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12120038I CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 10895 S BLANEY AVE CONTRACTOR: SUCCESS GRAPHIC PERMIT NO: 12120038 SIGNS OWNER'S NAME: PACIFIC RIM PARK LLC 1744 QUEENS CROSSING DR DATE ISSUED: 12/07/2012 OWNER'S PHONE: 4086671777 SAN JOSE, CA 95132 PHONE NO: (408) 667 -1777 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIALD COMMERCIAL License Class Lic. # I SHANGHAI DUMPLING- INSTALL 2 ILLUMINATED SIGNS Contractor I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions 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 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. APPLICANT CERTIFICATION 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue 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 C de, Section 9.18. Signature y"" Date ❑ OWNER- BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one 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 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 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 the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's 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 forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue 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. Signature. Date Sq. Ft Floor Area: I Valuation: $2500 APN Number: 36934052.10895 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: ��'� Date: 1 :? RE- ROOFS: All roofs shall be inspected prior to any roofing material being 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 HAZARDOUS MATERIALS DISCLOSURE I 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 Health & Safety Code, Section 25532(a) 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 Health &Safety Code, Sections =,5 and 25534. j Owner or authorized agent: Date: �� I CONSTRUCTION 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 Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CUPERTINO SIGN PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 • buildina(C)CUDertino.org PROJECT ADDRESS '^ �'v I APN# 0 '^ , OWNER N PHONE E -MAIL ( C ` STREET ADDRESS CITY, STATE, ZIP FAX CONTACT NAME PHONE E -MAIL STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER - BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME ! - LICENSE NUMBER LICENSE TYPE BUS. LIC tI COMPANY NAME E -MAIL FAX ! STREET ADDRESS CITY, STA P _ CA PHC�FIE s v S 4Z l J i ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK j� f `\ 1 USE OF ❑ SFD or Duplex ❑ Multi - Family ILLUMINATED SIGN TYPE N0. OF SIGN AREA VALUATION STRUCTURE: Commercial (YIN) (CODE) SIGNS (SQ. FT.) (S) SIGN TYPE CODES: �' Q B - BANNER SIGN M - MONUMENT (GROUND) SIGN BL -BLADE SIGN P. - PROJECTING SIGN D - DEVELOPMENT ID SIGN SP - SPECIAL EVENT BANNER DI - DIRECTIONAL SIGN T - TEMPORARY E - ELECTRONIC W - WALL SIGN READERBOARD WI - WINDOW SIGN REEELfIED& -= u�- TOTAL U j 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 beha I have read this application and the information I have provided is correct. I have reyd4w- 8escription of Work and vt ify it is accurate. I agr - to comply with all applicable local ordinances and state laws relating to building constru authorize representatives of�Cupertino to enter the above -ide i ed property for inspection purposes. Signature of Applicant/Agent: �.� v Date: b ,,! SUPPLEMENTAL INFORMATION REQUIREDv _:_ oc�rrsl arrz r. Site Plan -- PPC&ECITR lt�`iSL _� $uIr>xt*tRyi Elevations ❑�i;xplt>;s — Sign Details - including UL listing(s) applicable Structural Calculations (if applicable) sT�rinAxDr'{ PtrIFlx RE -v> — _ .. N&M- Copy of Planning Approval Letter or Meeting with Planning prior to q submittal of Building Permit application. xP-- ?Sri.