12080005 l
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10051 S DL'ANZA BLVD CONTRACTOR:COULTHARD IDENTITY PERMIT NO: 12080005
GROUP INC/
OWNEKSNANIE: MARDESICI-I CO CROSSROADS LLC 37428CF,N'1'RALNIONI'I'I,S'1'1?A DA'Z'E ISSUED:08/022012
OW'NER'S P116NE: 4 0844 147 54 FRENIONF.CA 94536 PRONE NO:(650)858-1221
❑ LICENSED CON I'RACFOR'S DECLARATION BUILDING PERMIT INFO: BLDG r FLECT r PLUMB r
License Lic.N_ r r
I \TECH RESIDENTIALCOMMERCIAL r
Contractor _Date D Z—�y
herchy affirm t I am licensed under the provisions of Chapter 9 306 DESCRIPTION:TLCHCU-REVISE EXISTING WALL SIGN PROM(TECHCU)
(commencing with Section 7000)of Division 3 of the Business& Professions TO TECHDANK-TECHNOLOGY DANK
Code and that tar license is in full farce and effect.
I hereb) affirm 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,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 provided for by Sy.Pt Floor Arra: Valuation:$5200
Section 3700 Of the Labor Code,for the performance of Ole work for which this
peril is issued.
ARN Number:35908018.10051 Orrupmtcy'I'ypa
App LICANI'CERTIFICATION
I certity,that I have read this application and state that the above intbnnation is
correct.I agree to comply With all city and county ordinances and stile Imus relating
to building Cmuiruction,and herebyauWorizerepresentatives ofthis city 1oenter PERMIT EXPIRES IF WORK IS NOT STARTED
indemnityupon the above )agree to save
mentioned
and Acep harml ss tiler City ofty for lCupertinection o against liabilities,, ,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR
toss,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION.
granting ofthis permit. Additionally,the applicant undersunds and will eonnply
with all non-point source regulations per the Cupertino Municipal Code,Sectio,
9.18. Issued by: 5F T- Z Date. �'-� •l�
Signature Date CC1W(L
❑ OWNER-BIIII.DER DECLARATION RE-ROOFS:
All roofs shall be inspected prior to any roofing material being installed.If a roof is
I hereby affirm that 1 run exempt from the Contractor's License Law for one of installed without first obtaining an.inspection,I agree to remove all new materials for
the following two reasons: inspection.
I,as owner of the property,or my employees with wages as their sole compensation,
will do the work,mid the structure is not intended or offered for sale(Sec.7044. Signature of Applicant: Date:
Business&Professions Code)
1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). ALL ROOF CO\'IiKINGS'f0 Illi CLASS",\"OR RF:'I'FEIi
I hereby affirm under penalty of perjury one of the following three II,\''/,AKDOUS NL\'I'lilt 1.\IS DISCLOSl112F
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the
Compensation.as provided for by Section 3700 Of the Labor Code,for the California I Iealth&Safety Code.Sections 25505,25533,and 25534. I will maintain
performance of the work for which this permit is issued. compliance with the Cupertino Nlunicipal Code.Chapter 9.12 and the llcalth&
I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code.Section 25532(8)should I store or handle hazardous material.
Section 3700 of the Labor Code,for the performance of the work for which this
,Additionally,should I use equipment or devices which emit hazardous air
emtuminans as defined by the ISay Area,Air Qunlit'Jlanagemenl District I will
permit is issued. maintain compliance with the Cupertino Municipal Code.Chapter 9.12 and the
I certify that in the performance of die work for which this permit is issued,I shall Health&Safety Code,Sections 255115.25533,and 25534.
not employ any person in any manner so as to become subject to the Worker's
Connpens'ation laves of California. 11',alter making this certificate of ecemption,I Owner au rizc r( Date:`�l
become subject to the Worker's Conlpensmion provisions of the Labor Code,I must
forthwith comply with such provisions or this permit shall be deemed revoked -
CONSTRIICI'ION LENDING AGENCY
APPLICANT CERTIFICA'T'ION I hereby affirm that there is a construction lending agency for the performance of work's
I certifv that I have read this application and state that the above information is for which this pemut is issued(Sec.3097,Civ C.)
correct.I agree 4o comply with all city unit county ordinances mid state laws relating Lender's Name
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address
indemnify and keep hamdess the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the ARCIIITECI"S DECLARATION
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records.
9.18.
Licensed Professional
Signature Date.
