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07060257CITY OF C;Uy!~:tcJtltvv BUILDING DIVISION PERMIT CRK BLVD OWNER'S NAME: POTSTICKER KING NE: ARCHITECT/ENGINEER: PERMIT NO. ALLEN SIGNS INC 07060257 PERMrr ISSUE DATE 1982 STOVE AVE 06/28/2007 SANrrARY NO. CONTROL NO. (408)280--6500 BUILDING PERMIT INFO LICENSED CONTRACTOR'S DECLARATION Job Description I hereby affirm that I am licensed under provisions of Chapter 9 (commencing vitn Section 70(X)) of Division 3 of the Business and Professions Code, and my license is INDIVIDUAL CHANNEL LETTER SIGN. n icensc full force and effe L —a,— ClasL� N Dam Contractor RCHITECTS DECLARA 101Y I understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractors License Law for the following reason. (Section 7031.5, Business and Professions Code: Any city or county which requires a permit to construct. alter, improve, demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or th t he is exempt therefrom and the basis for the alleged exemption. Any violation of S I. Ft. Floor Area a Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty 01 36906000 not more than five hundred dollars (5500). 1, as owner of the property, or my employees with ravages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law docs not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner - builder will have the burden of proving that he did not build or improve for purpose of sale.). 0 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044. Business and Professions Code:) The Coutractoes li- cense Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the contractor's License Law. B & P C for this reason ❑ 1 am exempt under Sec. Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a Certificate of Consent to self -insure for workers compen- sation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 1 have and will maintain Workces Compensation Insurance as required by Section 3 of the Labor Code, for the performance of the work for which this permit is issued. My Workees ompennstation Insurance carrier and Policy number are: . Cartier. r1 t Policy No.: 64122 — CERTIFICATE OF EXEMPTION FROM WORMS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) or less.) I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Applicant NOTICE TO APPLICANT: if, after making this Certificate of Exemption, you should become subject to the Workers Compensation provisions of the Labor Code. you mast Z forthwith comply with such provisions or this permit shall be deemed revoked. ZZ � CONSTRUCTION LENDING AGENCY F.c ►.� 1 hereby affirm that there is a construction lending agency for the performance of R! the work for which this permit is issued (Sec. 3097, Civ. C.) W QLender's Name a Z Lender's Address I certify that I have read this application and state that the above information is O corrct:L I agree to comply with all city and county ordinances and state laws relating to 0 U building construction, and hereby authorise representatives of this city to enter upon the ahove-mentioned property for inspection purposes. a(We) agree to save, indemnify and keep harmless the City of Cupertino against r/)liabilities, judgments, costs and expenses which may in any way accrue against said City U Zin consequence of the granting of this permit. r- APPLICANT UNDER TANOS AND WILL COMPLY WITH ALL NON -POINT SOURCE G LATI &1 Signat re of pli Contractor t[/ HAZARDOUS MATERIALS DISCLOSURE Will the plicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety Code, Section 25532(a)? / ❑ Yes o Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District? Yes NO 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Hcalth & Safety Code, Sections 25 505. 25 533 and 255 34. 