05040047CITY OF CUPERTINOibll �COiTRAC�fORtII'r'`UT.LMA,'
BUILDING DIVISION PERM
da?`si:a.' 1.•r DT7 ffv'iPsiM^.$'i. x"I'*n ,3 % a .
BUILDING ADDRESS:
ALLEN SIGNS INC
P
No05040047 ,
t%lr
NER'S NAME:
I
I
ISSURDATE
ONE:
j
I
SA
I
ARY NO. CONTROL NO.
ARCHITECT/ENGINEER:
I BUILDING PERMIT INFO
BO ELECTPLUMB MECH
O
LICENSED CONTRACTOR'S DECLARATION
lob Description
1 hereby afrom that1 provisions of licensed under provisioof Chapter 9 (ammencing
(
with Seenon 7") of Divides 3 of dm Business and Pro(casions Code.med my license is
in full torte and
--INDIVIDUAL
CHANNEL
'
License Class Lk. N
Dam Contncror.
'
ARCHITECTS DECLARATION
1 understand my plana shall he used u public records
Licensed Pmfessionel
OWNER -BUILDER DECLARATION
I hereby aMrm that I M exempt from NC C.."Clara License Low for the
following mason. (Section 70315, Business and Prolamines; Code: Any city or county
�
r. aher. improve, demoltsM b. repair any atrucwm
which requhca mit a peto cnaoct
prior m its issuance, also requires the applicant for such permit to file a signed statement
Sq. Ft. Floor
Area
Valuation
that he is licensed pomem, to the por,00ma the Conmcmer Name law(Chatmr9
(commencing with Section 7000) of Division 3 of the Business and Profwiom Code) or
that he is exempt therefrom and Ne basis for the alleged exemption. My violaden of
3 6PH09 t*aro 0
Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant be a civil penalty of
not moa more ftw hundred dollars ($500).
I
0 1, u owocr of the properly, ser my employees with wages u theirmlecompenmtlon,
-
Required Ins ectt
sns -
willdo Lhc"&.andLh.maumbnotimmndedoraRemdfo,ok(Stt.7044,Business
and Professions Cade: The Conmemr's License law does not apply to an owner of
q p
prapeny w ho hulics ser i m paves thereon, and who docs sue h work himself M through his
own employees, provided Nat such improvements arc not intended MnRered for sale. if,
however, the building or Improvement I. mid within we your of completion, Ne owner.
Wilder w10 nave the burden of proving that he did not build M Improv (M purpose of
sale.),
❑ 1. ea owner of the properly, am exclusively contracting with Bcensed conuumn to
Construct the project (Sec. 7044, Business and Profession Cade:) The Conmcm's LL
cense law does not apply m an owner of prepeny who builds or improv themon,and,
P ..
who contracts for sah projeeu with a contruter(s) licensed partners in the Contractors
License Law.
0 lamasemplundMSee. .Bk PCfartNsrcuon
saner Dam
3/s
WORKER'S COMPENSATION DECLARATION
.
I hereby Rinne under penally of perjury oof the following declarulons:
Rinne
1 haw soil will maintain aCenifieme of Consent to relr-Imam rhe Workers Compere
¢tion, u provided rhe by Section 37M of the labor Cade, for the performance of the
work for which Nb permit is Issued.
0 1 have and will maintain Worger's Compensation lamosea, a required by Section
3?00 of the labor Code, for dre perfarmmce of the wad: for which this permit is Issued.
.
My Workers Cnm rttiuMnYand Polity number son:
Caliry Nm:Qm -600/ R W
CERTIFICATE EKEM ONFROMWORKERS'
COMPENSATIO INSURANCE
'
(Thissatirn bad notnecampleteJ If dr Icrmh ts fnronc hundred dollen (5100)
1 amity Not I. to PCm.mamea of Ne wark for which this permit is issued. I shall not
'
employ any person In my manner an u in become subject to tin Worked Compensation
Laws of California. Dem
Applicant
NOTICE TO APPLICANT: If, after making this CcnlRcate of Exemption, you should
became subject in to Wommes Compensation provisions of the Labor Code, you mum
' farmwith comply with such provisions or this Permit shall he deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby that Nem its construction i lending agency for the performance of
corm
which 0
' the work for which Nb permit ts issued (Sec. 709'1, Civ. C.)
Landers Name
LeMers Address
I «A(y that I love it this application and rum Net dte .nous information I.
