12090054CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10495S DEANZABLVD CONTRACT 'OR:. SUCCESS GRAPHIC SIGNS PERMITNO:12090054
OWNER'S NARIF.: NORTFIWEST DE ANZA ASSOCIATES 1744 QUEENS CROSSING DR DATE ISSUED: 09/102012
OWNER'S PHONE: 4089139200 SANJOSE, CA 95132 PRONE NO: (408) 667 -1777
❑ Ll CENSE CONT'RACTOR'S DECLARATION
License Class C Lic. k
Contractor -- Date w
hereby affirm that I am licensed under the provisions of C apier 9
(com menci ng with Section 7000) of Division 3 of the Rusi ness & Professions
Code and that my license is in full force and effect.
hereby affirm under penally 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.
I have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance of die work for which this
permit is issued.
APPLICANT CERT'IFICAT'ION
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 slate Imes 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
indemnify and keep harmless the City of Cupertino against Iiabil ities, judgments,
costs, and expenses which may aceme against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non -point sourc a u per the Cupertino Municipal Code, Section
9.18.
❑ OWNER - BUILDER DECLARATION
hereby affirm that 1 am exempt from the Contractor's License Law Formic of
the following two reasons:
I, 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.7044,
Business & Professions Code)
I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
I hereby alarm under penalty of perjury one of the following three
declarations:
1 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.
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
permit is issued.
I certify that in the performance of die work for which this permit is issued, l shall
not employ any person in any manner so as to become subject to the Worker's
Compensation laws of Calif imia. If, after making this certificate of exemption. I
become subject to the Worker's Compensation provisions of the Labor Code, 1 must
forthwith comply with such provisions or this permit shall be deemed revoked.
APPLICANT CERTI FICATTON
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 Imes 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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may aceme against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
BUILDING PERMIT INFO: BLDG r ELECT r PLUDIB Ci
D1ECH r RESIDENTIAL Ci CONIMERCIAL r
JOB DESCRIPTION:. FOOTSPA & BODY. MASSAGE - REMOVE AND REPLACE
THREE(3) SIGNS. TWO(2) NEW COMPLETE LIGHTED ON
EXISTING CIRCUIT AND ONE(I) FACE CHANGE -OUT
Sq. Ft Floor Area: I Valuation: $3500
APN Number: 35917023.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYSSj FROM LAST CALLED INSPECTION.
/'
Issued by: , /�/✓ /4�z: / Date:
RE- ROOFS:
All roofs shall be inspected prior to any roofing material berg installed. If a roof is
installed without first obtaining an inspection. I agree to remove all new materials for
inspection.
Signature of Applicant: Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
DAZARDOUS MATERIAIS DISCLOSURE
1 have read the hazardous materials requirements under Chapter 6.95 of the
California health & Safety Code Sections 25505, 25533, and 25534. I will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Ilealth &
Safety Code. Section 25532(x) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Ilealth o e, ections 25505, 25533, and 25534. -
Owner horned g
• T - Date:
CONSTRUC`I'10\ LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
for which this'permit is issued (Sec. 3097, Civ C.)
lender's Name _
Lender's
ARCIIITECI "S DECLARATION
I understand my plans shall be used as public records.
Signature Date I Licensed
CUPERTINO
DEMOLITION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255
(408) 777 -3228 • FAX (408) 777 -3333 • buildino(o?cuoertino.oro
-2,09 00_5'
PROTECT ADDRESS I r l (.i � 7 V " (j W ^ �TG
APN d /3 5�! / 1 Z
OZ
Ei -MAIL
OWNER NAIVE PHONE. (-W 17 312-04
STREET ADDRESS 2- A4?-A- CITY. STATE. ZIP FAX
�j � tea- C •.-.�
� O "1. S
JLj
CONTACT NAME� I'
PHONE /
_E-MAIL
STREET ADDRESS r.IL L Cr ��
STATE, ZM EA_ I If �S/
FAX
cY
O❑
11 OWER ❑ OWNER - BUILDER ❑ Ow ERAGET x"oNTRACoR ❑CO MRAGENr ARCHITECT EVGNEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME 1 , , ^
LICENSE NIPN j
Y,
LICENSE�Tj'P� /
BUS. LIC a
rrrIII
COMPANY NAME
E -MAIL t- N /G1 /�(���/(, /
✓V(O UKN�
FAX
STREET ADDRESS /��� /� C�V �SIt ��b�y�
'-/
CITY. STATE. ZIP
®`�. �La
PHO �W/6
L� 7
DESCRIPTION OF WORK (1�(G ` I
S'�`
RESmENnA1 a DWELLING
Li, s'.j$L•.ri i A H'- , +.
