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13030031CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10889 S BLANEY AVE CONTRACTOR: A D & C DESIGN OWNER'S NAME: PACIFIC RIM PARK LLC OWNER'S PHONE: 4082554163 ❑ LICENSED CONTRACTOR'S DECLARATION License Class ! Lic. # Z g 2 Contractor Date _4� I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 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 theabove 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 t �Date C ❑ : 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 Compensalion 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 2060 WARM SPRINGS CT APT 4 FREMONT, CA 94539 JOB DESCRIPTION: RESIDENTIAL PERMIT NO: 13030031 DATE ISSUED: 03/06/2013 PHONE NO: (510)625-9566 INSTALL 18" ILLUMINATED LED CHANNEL LETTER RACEWAY SIGN Sq. Ft Floor Area: I Valuation: $1500 APN Number: 36934052.10889 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE_ OR 180 DAY F OM LAST CALLED INSPECTION. Issued by: DM4. �d 3 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 25505, 25533, and 25534. Owner or authorized agent: Dater 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 • build ing(U_)cupertino.org PROJECT ADDRESS h'j� ( ( APN# 3�q s a 0. ! c, OWNER NAME PHONE r j[I / 2 ) f 1 b ) E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX CONTACT NAME r,U V W PHONE4a 2 7 v S ,—g (S' S E-MAIL. STREET ADDRESS V �l . f{ ' /3 ]OWNER CITY, STATE, ZIP l i 0 f FAX ❑ OWNER ❑ OWNER -BUILDER ❑ AGENT ® CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME 5 V LICENSE NUMBER Z !a LICENSE TYPE C k i BUS. LIC # COMPANY NAME C-6 �l lS� E-MAIL 16l \ < �� FAX STREET ADDRESS v i `� S- C 2v 6, WAYvtn CITY, STATE, ZIP ._ V�e;,IAa(4 PHONE C r - 6Is— C �X (S6 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK j D C USE OF ❑ SFD or Duplex ❑ Multi -Family ILLUMINATED SIGN TYPE NO. OF SIGN AREA VALUATION STRUCTURE: ❑IC Commercial (Y / N) ((CODE) SIGNS (SQ. FT.) M SIGN TYPE CODES: 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 RECEIVE TOTAL VALUATION: 8 By my signature below, I certify to each of the following: I am the property ownef o uthorized 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 and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: ^ SUPPLEMENTAL INF RMATION REQUIRED OFFICE USE ONLY PLAN CHECK TYPE ROUTING SLIP Site Plan ❑ OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW Elevations Sign Details - including UL listing(s) applicable ❑ EXPRESS ❑ PLANNING PLAN REVIEW Structural Calculations (if applicable) ❑ STANDARD ❑ OTHER: _ Copy of Planning Approval Letter or Meeting with Planning prior to ❑ LARGE submittal of Building Permit application. ❑ MAJOR SignApp_2011.doc revised 03131111 CITY OF CUPERTINO Ti FF 1W4ZTr1V4 A TnR — RITIIDING DIVISION SIGN TYPE FEE ID QTY SIGN FEE Wall Sign, Electric 1SIGNWELEC 1 $266 TOTALS: w $266.00 Ifech. Plan Check' Phunb. Plan Check # Branch Circuits 1 -$45.00 :'Meeh. Permit Fee: Plumb. Permit Pees IESIGN Elec. Permit Fee: IEPERMIT Other Meeh. Insp. Other Plumb Insp. Other Elec. Insp. 0.0 $45.00 Meeh. Insp. Fee: Plumb. Insp. Fee: Elec. Insp. Fee: NOTE: This estimate does not include fees due to other vepartmenrs (tie. rtanning, ruouc rrorn�, rare, au✓uu.y .�crvc..�.,. ��, �.�.