12060106 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 73351301.1,INGER RD s,m A CONTRACTOR:SEE I DING SI 11:1: 1 RUS fl]: PERNII['NO: 12060106
&ET AL
OWNER'S NANIE: SET I'DING S111717TRUSTrAr&1:I'Al, P 0 BOX 1318 DA[E ISSUED:06/18/2012
OWNER'SPIION'E: 4083718770FREEDOM,CA 95019 PHONE NO:
11 LICENSED CONTRACI'OR'S DECLARATION BUILDING PERMIT INFO: BLDG F_ ELECT r- PLUMB r-
l'icense Class Lic.# MECII F_ RESIDENTIAL F_ COMMERCIAL F_
Contractor Date
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: SLE.A-INS I AI,I.A1[ON 01:2 1 ILJN I ING I ON LEARNING
(commencing with Section 7000)of Division 3 of the Business&Professions CEN"I ER WALL
Code and that my license is in full force and effect. SIGNS
I hereby of under penalty of perjury one of the following two declarations:
I have and will maintain a certificate of consent to self-insure for Worker's
Compensation,its provided for by Section 3700 of the Labor Code,for the
performance of the work lor Which this Permit is issued.
I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code.Ibr the performance of the work for which this Sq.Ft Floor Area: Valuation:53000
permit is issued.
AIIIII.1(7AN"['CER'riFICA'I'ION APN Number:35923018 00 Occupanc% Type:
I certils,that I have read this application and state that the above information is
correct. I agree to comply with all city and county ordinances and state laws relating
to building construction,and hereby authorize representatives ofthis city to enter
L111011 the ahOVC Mentioned property for inspection purposes (We)agree to save
indeninify.and keep harmless the City ol'Cupertino against liabilities,judgments,
PERMIT EXPIRES IF WORK IS NOT STARTED
costs,and expenses which may accrue against said City in consequence ofthe WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting ofthiS permit. Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION.
9.18,
Signature Date Issued by: Date:
❑ OWNER-BUILDER bECLA RATION-
RE-ROOFS:
I hereby
v affirm that I am exempt from the Contractor's License Law for one Of All Mors shall be inspected prior Many Mulling material being installed. If roof is
the following two reasons; installed without first obtaining an inspection,I agree to remove all new Materials for
1,as Owner of the property,or m)employees with wages as their sole compensation. inspection
will do the work,and the structure is not intended or offered for sale(Sce.7044,
Business&Professions Code) Signature ol'Applicant Date
1,it;owner Of the propen),am exclusively contracting with licensed contractors to
construct the project(Sec.7044.Business&Professions Code).
ALL ROOF COVERINGS 70 BE CLASS"A"OR BEI-1 ER
I hereby affirm under penalty of perjury one of the following three
declarations:
I have and will maintain a Certilicate of Consent to scir-insure for Worker's IIAZARDOtiS NIATERIALS DISCLOSURE
COrnpCosation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the
perl'ormance of the work for which this permit is issued, California licalth&Saret) (:ode,Sections 25505,25533,and 25534. 1 will maintain
I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Ificalth&
Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material.
permit is issued Additionally,should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
I certify that in the performance ofilie work for which this permit is issued,I shall maintain compliance with the Cupertino.%lunicipal Code,Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's licalth&Safety Code,Sectinns 25505.25533,and 25534.
Compensation laws ofCal ifiarnia. If.after making this certificate of exemption,I
become subject W the Worker's Compensation provisions of the Labor Code,I must Owner Or authorized age
forthwith comply with such provisions or this permit shall be deemed revoked. nf=—, Date:.
_T
APPLICANT CERTIFICATION CONSI'RUC11ON LENDING AGEN(I
I certify that I have read this application and state that the above information is I hereby affirm that there is it construction leading agency for the performance of work's
correct.I agree to comply with all city and county ordinances and state laws relating lor which this permit is issued(Sec.3097,Cis C.)
to building construction,and hereby authorize representatives of this city to enter Lender's Name
upon the above mentioned property for inspection purposes.(We)agree to save
21derooll') and keep harmless the Cit'of Cupertino against liabilities,judgments, Lender's Address
costs,and expenses which may accrue against said City in consequence of the
granting of this permit.Addilionali),the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code.Section ARCIII I E(-I-S BECLARA HON
9.18.
18 1 1 understand My Plans shall be used as public records
Signature 11 -Dale Licensed Professional
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 7335 BollingerRd#A DATE: 06/1812012 REVIEWED BY: Sean
APN: BP#: VALUATION: $3,000
*PERMIT TYPE: Building Permit Pt,I,v CHECK TYPE:
PRIMARY PENTAMATION
USE: Sign PERMIT TYPE: 10EAP5
WORK Installation of 2 "Huntington Learning Center"wall signs.