1 understand that if the building does not currently have a ten,�khttam.at it is my responsibility to notify the occupant of the r...... must be mo(plior to issuance of a Certificate of OcCW_, f. ` Date Issued by Re -roofs Type of F.00f ber $3000 Required Inspections valuation occupancy type All roofs shall be inspected prior to any roofing material being installed. If a roof s installed without first obtaining an inspection, I agree to remove ail new materials for inspection. R Sig aturt� G 2 y�o Date All roof coverings to be Class "B" or better 5 ITEMS OF 5 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 369060009.00 DATE ISSUED.......: 06/28/2007 RECEIPT #.........: BS000001834 REFERENCE ID # ...: 07060257 SITE ADDRESS .....: 19634 STEVENS CRK BLVD SUBDIVISION ....... CITY CUFERTINO IMPACT AREA ....... OWNER ............: POISTICKER KING ADDRESS ..........: 19E34 STEVENS CRK BLVD CITY/STATE/ZIP ...: , RECEIVED FROM ....: KIMBERLY LIN CONTRACTOR ALLEN LIN LIC # 22174 COMPANY ALLEN SIGNS INC ADDRESS . 19f;2 STONE AVE CITY/STATE/ZIP SAN JOSE, CA 95129 TELEPHONE (408)280-6500 OPERATOR: Patg COPY # : 1 FEE ID UNIT QUANTITY AMOUNT PD -TO -DT ---------- THIS REC ---- NEW BAL _ ______ BENERGY ___ _ ------ PERMIT FEE ---------- 38.37 ----------- 34.86 0.00 0.00 34.86 83.16 0.00 0.00 BPERMFEE VALUATION 3,000.00 38.37 83.16 83.16 0.00 83.16 0.00 BPLANCHK PERMIT FEE 3,000.00 0.63 0.00 0.63 0.00 BSEISMICOM VALUATION 1.00 38.37 0.00 38_37 EPERMITFEE FLAT RATE ---- ------0_00 240.18 0.00 240.18 0.00 TOTAL PERMIT METHOD OF PAYMENT ----------------- CREDIT CARD TOTAL RECEIPT : AMOUNT --------------- 240.18 --------------- 240.18 VOICE ID DESCRIPTION -------- ---------------------------- 101 FOUNDATION 104 REBAR 304 ROUGH ELECTRICAL 514 FINAL PUBLIC WORKS REFERENCE NUMBER -------------------- VISA VOICE ID DESCRIPTION -------- ------------------------- 103 UFER 105 ANCHOR BOLTS 505 FINAL ELECTRICAL CITY OF CUPERTINO .aS1 GN CUPEkTINO PERMIT APPLICATION FORM APN #o �o O O 9/, L U Date: Building Address: , X BPERMFEE Owner's Name: Phone #: Kc � Plein Check Fee Contractor: S&YIS lne-- License #: (9Atkil -34—S8 Seismic Commercial BUILIDNG Contact:Phone MbC-A #: 4P&�bCU �Sc1v Applicant/Contractor: If ag/ %y CS j L. Building Permit Info: Bldg =Elect Plumb Mech Job Description: _I Residential: 14 Vkd -e 5%mmercial: Sq.Ft. Floor Area: =q -Ft...: Architect/Engineer: Cost of Project: Rrndl Signs, Marquee ©"C o Type of Construction: Occupancy Group: Qty. if i; .-1-1 SPP m Fee Descrintion Fee Group rxFF %,%, _-- BENERGY En ergy - BUILIDNG X BPERMFEE Brig Permit Fees BUILIDNG BPLANCHK Plein Check Fee BUILIDNG BSEISMICOM Seismic Commercial BUILIDNG EPERMITFEE El,;ct Permit Issuance ELECTRICAL BREMSIGNAD Rradl Signs Add Branch ELECTRICAL BREMSIGNS Rrndl Signs, Marquee ELECTRICAL BUSLIC Business License BUILIDNG POTSTICKER KING BUILDING SIGN ELEVATION: 19634 STEVENS CREEK BLVD. CITY OF CUPERTINO 26-0" PRC POSE TWO SIGNS @ EAST ELEVATION 5" THICK INDIVIDUAL CHANNEL LETTER5, NEON FOR INTERNALLY ILLUMINATION. 3/4" BRONZE COLOR TRIM-CA12 RETURN PAINTED KELLY MOORE 701-M 5TONE AGE COLOR LETTER WILL BE YELLOW COLOR ECALE:1/4"=1'-0" DATE: MAY -03-2007 EAST ELEVATION CUFLIi,�:. )ATE 06 2-7 c7 — This qe kept on t:sa :., -:nd it is un lawful to rnaLa z°.i,r `J: c; a lata—icn on same w ., :e ^° m:sslon fron the buiAing Dolt., 0, v 0i Cep rtino. The stamping of t , s p,<,n �. nd spcdication' iHALL NOT be he;d to pe. mit or to be 21 approval of tate violation of any provvzl, ow r itv n"(1 w4rj `P nt Ainto I — Approval: Date: All designs & art works belong to Allen Signs, POTSTICKER KING BUILDING SIGN ELEVATION: 19634 STEVENS CREEK BLVD. CITY OF CUPERTINO 26-0" PRC POSE TWO SIGNS @ EAST ELEVATION o � 9i D , MIN I 5" THICK INDIVIDUAL (:HANNEL LETTERS, NEON FOR INTERNALLY ILLUMINATION. 5/4" BRONZE COLOR TRIM -CAP, RETURN PAINTED KELLY MOORE 701-M STONE AGE COLOR LETTER WILL BE YELLOW COLOR E CALE: 1/4"=1'-0" DATE: MAY -03-2007 EAST ELEN XTION APPROVED iN ACCORDANCE WITH THE CITY OF. CUPERTINO CODES AND ORDINANCES )ATE c9b /2 7/ 0 This set ci p:a;is "ioj .,pecificalions MUST De kept on the j?'j at ail ti les and it is un lawful to ma!<'e an.! or alteration, on same without wrilti,o permission fron. the building Dept., City of Cupertino. The stamping of this plan and specification SHALL NOT be held to permit or to be ar ipproval of the violation of any provwsin, •` anv r.tty nrotw4up. nr `Tato 1,P— Approval: ,P -- Approval• Dat.-: All designs & art works belong to Allen Signs,