03030133 (3) CITY OF CUPERTINO
BUILDING DIVISION PERMIT
BUILDING ADDRESS: CAL-NEON SIGN PERMITNO.
OWNER'S NAME: PERMIT Lg
1577 ALMADEN RD
PHONE: t SANITARY AN OL NO.
(408) 289-1883
1ECDPNOINEER: BUILDING PERMIT INFO
OEO PLUMB MECH
+�O o LICENSED CONTRACTORIS DECLA ON O
ly I hereby AmnonOA a am "a anmr previsions Gapmr 9(commencing Job Description
wahsa ] )ofDIVIAW3oflho�Simon
A 11som na aces ^n
'�z uceliuc `"IJe.d -�� SIGN-1 MONUMANT & 1-CHANNEL Lrt�R�u V A E D
_ Dem
Fe15 CHIIECT ECLARA N
t55 lA=41 hudWlbe MPublic reeam, JUN 1 9 2003
S� Licensed Professional
OWNER-BUILDER DECLARATION
ConTION
>: 1hereby.mere that 1Am 1. ,Bump:from me CssionC,e:Licenso anchor forth.followBUILDING
A00p DpB G
O o which
repenm permit
t IID L5,Business and Re.de Profession Code:My city m ewmy {J I4m 1 A X 6%1
$ which rcyahu a pvmlt re conatruc4 ober.hnprove,demoWh,on repair any munare
prior mits Issuance,also nt M the the applicant for such Conuncmil mnleeeLA*(tslomenl
C
Oat
ommencconrcdpamtion 700the pmvblov of me Comnamrl LIanselawaCode)9 Sq.Ft. Floor Area V IOn
>a (cot It far ng pt Octal.and Onof hauls
f r of nu B.Iaged o ma Prorestion.Any u Atino ortha +�3 1 �f
.• So io 4 eaL5 b any applicant
p li and far
aper for 0.allsubjects
the tmmpnt to Any•iohaon of
&qim 7031.3 M any red d.ntn(a prwuobjau me sPDlkanl m a civil Pendry of
not mom than nam beedred adrts(ssm). ,3 dINS Ngtglker 0 0 Occupancy Type
❑I,uawou of Om propeny,umy mpl)ycc,wlN weguuthe4 sok mnpenunon,
willdo th)work,and Wasaaalum is nottmlondedar.fund forum(San.7044,11udneu 101 - FOUND
P. 61Ud inspections
and Proludons Code.The Conemtoreu
s Uee law doas cot apply m Mannar an or of
property who bila;orimproves de eon,and who doescuchwoh himselfuthrough his 103 - UFER
own employaca,pmvlded that such Improvements am n)timmded orolfcmd!uvea.IL 104 - RE BAR
however,the building u m
improveent r sold within one year of cuopkilon,the owner•
builhr wen have the buNm of proving that M did nm Wild or improve for Whom of 105 - ANCHOR BOLTS
❑1.asawMrof the property,amoalnaivelyemrmIngwith nren,eaona.aa.m 304 - ROUGH ELECTRICAL
coaswm On project(Sm.7044,Business and Pmrewon,Code:)The Gaupee70r's U- 505 - FINAL ELECTRICAL
ecus Law does not apply m an Wrour of property who builds or improves thereon,and,
who contracts for such projects with a coamaclor(s)licensed pursuant in the contractor, 514 - FINAL PUBLIC WORKS
Licence Law.
[3I Am exempt under See. ,B t P C for this reason
Owner Dam
W ORKER'B COMPENSATION DECLARATION
I hereby amtm under penalty of perjury one of the following dNiarsti C
eve andwill mdnAd aCwnestsof Content m self-Inure(u Watke/aCompen.
u provided far by Sation 3710 of the labor Code,for On performances of Ne
u which this petmil Is iu md.
❑1 beN and will maintain Workers Compensation Incomes.As required by Semon
3700olthe Labor Code,for
thepetforman afW fuwhich Niapemrltrluma.
My Worker,Co mutt 1 7011_nier,of Po numbb/yy/�er�lmA ////��'lIII2
G �r PoII o.: �
C IFlC •OF (PMPIION FROM WORKERS
COMPENSATION INSURANCE
nbr,ection reed not he completed if the permit Isforomhundraddolrrt($10))
or kat.)
1 ecnify that in tho performance of No work for which this permit Is rsue4l&bell not
employ any poison In any mmaxrm As 70 become subject 0 the WMIMW CDmpensw M
Law of California.Dam
Applleanl
NOTICE TO APPLICANT:If.Aber making Nr CenlRcam of Exemption,you should
bezme subject in Ne Weaker'Compensation provisions of No Ubnr Code,you must
.,O forthwith comply with each Provisions ext this permit&hall be dammed conked.
'Z°'" CONSTRUCTION LENDING AGENCY
(-1 I hereby amrm Nat them is a com ucOm lending agency for the performance of
a dm work for which thin permit Is issued(Sac.3097,CIv.C.)
