11120013CITY OF CUPERTINO BUILDING PERMIT I
BUILDING ADDRESS: 20735 STEVENS CREEK BLVD I CONTRACTOR: ARROW SIGN CO I PERMIT NO: 11120013 I
OWNER'S NAME: LAU ALLAN CROOK YEE AND LINDA YIM S 1051 46TIl AVE I DATE ISSUED: 12/01/201 I
PI IONS: 7076733100
LICENSED C'CINTRCC"1'UR'S DECL\RA'I ION
License Closet . ;5 a.:.rt ,Lic.;p ;•s.:J� " '
ConuncmrAC2ReSa e (y. J Dale 12
I hereby aRciallhat I�amlicensed under the provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business & Professions
Code and that my license is in full torte and effect.
OAKLAND, CA 94601 I PHONE NO: (510(533.7693
BUILDING PERMIT INFO: BLDG ELECT r— PLUMB r
MECII F RESIDENTIAL r COMMERCIAL ('
JOB DESCRIPTION! VERIZON & GAMES 101'. INSTALL ONF(I ( ILIUM INA'I ED
CHANNEL LETTER SIGN FOR STOREFRONT
I hereby affirm under penalty of perjury one of the following two declarations:
I have mid will maintain a certificate of consent to sell' -insure for Worker's
Compensation, as provided for by Section 3700 of the Libor Code, for the
performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance of die work for which this Sq. F1 Floor Area:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and slate that the above information is
correct. I agree to comply with all city and county ordinances and state laws relating
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
granting ermit. dilio Ily, the applicant understands mind will comply
with all on -point ur a regulati is per the Cupertino Municipal Code, Section
9.18.
Signature._ ' :'. ' ter-?:; a, . ._ . .Date—. a %..0 \- A
OWNER -BUILDER DECLARATION
hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
I, as owner of the property, or my employees with wages as their sole compensation,
will do the work, and the structure is not intended or offered for sale (Sec.7044,
Business & Professions Code)
I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code),
1 hereby affirm under penally of perjury one of the following three
declarations:
I have and will maintain a Certificate of Consent to self insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
I certify that in the performance of die work for which this permit is issued, I shall
not employ any person in any manner so as to become subject us the Worker's
Compensation Imes of California. If. after making this cerif sate of exemption, I
become subject to the Worker's Compensation provisions of the Labor Code, I must
forthwith comply with such provisions or this permit shall he deemed revoked.
APPLICANT ANT CERTIFICATION
I certify that I have read this application mid state that the above information is
correct. I agree to comply with all city and county ordinances and state laws relating
to building construction, and hereby aulhortzc representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the,City of Cupertino against liabilities, judgments,
csts, and expenses which may accrue against said City in consequence of the
anting of this pennii. Additionally, the applicant understands and will comply
with all non -point source rcguhnims per the Cupertino Municipal Code, Section
9.18,
APN Number: 32632054.00
Valuation: $7500
Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: Date: /4
RE -ROOFS:
All roofs shall be inspected prior to any roofing material beug installed. If a roof is
installed without fast obtaining an inspection, I agree to remove all new materials for
inspection.
Signature of Appliantt Date:
ALI, ROOF COVERINGS TO BE CLASS "A" OR RETITR
IIAZLV.RDOUS MATERIALS DISCLOSURE
have read the hazardous materials requirements under Chapter 6.95 of the
California llealth & Safety Code, Sections 25505, 25533, and 25534. I will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the llealth &
Safety Code, Section 25532(a) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
mai 'n cam pit cc with the Cupertino Municipal Code, Chapter 9.12 and the
f alth . are Cr e, Sections 25505, 25533, and 25534.
O r or a or' .ed agud:
Dale:
CONSTRUCTION LENDING AGENC\'
I hereby affirm that there is a construction lending agency for the performance of m rk's
for which this permit is issued (Sec. 3097, Cie C.)
Lender's Name
Lender's
t\RCIIITECT'S DECLARATION
I understand my plans shall be used as public records.
Date I Licensed
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
imlADDRESS:
20735 stvns cek blvd. #E
DATE:
REVIEWED BY: bobs.
APN:
BP#:
"VALUATION: 1$7,500
"PERMIT TYPE: Building Permit
I' :_ C1171,01, 7 T'I>.
PRIMARY Si n
USE: g
PENTAMATION 1 CEAP5
PERMIT TYPE:
WORK
install illuminated channel letter si n for storefront.
SCOPE
Suppl. Insp. Fee:Q Reg. Q OT0,0
SIGN TYPE
FEE ID
,'« j}%-, i s; <'irr r jc
QTY
SIGN FEE
IESIGN
Elec. Permit Fee: IEPEIMT
Wall Sign, Electric
1SIGNWELEC
Other Elec. Insp. 0.0 $44.00
1
$260
Permit Fee:
$260.00
Suppl. Insp. Fee:Q Reg. Q OT0,0
hrs
$0.00
PME Unit Fee:
$44.00
PME Permit Fee:
$44.00
Work Without Permit? 0 Yes (j) No
$0.00
TOTALS:
$0.00
i
Travel Documentation Fee: ITRAVDOC
1 $260.00
Strong Motion Fee: 1BSEISMICo
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc.). These fees are based on the nreliminary information available and are only an estimate. Contact the Dept for addit7 info.
FEE ITEMS (Tee Resohrtion 11-053 E . 711111)
_ ` , h. $ l".' r" 1•_:_T:
,'« j}%-, i s; <'irr r jc
# Branch Circuits 1 $44.00
IESIGN
Elec. Permit Fee: IEPEIMT
Suppl. PC Fee: Q Reg. 0 OT
117,r, /" TnSp.
Other Elec. Insp. 0.0 $44.00
%;'c�'k i c_.
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc.). These fees are based on the nreliminary information available and are only an estimate. Contact the Dept for addit7 info.
FEE ITEMS (Tee Resohrtion 11-053 E . 711111)
FEE
QTY/FEE
MISC ITEMS
Suppl. PC Fee: Q Reg. 0 OT
0.0
hrs
$0.00
Permit Fee:
$260.00
Suppl. Insp. Fee:Q Reg. Q OT0,0
hrs
$0.00
PME Unit Fee:
$44.00
PME Permit Fee:
$44.00
Work Without Permit? 0 Yes (j) No
$0.00
Sign Master Plan: Q Yes (j) No
$0.00
i
Travel Documentation Fee: ITRAVDOC
$44.00
Strong Motion Fee: 1BSEISMICo
$1.58
Select an Administrative Item
1
Bldg Stds Commission Fee: IBCBSC
$1.001
SUBTOTALS:
$394.58
$0.00 TOTAL FEE:
I $394.58
Revised: 10/01/2011
(11