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CITY OF CUPER'fINO
TOR IN
INFORMATION
BUILDING DIVISION PERMIT
BUILDING ADDRESS: -
ALLEN SIGNS INC
PERMITN04100096
9674 STEVENS CREEK BLVD
OWNER'S NAME:
PERMIT ISSUE DATE
ok ACUPUNCTURE
1982 STONE AVE
10 14 2004
NE:
SANITARY NO. CONTROL N0.
(408)280-6500
ARCHITECTIENGINEER:
BUILDING PERMIT INFO
BLDGELECT PLUMB MF.CH
I 0
LICENSED CONTRACTOR'S DECLARATION
1 hereby Chapter 9
Job Description
P
affirm that 1 am licensed under provisions of teom ming
with secreandC,ufonisinn Sof the Business and Prufcssinns Cntic, end mYlrivcnu is
in full force and cffp�t.
SIGN
FINALE®
License Class (, Lic.N!h��'OD
Date Contractor
ARCHITECPS DECLARATION
I understand my plans shall he used as public records
DECtl1 C A 2004
7
Licensed Pmfessinnal
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Low for the
following reason. (Seem.. 7131.5, Business and Professions Code: Any city .r county
which requires a permit m construct. alter, improve, demolish, Or repair any soudtoo
$2200
prior ba its issuance. also requires the applicant for such permit to File a signed matamcm
that he is licensed pursuant o the provisions or the Contractor's License Law (Chapter 9
Sq. Ft. Floor Area Valuation
(commencing with Secti.n 7") of Division 3 of the Business odd Prafessi..s Qvle) or
Nat he is exempt therefrom and the basis for the alleged exemption. Any vioimton of
Section 7031.5 by any applicant for a Pesmh subjects the applicant o a civil penally of
3 6 A IN RSVqq D
OccupancyType
not more man five hundred Call... (S500).
YP
C 1, as owner of the prefixty, or my employees with wages as their sole compensation,
will do the work, and me structure is not intended or offered for sale (Sec. ]044, Business
and Pmfessions Code: The Contractor's License Law does not apply to an owner of
Required Inspections
pr.peny who builds or improves thereon, and who does such work himself of through his
awn employcee, provided that such improvements are not intended or offered for mile. If,
however, me 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 puryou of
sale.).
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to
contract the project (Sec, 7044, Business and Pmfessions Code:)The Contractor's Li.
cense Law does not apply to an owner of property who builds or improver mereon. and ,
who contracts for such pmjeets with a contractors) licensed pursuant to the Contractor's
License Law.
❑ I am exempt under See. , B & P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a C(inificae Of Consent to rel f -insure for Worker's Compem
anion, as provided for by Section 3700 of the Labor Code, for me perro mono of the
work for which this permit is issued.
0 I have and will maintain Worker's Compensation Insufanec, as required by Section
3700 of me Labor Code, for the perormarce of the work for which this permit is issued.
'
M1y—WWorkers Compensation Insurance earier and Policy .umber am:
car:y;YA� Policy N..D&C'Qd)/Q-Z�
'
ERTIFICATE OF EYEMPTION FROM WORKERS'
COMPENSATION INSURANCE
'.
(Thissection need not he completed Run, Permit is forum hundred dollars DIIgB
or less.)
I coni fy mut in the performance of the work for which this Form it is issued, I shall Lot
employ any person in any manner so as in become subject to the Wormri Compcnaati.n
Laws Of California. Date
Applicant
NOTICE TO APPLICANT: IL after making this Cenifcate of Exemption, you should
become subject to the Worker's 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 afOrm that mere is a construction lending agency I'or the performance of
me work for which this permit is issued (Sec. 3097. Civ. C.)
Lender's Name
Lender's Address
1 certify mat 1 have read this application and store that the above information is
Correct. 1 agree to comply with all city and county ordinances and state laws relating to
hereby scnmtivcs of Nis city m enter upon the
Construction,ne
proand
abonng
shove action Proposes,
property for inspection
(We) are
(We) agree m save, indemnify and keep harmless the City of Cupertino against
ankeeph
liabilities, judgments, costs and expenses which may In any way accNe agalnal.[ald City
in consequence of the granting of this Permit.
/
:7D42I
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NOWPOINT
Issued by:
SOUR E G ATION
(o//
oleo
Re -roofs
Signamrc of App ratmiractor
HAZARDOUS MATERIALS DISCLOSURE Data
Type of Roof 1
Will the applicant or future building Occupant store or handle Infamous material
as defined by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety
Code, Section 75532(x)7
IlyN.
