04090262 (2) CITY OF CUPERTINO ` yy t"�y��5y� *��Tr4:
BUILDING DIVISION PERNO ° CO1 �RAC�QI.tL
BUILDING ADDRESS: PERMIT No,4 0 9 0 2 6 2
OWNER'S NAME: PERMIT ISSUE DATE
PICK UP STIX
ONE:. - SANITARY NO, CONTROL NO.
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
loo LICENSED CONTRACIDWS DECLARATION
�I bercby affirm Nal l am limned under provisions of Chapter 9(commencing Job Description
ZZ with ZFon 700Baf Division 3 of the Busincnand Prptesaium Code,and my licence is
^= in fol a and eIT
zqi Lieenecl . � tie. Ol SIGN-IL RS
3 Data Comment, CONTRAC 0
�4 yg- ARCHITECrS DECLARA N ELECT. SIGN.
y m 1 understand my plans,hall Mused as public..,us
;mO Licensed Profmaionl OCT
ZOOk
i0 OWNER-BUILDER DECLARATION
i2 I hereby alliirm Not I em exempt from the Contractor's License Law for the
a eO following reason.(Section 7031.5,Business and Professions Code:Any city it,county
+�m which requires a permit to construct,alter.improve,demolish,or repair any structure
prior m its fountain, the applicant for.uch permiu
R1 III r)lhl^
yo file a signadaummcat
FF G thalheisliccnudpunuarat,lftpmvisiomofthe Commiar's LicenmUw(Chapmr9 IIkTq. Valuffid(1 00
C (commencing with Section 7")of Division 3 of the Busines,and Professinna Cnde7 tar 4Y
y 3 that he is exempt dmmfrom and the Wab for the alleged exemption.Any=of
SeNon 7031,5 by any applicant for a permit subjects Ne applicant to a civil penalty of APN Number Occupancy Type
not more than fin hundred dollars(S5010). - P Y YP
❑Las owner of the property,or my employees with wages es theirsolo compenre0on, 35908018 . 00
will do thewmk,and the stratum is notimended or offered forsale(Sec.7044,Business Required Inspections
and Proteins...Code:The Canvacmrs License Law dors not apply In an owner of q p
prepenywho h tildsmimprowes the......dwhodoea suchworkhlmself mlbmugh his '
own employers,provided Net such Improvements are not intended oraaered forsake.If,
however,Ne building or improvement is sold within one loser of completion,the owner.
Miller will have the burden of proving that M did not build or improve for purpose of
aale.l.
❑Z as owner of the property,am exclusively contracting with licensed contractom to
consumes Ilse project(Sec.7044,Business and Professions Code:)The Comractor'a U.
cave law does not apply to an owner of property who builds or improves demon,and
who contracts for such projects with a cha racter(s)licensed pursuant to the Contractor's
Livnm Law.
❑slam exempt under See .B&PCfmdd3maeon
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hemby affirm under Penally of perjury one of the following declarations:
I have and will maintain a CCNfiate of Conscntm self-insure for WorkcrsCompen-
sation.as provided for by Section 3700 of Ne Labor Code.for Ne performance or tax
weak for which this permit is issued.
❑I have and will maintain Workers Compensation Insurance,as required by Section
37M of the Labor Code,for the performance of the work forwhich this perinh is issued.
My Workers Compensator Insu`n'nm{carr-ifsfpe�nd Policy number are:
Cau�r. �:`GI��+W"vtaYN tivIB/1I.�."'P67icy No 7 p4 1
✓/ CERTIFICATE OF EXEMPFIONVOM ORKERS'
COMPENSATION INSURIANCE i
(This remlan used not hecompleeJ if the permit Is for mmhundmd dollsm($100)
or less)
1 certify that in the performance of Ne work for which this permit In issued,l shall not-
employ any person in any manner an as to become subject to the Workers'Compensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If,eBar making this Cartifeme of Exemption,you should
become subject to Ne Workers ComMosation provisions a(Me Labor Code,you must
.J Q foMwllh comply with such provisions or this permit shall M deemed mvaked.
