 RED BKGD.,
(FORMED EDGE BECOMES INTEGRAL (APY,
BLAO( OUT UNE & WHITE COPY.
ILLUMINATION - FLUORESCENT LAMPS AS NEEDED
MOUNT - FLUSH TO FASOA
STEVENS CREEK BLVD.
4'8"x7'1' MONUMENT SIGN
PLOT PLAN �
HEATH
Signs Nationwi,
1762 Airport Way S.
Seattle, Washington 98134
Phone: (206)623-3100
Fax: (206)623-1785
10213 NE Marx St.
Portland, Oregon 97220
Phone: (503)408-8510
Fax: (503)408-9576
This is an original design created for
the exclusive use tithe customer. Until
transfer by sale, all rights reserved and
Is not to be reproduced in any manner
without permissianfrom Heath Signs.
CUSTOMER APPROVAL
DATE •
By
LANDLORD APPROVAL
DATE
By _--
-rrm,
R E V I S I C !
DATE
V. EES:GP
DRAWN BY
ROGERKORSTA.D
SALESPERSON
AS N07ED
SCALE
ajiff�iu
#2355 •
19480 STEVENS CREEK BLVD
CUPERTINO, CA.
SHEET 2 OF