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12100052 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10745 S DE ANZA BLVD CONTRAC`fOR:SUCCESS GRAPHIC SIGNS PERMIT NO: 12100052 ON'Nlilt'S NApIIi: LISW: fl'\Q 9,l u 4 JAI A 6t0�0rJ-t 1744 QUEENS CROSSING [)It DATE ISSUED: 10/09/2012 /OWNER'S PHONE: 8314254549 SAN JOSE,CA 95132 PHONE NO:(408)667-1777 hICF:NSED CONTRACT'OR'S DECLARA'T'ION BUILDING PERDIIT INFO: BLDG [ ELECT(✓ PLUi1IB License Class_�C� Lic.N 0 krly r r r' ( ( N1EC11 RESIDENTIAL COMINIERCIAL Contractor Dal! L I hereby affirm Ilia l fa inlnsed under the provisions of Chapter 9 •10 B 1)ESCR I PTION:STE B-HAIR FASI HON-INSTALL 2 ILLUMINATED (commencing with Section 7000)of Division 3 of the Business& Professions CHANNEL Code and that ore license is in full force and effect. LETTER SIGNS AT EAST&WEST OF 13LDG hereby affirm muter penally of perj or)-one of the following Iw'n declaration,: I have and will maintain a cent ficate 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 tie work for which this permit is issued Sq.FI Flour Area: Valuation:$2500 APPLICANE CERTIFIC TION I certify than I have read this application mid state that the above information is ,O'N Number:384339+7-. 9 OceupaneyType: correct.I agree to comply with all city and county ordinances and state laws relating 7j'Sq Z 3 Cl t 1 . C)CD to building construction,mid hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (1Ve)agree to save indemnify and keep harmless the City ofCupertino against liabilities,judgments, PERMIT EXPIRES IF WORK IS NOT STARTED costs,mid expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR with all non-pointegulaticrnM per the Cupertino Municipal Code, I8U DAYS M LAST CALLED INSPECTION. 9.18. // I k� Signature Date Date: U ❑ ONS\ISR-BUILDER DECLARATION hereby affirm.that I am exempt from the Contractor's License Law for one of RE-HOOPS: the following two reasons: All roofs shall be inspected prior to any roofing material belig installed.If a roof is I,as owner of the propcny,or my employees with wages as their sole compensation, installed without first obtaining in inspection,I agree to remove all new materials for will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection. Business&Professions Code) I,as owner of the property,ran exclusively contracting with licensed contractors to Signature of Applicant: Date: construct the project(Sec.7044,Business&Professions Code). 1 hereby affirm under penally of perjury one of the following three ALL ROOF COVERINGS TO RE CLASS"A"OR BUFFER declarations: , I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE 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 read the hazardous materials requirements under Chapter 6.95 of the I hive and will maintain Worker's Compensation Insurance,as provided for by California Ilenith&Safety Code,Sections 25505,25533.and'5534. I will maintain Section 3700 of the Labor Code,for the performance of the work for which this compliance with the Cupertino Municipal Code,Chapter 9.1_and the Health& Safely Code.Section 2553_(a)should I store or handle hazardous material. permit is issued. Additionally,should I use equipment or devices which emit hazardous air I certify that in the performance of the work for which this permit is issued,I shall contaminants as defined by the Bav Areu Air Qualify Management District I will not employ any person in any manner so is to become subject to the Worker's maintain compliance with the Cupertino Municipal Code.Chapter 9.12 and the Compensation Imus ofCalifomia. If,after making this certificate ofexemption,.1 Ilealth&Sof . e,Sections 25505.25533.and 25534. become subject to the Worker's Compensation provisions of the Labor Code,I must Ow'ncr or aul or . forthwith comply with such provisions or this permit shall be deemed revoked tr Date: ,O'1'IJCW'I'CI?R'I'IPICVI'i(IN CONSTRUCT ION LENDING AGENCY I certify that I have read this application mid state that the above information is correct.I agree to comply with all city and county ordinances mrd state laws relating I hereby affirm that there is a construclion lending agency for the performance of work's to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.) upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the Lender's Address granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section ARCII I TTCI"S DECLARATION 9.18. 