CONSTRUCTION LENDING AGENCY
[••rte 1 hereby affirm Nal them is a construction lending agency lot the performance of
ai s7 the work for which this permit is issued(Sae.3097,Civ.C.)
Wti Q Leader'.Name
z Lender's Add.,
U 0 1 certify that 1 have rad this application and state that Ne above information is
(y F correct.I agree to comply with all city and county On irmams and mine laws relating to
V buildingconswctiom,and hereby aothmim represemJves of this city to cnlerupon Ne
yys�Gk( ,hove-memimned properly for iapection purposes
L-,C (We)agree m save,indemnify,and keep harmless The City of Cupertino against
GGy liabiliimajudgmems coats and expenses which may in any way same against said Coo
U 7 in conaegancc of the grouting of this porrol. '
r1- APPLICANT UND RSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCftEGUL 0 S. /
nn, �uIData 04' Re-roofs
Signature of ApplicaHAZARDO Dem
HAZARDOUS MATERIALS DISCLOSURE Type Of Roof
Will the applicant or future building e,Chapter
erre m handle Heartlnun matcdal
u tleRned by the Cupertino Municipal Code,Chapter 9.12,and Ne Health and Safety
Code,Section 25532(x)? All roofs shall be inspected prior to any roofing material bei. installed.
❑Ya $
Will the applicant or future building accupam tau equipment or Devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hay.ardous air contaminants as JCBncd by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Ya
1have and the haos' ocelots requirements under Chapter 6.95.(IMCalifor-
me Hard di&Safety Codc Sccdom 25505,25533 and 25534.1 undcmtsnd last ifthe building
does not curremly bona team,that it u my reapoaihilly m no'I'y the oecupml of Ne
requiremcros whit antMme 'on issuance ofa CeniB�m (CccL-OZ Signature of Applicant Date
owner or aur ixcd agent Date All roof coverings to be Class "B"or better
301-011 Q -co
dam @
(StM Frgaape) U O 5
PLOT PLANS Equal 7'-4 Y." Equal E z uh r
$Y loveran Sipn widen) = W p
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its budding Dept., City of Cupetthto. $
owCamping of this plan and c m
§HALL NOT be held to PPMA Of 0 08 ag Q Q t
rp®tdval of the violation of MY 0009OW '
if env Citv Ordinance or SO�tea. A WEST ELEVATION - PROPOSED CUSTOM "PICK UP STIX" ICON SIGNAGE R: i
Quantity: Make One (1) Sign Scale: 3/16" = 1'-0"
Photo rendition for representational purposes only Photo scales are close approximate.Actual sion may appear larger or smaller then shown. Colors shown may very due to ink iet printing interpretations.
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-------------------------------Z- 0--A-PP-R�V'A L
PLEASE SIGN X Title
Pri - oat
& RETURN NOTE: Please make sure to sign all pagesl�
,J( o Rwisions 'ba N'� Pick Up Stix
No, Dale Mn
MW + 07.02.04 AD CUPERTINO CROSSROADS CNTR 20530 STEVENS CREEKBLVD. CUPERTINO,CA
ml+am.Arn. 08-04-04 A� sanacrsaa D. vara Ry snaal Namsar
• .o.ao•,wn�aw,�< ? J.Blue 4107/04 JB 3 o/ 3
s OB-04-04 FM Ciswnx Appy al Dma rnawna NwnCn
310-549-4661 officen 08-30-04 FM 04-05-5786
310-549-8882 fcx 5 09-24-04 FM
0
CITY OF CUPERTINO
Ism 1 of 1 PERMIT RECEIPT OPERATOR: conniew
COPY # 3
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . . 35908018 . 00
DATE ISSUED. . . . . . . : 09/27/2004
RECEIPT # . . . . . . . . . : 27196
REFERENCE ID # . . . : 04090262
SITE ADDRESS . . . . . : 20530 STEVENS CREEK BLVD
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : PICK UP STIX RESTAURANT
ADDRESS . . . . . . . . . . .
