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09030012 CITY OF CUPERTINO � � BUILDING DIVISION PERMIT PERMIT NO. BUILDING ADDRESS: 10070 IMPERIAL AVE SAM' S S-=GNS NEON & PERMTT LSSUE DATE OWNER'S NAME: ELECTRICAL S A CONTROL NO. eHONE: (510) 431-1700 BUILDING PERMIT INFO ARCHITECT/ENGTNEER: BLDG ELECT PLUMB MECH p C LICENSED CONTRACTOR'S DECLARATION Job Description U I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing Z withSccuon70(10)ofDivision3ofthcBusincssandProfcssionsCodc.andmyliccnscis MANUFAC PURE AND INSTALL ONE SET OF INTERNALLY rs in full force and e t [• p7 z Lice Cl s G L� ILLUMINkTED CHANNEL LETTER SIGN F o Dice Contractor ARCHLTHCTS DECLA A ON I understand my plans shall be used as public records m �yU U.y Licensed Professional ow OWNER-BUILDER DECLARATION r 1 hereby affirm that 1 am exempt fro the Contractor's Liccnse Law for the no following reason.(Section 7031.5,Business and Professions Code:Any city or county K m alter,improve,dcmalith,or repair any structurewhich requires a permit to construct. Valuation y"y prior to its issuance.also requires the applicant for such permit to file a signed statement $ Ft.Floor Area that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 q $2500 Y.t= (commencing with Section 7000)of Division 3 of the Business and Professions Code)or i .. that he is exempt therefrom and the basis for the alleged exemption.Any violation of Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number P y yp not more than five hundred dollars(5500). 35717066 . 00 ❑1,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.7W,Business Required Inspections and Professions Code:The Conuactries License Law does 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.). ❑I,as owner of the property.am exclusively contracting with licensed contractors to construct the project(Sec.7044.Business and Professions builds imp ves thereon,Li- cerise Law docs not apply to an owner of property Pro 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 far Worker's 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 Worker's Compensation Insurance,as required by Section 3700 of the Labor Cade,for the performance of the work for which this permit is issued. My Wor to ensa• n Insuragpcarrier and Policy number are: Cartier Policy No.: CER IC OF FJCEMFIION FROM ORK S' COMPENSATION INSURANCE (chis 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 Worker's Compensation provisions of the Labor Code.you must ,J',Z forthwith comply with such provisions or this permit shall be deemed revoked. Z� CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of (Y. the work for which this permit is issued(Sec.3097,Civ.C.) W ALender's Name 0.z Lender's Address [certify that I have read this application and state that the above information is LUL� correct.I agree to comply with all city and county ordinances and state laws relating to 0 V building construction,and hereby authorize mpmsentatvcs of this city to enter upon the above-mentioned property for inspection Purposes- >4 urposes>4 a (We)agree to save,indemnify and keep harmless the City of Cupertino against Hf� liabilities,judgments,costs and a uses