05060059CITY OF CUPERTINO
T
BUILDING DIVISION PERMI
iriCONT==RACTOI2INk'QRIA
BUILDINGADDRESS:
NORTHWEST SIGNS
PERMIT NO 05060059
OWNER'S NAME:
PERMIT LERM DATE
NE:
SANITARY 0. CONTROLNO.
ARCHITELT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION -
In
]017 DOSCTI j� ®®®
1 hereby affirm thm I am licensed under provisions of Chapter 9 (commencing
���
with Section 70(IIB of Division 7 of Ne Business Profession Code. and my license Is
infull and off �, gS
License Clara'u� Lk.g
SIGN (ELECT. SIGN) '
nfame
Dale h Q.f)S' Contractor IV4,46Wrlr 51g6j
ARCHfIECI'S DECLARATION
F{, [
Il I �} ZOOM
1 understand my plans shall he used as public record
non /1
O B'�
Licensed Pmfcasi... I
OWNER -BUILDER DE CLARATION
I'j klaa
1 botchy .(fete that 1 exempt from Ne Conlns
Anyc Law for the
V tIt 96' rtey
following mssoa (SecOum 7117 t.5, Business and Professions Cnde: Any city or county
1. Ca :
�a
which a permit to 4@4 improve, demolish, mash any
(
airswc6
fi statement
aalso for such Permit loflcemignedxmtemcm
il, issuance,
to (Chapter 9
Sq. Ft. Floor Area
Valuation
Iammenci gwitpSemamIntheofDivionsofthe
thatkItscensed uant Me provisions
of Business and Coca) or
(coheir xem with lone Code)of
on.fMyvi
I Net he u exempt mc¢(rom and Ute bub for the alleged exemption. My violation of
and bastsnrafrbeeed
3 51,3`0T2NW*er0 0
Occupancy Type
Section 7031.5 by eery epplimnt fora permit subjects Ne applicant to a civil penally of
not more Nan Bve hundred dollen (SSW).
❑ 1, ae owner of the property. m my employcu with wage u doirmu compensation,
Required Inspections
will do Mowork,end theswcmni... I intended or offered for sale 7014, Business
and Profusions Code: The Conoacuh License law does net apply to an owner of
q p
property who builds or im proves thereon. and who does such work h imself or through his
awn Tployaes, provided Met man improvements ere nminiended maffered formic. IL
however, the building or improvement is mid within am: Year of completion. the owner
builder will have the burden of proving that he did not Wild ar improve for purpose of
sal..).
❑ 1, as owner of the property, em "elusively contracting with licensed contractors It
construct the project (See. 7044, Business and Professions Code:) The Conmcmfs Li.
room law docs not apply m an owner of property who Wilde or improv" thereon, and
who contracts for such projects with a commelor(O licensed pursuant m the Contractor'
Lineae I.
C3I am exempt under Sec, B & P C far this recon
Owner Date
WORKERS COMPENSATION DECLARATION
1 hereby affirm under pcna0y of perjury arc of ds following doeleantions:
I haw and will maintain aCco fiats of Consent to self -insure for Worker's Compcm
salon, u provided for by Section 37W of the Labor Code. for the performance of the
work for which this permit is Issued.
❑ 1 have and will maintain Worker's Compensation hourence, m required by Section
3700 of me Lator Code, for Ne performance of Ne work for which Nis permit is kuued.
My Worker. ComPmandan Insurance moria and Policy number are:
SriAf�
Cartier. i�idlCl PaltryN.AS V7,,?A-MOal
CERTIFlCATE F FXEM MON PROM WORKERS'
COMPENSATION INSURANCE
(Thu ¢action need not Woomple ed trust permit is feemmhundrnd dollars (SIM)
nr mm.)
I certify that In the performance of the work far which this permit It Issued, I shall mol
employ any petmn in any manner an as to become mbjeeuo the Workers' Compcnsalion
Laws of California. Dem
Applicant
NOTICE TO APPLICANT: If, after making this Cenifcate of Exemption, you should
become subject in Ne Worker's Compewtion provisions of the LaMer Code, you most
' foMwim comply with such provisions Or this permit mall W deemed revoked.
..
CONSTRUCTION LENDINGAOENCY
1 herby ahem Net mart is lending agency for the performance of
s (Scctinn
' to work fur which this permit Is Issued ed (Sm:. 7097, Civ. C.)
Lender's Name
Lender's Add..