All roofs shall be inspected prior to an roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
the applicant or bootie building occupant use equipment or devices which
kWill
it hao.artlnus air crnmminan. as defined by the Bay Arca Air Quality Management
all new materials for inspection.
istrict7
❑Yes.
I have read the haoardous materials requirements umler Chap¢r 5.95 of the Califon
(�^3
ria Health&Sofmy Codc. Sections 25505,25533 and 25534.1 understand thotifthc building
does not curemly haw a tenant mat it is my responsibility m n.rfy the Occupant of me
requi s wit must met pri.r to asccrce 0f a Cen�Oca¢o Occ. ancy.
Signature Of pphcan[ � Date
b
All roof coverings to be Class "B" or better
Owner or auth ejed .,at, arc
BUILDING DIVISION
ACUPUNCTURE
Loo LICENSED CONTRACTOR'S DECLARATION
inu � 1 hereby affirm that l am licensed under provisions of Chapter 9 (commencing
<with Se
n ction7000)u(Division Sof the Rusinea and Professions Code, antl my license is
in full force and eft t.
LiLic. p3T
n F ❑ Dam Cummctor
ARCHITECTS DECLARATION
I understand my plans shall he used as puhlic records
3oG Lmcnscd Pmfcxianal
5 OWNER -BUILDER DECLARATION
j<i 1 hereby affirm that 1 am exempt from the Contractor's License Law for the
❑ O fallowing reason. (Section 71D1.5, Business and Professions Code: Any city or county
>; fL which requires a permit or construct, alter, improve, demolish, or repair any structure
Fes- prior
ln its issuance, also myuims the applicant fonuch permit file asigncJ statement
Cl that he is licensed punuam to the provisions or the Contncmr's License Law (Chapter 9
ngI (commencing with Section 7mah or Division lof the Business and Professions Code) or
�.. Nat he is eaempt Ihemr1ma and the basis for the alleged esemption. Any vinlntion of
Section 7031.5 by any applicant fora permit subjecls the applicant to a civil penalty of
not more than rive hundred dollars (5500).
D I, as owner of the pmperty, or my employees with wages u Ncir.sole compensation,
will do Eric work, and the swctum is not intended or offered torsed. (Sec. 7044, Business
.it Professions Code. The Convector's License Law docs not apply to an owner of
property who builds or improves themon, and who does such work himsel(or through his
awn employees, provided that such improvements are not intended or o(fexd 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 k itid not build or int prove for purpose of
sale.).
D I. as ownef of the propeny, am exclusively contracting with licensed contractors to
consuuct the psojcct (Sec. 7054, Business and Professions Code:) the Convector's Lf.
cense law does not apply m an owner of property who builds or improves themon, and
who contracts for such pmjecs with a contractor(s) licensed pursuant 0 the Contractor'a
License Law.
D l am exempt under Sec, ,B& P C for this reason
Data
' WORKER'S COMPENSATION DECLARATION
1 hereby effinn under penally of perjury one of the following dcclarnions:
❑ I he ve and will maintain a Ccnifcala of Consent o setf-asumfor Worker'sCompcn-
eatitn, sa Provided for by Section 37W of the labor Code, for the perramance of the
work for which this permil is issucd.
Cl 1 have and will maintain Workers Compensation Insurance, as required by Section
3700 of the Labor Cade, for the performance of Ne work for which This permit is issued.
My Workers Compensation Insurance carrier and Policy number am:
C; ' ,: MTbl j\ )C $u rc�.y Policy No.01 [ �1/.�>/3 ( is c�
ERTIFI :ATE OF EYEMPnON FROM WORKERS'
COMPENSATION INSURANCE
need not be completed if the Permit is for enc hundred dollars (SIM)
ccnify that in Eric perromunec of the work for which this permit is issued, 1 shall not
mploy any person in any mannersee as us become subject to thC Workers' Compensation
Applicant
NOTICE TO APPLICANT: IC after making this Ccnificam of Exemplioo, you should
become euhjcel m the Worker's Compcnsaion provisions of the Lobar Code, you must
.JO forthwith Comply with such provisions or this permR shall M deemed favored.
z� CONSTRUCTION LENDING AGENCY
f -n I hereby affirm that there isa construction lcodingagency lot he perfurmanecof
!Yi > thc work for which this permit is issued (Sec. 3M, Co, C.)
