05080195 (3) CITY OF CUPERTINO
BUILDINGDIVISION PERI C�1)°��CTQ�dI1�.0�lva'1 QN y'
BUIfAING ADDRESS: ALLEN SIUN6 INC PERMIT NO05080195
10891 N WOLFE RD
OWNER'S NAME: PERMyC ISSUE DATE
GGI (GOLDEN GATE INTERIOR) 1982 STONE AVE 08/22/2005
NE: SANITARY NO. CONTROL NO.
(408) 280-6500
ARCHITECT/ENGINEER: - BETIDING PERMIT
BLDG ELECT PLUMB PLUMB MECH
0 0 0 0
j p LICENSED CONTRACTOR'S DECLARATION Job Description
C 1 hereby"Mom sial l am liamed under pm`vions of Clupn,9(commencing P
w with section 7")ofDivivan3ofdeBusimssand Professions Cam,and myIncomis SIGN--ILLUMI CHANNEL LETTER
s ifull farm rob c"Ta �� -3 O
in License07��—�`2}—Lk.g - -
p Da¢ 527 . Contrutar
F
ARCH1-sDECLAR TI
y 1 undersand my phos shall be rand een
as public rds
yU
Licanscd Profcoionel
OWNER-BUILDER DECLARATION
w I 1 Wrthy air,.that 1 em exempt from silo Convanore Lkcnnl law for the O following season.(Section 1031.5,Basions and Prorossions Cade:Any city or county $1S00
m which mquires a Permit m construct.alcor.imprort,demNbh,or mpair any soucma
ziprim m its issuanco,also mquina the applicant fm such permit to Bk a signed ualomont
Uw be is licemcd pursuant m the pannhiora offs Canuxlurs LJcc Low(Chepar9 Sq.Ft. Floor Area Valuation
$ (commcmingwith Scodon7000)of Di,hWa3ofdre Busioeuand Professions Cod)m
.. dint be is exempt thamGom and the bash fm the alleged exemption.Any viohGon of
Section 7031.5 by any applicant for a permit subjects dw applicant to a civil Porosity of Occupancy Type
not mom Nan rise handood dollars(5500).
1,as owner of the prapvty,m my employer with wages u thou In eompensadon,
will do dm wart,and Ce swctum is nut intended or aBerW fm sale(Sec.7044.Butinrsa Required Inspections
and Professions Code:The Communes Limns,Law ems ant apply W sonhame,of 9 P
property who Wilds or improves thereon,and who daesanch work himself orth ough his
awncmr.meWildin i oul or imuwamsuch at I.sold home o.ofEmoRered(m aaar-
bawevv,Ne Wihingorich a nenlis Bald within one year of completion,Pdom uplotter- ,
Wilder will bort the Wrtlen of proving that he did nm build m improve far puryos of
••ule.).
❑1.as tawmothe p of the Poe.704 .B exclusively pro eutins,with licensed oontnmes U.
construct de percent(sec.70x4,Business and n,who Wilds
Code)The mso Om .V- /
who Law doesnm applyroman ithaofproperty oWildsor)mprovm Conlon,cad
whoconLacts for such percents wiCaronwcsor(s)liccn¢d pursuant on Ce ConuactoYa 2
Linens law. s/
under 5m. .B&P C fm this masse �
Owner Date
WORKERS COMPENSATION DECIARATION
I bemby affirm under penalty of perjury arc of the following dalarn)anc
m and will maintain a Certiftcm,of Comenuo olf-manacforWarkersCompen-
,as provided fm by Section 3700 of the labor Cade,fm silo perfonnama of the
k fm which this permit is iuued.
1I have and will maintain Worker's Compcns dont Insuunm,as mounted by Smdon
w of Cc Leber Code,for Cc performance or the work for which this permit is hound.
My Wortces Compensation Iv---111u��aa ce carrier and Polity numbs am:
carrier. *EMP Policy No.:!�I G 115-07 J
CERTI CATS FIEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(ibis moron nerd not W complemd if the permit is foram humbod dollam(SIM) "
Or lass)
1 comity Cat in the pnicam.of the work fm which this permit to issued.l small am
emplq any person in any manner m as m become subject o silo Workers'Compensation
Laws of Califomia.D.