E.CTVPE3 rru V
FLOOR AREA UNITS
WIN II ;14_10
FLOORFLOOR AREA
s' ws -
TYPE OF CONSTRUCTION
0 STORIES
L y � y R
2a9' TCi 0 a 11 W--- - w' it
AQ.Vm JOB NIJ ®EA
�- ='-. [ TOTAL V UATI
hRECE[VED BY:- '
By my signamre below, I certify to each of the followin � m the prope owner or authorized agent to act on the property owner's behalf I have d this
application and the information I have provided' rtect. I have read the•Descrip ion of Work and verify it is accurate. I agree to ca y with all pplicable 1=1
ordinances and state laws relating to buildin -1 nuthor' e r rese dve of Cupertino to enter the above- idendtl rtY for ins etionr-p�urposes�.
Ci
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INFORMATION REQUIRED PRIOR TO ISSUANCE OF DEMOLITION PERMIT
Q
,�a.p ujpc,n ttiacet..,e._,
'a" �a iolnTCEDSeou:Y -.. °
Provide Job Number from Bay Area Air Quality Management District w•wrv.banamd. ore @415-749-4762.
- �+set:Aa CHEac•TYrea±';3�
Provide three copies of a site plan showing protection for any trees 10" in diameter or more at 3' above grade.
_
Provide letter from PG &E (408 -725 -3325) stating all gas and electric has been disconnected.
O• STANDARD. f
_Provide aletter of inspection, tests, and abatement of any Hazardous Materials. Letter to be initiated by person(s)
-
;r -
certified in asbestos, mercury ¢nd/or hazardous material examination.
Planning Dept clearance to verify building is not considered an historical landmark. Allow 10 business days.
bgP:a
Provide letter of clearance of all vermin from a licensed pest control contractor.
Applicant shall call the Public Works Department at 408- 777 -3104 and schedule a "habitable dwelling" inspection.
`2: - .•
_Provide signed Debris Bin and Recyclable blaterial5 form.
Commercial Buildings Only: Provide Fire Dept clearance for fire suppression /alarm system review.
C:,x•,a: -Ma�P
•
DemoApp_2011.doc revised 03116111
W
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
SIGN TYPE
ADDRESS: 10495 S. DeAnza Blvd. Ste A
DATE: 09/1012012
REVIEWED BY: RDW
Alech. Permit Fee:
APN:
BP#:
- VALUATION:
$3,500
*PERMITTYPE: Building Permit
Pl.hV CHECK TYPE:
PRIMARY
USE: Sign
$532
PENTAMATION
PERMITTYPE: 10EAP5
WORK
Remove and replace 3 signs. 2 new complete lighted on existing circuit and one face than a -out.
SCOPE
1 0,0
SIGN TYPE
FEE ID
Plumb. Plan C'hmA
QTY
Alech. Permit Fee:
SIGN FEE
Elec. Permit Fee:
Wall Sign, Electric
1SIGNWELEC
Other Elea Insp. El $0.00
2
Phmhh. bnp. Fee:
$532
Permit Fee:
$532.00
Suppl. Insp. Fee0 Reg. Q OT
1 0,0
1 hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Cmu•n•uction Tae:
Administrotive Fee:
Work Without Permit? Q Yes Q No
$0.00
TOTALS:
$0.00
Travel Documentation Fee: ITR lVDOC
$532.00
Strong Motion Fee: 1BSEISAHCO
NOTE: This estinmte noes not include jeer due to other Departments (i.e. Planning, Public /forks, Fire, Sanitary Sewer District, School
District. etc .). These fees are baser/ on the oreliminary information available and are only an estinmte. Contact the Dept for addn7 info.
