04110013CITY OF CUP
` ^"'""d1�''"`" 'n°�� -
� Q��R'xev r �'R.i�',� aN
BUILDINC DIVISION PERP'
BUILDING AODADDRESS:NO..
PERMIT
l/4110 013
R'S NAME:
PERMI'1'I.SSUEDATE
CHINATRUST BANK
SANITARY N0. 9 CONTROL 10.
PHONE
BUILDING PERMIT INFO
ARCHIIE(.TIENGINEER:
eO elrcr PLUMB MECH
O
LICENSED CONTRACTOR'S DECLARATION
lob Description
1 b &?tome Net 1 am limmed under provisions of ChsPw 9 (rom"ne"'I
mi
with Secli ).1DIX'im 3afdm B..heFfYnd Profceslom Code, and my license is
I n failr dcaltL /
rel
GN--CHINATRUST BANK
, r a
IJcvI _(-�_ Ix..
m Cantraamr
CONTRACTOR: SIGN ART CO.
A CHRECFS D ATION
I understand my plans (.lull he®ed u f c..,us
_
Licensed P.fcastaml
OWNER -BUILDER DECLARATION
I Mashy alto that l am attempt from de Canuaetors License Law for the
following moron. (section 7031.5, Business and Pmfes.iom Cade: Any city or county
which mqulms a permit or emumact tiro[ Improve. demolish, or repair my structure
Prim in its issuance. also mquma ft oplies, Ramos Permilm rileasigned statementS
Us,(Chapmr9
q• Ft. Floor Area
Valera 38000
dut d, is licensed pumuntm provisions, provisioof the Cunu.etnrt license
(ewnm ueWs with Section 700D)of Division Sof tie nudws and Profetmem Com) to
thatUe Is neempt therefrom and the bass for the alleged aaamptim. Any violation of
Section 7031.5 by any applicant for a permit subjects tlrc applicant m a civil Penally of
APN Number Occupancy Type -
nm mom than Rw hundred doll.n (5500),
36906009.00
❑ L u ower of the Property, ar my—play=with wgas as Nein sole mmpe—fire,
win do the wart and thescommon is on, Intended molfaied for Onto (Sec. 7044, Business,Required
Inspections '
q p
and profession, Code: The Conmcmes Licems Law dons nal apply in Owner or
property who builds ar improvus thereon. and who doos such wok leinmlf or through his
own amployeca, Provided melsechartmoem omare nalinended maRered retail'- It,
own
. owner -
ImprovementWhin oneyea ofmproe,IWtheower-
/
improve fm PmPmmbe
omorImprovementg tall
hm o win law the bard. of due h did nm build Of
Wilms have
isle.).
❑ 1. as Owner of de property, am useloonly contracting with licenced contractors In
muswct the pmjmt (See. 7014. Business and Professions Cade:) The Conuucmrs Li-
.
eche Law dons not apply an of Property rr improves Ihmeon. and,
who Wilsed
for such projects WN amntramn(s) Ikxmed pmausnt rolbeCanum.7ora
who. r with ctoms p
Law.
Leen slaw.
❑Tisa eaempl undo Sea .BAPCto, Nibrwon
Data
WORKER'S COMPENSATION DECLARATON
/
I hereby arrow under parody of perjury one of den following dedaN)mu
!/
❑ I hew and will maintain. Ceniftcata orConscm to self-imure fon Workers Comp.-
O,(�
salon, u provided for by Secli. 3700 of de Labor Code. for Ne Performance of Nn
(�
work for which Nis permit Is Whad.
❑ 1 have and M0 maintain Worker. Compensation Insurance, ss required by Section,
3700 orthe Labor Code, for to Performance of the work forwhich this permit is issued.
My Worker Compass a Insurances Her and Policy number are:
Grier. Polis No.: _,
CERT? OF IX PDONfRe 0 as'
'-- - COMPENSATION INSU E
'
Crah rectirm need not hemmpleted Rose Permit is form hundred ddlms(5100),-
m int)
I certify that in the parro manse of Ne wad, fur which this Permit is Issued, I snail not
employ anypermn in any mwmrm as m became wbject m the Works*'Compemdirm
Law of Califamia. Data
--
Applicant
NOTICE TO APPLICANT: If, army making this Cenlficare of Exemption. you should
became subjca In Nc workers Compensator pmvldom of Ne Libor Codc. you must
forthwith =reply with sato provitlam on this pit than be droned ranked.
i CONSTRUCTION AGENCY
lending agency for No peNuwance of
I thi Nn thare Is u rn uctim loading
-
(San. 0
work for which this permit h )sss*d (Ss*. J037, Civ. C.)
for which
La Name
LeMera Added
Lemimes
�
1 certify that 1 have reed this application and vete Nu Out Wove Information Is-
�- torsed 1 agree to comply with all city and county ordinances and sum law mW ng in
building construction, and Wmby antborim rtpms.udwa of Ws city or enter upon the
show-m.tias*d property for impeNs* purpau
(We) alice to Ped, indemnify ad keep harmless Ne City of Currents* aguml
rLj liahilllln.}edgmanu.ccats and capessn which may ln anyway acme agmmsnid Oily
'
In cansequnme, of the grating of Wa permit.