Applicant
NOTICE TO APPLICANT:Jr.often meting this CortiOnlo of Exemption,you should
t moue subjm,an Our Wmker's Compensation pmvisnm,or silo labor Com,you must
,Z foMwiC comply with such pmvistons or this permit shall W dmmed rmmked.
y CONSTRUCTION LENDING AGENCY
1 Wmby a1Bmm that Gem is a construction lending agency for da,pMor ommo or
(. .�+ Ca work for which this permit Is issued(Sm.3097,Civ.C.)
U Q Lenders Name
Z Landers Adders
J O 1 comfy that 1 have most this application and sum that do abase infmmatiun is
P corms I agmc m comply with all city and county ordinances and slow laws missing m
�U Wilding construction,and hemby authorlm mpremmatims of this city m color upon the
above-mentioneE property,for inspection puTates
4 (We)agrte On save,indemnify and keep harmhss IW City or Cupertino against
rn
liabilities.judgments.costs and eaprnss which may in my way accrue against said City
Z in consacueem of the grouting of this Permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:9 Date .—�^� V
SOURCE REGULATIONS.
Re-roofs z/_i
Signalum ol'ApplicanuCcasmoca Dew
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will llm applicant or fumy Wilding occupant rtort or tensile Hoadom maloriai
as de.Sm by the Cupertino Municipal Cade.Chapter 9.12.and the HWth and Safay
Code.Section 25532(e)T
❑Yu )(NoAllroofs shall he inspected prior to any roofing material being installed.
Will the applicator or frmm Wilding Occupant ue equipmcra or davi=which .If a roof is installed without first obtaining an inspection,I agree to remove
ha ardnm air cunmmituna as dcrincd by the Bay Am Air Quality MarmScamat all new materials for inspection.
hen
❑Yea NO
1 hart mad dr,hoo dross maloriais to,amments under Chaim,6.95 of silo Califm- /sk�
nieHwlthg•.SafnyCodc,Smtiwu 25505.i553J end 2554.1 unticrsaM thui(thc Wilding
docs not cwscndy have a truant.thu it h my ramonsibility to unify Our occupant of dw
mq=h on VW met prior to issuance or a Cenificao of Parmy Signatur Of pplieant Date
owner m arena and agent — / Delo All roof coverings to be Class 'B"or better
CITY OF CUPERTINO
I 1 of 1 PERMIT RECEIPT OPERATOR: 3onniew
COPY #Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 31605053 . 00
DATE ISSUED. . . . . . . : 08/22/2005
RECEIPT # . . . . . . . . . 30851
REFERENCE ID # . . . : 05080195
SITE ADDRESS . . . . . : 10891 N WOLFE RD
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : GGI (GOLDEN GATE INTERIOR)
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-3548
RECEIVED FROM . . . . : KIMBERLY LIN
CONTRACTOR . . . . . . . : ALLEN LIN LIC # 22174
COMPANY . . . . . . . . . . : ALLEN SIGNS INC
ADDRESS . . . . . . . . . : 1982 STONE AVE
CITY/STATE/ZIP . . . : SAN JOSE, CA 95129 /
TELEPHONE . . . . . . . . : (408) 280-6500
E ID UNIT - QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
- ------- --------- ---------- ---------- ---------- ---------- --- ---
BPERMFEE VALUATION 1, 500 . 00 83 . 16 0 . 00 83 . 16 0 . 00
BENERGY PERMIT FEE 1 . 00 34 . 86 0 . 00 34 . 86 0 . 00
BPLANCHK PERMIT FEE 1 . 00 83 . 16 0 . 00 83 . 16 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 1, 500 . 00 0 . 63 0 . 00 0 . 63 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 264 . 16 0 . 00 264 . 16 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
OTHER 264 . 16 VISA
TOTAL RECEIPT 264 16
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 CUPERT
SIGN Q S
CUPEkTINO PERMIT APPLICATION FORM
APN# Date:
S
Building Address:
is
Owner'sName:, _ hone #:
Contr I L License #: 8� S
Contact: Phone #:
Klojher14b
Applicant/Contract r:
(( S; • 1/1c.
Building Permit In S( u m I Y\. C A v 11 St
Bldg Elect Plumb Mech
Job Description: s( uKvll ChGiY7 Siff,n
Residential: Commercial:
Sq.Ft. Floor Area: $/Sq.Ft.:
Architect/Engineer: Cost of Project:
Type of Construction: Occupancy Group:
Qty. if
A licable Fee ID Fee Description Fee Grou
BENERGY Ener 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
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