1 understand my plans shall be used as public records. Signature Date Licensed Professional SUBTOTALS: $668.53 $0.00 TOTAL FEE: 1 $668.53 Revised: 10/01/2012 SIGN PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228 • FAX(408) 777-3333•buildingoc//uuytt,erino.ora 1 �J PROIECr ADDRESS APN1 WNER 2 (�� ONAME �✓T S� . lE JC V STREET ADDRESS / CITY, STATE,ZIP I FAX CONTACT NAME , PHONE E-MAIL l\ STREET ADDRESS City,STATE, ZIP FAX ❑ OWNER ❑ OWNER-BUILDER ❑ O`.WERAGENi cDNTRArOR ❑CONTRAC X00.AGfNr ❑ ARCHI ECr ❑EYGLN'EER ❑ DEVELOPER ❑h ANT CONTRACTORNAIM � � �M LICENSENUAIBER ✓O LICENSE / BUS.LIC9 COMPANY NAMEE-MAIL 1 O 1 FAX SUcG�S C c �ll� S1v �9(o f�JtSMh �.cS'�+ STREET ADDRESSl Ci rY.SLATE,Z P Lt 86 1 ARCHI ECT/ENOWEER NAME LICENSE NUMMER I BUS.LIC a CONTANY NAME E-MAIL FAX STREET ADDRESS CITY.Y.STATE.ZIP PHONE DFSCR,iP;IONNOOF WORK USE OF SULgrDuplex �, Multi-Farnily B UMINATED SIGN TYPE NO.OF SIGN AREA VALUATION STRUCTURE: IjJl•Gzmrnercial (YIN) (CODE) SIGNS (SQ.FT.) (.S) SIGN TYPE CODES: 2 B - BANNER SIGN MONUMENT(GROUND)SIGN BL - BLADE SIGN P. -PROJECTINGSIGN D - DEVELOPI E 0SIGN SP - SPECIA-EVENT BANNER DT - DIRECTIONAL SIGN ///TT - TENIPORAAY WALL READERBOARD e SWI - WINDOW SIGN - RECEIVEDB.Y _ L ca TOTAL UATI N By my signature below,I certify to each of the following: I am the property owne or authorized agen[to as an the roperty owner's behalf 1 have read this application and the information I have provided is correct. 1 have read the Descripdonb'f Work and vcdfy it is ac ram. I�tee to comply-with all applicable local ordinances and state laws relating to building eonsm arize reprsenrzdves of Cupertino to enter the ab u ed 'rope for inspection purposes. Signature of Applicant/Agent: Data: Ld Q x nsa ate- NL s SUPPLEMENTAL 1NFOR.HL4TION REQUIRED �-�� _3aoFetce useo LY�,�. Site Plan - I �PLi\CBEChiTtTE IRO=.*G _Elevations °" ��Ess- '�� jLY+�eu¢nLAGYLA.viREvtEw _ Sip Details-including UL listing(S)applicable Structural ❑ srA.�nARnsy PUA.NYL cPu�R_Ev�'¢`w - Calculatioas(if applicable) oTE£R '9 _Copy of Planning Approval Letter or Meeting with Planning prior W I Qrlu.Io submittal of Building Permit application.' : r- Sigm4pp_201 Ldoc revised 03116111 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR / SUBCONTRACTOR LIST JOB ADDRESS: 0 Lj5 .S OC-AA[ZA PERMIT# JZ000,5a OWNER'S NAME: PHONE# GENERAL CONTRACTOR: ,gs I BUSINESS LICENSE # ADDRESS:1139 e4i prl*Vt✓ CITY/ZIPCODE: *Our municipal code requires all businesses w4rking in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: t/ SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring /Carpeting Linoleum / Wood Glass/Glazing Heating Insulation Landscaping Lathing Masonry Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile L<4 Owner/Contractor Signature Date W —n �� :fig Pamainaclia m N Q 3ONHIldWO03000 Noi COMMUN ZIOZ 8 0 loo ` o auaugjedap 6u p peONUN3dn3 Le a � � O G r m N N I U m W O N J (A l�6 • �� mV- o on3 N cp W VJ UQ N�Zmm61 21 U i.ic W aWJ J _m_OQ— o L m ' Z0 r U3Z)d> d �10 ep m � �• I 0 N rr 11 c M � 3 CL LL m w _ Q F c y , R,'y c m W m n E oma`o w Q m z E mem 0 - E .oEam J xJay I o_Em3 i 0 m co Zcli b � 9 Q n O I i In y y N y 03 ge U Ern 3 � ca loon I �N ;Q -_-I -� � 7:tN •��'-m':�� O a •_ " n oa J � om e � Nr, E a d i J Z > W - G 't Jl Q P 1 M �� / '1.0 CL:C: 4rr� I W5; EL W - 0 - U - OCD N N 2 `a Q N O L _ZJ y U 0 t I�pG OnC • mm m smm 3 �2a q' Eo 0 w 7 i I N N V t: r j i Lr �I 7 �ru� rttp SOe nza nza BI BI vd IAN- CL IL 71