�� District, etc). Theseees are based on the prefinWina information available and are only an estimate. Contact the Dept for addn7 info, ADDRESS: 10889 S BLANEY AVE DATE: 03/06/2013 REVIEWED BY: MENDEZ MISC ITEMS APN: BP#: *VALUATION: $1,500 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: PRIMARY Sign Plum b./Mecll./Elec PENTAMATION 10EAP5 USE: Permit Fee: PERMIT TYPE: A WORK INSTALL 18" ILLUMINATED LED CHANNEL LETTER RACEWAY SIGN hrs $0.00 SCOPE PME Unit Fee: SIGN TYPE FEE ID QTY SIGN FEE Wall Sign, Electric 1SIGNWELEC 1 $266 TOTALS: w $266.00 Ifech. Plan Check' Phunb. Plan Check # Branch Circuits 1 -$45.00 :'Meeh. Permit Fee: Plumb. Permit Pees IESIGN Elec. Permit Fee: IEPERMIT Other Meeh. Insp. Other Plumb Insp. Other Elec. Insp. 0.0 $45.00 Meeh. Insp. Fee: Plumb. Insp. Fee: Elec. Insp. Fee: NOTE: This estimate does not include fees due to other vepartmenrs (tie. rtanning, ruouc rrorn�, rare, au✓uu.y .�crvc..�.,. ��, �.�.�� District, etc). Theseees are based on the prefinWina information available and are only an estimate. Contact the Dept for addn7 info, FEE ITEMS (Fee Resolution 11-053 Ef. . 7/1/12) FEE QTY/FEE MISC ITEMS Plan Check Fee: Suppl. PC Fee: (j)Reg. ® OT 0.0 hrs $0.00 Plum b./Mecll./Elec Permit Fee: $266.00 Suppl. Insp,,Fee:q Reg. ® OT 0,0 hrs $0.00 PME Unit Fee: $45.00 PME Permit Fee: $45.00 -T-T Construction Tax: A.dtninistrative .Fece: Work Without Permit? 0 Yes Q No $0.00 Sign Master Plan: Q Yes (E) No $0.00 Travel Documentation Fee: 1TRAVDOC $45.00 Strong Motion Fee: 1BSEISMICO $0.50 Select an Administrative Item Bldg Stds Commission Feer IBCBSC $1.00 $402.50 $0.00 $402.50 Revised: 01/01/2013 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C O P E RT I N O Fax: 408-777-3333 CONTRACTOR / SUBCONTRACTOR 'IST' JOB ADDRESS: PERMIT # I OWNER'S NAME: PHONE #- GENERAL CONTRACTOR: BUSINESS LICENSE# ADDRESS: CITY/ZIPCO .E: *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 „ SCI=IEDULED 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-;--, -i 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 z Septic Tank Sheet Metal Sheet Rock Tile f Owner / ontractor Signature Date 18" HIGH ILLUMINATED LED CHANNEL LETTER SIGN ON RACEWAY FOR "QQ NOODLE" COLORS AND MATERIAL: t SIGN FACE: WHITE 3/16" THICK TRANSLUCENT PLEX SHEET WITH GREEN VINYL Phone: SIGN BODY: BRONZE Company: TRIM CAP: 314" BRONZE TRIM CAP 18" RACEWAY PAINTED TO MATCH THE WALL COLOR numberor ALL LETTERS ARE UL LISTED date: 02/25/2012 Frontage EXISTING SIGN 27.8' -- Frontage PROPOSED SIGN t QQ N00t)LE NIP, . h r: NEW SIGN 4 PEGGED OUT FROM RACEWAY SILICONE SEALED L.E.D. UNITS TRANSLUCENT PLEX FACE 1/4"x3/4" SELF DRIVE SCREW (MINI 4/LETTER) - CLASS 2 POWER SUPPLY DC 12V, 6 Amp' 314" TRIM CAP •--� 1/4" DRAIN HOLE •— GROUNDING LUG OR RING 10411 D,:v ni t �. e�ra ap RACEWAY LISTED DISCONNECT SWITCH -• (WATER PROOF) RACEWAY BE SECURED ON STUCCO WALL BY 1/4"x2" ANCHOR BOLT EVERY 36" INTERVALS BLDG. WALL (WOOD) PRIMARY ELECTRIC LINE (NEC600.5) TO JUNCTION BOX (120V, 20Amp CIRCUIT) LED LETTER SECTION SCALE: 1"=16" Note: Col,ars depicted firer eWTMENT CO a graphic representai�n--RTIN0 actual colors maxvap- Total align area:113x104/1fjnWggT<ept at the of pla^s and ape !i`,: ations J vc s} �, icn. It is unlawful to malany ,..� c; Gitr>.rat!o;is on same, or to deviate Official. royal from the Building fir rafrOni, W; Official. approve. Y t 1ni e, of this plan and specifications SHALL NOT roval of the violation perffiit Or t0 be an a^P �isicns Of any City Ordinance or State Law. ,3) tD� BUSINESS ADDRESS address: 10889 S Blaney Ave Cupertino, CA 95014 Contact : Mr, wu Phone: 408-705-8155 Company: 510-625-9566 APPROVAL BY PROPERTY OWNER address: phone: signature: date: PROJECT APPLICANT name: AD&C DESIGN address: 2060 warm springs CTti4 Fremont, CA 94539 phone: 510-625-9566 contact person: Simon numberor 929828 date: 02/25/2012 HCE COPY