SCOPE
SIGN TYPE FEE ID QTY SIGN FEE
Wall Sign, Electric 1SIGNWELEC 2 $520
TOTALS: $520.00
Mech. Plan Check Plumb.Plan Cbeuk k Branch Circuits 1 $44.00
M"'A 1"-rmit Feu: Mumb. Permit Feer IESIGN Elec. Permit Fee: IEPERMIT
Other'diet h. Inep_ Oilier Plumb Insp. Other Elec.Insp. 0.0 $44.00
,4 loch. Imp. F,c: Plumb. bui). Fre: lifer.Leep. Fcr'
NOTE: This estimate does not include fees due towther Departments(i.e. Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc.). Thesefees are based on doe prefinddna information available and are only an estimate. Contact the Dept for addn7 info.
FEE ITEMS (Fee Resolution 11-053 EfI 7111/1) FEE QTY/FEE MISC ITEMS
Plan Chuck Pec:
Suppl. PC Fee: (F) Reg. Q OT 0.0 hrs $0.00
/'/urn h.hl-!ec/rJ7i I cc
Permit Fee: $520.00
Suppl. Insp. Fee.0 Reg. Q OT 0,0 hrs $0.00
PME Unit Fee: $44.00
PME Permit Fee: $44.00
Construction Tax:
Adininkir tine Fee-
Work Without Permit? O Yes 0 No $0.00
Sign Master Plan: O Yes .(E) No $0.00
Travel Documentation Fee: ITRA VDOC $44.00
Strong Motion Fee IBSEISMICO $0.63 Select an Administrative Item
Bldg Stds Commission Fee: .IBCBSC $1.00
SUBTOTALS: $653.63 $0.00 TOTAL FEE: $653.63
Revised: 06/30/2012
¢ECF�Y V ED
JUN 18 2012
� 0
Huntin 46 16.75"
29.5" 26"
LEARNINCI MMUNI ' CENDEVPT ETR ?
138" BUILDING DIVISION-CUPERTINO
160" APPROVED
This set of plans and specifications MUST be kept at/t IS
Job site during construction. It is unlawful to make any
changes or alterations on same,or to deviate
therefrom,without approval from the Building Official.
The stamping of this plan and specifications SHAM NOT
be held to permit or to be an approval of the violation
Of any provisions of any City Ordinance or State Law.
Notes: ter
Side f acing 9 o R 7335 Bollin er,Road
1. All letters and leaf sign are Side facing s�i�g _
7inches deep Date 6/16/20#mMrrNO. D/ uite A_
2. Color: Dark Green Version 1.00 Cupertino
CA, 95014
CUPERTINO
Building Department PLOT PLAINS
QWCxW BY
JUN 18 101 DA= ZZ
REVIEWED FOR OD FLIANCE : PLANNING DEPT. FFIYrr
E CAhPY..
Reviewed By:
DATE
BLDG. DEPT.
RECEIVED
SPACINGTABLE
Listed GTO cable A Between primary wiring and insulated high voltage wiring.
PV; — B. Between Insulated high voltage wiring and dead metal where wiring
_ _ parallels dead metal for more than t'withinsign Sections.
C. Between neon tube(if over 7500volt circuit)and nearest surface.
Grounded continuous sheet metal 0.Between uninsulated high voltage conductors or components.(Mid-
section(consists of enclosure(°sheat metal raceway° point-grounded transformer)and dead metal(ground),low voltage
Listed sign or sign with sheet metal cover). circuit conductors and high voltage conductors of opposite polarity.
channel letters ached to raceway,
transformer,insulating boots,
Insulating sleeves,and disconned
Depth �. . .. Listed d'acognactpwilclLinprimary Voltage A B C Q
switch if provided)suilable,for outdoor varies to bewllhin sight(ictal alum 50it.) 1001 to 5000 12 inch 12 inch none 314 in
id cation unless marked for Indoor only. - _ of sign.(Switch may.be Integral.. - -
wilhsignesshown.). 50011otOlHJO 3/4irtch 3/4 inch 1/4inchil 1-Min
NEC 110-3(b),600-2;.600-0: 10001 to 15000. 1 inch 1 inch 7500V+ 1-12 iP
Plastic face—►
Tube support - �—Raceway
Per NEC 600-33(b). F�ample°A'
Neon Juba. _ One place BOBS
Spacings maintained sign (Sign listing mark)
per spacing table.