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014
RECEIVED FROM . . . . : ALL SIGN SERVICES
7 CONTRACTOR . . . . . . . : LIC #
COMPANY . . . . . . . . . . :
ADDRESS . . . . . : . . . . :
CITY/STATE/ZIP . . . : ,
TELEPHONE . . . . . . . . :
•
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
- --------- ------------- ---------- ---------- ---------- --------- - ----------
BPERMFEE VALUATION 4 , 300 . 00 115 . 56 0 . 00 115 . 56 0 . 00
BPLANCHK PERMIT FEE 115 . 56 154 . 21 0 . 00 154 . 21 0 . 00
BENERGY PERMIT FEE 115 . 56 55 .47 0 . 00 55 . 47 0 . 00
BREMSIGNAD NO. CIRCUITS 1 . 00 4 . 80 0 . 00 4 . 80 0 . 00
EPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
BREMSIGNS NO SIGNS/MARQ 1 . 00 23 . 98 0 . 00 23 . 98 0 . 00
BSEISMICOM VALUATION 4, 300 . 00 1 . 05 0 . 00 1 . 05 0 . 00
BUSLIC FLAT RATE 1 . 00 100 . 00 0 . 00 100 . 00. 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 493 .44 0 . 00 493 . 44 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
CHECK 493 . 44 7774
TOTAL RECEIPT 493 .44
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
CITY OF CUPERTIN�?
I
SICK a Z
•CUPEkTINO PERMIT APPLICATION FORM
APN # Ge? GM—
Date: ((S 0q
Building Address:
aaa530 '5ktW Ws C UAJ 906 a,
Owner's Name: Phone #:
�,45,a, co. Pi�u� 54-1y 401 266- 30a.2
contractor: 50,-- P License
5 #: 3 J (ro'
�.2c1(v�c � J q
Contact: Phone
I% Jq9 —(044(,
Applicant/Contractor: A ' r
Building Permit Info: f+
Bldg Elect Plumb Mech
Job Description: v,,y4 uv R,� w i se� i 61uv�, Wn1� Qp{{pns
Residential: Commercial:
Sq.Ft. Floor Area: $/Sq.Ft.:
�krchitect/Engineer: Cost of Project: 4 43vo
c
ype of Construction: Occupancy GrouhD
Qt if
A lic le 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 Signs, Marquee ELECTRICAL
BUSLIC Business License BUILIDNG
�3 . 4ck
CTfY OF CUPERTINO _ . - . s� a, .� ,^a q,�tsr - -
BUILDING DIVISION PERMIT CO R OI2INFM69MATION:
BUILDG INADDRESS: PERMIT NO0 4 0 9 0 2 6 2
OWNER'S NAME: PERMIT ISSUB DATB
PICK UP STI
Eo SANITARY NO. _._ _ --CONTROL NO. -
"ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
upp LICENSED CONTRACTOR'S DECLARATION
�1 h�ereby affrm Ilial 1 am licensed under previsions of Chapter 9(commencing Job Description
wiWrxx on70(1a ofDivision3oftheBuainrseendPro(csalnnxCode,endmylicenceis ALE
inra reeandeffa _A v/ ( SIGN-ILLUM. WALL LETTERS
m Lkense CI Lie.p
= e De canna car' CONTRACTOR: SAN PEDRO ELECT.
a34�49 ARCHITECTS DECIARA N
y 3 1 understand my plans shell he usedw.public recmda
' OCT �� 2004
C�y Liceved Professional
3 OWNER-BUILDERexemptDE00 ConoION
Z 1 hereby maso affirm on 1 am exempt from the rosins Co License Lew for the
y O O followhich re uires a.permit
t 703 construct,
BaalM6a and Proow,demolish,
Cale:Any can or Canary
$ which requires a...Is.to cnnswct,eller,improv,demolish,fi repair any alredum
prior In its iasuanee,aho requires rhe applicant for such permit In file a signed mmmanl
�x�x< 0tanc�ialicomelptionsatteWcpmvisi...rNe0muacmr'i License Law(Chapter9 Sq.Ft.Floor Area a ' 300
yF0 (commencing with Section 7000)af Division3af NC Business and Profeesinv Cn of
that he is exempt therefrom and the basis for the alleged exemption.Any violation
on of -
Salon 7031,5 by any applicant fora permit subjects the applicant W idivil penalty of APN Number Occupancy Type
not more Nan five hundred dollars(53110).