^ - Si,gnApp_2011.doc revised 03116111 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION SIGN TYPE ADDRESS: DATE: REVIEWED BY: 1 - &>, h. I'"rru "t 1�'C"" APN: BP #: "VALUATION: 1$2,500 PERMIT TYPE: Building Permit Other Elec. Insp. 0.0 $45.00 PRIMARY USE: Sign J /umh. h)xp. FCC, PENTAMATION PERMIT TYPE: 10EAP5 WORK Permit Fee: SCOPE Suppl. Insp. Fee-0 Reg. Q OT SIGN TYPE FEE ID QTY/FEE QTY 1 - &>, h. I'"rru "t 1�'C"" SIGN FEE IESIGN Elec. Permit Fee: IEPERMIT Wall Sign, Electric 1SIGNWELEC Other Elec. Insp. 0.0 $45.00 2 J /umh. h)xp. FCC, $532 Permit Fee: $532.00 Suppl. Insp. Fee-0 Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $45.00 PME Permit Fee: $45.00 Cwnsfruction Trrr. AdIninistnaive Fee: Work Without Permit? Yes (j) No $0.00 TOTALS: $0.00 Travel Documentation Fee: ITRAVDOC 1 $532.00 Strong Motion Fee: IBSEISMICO NOTE. This estimate does not include fees due to other Departments (i. e. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc). These fees are based on the oreliminary information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11 -053 Ef: 7j il!12) FEE QTY/FEE # Branch Circuits 1 $45.00 1 - &>, h. I'"rru "t 1�'C"" T`frrmh. Pcrrr<11�"'C: IESIGN Elec. Permit Fee: IEPERMIT thhcr Al., ch. Insp. Onc"'t� hlomT, Other Elec. Insp. 0.0 $45.00 alc'c {z. fnsp' I 'c J /umh. h)xp. FCC, / -"/C( Insp. Pao: NOTE. This estimate does not include fees due to other Departments (i. e. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc). These fees are based on the oreliminary information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11 -053 Ef: 7j il!12) FEE QTY/FEE MISC ITEMS Plan l.'hc.ck T A Suppl. PC Fee: Q Reg. Q OT 0.0 1 hrs $0.00 f'ltrrnl�.; 1 f�t:Cr.i�;fet Permit Fee: $532.00 Suppl. Insp. Fee-0 Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $45.00 PME Permit Fee: $45.00 Cwnsfruction Trrr. AdIninistnaive Fee: Work Without Permit? Yes (j) No $0.00 Sign Master Plan: Yes (!) No $0.00 Travel Documentation Fee: ITRAVDOC $45.00 Strong Motion Fee: IBSEISMICO $0.53 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $668.53 $0.001 TOTAL FEE; $668.53 Revised: 10/01/2012 CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014 -3255 Telephone: 408 - 777 -3228 Fax: 408 - 777 -3333 JOB ADDRESS: r -P-JAAle-cl PERMIT # OWNER'S NAME: PHONE # GENERAL CONTRACTOR: �,d �� {� ct �kt< <— . BUSINESS LICENSE # ADDRESS: U < �, -ITY /ZIPCODE: *Our municipal code requires all businesses working 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 SUBCONTRACTORS 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: Owner / C 1 -'/6 >-� (-�2- Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping r ' '�� Lathing J °° Masonry Painting / Wallpaper Paving Plastering la Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner / C 1 -'/6 >-� (-�2- Date Arnrt;ust Kax w . Errs %alt S« I 228'1 1 r44 Quetwi s 4'eos:x"im; OtfbO " e.1,10 ,±fxft CA ; ?Fi i ? %-[a�x�artattCt HOW) 661(' 1 r' 7 �: rra �t� � w�t�i'���tr <� €r7r7trarr� Caatd a r'� 60 ft. I iljl!lIIIIIIIIIIIIIillli�llllll - 32 ft. Ifr11l�lllll' s3H..]A�N,1I�I�IAII u Fascia Building Mounting Screw (3) Min, #10 x 1/2" 5" Aluminium Return (,040) Trim cap —� Acrylic Face —� 18 AWG Jumper Wire Class 2 Low Voltage i Wiring, Note: No conduit or Flex required per Class 2 Low Voltage wiring guideline Mounting Bracket I '; LED Strip Trim Cap 114" Drain Hole Junction Box with Disconnect Switch Primary electrical source Power Supply (120 -277 VAC) Sign - to - Wall Fastener 4 E314210 377" n, > -0 P OLt I p -) Mn N S_tA ut L -,I ky,� 88" 1 iL 6" A. ' � - S ign Type: (1) Internally illuminated L.E,D individual Channel Letters Sign, Letter Face: 3116" Thick acrylic face color as shown Letter Returns: 5" Black with .040 Aluminum Trim Cap: 314" Black i-rojeCT LOcauon • , 1744 Queens Crossing Drive — San Jose — CA 95132 10895 S. Blaney Cupertino I T.- (408) 667 -1777 E -mail: swu1966 @gmail.com RRCEj[vED DEC 0 7 12 U FRTIM0 Fk;ildincg Department D 0 2012 I c E CO P, PLOT Pi.AJN3 CHECKL By ONPL eN0jEP% DATE TT, . U--ucce s 1 6 1744 Queens Crossing Drive - San Jose - CA 95132 T (408) 667-1777 E -mail: swu1966@gmail.com 10895 S. Blaney Cupertino I I W I�ACMRTIMO 4 ..'Ailding Department DEC 0 7 2012 P.1 I SOED F-CR %.j -PLIAN01- Q may.