Primary electrical source Joint N
Leber �', p (121n.minimum conduit, raceway
height metal shawl). Exempla•B
varies Electrode insulating s '- NEC 600.6&600.21. Two place BIG BOBS
boot and sleeve E: m+'3 f.I r gV 3 ; sign
I a�p s �— Two raceways
se,44,r
provided whhsign. t r.r :^ ;,qvt Transformer connected together
(two section piing mark)
Kai, Pl
r.o a.:,spnu �" ;ease-K-y
two signs BIG BOBS
5 -a._ ..-_
�, s• eu,i.,r ' �— Seperatereceway
. sign
Fationersasrequired fareachko
by;locel�udsdialon. (one sign fisting mark on each sign)
Drsin-holes r A Installation of signs listed per UL48
ilused outdoors. ; '...: Note: Installation requirements only.
Manufacturing requirements contained in UL48. i
LISTED Al rights reserved.no pad of This work covered by the eopyriDht hareon may
ILLUMINATED CHANNEL LETTER !
Listing marks: by qualified electrical be reproduced or used
P n any farm or by any moans-go!P^io.electrank.Of n storage CONTINUOUS RACEWAY
Sign or section listing mark tasting laboratory mrchaniral,including hotoeopying.recording.raping, INSULATING BOOTS AND SLEEVE
Required an sign or Sections. and rctrieral systerrs-without minen permission of the publisher,aampt
Sae examples A B,8 C- ELECTRIC SIGN SECTION that single mpies of individual pages may be made by a bona lila electrkd Date: October 1994
The first blank spare Identifies the number of NO. XX-123456 sign talon of a firm for lima, parr of ng,without
t the Permission
an the
each sign section.The second blank space I installalbn of ekcakal slpm or outline IlpM1lirq,without Me Dermssian of Me 3�ta IAEI UL48-T3B
indicates the total number of sign sections. of (_.� publisher. Nona Dwg-No.
YV( �
� - I?`+1 I� j it � r/ � � � �'+' i•,� �
kti
I
l� ( �� ♦! YV �� �r_
I�4��hii
l
o t
I
1 �
( 111I � t kc ,
��-
1 � w.. Ir .s•: Y
4s N _ . tea+ ;.•. ''+ Ya•�•
�i1 � �'„ I• r 1
1^q
t�
,
i, qr
�. -
it
+_ �, a �•.; E C ._ ;t`�
,
�h > r •ro ' I ( p
� _ r
rPi
It
Ssit
p�� � / -•• - • 1 II1• I y C
�J:' r
:J"�•: lag1 r �
� 3
i
OWNER-;BUILDER DISCLOSURE FORM
COMMUNITY DEVELOPMENT DEPARTMENT•.BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTINO (408)777-3228" FAX(408)777-3333"buildingCcDcuoertino.org
Dear Property Owner(s):
An application for a building permit has been submitted in your name listing yourself as the builder of the property
improvements specified at:
SITE ADDRESS S�, APN 35 .23 DigBPp / rP(//-h D(O
/
OWNER NAME OWNER ADDRESS
'bT Y—Pvr l .� _)2s arr. r. -d IJP �l.l �
DESCRIPTION OF WORK: 5\br1 I N
We are providing you with an Owner-Builder Acknowledgment and Information Verification Form to make you aware of
your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner-Builder. We
will not issue a building permit until you have read, Initialed your understanding of each provision,signed, and
returned this form to us at our official address Indicated. An agent of the owner cannot execute this notice unless
you, the property owner, obtain the prior approval of the permitting authority.
OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION
(DIRECTIONS:Please read and initial each statement below to signify you understand or verify this information.)
�_1. 1 understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-
BJilder" building permit that erroneously implies that the property owner is providing his or her own labor and material
personally. 1, as an Owner-Builder, may be held liable and subject to serious financial risk for any injuries sustained by
an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not
provide coverage for those injuries. I am willfully acting as an Owner-Builder and am aware of the limits of my
insurance coverage for injuries to workers on my property.
_ _2. 1 understand building permits are not required to be signed by property owners unless they are responsible for
ttie construction and are not hiring a licensed Contractor to assume this responsibility.
3. 1 understand as an "Owner-Builder" I am the responsible party of record on the permit. I understand that I may
-
p otect myself from potential financial risk'by hiring a licensed Contractor and having the permit filed in his or her
name instead of my own.
—4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license
tlumbers on permits and contracts.
5. 1 understand if I employ or otherwise_engage any persons, other than California licensed Contractors, and the
to a1 value of my construction is'at least five hundred dollars($500), including labor and materials, I may be
considered an"employer"-under state and federal law.