01,as owner of the property,a my employees with wages a Weir sole compensation; 35908018 ' 00
will do thewark;and the structure Is nor intended or oODred road.(Sec.7044.Business
and Professions Coda,The Con entenn'a License Law does not apply W an owner of Required Inspections
property,who builds m i mpmews Thereon,and who dOcs such walk himself car through his
own employees,provided that such improwmenu are not intended oroRead for sale.It,
however,the building or improvement Is sold within one year of compleban,the owner.
builder wiB have the burden of proving that he did not build or improve for purpose of
oared.
C 1.as owner of the properly,em exclusively contracting with licensed contractors to
construct We project(Sea 7014,Business and Profession Code:)The Contractor's Li-
cave law does not apply m an owner of property who builds or improves Wemon,and,
who contracts for such projects with a commandants)licensed pmavant to dm Conuamrs
License Law.
❑I am exempt undo,Sec. B&P C for this reason
Owner Date
4916, WORKER'S COMPENSATION DECLARATION
I hereby a1Brm under penalty of perjury ore of We fallawin8 dalwtions:
haveend will maintaino Cc RnWof ConsentWself-insumfor Workers Compmr
ration,as provided for by Section 3700 of the labor Code,for the performance of the
work for which this permit is issued.
C 1 have and will maintain Worker's Compensation Insurance,as required by Section
3700 of the Labor Code.for the performance of the work for which this permit is issued.
My Workr`ss'Camp_ew.tlogp_Inaunncgycal Warnd Polity number am:
Ca6Qr. t: WVAACATENO/EMPT
✓// CERTIFlC OMPE SATIONINSUTAN ORKERS'
COMPENSATION INSU ANCE m
(This section need not Imcompleted if the permit Is fnronchundred dollars($110)
or Ices.)
1 anify that in the performance of the work for which this permit is issued,I shall not
employ any person in any manner an as in become subject to the Workers''Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,aper making this Certificate of Exemption,you should
become subject 0 We Workers Compensation previsions of the labor Code,you mum
.JO forthwith comply with such powisinv or thmitsbe
i.perhJl deemvo
ed reked.
„Z,i 5; CONSTRUCTION LENDING AGENCY
[r 1 hereby affirm that there is a construction lending agency for the Performance of
(Yi the work for which Wu permit is issued(Sec.309/,Co.C.)
ALarolm'a Name
'a z Lender'sAddoms
U O 1 Minify that I have mad this application and state that the shove information is
F correct.1 agree to comply with all city and county ordinances and sure laws relating to
0 building construction,and hereby Minimize represemutiws of this city in color upon the
a alumm-mentioned properly for impaction purposes.
(We)agree to saw,indemnify and keep harmless the City of Cupertino against
PF.m fA liabllidea,judgments,casts and expenses which may in any way acema Against Mid City
U z in consequence of the Starting of this permit. .
^" APPLICANT UND RSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOUREGU 0 S. ^ , ����o
�•(t/� Re-roofs
Signalurc of AWlicanuContmcror �� Dat4
Dole
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicsnt urfutum building Occupantatore or handle hamedous Mocrud
v defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Cade,Section 25532(.)7 All roofs shall be inspected prior to any roofing material being installed.
C Yea
Will the applicant at future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
E hmmdnue air conuminenu as Jcfincd by the Bay Ama Air Qusliry Management all new materials for inspection.
C Ya.
1 have tend the Noun:mmsmat mine yuiremcnu untkr ChaPlor 6.95ofNa,Caliror-
HcalW&SafetyCodc,Section 25505,25533 aod25534.1 undcrstend that if dtc building
nia -
docs snot currently haw a uniona.that it is my omponsihm pan
ility na'r`y We occut of the
requirements war um bcm br imuencc of a Cmdr, ¢ f uan .. Signature of Applicant Date
10
Owner or Col isle ant -` Date All roof coverings to be Class"E"or better