w• may in any way accrue against said City 2 V Zin consequence of the g n 's t. Date APPLICANT U WILL COMPLY WITH ALL ON-PO NT Issued t y: sovRc O Re-roofs - sig outor °'° T e of Roof AZARDOUS MATERIALS DISCLOS E yP Will the applicant or fur building occupant store or ndlc hazardous material as defined by the Cupertino M ichpal Code.Chapter 9.12,and the Health and Safety Code,Section 25532(a)? All roo s shall be inspected prior to any roofing material being installed. ❑Yes If a roof is installed without first obtaining an inspection,I agree to remove 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 all new materials for inspection. District? ❑Yes QN 1 have read ire hazardous materials requi is under Chapter 6.95 of the Califor- nia Hca1th&Safcty Code cions 5 25 d 15534.1 understand that if the building docs not currently a responsibility w notify the occupant of the Date require n t uance of a Certificate of Occ cy. Signature of Applicant - Z. D All roof coverings to be Class'{ or better ate Ow r or a a CITY OF CUPERTINO BUILDING DIVISION PERMiT COrlTRAGTORINF�QRMATION s BUILDING ADDRESS: PERMfT NO. 10070 IMPERIAL AVE SAM' S SIGNS NEON & OWNER'S NAME: ELECTRICAL PERMIT ISSUE DAM PHONE: 5 A CON[ROLNO. (510) 481-1700 ARCHTfECTIENGINEER: BUILDING PFRMnr INFO BLDG EfECf PLUMB MECH 0 0 0 0 LICENSED CONTRACTOR'S DECLARATION - 4 C 1 aneby affirm Wal 1 am li¢mN under Provisions,Of Cb&Pier 9(cammcncing lob Description n wiWSedon10N)af Diviaon 3ofthc Busies and Pmfodons Code.and my Itis oh mfdlrortsadr LC 1 a7 MANUFACTURE AND INSTALL ONE SET OF INTERNALLY cnmctar ILLUMINATED CHANNEL LETTER SIGN ARCHnEcrs DECLxa ON U 1 understand my plans Wall be used as Public tumor 0GIn Licensed PmressiMal 3OWLAR OWNER-BUILDER DECLARATION 1 hcrtbY olnrm Mai 1 am acmpt from the corusemea s;—sMc law far the Eno O following m• n^ (Section IBI 1.5.Business and Peofesafa Cade:MY calf m-army e m which mquires a permit W cowncL shot.Impious.*:mmILsh,or repair any Moons iy prior in its issuuce,dso require;the applicant fm such permit in Bk a signed mWeement E i G than he b li-nsedsmaMe,pr pant W ovisns Communes ioof the Cones License law(Chaining Sq.Ft.Floor Area Valuation Y t"'$ (Commencing win Section 700(r)of Dilision J or We Busin6f Md Pro, CadC)of G^5 O O y _ Jut be u elcmpt therefrom and see bub for We alleged exemption MY riohdu o! Section 7070 by say.pplinn,for a permit subjects We aPpkwlto a civil penalty of APN Number Occupancy Type rot more than five handled dollars(15(70). 35717066 . 00 ❑Luowoer of the pmpvry.amy eroPlnym srblt wagesathe'v uleemtpersaJon, and dothewet sedthe swctwelato WWndede: awfloe, We(See.1044,Hudnas rd Prvfcalans code Tito Contractors 1.imsx Law dila-t apply n a owner or Required Inspections pmpem whowildorimpram amt-nandwhin an,mat wmkhlmWfe thrugh his ownemployes,provided Warsuch improvementsMid artimudremaQUW fm sale H, however,the building m bet of pa cnt baald within au year ff-m umefar the owna- wiWer wiB have see burden of proving Wn h did m UdW an wP-ve for purpace of LkJ. ❑I.as owner of the pmpcny.am acludvely counseling win licensed CmNwM n -awct the pmjen(Sce TOsa,Business ud Rafcsdoa Cade:)The Canvassers LL cone Law does not apply W an owner of Property ww builds or improves ihcsmn.sed who contracts for soh prapets unit a convrtmr(s)licensed potstmm in We ConmactaYa License law. 1aft raernpt undo Sec _ ,Bd:PCfor Wbmmm Our. Dan WORKER'S COMPENSATION DECLARATION I hereby aff.under perWtY of perjury one of We fmllovring drft.mvdn-.