APPLICANT UbIDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCE ITEC TIONS.
a4 4 1
Re -roofs
Type of Roof
!ipsfimaa atApplian on Due
H=US MA ALS DISC
Will de applicant or future building occupant mom. han le huudaus mateAl
defined by the Cupertino Municipal Cade. Chapter 9.13, and de Heald used Safely
Section 35533(.)7
All roofs shall be inspected prior to any roofing material being installed.
❑Yn yNa
If a roof is installed without first obtaining an inspection, I agree to remove
Will Uta applicantrms I future building ampam tree ea Air OUl m devices which
droll hayseous air canuminanu u de0ncd by de Bay Area Air Duality Management
all new materials for inspection. '
District?
❑Yn RNo
I han .ad the hvsrdtulul lnamrlall mquimmenu undor Cbupw 6.95 of the C.litor-
niaHnf"SafnyCode.Secdms75505.35533.d35534.ImdermondthmlfNe building
..
dm on, currently haw a tamr0. that It h my responsibility m maty tie occupant of Ne
Date
rcw'mmama iahmaw amt mtssYancaaraCmuficacOfOccupancy.
Signature of Applicant
—�
All roof coverings to be Class "B" or better
Owns orauthorizedagent
0
Item 1 of 1
0
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 36906009.00
DATE ISSUED.......: 11/02/2004
RECEIPT #•........: 27629
REFERENCE ID # ...: 04110013
SITE ADDRESS .....: 19648 STEVENS CREEK BLVD
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA ......
OWNER ..:.........: CHINATRUST BANK
ADDRESS ..........:
CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014
RECEIVED FROM ....: DBA SIGN ART CO.
CONTRACTOR .......: LIC #
COMPANY ..........:
ADDRESS ..........:
CITY/STATE/ZIP : ,
• TELEPHONE ........:
FEE ID
----------
UNIT
QUANTITY
BPERMFEE
-------------
VALUATION
----------
3,000.00
BPLANCHK
PERMIT FEE
83.16
BENERGY
PERMIT FEE
83.16
BREMSIGNAD
NO. CIRCUITS
1.00
EPERMITFEE
FLAT RATE
1.00
BREMSIGNS
NO SIGNS/MARQ
1.00
BSEISMICOM
VALUATION
3,000.00
BUSLIC
FLAT RATE
1.00
TOTAL PERMIT
i)
METHOD OF PAYMENT
-----------------
CHECK
AMOUNT
------------
401.84
TOTAL RECEIPT : 401.84
OPERATOR: conniew
COPY # : 3
AMOUNT PD -TO -DT THIS REC
83.16
0.00
83.16
110.98
0.00
110.98
39.92
0.00
39.92
4.80
0.00
4.80
38.37,
0.00
38.37
23.98
0.00
23.98
0.63
0.00
0.63
100.00
0.00
100.00
---------- ----------
401.84
----------
0.00
401.84
NUMBER
------------------
6941
VOICE
ID DESCRIPTION
101
FOUNDATION
104
REBAR
304
ROUGH ELECTRICAL
514
FINAL PUBLIC WORKS
•
NEW BAL
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
VOICE ID DESCRIPTION
--- ----------------------------
103 UFER
105 ANCHOR BOLTS
505 FINAL ELECTRICAL
0
•CUPEkTINO
4
1
• CITY OF CUPERTIN41
SIGN
PERMIT APPLICATION FORM
n�Ic0-0G3
APN #
Energy
Building Address:
C b L
Owner's Name:
Phone #:
t 316 / -->'-).
Contractor:
License :
7 S' 903
Contact:
Phone #:
Applicant/Contractor:
Seismic Commercial
B ' ding Permit Info:
'Bldg3 Plumb Mech
Job Description: r
Commercial 0 pav Si h
Sq.Ft. Floor Area:
$/Sq.Ft.:
If
Architect/Engineer:
Cost of ' t:�
Type of Construction:
Occup c Group:
A2XQt . if
icable
Fee ID
Fee Descrintion
Fee (noun
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
0
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