W� Lander,Nam)
z Lenders Addmas .
U 0 1 certify that 1 have read this applintlon sed suss that the above informwon is
C7. creat.I&gree 70 comply with all ally and cmnty ominumes and sum law muting m
0 Wilding construction.and hereby aulhonre representatives of Nis city to color upon No
shove-memloned properly for Inspection purposes.
q (We)agree to save,Indemnify and kmp hatmku Ne City of Cupcnln t against
IubilWes,judgmenu,caua despenma which cosy in enywyaccue agalnn said city V F77 in conaequcnce of the ism' Col Nr Permit
APPLICANT
NO Nos AND WI COMPLY WITH ALL NON- INT ISS d by: Date
SOIIMLE REOU 0
t/ -GOOFS
signuurc of _
HAZARDOUS OUS MATERIALS DISCLOSURE O't` pe of Roof
Will the applicant or futum building=upset nom
our huardou mamdd
u ddined by Ne CoPatlino Mun(d otic,Chapur 9,12.And On Health and Safety
Code,5emlen 25552(a)7
Yes All roofs shall be inspected prio o any roofing material being installed.
❑ a
Will Onapplicant orfuture building ottvputmeequipment mdcvia,which If a roof is install without fir t btaining an inspection,I agree to remove
C!
hazardous air contsmimnu u and by lbe Bay Arca At,Quality Mm,Ccment all new That la r inspecti
id7
❑Yes Na
I beve no thehm oumuerials requirements under Clupw6.95ofnm Callfar- D
In Raalth&SdclyC esu 25505.25 )uW2553/.lundcmand thulfNo buil ng
doe not comedy h nam.that It r nes wblllty m Mnf the naupml the
1 requirements car wnamar topancktr �na fApplicant Dat
• Owner or epem D✓ All roof coverings to be Class "B"or better
CITY OF CUPERTINO
I� 1 of 1 PERMIT RECEIPT OPERATOR: conniew
COPY # 3
Sec : Twp: Rng : Sub: Blk: Lot :
APN . . . . . . . . : 36901001 . 00
DATE ISSUED. . . . . . . : 03/25/2003
RECEIPT # . . . . . . . . . : 21423
REFERENCE ID # . . . : 03030133
SITE ADDRESS . . . . . : 10100 DE ANZA BLVD
SUBDIVISION . . . . . . :
CITY CUPERTINO
IMPACT AREA . . . . . . :
OWNER . . . . . . . . . . . . : ARMADILLO WILLY ' S RESTAURANT
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : CAL-NEON SIGNS
CONTRACTOR . . . . . . . : PRIOLA, RICHARD LIC # 20444
COMPANY . . . . . . . . . . : CAL-NEON SIGN
ADDRESS . . . . . . . . . . : 1577 ALMADEN RD
CITY/STATE/ZIP . . . : SAN JOSE, CA 95125
TELEPHONE . . . . . . . . : (408) 289-1883
OE ID UNIT QUANTITY AMOUNT PD-TO-DT. THIS REC NEW BAL
---------- ------------- ---------- - --------- ---------- - ------- -- ------ - ---
BPERMFEE VALUATION 3 , 400 . 00 97 . 00 0 . 00 97 . 00 0 . 00
BENERGY PERMIT FEE 97 . 00 29 . 10 0 . 00 29 . 10 0 . 00
BPLANCHK PERMIT FEE 97 . 00 82 . 45 0 . 00 82 . 45 0 . 00
EPERMITFEE FLAT RATE 1 . 00 35 . 52 0 . 00 35 . 52 0 . 00
BREMSIGNS NO SIGNS/MARQ 1 . 00 22 . 20 0 . 00 22 . 20 0 . 00
BSEISMICOM VALUATION 3 , 400 . 00 0 . 84 0 . 00 0 . 84 0 . 00
---------- ---------- - -------- - ------- - - -
TOTAL PERMIT 267 . 11 0 . 00 267 . 11 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
CHECK 267 . 11 1097
TOTAL RECEIPT 267 . 11
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
•
N `ITY OF CUPERTINOSIGN
,
CITY OF
CUPEI,TINO PERMIT APPLICATION FORM
APN# �3 /G_ Q I 0 O Date: 2 �/
Building Address:(? �.J J
101.bCo Oe Hu2c,-- (-� Ud
Owner's Name: I 1 r e ' l i t� Phone#:
Contractor: J A e� \ 1 License#: -3
Contact: /v }JR0� Phone#:
�.�'tC •�O )�S
UJvV�
Applicant/Contractor:
Building Permit Info:
Bldg Elect Plumb Mech
Job Description! ' L
Residential: e(tOUtxnGYl� ��/ G Commercial:
Sq.Ft. Floor Area: $/Sq.Ft.:
Architect/Engineer: aluat'
Type of Construction: Occup c
Qty. if
A c b Fee ID Fee Description 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 Sings, Marquee ELECTRICAL
BUSLIC Business License BUILIDNG
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