FEE ITEMS (Fee Resolution 11 -053 F_lT 71111 1)
Mech. Plan Check
Plumb. Plan C'hmA
# Branch Circuits 0 $0.00
Alech. Permit Fee:
Phlnlh. Permit Fee
Elec. Permit Fee:
Odher,lfeeh. Insp.
Other Plumb Insp.
Other Elea Insp. El $0.00
Plech. Insp. Fee:
Phmhh. bnp. Fee:
Flee. Insp. Fee:
NOTE: This estinmte noes not include jeer due to other Departments (i.e. Planning, Public /forks, Fire, Sanitary Sewer District, School
District. etc .). These fees are baser/ on the oreliminary information available and are only an estinmte. Contact the Dept for addn7 info.
FEE ITEMS (Fee Resolution 11 -053 F_lT 71111 1)
FEE
QTY /FEE
MISC ITEMS
Plan Check Fee:
Suppl. PC Fee: Q Reg. Q OT
0.0 1
hrs
$0.00
Phimb. 11fech.A:lec
Permit Fee:
$532.00
Suppl. Insp. Fee0 Reg. Q OT
1 0,0
1 hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Cmu•n•uction Tae:
Administrotive Fee:
Work Without Permit? Q Yes Q No
$0.00
Sign Master Plan: Q Yes 0 No
$0.00
Travel Documentation Fee: ITR lVDOC
$45.00
Strong Motion Fee: 1BSEISAHCO
$0.74
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$578.74
$0.00
TOTAL FEE:
$578.74
Revised: 07/01/2012
i
66.2 ft. oil r—_
I• -fir— - q -7�- — -66.2 k. — ssffl i
1'-.
� 132"
18fl4 M USAGE
328"
rMs�
IL Replace faces only
AS l W41t14 0,11-
90°
FOOT SPA A
BODY MASSAGE
Rrivod Bxkbv —.
SMnmd:m Rehm 040
FOOT SPA G' BODY MASSAGE � t
COMMUNITY DEVELOPMENT DEPARTMENT Tm`Cap
BUILDING DIVISION - CUPERTINO
aechical source
upplies by othm
Junwon Box
p Lsv Village
Vo mndul or Rex
Disconnected Skohn
ffl w
•» CUPERTINO
: Building Department
= SEP 10 1012
REVIEWED FIOR ODE COMPLIANCE
4r. a:c:.aD ay: •-lit
5 ti
�C Y,
C��Dr
RECE1 VEIL
SEP 10 2012
BY :_ �``j
f•d,;.T ;?J lU
l :
DAW,
Rim C lwa
Sign Type: (1) Inlemally Illuminated LE ,D IndWual Channel Letters
APPROVED 114'Dmin Rol,
Letter Face: 1/S' thickness acrylic face color as shown
Leger Relums: 5' Back with .OdD Aluminum
Trim Cap: 314'
This set of plans and specifications MUST be kept at the
4=11
god
job site during construction. It is unlawful to make any
Chnnne:C nr sl Prntlnnc
Q
ProjectLocation
i
1744 Queens Crossing Drive -San Jose - CA 95132 I The stampinl3 of this plan and specifications SHALL NOT
10495 S. De Mae Blvd. Ste A. t
T (408) 667 -1777 E -mail: swu1966 @gmail.com
t held to 3ermit or to be an approval of the violation
of any provisions of anv Oftv Ordinane' nr 1 ..,..
BY
DATE J— l 0— f Z 1
PERMIT NO. _/- 209005.4
aechical source
upplies by othm
Junwon Box
p Lsv Village
Vo mndul or Rex
Disconnected Skohn
ffl w
•» CUPERTINO
: Building Department
= SEP 10 1012
REVIEWED FIOR ODE COMPLIANCE
4r. a:c:.aD ay: •-lit
5 ti
�C Y,
C��Dr
RECE1 VEIL
SEP 10 2012
BY :_ �``j
f•d,;.T ;?J lU
l :
DAW,
Rim C lwa