1 coolly mat 1 hate read this application and more thm me sheve InfOrmatiun Is
` correct. I agree In comply with all city and county oNinances and sum laws rclati.1 m
building construction. and hereby mmorim representative; of mix city to enter upon me
a on -mentioned property for Inspection purposes. '
(Wc) agree to save, indemnify and keep harmkst me City of Cupertino against
Ilebllidee, judgments. casts and expenses which may in my way sensate .guns, said City
In consequence of me grand ng of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCE R UL��77ONS.
" 6.cl•0Y
Y�An�Q
Re -roofs
Signature of ApplicanUCanmmmr Data
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
' Will the applicmt or future building Occupant mom or handle Incautious material
as dcfned by the Cups:rtino Municipal Code. Chapter 9. 12, and the H"Im and Safety
Code. Section 25571(4)7
All roofs shall be inspected prior to any roofing material being installed.
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 Cor devices which
mit haxadnua air coma rounm u Jefncd by the Bay Arca Air Quality Management
all new materials for inspection.
District?
❑Yes t2Nu
I have recd me h tratd,msmaterialx requirements under Chep urd.95of the Califon
ria H"hh&SafetyCode, Secdons 15505,25573 and 25534. ImalmseM daifile Wilding
does nut currently hoc a sonant, mm it is my rupomibilay in andfy the omupanl of the
rcquinmcnman cenid"maraapaacy.
0= ImPR=
Signature of Applicant Date
All roof coverings to be Class "B" or better
Owner Orsallmrixedagent Data
7J
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0
City of Cupertino
Plan Check Transmittal
E
Permit#
Project
Address
Owner
Description
05060059
Plancheck# 1
FileDate 06/06/05
SIGN
20400 STEVENS
CREEK BL #130
LE BOULENGER
ELECT. SIGN
Plan Check Status (attach comments and return to Building with plan set)
Dept
Plan
check#
Date
Due Date
Staff
Comment Date Approval?
1
06/09/05
06/23/05
CIDDY 06/09/05
❑O
Buildin
1
06/09/05
06/23/05
BOB 06/09/05
Plannin
1
06/09/05
06/23/05
CIDDY 06/09/05
Additional Plan Check Fee ❑ Hours
Planning Fees
Housing Mitigation Fee Amount
Heart of the City
Specific Plan Fee Amount
0
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OCUPEkTINO
0 0
CITY OF CUPERTINO
SIGN
PERMIT APPLICATION FORM
APN # •23 to q , 0 l - 028
Date. OS
Building Address:
OQ Sttjen S CrtiL gbsd A 130
Owner's Name:n
Phone
77y• 9000
Contractor:
License #:
Plan Check Fee
BUILIDNG
Contact:
Pr 1 a
Phone #:
831. U bq. 8to$
Applicant/Contra
tor:
• Ne r
o S� ntiS
$uilding Permit Info:
Bldg Elect Plumb Mech
Job Description: pp
Residential: Flet-lbri(a( 114,l 9.1 ^t) Commercial:
Sq.Ft. Floor Area:
$/Sq.Ft.:
Architect/Engineer:
Cost ofProje
Type of C mstrucCttion: '' nn
&Iuun
Occupancy Group:
Cl-eific.J Signs
Qty. if
Annlicable
W-- WIo
Fee Descriution
Fee Group
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
7�9- �/1-�
Zz
�
y
WQ
r7Z
UC
UL `
OL
1
CITY OF CUPERTINO�
- ' * ,�.^?
A'TTgI� `!'�
BUILDING DIVISION PERMIT
-lCOIVTR4TOIL�gTNFyyC'1'�
s
imp"
Bu1LDINGADDRESS; -
NORTHWEST SIGNS
PERMIT NO 05060059
OWNER'S NAME:
PERMIT ISSUE DATE
E:
SANITARY 0. CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
lois Description
1 bereby affirm Nat I am licensed under provisions, of Chapter 9 (commencing
wish Suit. 70010 of Division 3 of the Bwrv•• and Profession Code. and my licence is
m ren foran wderuy. ,,,
786IES
SIGN (ELECT. SIGN)
Lkcnce Clan—Lug
Dale h• C cwnuwrd Well !OO
ARCHITECTS DECLARATION
1 understand my plans NN be used an public =or&
4
Licensed Profeuinnal�`,�
OWNER -BUILDER DECLARATION
1 hereby afford that I am exempt from the Contractor's License Law for the
.h .