- ❑1 hate sed rill mdnein a Ceruli.te of Officers In WINUO T far Wallow Camper 'el melon,a pfwided fm by Section 37M of We labor Cade.far the per(armuec of We work for which this permit is issued ❑I haw and will maintain Workers Compensation Innaaue a required by Sidon 3IOOof the laborCde,far the pefformaue ofthe wart farrhich this Permit b issued ' MY War go hcommee amer and policy number ere: - Carrier Pollry No.:��/r�' &11 CE C OFMEMPIONFROM OW RKLER5' COMPENSATION INSURANCE (thissorban need not w eompk.dI if We Permit b foram hural delaliva(SIOO) ser less) 1-rufy that in We ptsfmmu-of else ami,far which Ws permit IS m,u 1 shall not employ any person in try munerw as In became subject W the Warkcrs'COMIXfo ad® laws of California.Due Applicant NOTICE TO APPLICANT:If,after making Wb CeniBam of Eacmpnion.you should become sub jeer n the WarYxe`a Compmaudon proWumu of the Labm Cade.You mon z faMwith comply with soh pmvimms or Wb pmmL.IWl be healed makcd. - Z O CONSTRUCTION LENDING AGENCY [..� I hcteby affirm Wu them is a-nswction lending agency far the performance of 1r We work far which Win permit b vaned(Sec 3097,CN.G LuQ Len&o',Num = z Iandees Address U Q 1 mairy Mt 1 haw tad this applkaaian and sun Wil the-bow bJorumaum In U. E' -ala I more,m comply win all city and county Ordinances and sore Lara Misting n 0 U Wilding communion.and hcmby amhonm represcmdva of this city in aur upon Wil N [L7 alto e-mcnaomd property far inspection putipmea (We)agree n saw,indemnify and kap harmless the City of CuperWn agalm F raj) liabilidyluagmenu.eaw arae w may In my uaY amuagairs.and City C.)? APPLICANTeU[thcg n u WILL COMPLY WITH ALL ON-PONT Issued by: Date SOUR 0f Re-roofs Si u•`n` "° of Roof ILAZARDOUSMATEIUALSDISCLONmaterial WIIl the apPliontm form wilJingamtputnmem die haaoas a deMd by the Cupnano Mf daipal Cade ChapWr 9.11 ad the Media and Safety Cadc,section 25532(a)7All roofs shall be inspected prior to any roofing material being installed. o Ya apIf a roof is installed without first obtaining an inspection,I agree to remove Will ire plicant of future wilding ocmpant u:wuipm-t m dee�a whkh emit haaardmm air conmminuis a dcfincd by We Bay Area Al,Quality Marugenunt all new materials for inspection. Dbu ct? / C3 Y. eta I low real the haranma nanriaisrequl undnOaPnm695aflbeCdifar- nbHdth&Sarety25 J 25534.I understand WtlfJC Wilding Jae.".ad a t �, fopotmMlit,n near,see octo a t of tun .q... n t auear.Cenineaearoc ry. Signature of Applicant Date ow ar - a ZY W. All roof coverings to be Class"oW'or better ��D` CITY OF CUPERTINO SIGN CUPEkTINO PERMIT APPLICATION FORM Gqb Def 2 APN # Date: �3 -7 7 O W67, QO Building Address: UO 70 -7-m aeria / Ave- Mailing Address (if different from building address): Owner's Name: Phone #- y��, �ra� CSio)sC?,f Contractor: Phone #: (S,O) %q/_ /-lob Fax #: Sia Jc/�-j - 03✓2 Contractor License #: �3 D Cupertino Business License #: Contact: i Hu or 5holzer` lLkah Phone #: (ISiO J y>?