4 correct. 1 agta ve comply with all city and county mdinanas and some laws mining to
building construction, and hereby minnow raim unntives of this city in enter upon the
chow-mendoond property for inspection purposes
(We) agree to saw, indemnify and keep harmless the City of Cupertino against
7 Iiahilldes, judgments, casts and expenses which may In any way acmm against said City
y In consequence or the granting of thispermlb
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: ,
Date
SOU i RE LATIO
Re -roofs
Type of Roof
J
Sign temafAm/ ntnnor ate
HAZARDOUS MATERIALS DISCLOSURE
Will the p liant or future building acupent nom or handle hanNous mammal
lupniao
1J
see aenmd by tete Municipal Cade, Chapter 9.13. and the Health and Safety
23532(¢)9
co", SE]
be inspected to any roofing
being installed.
Y. Xbm
All roofs shall prior
15aterial
11
If a roof is installed without first obtaining an in
pection, I agree to remove
Will the applicant or forum building occupant use equipment or devices which
emit heurdous sir contaminants u inan&fl.d by the Bay Area Air Quality Management
all new materials for Inspection.
District?
oYea *No
'
I have road the hauNnusmateri ils req ibentents under Chapmrd.95 orthe Califor.
nib H.111, SRcty Codc, Sccmms 5505.25533 and 25534.1undcnmnd thmifthe WildingAd
Jam not currently how a mmol Net it is my reapomlM1ility In tmtify the acupant of Ne
Si natureo Applicant)
reyuir nwhidhmustbcfnclprtormissumaoraCcrdfreaw2rpcra y
Date
All roof coverings to be Clat
s "B" or better
Owner ser awhorimJ
tan Datc
0
Item 1 of
0
CITY OF CUPERTINO
1 PERMIT RECEIPT OPERATOR: conniew
COPY # 3
Sec: Twp: Rng: Sub: Blk: Lot:
;.APN 36906009.00
DATE ISSUED.......: 04/08/2005
RECEIPT #........:: 29247
REFERENCE ID # ...: 05040047
SITE ADDRESS .....: 19690 STEVENS CREEK BLVD
SUBDIVISION ......
CITY CUPERTINO
IMPACT,AREA ......
OWNER SCOTTRADE
ADDRESS ..........:
CITY/STATE/ZIP CUPERTINO CA, CA 95014
RECEIVED FROM ....: K LIN
CONTRACTOR .......: ALLEN LIN LIC # 22174
COMPANY ALLEN SIGNS INC
ADDRESS 1982 STONE AVE
CITY/STATE/Z-IP SAN JOSE, CA "95129
• TELEPHONE (408)280-6500
FEE ID
----------
UNIT
-------------
QUANTITY
BPERMFEE
VALUATION
---;------
2,000.00
BENERGY
PERMIT FEE
83.16
BPLANCHK
PERMIT FEE
83.16
EPERMITFEE
FLAT RATE
1.00
BREMSIGNS
NO SIGNS/MARQ
1.00
BSEISMICOM
VALUATION
2,000.00
TOTAL PERMIT
METHOD OF PAYMENT AMOUNT
----------------- ------------
OTHER 297.04
TOTAL RECEIPT 297.04
AMOUNT PD -TO -DT THIS REC
83.16
0.00
83.16
39.92
0.00
39.92
110.98
0.00
110.98
38.37
0.00
38.37
23.98
0.00
23..98
0.63
0.00
0.63
---------- ----------
297.04
----------
0.00
297.04
NUMBER
------------------
AMEX
VOICE,ID DESCRIPTION VOICE ID DESCRIPTION
101 FOUNDATION 103 UFER
104 REBAR 105 ANCHOR BOLTS
304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL
514 FINAL PUBLIC WORKS
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0.00
0.00
0.00
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•CUPEI�TINO
4fITY OF CUPERTINO~ . -7
SIGN vS-�'�f
PERMIT APPLICATION FORM
APN #
Energy
BUILIDNG
Date:
Bldg Permit Fees
BUILIDNG
BPLANCHK
Plan Check Fee
Building Address:
BSEISMICOM
Seismic Commercial
S-Eewens
CrzYk
l v
Owner's Name:
Phone #:
Contractor:
Elect Permit Issuance
ELECTRICAL
License #:
Rmdl Signs Add Branch
Inc.
BREMSIGNS
Rmdl Sips, Marquee
Contact:
Phone #:
1 L
Applicant/Contractor:
BUSLIC
Business License
AllflA Si
S 1AC.
lding Permit In :
Bld
lett
Plumb Mech
Job escription:
Residential: and
i %
S Commercial:
Sq.Ft. Floor Area:
$/Sq.Ft.:
Architect/Engineer:
Cost of Project:
Type of Construction:
Occupancy Group:
Qty. if
Annlicable
Fee M
FPP nperriTt;nn
FPP \ �i1111T
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 Sips, Marquee
ELECTRICAL
BUSLIC
Business License
BUILIDNG