rJ
following mason.(Section 7031.5, Business and Profeasimn Code: Any city or county
tl
which requires a permit to construct. alter, improve, demolish. cr repair any structure
/�!y
- �(( (/ )j
prior m I% issuance. also requires the Applicant(onuch Permit Nc a signed statement
Oat het,0eensed(Chapter 9
/
Sq. Ft. F1oorArea
Valuation
pursuant totheProvisions OfOmCorarectus'sucuselaw
�(�l�//�H/�
(commencing with Section 7")of Division 3 of the Business and Professions Code) or
mat he is exempt themfrom and the basis for the alleged exemption. Any violnon of
v / N �,•- 0��•
3 e�mDiIIdltii�ef0 �'
ro 0
Occupancy Type
Section 7031.5 by any applicant for a pemtil •ubjecu the applicant to a civil penalty of
net more man fin hundred dollars ($501A
E] 1, as owner of the property, or my employees with wages ueh jhsok continuation,
"
/'�'
=+.
Re
was do the work. sad the stroaure is ngtintended oronered fornu(Su. 7044, Busiest
and ProfelVON Code: nic CanVClola License Law dM] Ml apply m an owns, of
uiiediIns�`ections
q p
property who builds orimprows thereon. and whodoeaauch workhlnlselforthe ugh his
own employes, provided mat such improvements are notinunded oroaered forsale. IT.
however, me building or Improvement is cold within once year o(completion, me wxr.
builder will haw Ibe burden of proving that he did not Wild or improve (or purpose of
sale.).
❑ 1, as want of Ota property am exclusively contracting with licensed cenwerors in
construct the project (Sec. 7044, Business and Profession Code:) The Contractor's U.
cane Law dean not apply to an owner of property who Wilda or improves thereon, and
who contracts for such project, with acomneuu(O lira sed pursuant to the Conuaetoe.
License Lew.
❑ I am exempt under Sec Bk P C for this mum
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby arRnn under penally of perjury an of the following declarations:
have end will maintain aCwHicate of Consent anself-insure for Workees Creation..,,.a.u
provided for by Sutton 3700 or the labor Cade. far the performance of ted
work for which this Permit is issued.
❑ 1 ban and will maintain WorkeYs Compensation Insurance, as required by Section
3700 of the Labor Code, for the perforotanee of me work far which this Permit is issued.
My Workees Compensation lnsumane carrier and Policy number are:
carrier. S#ahr atGi PeRcyNoA9g4V983-zo0M
CER77FIGTfi 7j—F EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
mossectiw aced lest W completed lane permit lsforone hundred dollan(SI00)
er lees.)
1 unify that in the performance of the work far which ibis Permit 4Issued. I shall not
employ any person In say manner an as to Wooden subject in the Worken' Compena0on
Law, of California. Data
Applicant
NOTICE TO APPLICANT: If, afar making this Certificate of Exemption, you should
become subject in me Worker's Compensation provision of the labor Code, you muse
forthwith comply with such provisions w this permit shall be deemed revoked.
..
CONSTRUCTION LENDING AGENCY
I hereby aper that mem its construction lending agency for the Performance of
On work for which Out permit is issued (Sec. was, Co. C.)
Undere Name
Lenders Address
1 unify that 1 ban reed this application and suit that the ebow information is
Centel. I agree to comply with all city aM cowry admances and mu laws misting in
building convection, and hereby amhorim representatives of thh city in emu upon the
aWw-mendend jamp coy for inspection purposes.
(We) agree to an. indemnify and becp hvmles, the City of Cupertino against
llabilitin judgments,cosu and expenses which may in any way aeuue ag,insisaid City
in consequcna of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCE R ULAIONS. A_
6 4 d�
Y 'y
Re -roofs
Signature of Applioant/Cou asor Dau
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will On applicant or future Wilding occupant now or handle hazardous material
u defined by the Cupertino Municipal Code. Chapter 9.12. slid the Health and Safety
Code. Section 25532(4)7
All roofs shall be inspected prior to any roofing material being installed.
❑Yrs We
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future Wilding occupant use equipment or devices which
I haurdau air ewWninant, as deposit by the Bay Arca Air Quality Management
all new materials for inspection.
District?
rp��
❑Yrs t,ann
I ban real the hazardous maurlahrequiremcnts under Chap crd.95 orihe Calder.
nu Hullhk SafctyCode,Scc o=25505.25533u 7.5534.1umunwdmaifthc Wilding
does rest currently haw a tannic that It u my rupomibdity In nmiry the occupant of he
requimmcrulriren =P1 = is CertiOule or occupurey.
Signature of Applicant Date
All roof coverings to be Class "B" or better
Owner or authorivad agent Date