a (� Lender's Name
7 z Under's Address
U O 1 ccnify that 1 have read this application and sure that the above information is
Ll (•^coned 1 agree to comply with all city and county ordinances and state laws Olsten, a
0U building construction, and hereby aulhorin, represenutiws of his city to enter upon the
Fchow -mentioned pmperty for inspection purposes. y (We) agree to save, indemnify and keep harmless the City of Cupcnino against
N Iiabililies.judgmcroorcosls and expenses which may in any way accrue against said City
Uz in consequence of the granting of this Permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
e„n rake —,,
\.) HAZARDOUS MATERIALS DISCLOSURE
Will die applicant or future building occupant stoic or handle hamruus material
U defined by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety
Code, Section 25532(ap
D Yes ON.
Will the applicant or future building occupant use equipment or devices which
.,it hovenduus air cnnmmioents as delinCd by the Bay Arca Air Quality Managnncn.
DI... "7
DYE, Nu
I have read the humorous materials requirements under Chapter 6.95 of the Cali foo-
nia Hcallh &Safely Codc, Sadons 35505.]5533and 25534.1 undersand thatifth. building
does not currently haw a mnam. pmt h is my responsibility m nutily the no,o ent of the
t 4
rcqui s ch musmctpdorm issuance ofa Ccrficam of Occu ancy. 91. �''. � _
SIGNS INC
(408)280-6500
PERMIT NO 4 1
�craMll LV IIC VMIC
10/14/2004
SANITARY NO. CONTROL N0.
Job Description
SIGN
9�
Sq. Ft. Floor Area
7M6
Owner
Issued by:
Re -roofs
Type of Roof
BLI
C
Required Inspections
Date
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
all new materials for inspection.
1
Signature of ppricant Date
All roof coverings to be Class "B" or better
CALIFORNIA ACUPUNCTURE BUILDING 51GN ELEVATION: 196745TEVENS CREEK BLVD. CIN OF CUPERTINO
I;
APPROVAL:
m RACEWAY PAINTED KM -587
gFn
��-unc- urC�u
5" THICK INDIVIDUAL CHANNEL LETTERS, NEON FOR INTERNALLY ILLUMINATION,
3/4" RED TRIM CAP, RETURN PAINTED 701-M STONE AGE (DURAPO)(Y) COLOR
SCALE: 1/4"=1'-0" DATE: OCT -01-2004
EX15TING WOOD BEAM
SHEET METAL RACEWAY
FOR ELECTRICAL WIREING
1/4"x.2" LAG SCREW INTO WOOD BEAM
TOP & BOTTOM ® 4'-0" O.C.
DISCONNECTED SWITCH
#10x1" SCREW MIN.3 PER LETTER
TRANSFORMER BOX
#10x1/2" SCREW FOR RACEWAYCOVER
CHANNEL LETTER
INSTALLATION DETAIL
DATE: PROJECT:
• 0
!'
2
F STORE FRONTAGE
NEW SIGN LOCATION OffICE CW1
0
• 1 •
All designs & art works
PLOT PLANS
eaekl q , f
a qmrf m 44y Oman vs am,
.Ciaofn �&
WALL hOT be hIs eld to *M t7
DDroval of the Vi0laap �w . da
R oI any ao
any % Ordrnanla py Ift � IT
to Allen Signe, Inc. Any duplication is prohibited. COPY RIGHT 2004
rf�408/Y80-6500
lip
fN4408/289-8700
2982 STONE AVE.
SANJOSE CA. 95125
State Lic.#385551&5
Saudi
•CITY OF
CUPEkTINO
CITY OF CUPERTIN •
SIGN
PERMIT APPLICATION FORM
APN #
30-06-oo
Date:
1"Mo
Building Address:
I q6 T4 ZIVOO Creek i Vd
Owner's Name:
Phone #:
BPLANCHK
Plan Check Fee
Contractor:
License #:
1(--
BUILIDNG
Contact'/: _JJ� ,
K; wl1 I
Phone #:
Applicant/Contracto :
Building Permit Info:
ld lect Plumb Mech
Job Description:
Residential: _1—YI /' 9 ommercial:
Sq.Ft. Floor Area:
Sq.Ft
Architect/Engineer:
Oost of Project:
ELECTRICAL
4 aa6yp —
Type of Construction:
Qccupancy Group: j
Qyy. if
I '
A heable Fee ID FPe T1Pacrintinn FA<
B NERGY
Ener
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
I Business License
BUILIDNG
�# 2�7 e( 2-7