-6. 1 understand if I am considered an"employer"under state and federal law. I must register with the state and
felieral government,withhold payroll taxes, provide workers'compensation disability insurance, and contribute to
unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject
me to serious financial risk.
k—7. 1 understand under California Contractors' State License Law, an Owner-Builder who builds single-family
residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by
licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work
is performed under contract with a licensed general building Contractor.
1 t 8. 1 understand as an Owner-Builder If I sell the property for which this permit is issued, I may be held liable for
any financial or personal injuries sustained by any subsequent owner(s)that result from any latent construction
defects in the workmanship or materials.
' O�rnerBuilderFarn 10/O.doc remised 04/14//0
9. I understand I may obtain more information regarding my obligations as an"employer"from the Internal
venue Service, the United States Small Business Administration,the California Department of Benefit Payments,
and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State
License Board (CSLB)at 1-800-321-CSLB�(2752)or www.cslb.ca.gov for more information about licensed
contractors.
10. 1 am aware of,and consent to an Owner-Builder building permit applied for in my name, and understand that I
a' the party legally and financially responsible for proposed construction activity at the site address listed above.
11. 1 agree that, as the party legally and-financially responsible for this proposed construction activity, I will abide
b' all applicable laws and requirements that govern Owner-Builders as well as employers.
12. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the
information I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If
you contract with someone who does not have a license, the Contractors' Stale License Board may be unable to
assist you with any financial loss you may sustain as a result of a complaint.Your only remedy against unlicensed
Contractors may be in•civil court. It is also important for you to understand that if an unlicensed Contractor or
employee of that individual orfirm,is injured while working on your property,you may be held liable for damages. If
you obtain a permit as Owner-Builder and wish to hire Contractors,you will be responsible for verifying whether or not
those Contractors are properly licensed and the status of their workers'compensation insurance coverage.
CONSTRUCTION LENDING AGENCY
(DIRECTIONS:Please complete the following construction lending agency information.)
I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued
(Sec 3097 Civ.)
Lender Name: Lender Address:
Before a building permit can be.issued,this form,must be completed and signed by the property owner and
returned to the agency responsible for issuing the permit. Note:A copy of the property owner's driver's license,
form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued
to verify the property owner's si na ure.
Property Owner's Signature: .27
Date: i fj
— — - ---- - -------- — ......
(NOTE: The following Auth zation Form is required to be completed by the property owner only when designating an
agent of the property owner to apply for a construction permit for the Owner-Builder).
AUTHORIZATION'OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF
Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby
authorize the following person(s)to,act as my agent(s)to apply for, sign, and file the documents necessary to obtain an
Owner-Builder Permit for my project.
Scope of Construction Project(or Description of Work):
Project Location or Address:
Name of Authorized Agent: Tel No
Address of Authorized Agent:
I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the
above information and certify its accuracy-. Note:A copy of the property owner's driver's license, form notarization, or other
verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's
signature.
Property Owner's Signature: Date:
0v7erBuilderForm 1010.doc revised 04114110
COAT S nal ` ManagementWMember of Accredited
of Shopping centers Organization
June 12, 2012
City of Cupertino
Building Permits
Re: Bollinger Plaza—sign permit
Surinder Dulai
HUNTINGTON LEARNING CENTER
7335A Bollinger Road
Cupertino, CA 95014
To whom it may concern:
Please accept this letter as approval from the Landlord that the above-captioned tenant is
permitted to acquire a sign permit from the city of Cupertino and that we approve of the
current signage, and that said signage has also been approved by Mr. Simon Vuong in the
city Planning Department.
Sincerely,
COTES & SOW�ARDS, INC.
