12080065 CITY OF CUPERTINO BUILDING PERMIT
BUILDING,\DDRIESS: 2054159'EVENS CREIEK BLVD CONTRACI'OR:ADIMPACT PERMITNO: 12080065
OWNER'S NADIR: CALIFORNIA 13ANK&-TRUST 19772 MACART'DUR BLVD DA'Z'E ISSUED:08/078012
OWNER'S PIIO,NIE: 8587937430 IRVINE.CA 92612 PRONE:NO:(949)723-0187
LICENSED CO\VRAC`fO,R'SS DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r7 PLUMB r
'License Class Gu _ Lic,q Lo to Z y r r r
I p1ECF1 RESIDENTIAL CCOMMERCIALContractor //1'N l,/j�n � Date —7'�l2—
I herebyaffirm that 1 am licensed under the provisions of Chapter 9 .106 DESCRIPTION:CALIFORNIA BANK$TRUST-REPLACE EXISTING
(Coil] tcncing with Section 7000)of Division 3 of the Business&Professians ILLUMINATED MONUMf:NT SIGN NIKE FOR LIKE
Code and that nry license is in full force and effect.
1 hereby affirm under penally of perjury one of the following two declarations:
I have and will maintain a cenifleote 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.
I have and will maintain Worker's Compensation Insunnoe,as provided for by
Section 3700 oflhe Labor Code,t'or the performance of Ute work for which this Sq.Ft Floor Area: Valuation:$3000
permit is issued.
APPLICANI'CIERTI FICAT'R3,N APN Number:32634067.00 Occupancy Type:
I certify that 1 have read this application and state that the above information is
correct.I agree to comply with all city and county ordinmrces mid state laws relating
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN I80 DAYS OF PERMIT ISSUANCE OR
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant undcrstandsand will comply 180 DAY ZZI
OM LAST CALLED INSPECTION.
with all non-point source regulatims per the Cupertino Municipal Code,Section ,
9.18. Is uc y. Date.
Signature Date
❑ OWNER-BUILDER DECLARA'T'ION
RE-ROOFS:
hereby affirm Ihafl am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material beiig installed.If a roof is
the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for
I,as owner of the property,or my employees with wages as their sole compensation• inspection.
will do the work,mid the structure is not intended or o0ered for sale(Sec.7044,
Business$Professions Code) Signature of Applicant: Date:
1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,13usiness&Professions Code). ALI,ROOF COVERINGS TO 13E CLASS"A"OR BEATER
I hereby affirm under penalty of perjury one of the following three
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's IL\%,\RDOIIS MATERIALS DISCLOSURE
Compensation,as provided for by Section 3700 of the Labor Code•for the 1 have read the hazardous materials requirements under Chapter 6.95 of the
perl'omnnce of the work for which this permit is issued. California Ilcalth S Safco Code,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 Ilcalth S
.Section 3700 of the Labor Code,for the performance of the work for which this
Safeq CoJr,Section 25532(a)should I store or handle hazardous material.
AJdilionall%.should I use equipment or devices which emit hazardous air
permit is issued. contaminants as defined by the Bay Area Air QualityManagement District I will
I certify that in the perfommnce of tie 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 S Safety Code,Sections 25505.25533,and 25534.
Compensation laws of California. If,atter making this certificate of exemption,I
become subject to die Worker's Compensation provisions of the Labor Code,I must O"'ner-r!r au Iw ized �ut:_ y��7 _�
forthwith comply with such provisions or this permit shall be deemed revoked. Date'4
.\I'I'LIC.\N'I'CPER'1'IPIG\'IIfIN
CONS1'RUC11ON LENDING AGENCY
I certify that I have read this application and state that the above information is I hereby affirm that(here 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,mid 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,mid expenses which may accrue against said City in consequence of the
granting of this permit.Additionally,the applicant understands had will comply ARCI I ITECI"S DECLARATION
%kith all non-point source regulations per the Cupertino Municipal Code,Section
9.18. 1 understand my plans shall be used as public records.
Signature Date I Licensed Professional
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 20541 SCB DATE: 08/07/2012 REVIEWED BY: Sylvia
APN: BP#: VALUATION: $3,000
'PERMITTYPE: Building Permit UN CHECK TYPE:
PRIMARY PENTAi�4>,TION
USE: Sign PERMITTYPE: 10EAP5
WORT: Re lace existing illuminated monument sign like for like
SCOT'E
SIGN TYPE FEE ID QTY SIGN FEE
Ground Sign 1SIGNGR/RF 1 $334
TOTALS: $334.00
,Nvclr. I'lon Check Plumb.Plan Check it Branch Circuits 1 $45.00
Meeh. Permit Fee: Plumb. Permit Fee: IESIGN Elec. Permit Fee: IEPERUIT
Odrm•,i/ech.Imp. Other Plumb Insp. Other Elec. Insp. 0.0 $45.00
Jloch. lnpp.ree: Plumb. Insp. Fee: F.lec.Insp. Fee:
NOTE: This"nature does not include jeer Clue to other Departments(i.e. Planning, Public Works, Fire,Sanitary Seaver District,School
District.etc.). These ees are based on the relindnat) information available(aid are onit•an estimate. Contact the De t or whin'I info.