/- /foo Fax #: �SioJt��/ - o3n z Building Permit Info: Bldg Elect Monument ❑ Mounted on Buildingf Residential ❑ Commercial Job Description: Manu�ackure arm IV\St W 0*10- -Rd k �M ere,l� co,vQ ,vim Yk,� N\StM(UJ oel LXwIIC�irj_ bfoovage Valuation (cost of project): 12-15-00 Project Size: Express ❑ Standar Lar e ❑ Major ❑ Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the application or if applicable, include in plan set& the sheet index. Revised 01/07/09 SCOPE OF WORK: ^� ® ❑ ■ � vkao 314'BRONZE TRIMCAP �_EXTERIOR WALL MANUFACTURE AND INSTALL ONE SET OF INTERNALLY ILLUMINATED CHANNEL LETTERS 5-BRONZE RETURNS '\ EXISTING 12AWG 20AMP PRIMARY ELECTRICAL 26.25 SQ FT SIGN AREA P E UG ASSLN PLUG A53 230 GREEN PMS 000 WEATHERPROOF LISTED 92 LN FT BUILDING FRONTAGE RED 1187 7116 IYdRE SGN A1111S TRANswc6NT DISCONNECT SWITCH(NEC 600.6A1) 17'-6" 5- .04 ALUMINUM RETURNS os4 CHANNEL LETTERS RETURNS Contractor: b ®'I ACADEMY1 - - --SLOAN"WHITE LED" SAM'S SIGNS NEON POWER ELECTRICAL SIGNS0ME1 � /- SLOAN#7015007-MOO @ 16719 E. 14TH ST. / OUTPUT I2VDV 60W SAN LEANDRO, CA 94578 15'-0" PH: 510.481.1700 FAX: 510-481-0302 • _ - 314 TRIM CAP info@samssigns.com ST LIC#717307 class C-45 f ( 3/16'THICK PLEXIGLAS LETTER-FACES AS REQUIRED LISTED BUSHING r — 12VOLT 14 AWG SLEEVED SECONDARY WIRE b r i FASTENERS MIN.3 PER LETTER AIINA KHAN ; � ( '; - \_` _ - •� #31/4'X2-1/4'FLAT HEAD PHILLIPS - - a ro �i _ - __ '� `. _� ••\ STAINLESS STEEL CONCRETE SCREW , Project: 3251, OMEI ACADEMY-- . • -�.. — T-- _ HOLES BOTTOM '100.70.impeHat,ave v j WEEP Cupertino ca r Tani 510-504.5393 - I r IFS., - - _ , Account Manager: IN5TALLATION SCALE:NTS - NOTES: t:ALL CONNECTORS ARE WITHING SIGHT- Designer: (NO MORE THAN 50') 2.-ALL SIGN ELECTRICAL MAGDIEL ESTRADA - COMPONENTS ARE UL LISTED 3:ALL PENETRATIONS Scale- As noted TO BE SEALED WATER TIGHT WITH WINDOW AND DOOR CLEAR SILICON. Revisions: P primary electrica to sign. �� --- gnsI OES NOT rLE 0,5e a sxnrn ... N l 1 A circuit 2.Junction box installed writhing 6 feet of sign pimp UPERTINO CODES 3.Three wires:Line.Ground,Neutral rvc, .,z LC c'r:LG-1 62I`,,0. .t�1 iIGpEU � ­— l � 3-27 -o �Rd8Set�fpL. atiS� • r be kept on the ; %S and R is un lawful to mak: . ] Date: Map- or 816BreUrnl' C L' 011 settce wnh::u , uamieston Eton. the building Delp-.. . uperNno. 64AR eU r The afBlnpiRg of Lha 4 09 e IT 3►IALL NOT be held t.: pe mit or to b9 ar This is an original,unpublished lojfi 'MF" of the Wation of any PraVISIO I drawing created by Sam's I D ,f 9 ^nV f:IfV nrNRRnfp of \rAfP 1 qy Signs. It is submitted for your approval. It is not to be shown ,� „ - C +•;y. ` , m MMiF IUw'I anyone outsideyour organization,rproduce d or •c�, ' copied in any fashion. -' UP//-{1� Ownership o!this design is held sL' r❑11�I_' {��j��_�� trrf,'y��� by Sam's Signs. ®fr- mustobe obtained by rization to use[Samhis s Signs. LOMITA AVE , ~ _ V e 510-491-1700 www,SAMSSIGNS.cD.. - © 2009 -� - - — Colors depicted are graphic •- RLWK _I� representation. Refer to call • ,4 _ II 11--I outs for actual colors to be L�_1i'sv used.