Jason Sowards,
Canaging Agent for Bollinger Plaza
Real Estate Management• Leasing•Sales•Consulting
1725 S.Bascom Avenue.Suite 104•Campbell,CA 95008•Bus.408.371.8770• Fax 408.371.4865
CITY OF CUPERTINO
6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: suew
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35923018 . 00
DATE ISSUED. . . . . . . : 06/18/2012
RECEIPT #... . . . . . . . : BS000017098
REFERENCE ID # . . . : 12060106
SITE ADDRESS . . . . . : 7335 BOLLINGER RD
SUBDIVISION . . . . . . :
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER SEET DING SHEE TRUSTEE & ET AL
ADDRESS P 0 BOX 1318
CITY/STATE/ZIP . . . : FREEDOM, CA 95019
RECEIVED FROM . . . . : SURINDER DULAI
CONTRACTOR . . . . . . . : LIC # *OWNER*
COMPANY, SEET DING SHEE TRUSTEE & ET AL
ADDRESS P 0 BOX 1318
CITY/STATE/ZIP . . . : FREEDOM, CA 9.5019
TELEPHONE . . . . . . . . :
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- --------- - ----- ----- ------- --- ---------- ---- ------
1BCBSC VALUATION 3, 000 . 00 1 . 00 0 . 00 1 . 00 0 . 00
1BSEISMICO VALUATION _ 3, 000 . 00 0 . 63 0 . 00 0 . 63 0 . 00
1EPERMITFE FLAT RATE 1 .00 44 . 00 0 . 00 44 . 00 0 . 00
1ESIGN UNITS 1 . 00 44 . 00 0 . 00 44 . 00 0 . 00
1SIGNWELEC EACH 2 . 00 520 . 00 0 . 00 520 . 00 0 . 00
1TRAVDOC FLAT RATE 1 . 00 44 . 00 0 . 00 44 . 00 0 . 00
---------- ---------- -- -------- ---- ------
TOTAL PERMIT 653. 63 0 . 00 653 . 63 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
---------- ------- - -------------- --------------------
CHECK 653 . 63 1108 CEDAR QUEST
---------------
TOTAL RECEIPT 653 . 63
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- --------- - ---- --------------
101 FOUNDATION 103 UFER
104 REBAR 105 ANCHOR BOLTS
304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL
a&P
SIGN PERMIT APPLICATION r -_S�rW/ 7Y
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUPERTINO (408)777-3228• FAX (408)777-3333•buildinG(&cupertino-Oro /aDfGCJi��D
�e� -Fa" \ -cis
PROIECT ADDRESS 3 P�dti ev Qa ' 1 APN M �`,J 5 •�J �/ �j
OWNER NAME �I YI S' PHO ^?1 EMMALL o
STREET ADDRESS Po 6 CITY.STAT
tIIP FAX t
CONTACT NAME 7D &` C,, A `��M PHONE
/-'S-lO CGr�O 1S.A[` EMAa.75UP tY�ev o��llai@ yo `���Q
STREET ADDRESS-1
33s JV M. I A eu PEToyNO dC(�r] g*5D1 FAX
O16 Oft 6 -11\�
❑OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT 13 CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHRECT ❑ENGINEER ❑ DEVELOPER TENANT
CONTRACTORNAME LICENSE NUMBER LICENSE TYPE BUS-LICA
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC d
COMPANY NAME E-MALL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE '
DESCRIPTION OF WORIC > "
W CI.0 Ina .
USE OF ❑ SFD or Duplex ❑ Multi-Family ILLUMBJATED SIGN TYPE NO.OF SIGN AREA VALUATION
STRUCTURE: ommemial (YIN) (CODE) SIGNS (SQ,FT.) (S)
SIGN TYPE CODES:
B - BANNER SIGN M - MONUMENT(GROUND)SIGN
BL - BLADE SIGN P - PROIECTINGSIGN
D - DEVELOPMENT ED SIGN SP - SPECIAL EVENT BANNER
DI - DIRECTIONAL SIGN T - TEMPORARY
E - ELECTRONIC W - WALL SIGN
READERBOARD WI - WINDOW SIGN
iRECCFIYYED BCz�: w 'F rTwl '='I "' �. TOT VA.UATION��
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information 1 have provided is correct 1 have Teed the Description of Work and verify it is accurate. I agree to comply'w ah all applicable local
ordinances and state laws relating tobuildingconstruction. 1 au[h mentatives of Cupertino to enter the above-identified property for inspection purposes.
Signature ofApplicanVJ
Agenr v"_L� d � - Date: p_(D
SUPPLEMENTAL INFORMATION REQUIRED 4'--..i,oBBTT.zoseONLY
Site Plan PLA.NCHECR TYPEr±' ROf7@GSL
Elevations
�❑ v�Ttiss-'^7Tr �. �lau¢DwcPLaxaevLEw -sig?
'p t
S,�D Detains-including UL listing(s)applicable �❑ sr,uvo R'nh •� � �Py'�'AN�vrvG••eur"'aes�w+-„ .
Structural Calculations(if applicable) Jr` >❑''i eocg�?'�Y- z -. ❑I'o.T. a ' ".•
'Copy of Planning Approval Letter or Meeting with Planning prior to �❑,MA.TdR ys�c` YID r a ;�r x"--=I sti a
submittal of Building Permit application. v -, � �� .,_•ice (�.vt.'-i1 sem-r
SignApp_201 l.doc revised 03116111