FEE ITEMS (Fee Resolution 11-053 L7X 7/1/!1) FEE QTY/FEE MISC ITEMS
Plan Chuck Fire:
Suppl. PC Fee: Q Reg. O OT FO.0 hrs $0.00
Plumb.Ablech./Glee
Permit Fee: $334.00
Suppl. Insp. Fee-.0 Reg. Q OT 0.0 hrs $0.00
PME Unit Fee: $45.00
PME Permit Fee: $45.00
Consnvction Tax:
Administrative Fee:
Work Without Permit? O Yes Q No $0.00
Sign Master Plan: O Yes (E) No $0.00
Travel Documentation Fee: ITRA VDOC $45.00
i
Strong Motion Fee. IBSEIS1111CO $0.63 Select an Administrative Item
Bldg Sids Commission Fee: IBCBSC $1.00
SU13TOTALS: $470.63 $0.00 TOTAL FEE: $470.63
Revised: 07/01/2012
SIGN PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO, CA 95014-3255
CUPERTINO (408)777-3228 • FAX(408) 777-3.333•building(acuoertino.orD
PROJECr ADDRESS ao 5 y/ ST�v�vs e G3lC.Y0 I APN�i�L — O r„l
0 N v�
S� .0 , 7 E-MAB.
6 r c ,vtJ CRY,STA )-�/7 , 0`�
ME D FAX
CONTACT NAPHONE E-MAR
S"IREEr ADDRESS ��� CriY,SrATE, ZIP FAX
11O OWNEROWNER-BUILDER 13 ENT 12 OWNERAGCONTRACTOR CICDKTRA ORAGE 0 ARCHITECT 11'ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTORN ME LICENSE NUMBER LICENSE TYPE BUS.LICA
rEUE. �7,62r�ti/ g o 12- c S r � 7
COWANYNAMEADIM(��GORQ SiCeNAG�. E-MAR FAX
STREET ADDRESS / JJO'�/t-yL��`S �0_R� S) CTTY.STATE.ZIPT-� Il�(l�G/.�- g�.G06 PHONE 6GGy`j
ARCHrrECriENGINEER NAME /7 LICENSE NUMBER f—�-` BUS.LICi
CON@ANY NAME E-MAIL FAX
STREET ADDRESS CrrY,STATE,ZIP PHONE
DFSCRIP'RON OF WORK / ��lSTiNG &oNop7 r--4, S/G lexs , z.e
(SLS -/ST/N� G S7�6L U(u/ , Q�yJ r��pA�llu�/
USE OF ❑ SFD or Duplex ❑ Nlulti-Fam1IV RLIIMDIATED SIGN TYPE NO.DF SIGN AREA VALVATION
STRUCCURE: ❑ Commercial Cy 1114) (CODE) SIGNS (So FT.) (S)
SIGN TYPE CODES: I G 3 C �—
B - BANNER SIGN M - MONUMENr(GROU, )SIGN
BL - BLADE SIGN P - PROJELTINGSIGN
D - DEVELOPMENT m SIGN SP - SPECLV-EVENT BANNER I -
DI - DIRECRONALSIGN T - TEmrui MY
E - ELECTRONIC W - WALL SIGN
READERBOARD WI - WINDOW SIGN �
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 I have provided is correct. I have read the Description of Work end•:eaPy it is accurate. I'agree to comply with all applicable local
ordinances and state laws relating to building co I tho ' e representatives of Cupertino to enter the abov-e'-iiddentined property for inspection purposes.
Signature of ApplicandAgenC 4 Date: -
SUPPLEMENTAL RNFOOIATION REQUIRED
Q
_Site PlanPL. r� cK2,rnetr•.- , Dori•c:scte�l., ''l,
Elevations '-O.tEXPRiss s � r v aEvlEwr
t -4YB5-ate
Sign Details-including UL listing(s)applicable 3� srAN6AiiD R BE.-.49e1.Av REVIEW'P
7 r
_Structural Calculations(i(applicable) 7u'�1GE
Q-I �reON
_Copy of Planning Approval Letter or Meeting with Planning prior to Q wA,IOR '- _-` �-, _ _y_ -P.-•
submittal of Building Permit application.
tom, : €-•`, "� -'� . ..us,r.,�
SignApp_2011.doc revised 03/16/11
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