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SIGN PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO, CA 95014-3255
CUPERTINO (408) 777-3228• FAX(408) 777-3333•buildinG(rDcuoertino.or0
PROTECT ADDRESS �Oc S1 S .�Eb N26 �jLVp I APN+ �j _ UX -io �U
OWNER NAME PHO E'MA1L
STREET ADDRESS CRY,STATE,ZIP FAX
Zola H• u SJLK xE
CONTACT NAMEPHONE E-MAa
lia7VILGo v t-7 a Tao
STREET ADDRESSCITY,STATE, ZIP FAX
'1•rf R♦ a 7pp♦ Ma q'q S 3�a •�6$ - 1�•T�J
Cl OWNER ❑ OWNER-BUILDER ❑ OWNERAGEYI' Ay CONTRACTOR ❑CONTMCIORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONIRACLOR NAIv� LICENSE NUMBER LICENSE TYPE BUS.LIC 4
STI' C c V(--r r4o -7 o�6q 2. _4 ty
COMPANY NAME E-MAILFAX
MGe - cr GaMJ?A-N AEN aMceESI Ncary
STREETADDRSS CRY,STATE,ZIP PHONE
7 2 C4 AS
an P4'kCC (.Mo hjr
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC d
X COMPANY NAME EMAIL FAX
!G GOM•�,6
STREET ADDRESS CRY,STATE,ZIP PHONE
3742 C L p6AC4 -REMOM
DESCRIPTION OF WORK
(•. (No- � o C ¢e •l-Ec.HG
USE OF ❑ SFD or Duplex ❑ Multi-Family I.LUMRIATFD SIGNTYPE NO OF SIGNAREA I VALUATION
STRUCTURE: Commercial YE
(CODE) SIGNS (SO.FT.) (s)
SIGN TYPE CODES: YES w ) 32 7#C Tj Ze.e. 00
B - BANNER SIGN M - MONUMENT(GROUND)SIGN
BL - BLADE SIGN P - PROTECTNGSIGN
D - DEVELOPMENT m SIGN SP - SPECIAL EVENT BANNER
DI - DIRECTIONAL SIGN T - TEMPORARY
E - ELECTRONIC W - WALL SIGN
READERBOARD WI - WTNDOW SIGN
RECEIVED . rC` N•-h .
—24 `� T S VALUATION
OtnOID
By my signawre below,I certify to each of the following: 1 am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information I have provided is carte=. I have mad the Description of Work and:•e:&j it is accurate. I agree to comply with all applicable 1=1
ordinances and state laws relating m i ing vection I authorize rerm tatives of Cupertino to enter the above-identified pmperty for inspection purposes.
Signature of ApplicanVAgenu Dam: S6 - 7— /-
SUPPLEMENTINF'OR:NIATION REQUIRED
_✓Site Plan !-Mer;A..srnE �,-',xotm.��e:sEtP�•�
*+
✓Elevations 'Oess -`7} S q' B' iTv:o Grra
]Sign Details-including UL listing(s)applicable -
jAOySTANDAitp _r, ,.et.A.N Geuv.REvtsw
—XStructurai Calculations(if applicable) ,'�',y LARGE YQ-ioTeEx
xCopy of Planning Approval Letter or Meeting with Planning prior to
—Y submittal of Building Permit application.
SignApp_2011.doe revised 03/16/11
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10051 S DE ANZA BLVD CONTRACTOR:COULTHARD IDENTITY PERMIT NO: 12080005
GROUP INC/
OWNER'S NAME: MARDESICH CO CROSSROADS LLC 37428 CENTRALMONT PL STE A DATE ISSUED:08/02/2012
OWNER'S PHONE: 4084414754 FREMONT,CA 94536 PHONE NO:(650)858-1221
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT f— PLUMB
License Class Lic.#
MECH RESIDENTIAL COMMERCIAL
Contractor Date
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:TECHCU-REVISE EXISTING WALL SIGN FROM(TECHCU)
(commencing with Section 7000)of Division 3 of the Business&Professions TO TECHBANK-TECHNOLOGY BANK
Code and that my license is in full force and effect.
I hereby affirm 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 O
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Floor Area: Valuation:$5200
permit is issued. "
APPLICANT CERTIFICATION APN Number:35908018.10051 Occupancy Type:
I certify 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 of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
Issued by: Date:
Signature Date
❑ OWNER-BUILDER DECLARATION " "
RE-ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is
the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for
I,as owner of the property,or my employees with wages as their sole compensation, inspection.
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Signature of Applicant: Date:
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I hereby affirm under penalty of perjury one of the following three
declarations: HAZARDOUS MATERIALS DISCLOSURE
I have and will maintain a Certificate of Consent to self-insure for Worker's
Compensation,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
performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
1 have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
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.
Additionally,should I use equipment or devices which emit hazardous air
permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will
I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534.
Compensation laws of California. If,after making this certificate of exemption,I
become subject to the Worker's Compensation provisions of the Labor Code,I must Owner or authorized agent:
forthwith comply with such provisions or this permit shall be deemed revoked. Date:
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's
correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ 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
indemnify and keep harmless the City 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.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. I understand my plans shall be used as public records.
Signature Date Licensed Professional