11090146CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10562 S DE ANZA BLVD
CONTRACTOR: MID WAY SIGNS
PERMIT NO: 11090146
OWNER'S NAME: BYER PROPERTIES
3290 BASSETT ST
DATE ISSUED: 09/20/2011
OWNER'S PHONE: 4156262937
SANTA CLARA, CA 95054
PHONE NO: (408)982-9696
LICENSED CONTRACTOR'S DECLARATION
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BUILDING PERMIT INFO: BLDG ' ELECT PLUMB
f" ���j
License Class! Lic. # O
mRESH)ENTIAL
Contractor Date
MECH COMMERCIAL
I hereby affirm t t I am licensed under the provisions of Chapter 9
JOB DESCRIPTION: FIDELITY NATIONAL TITLE - ILLUMINATED CHANNEL
(commencing with Section 7000) of Division 3 of the Business & Professions
LETTER SIGN
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.
Sq. Ft Floor Area:
Valuation: $2500
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.
APN Number: 36938037.10562
Occupancy Type:
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
PERMIT EXPIRES IF WORK IS NOT STARTED
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs, and expenses which may accrue against said City in consequence of the
180 DAYS FROM JAST CALLED INSPECTION.
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
Ote:
9.18. %
Issued by:
��L
RE -ROOFS:
❑ OWNER -BUILDER DECLARATION
All roofs shall be inspected prior to any roofing material being installed. If a roof is
I hereby affirm that I am exempt from the Contractor's License Law for one of
installed without first obtaining an inspection, I agree to remove all new materials for
the following two reasons:
inspection.
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,
Signature of Applicant: Date:
Business & Professions Code)
I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
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
I have read the hazardous materials requirements under Chapter 6.95 of the
Compensation, as provided for by Section 3700 of the Labor Code, for the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
performance of the work for which this permit is issued.
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
I have and will maintain Worker's Compensation Insurance, as provided for by
Safety Code, Section 25532(a) should I store or handle hazardous material.
Section 3700 of the Labor Code, for the performance of the work for which this
Additionally, should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
permit is issued.
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
I certify that in the performance of the work for which this permit is issued, I shall
Health & Safety Code, Sections 25505, 25533, and 25534.
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
Date:
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION
I hereby affirm that there is a construction lending agency for the performance of work's
I certify that I have read this application and state that the above information is
for which this permit is issued (Sec. 3097, Civ C.)
correct. I agree to comply with all city and county ordinances and state laws relating
Lender's Name
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
Lender's Address
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
ARCHITECT'S DECLARATION
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
I understand my plans shall be used as public records.
9.18.
Licensed Professional
Signature Date
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 10562
DATE: 09/20/2011
REVIEWED BY: larrys
APN:
BP#:
-VALUATION: 1$2,500
}PERMIT TYPE: Building Permit
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PRIMARY Si n
USE: g
77-[PERMIT
ENTAMATION 1 CEAP5
TYPE:
WORK
illuminated channel letter sign
SCOPE
SIGN TYPE
FEE ID
QTY
SIGN FEE
Wall Sign, Electric
1SIGNWELEC
1
$260
TOTALS:
1 $260.00
.."• <. r _�- (:f',
�r�?,. -- t""trl+r:?;
# Branch Circuits 1 $44.00
1r�, .,. -°er�ar , , .._.
I° a�r�r1>. _, ret rri- F<:;e:
IESIGN
Elec. Permit Fee: IEPER ffT
r�%11L—'r Pf :ar„ TarLj
Other Elec. Insp. 0.0 $44.00
NOTE. This estimate does not include fees due to other Depts (i.e. Public Works, Sanitary Sewer District, School District, etc.).
These fees are based on the Dreliminary information available and are only an estimate. Contact the Dent for addn'l info.
FEE ITEMS (Fee Resohitiolr 11-053 a. 7/L11I
FEE
QTY/FEE
MISC ITEMS
7
Suppl. PC Fee: (D Reg. 0 OT
0.0
1 ln•s
$0.00
'/ ,.
Permit Fee:
$260.00
Suppl. Insp. Fee: Reg. 0 OT
0.0
hrs
$0.00
PME Unit Fee:
$44.00
PME Permit Fee:
$44.00
-T-T
r
,'E f. T72r�t:�•�'�•f j:°Ii';.:' � C'i:,'.
Work Without Permit? 0 Yes Q No
$0.00
Sign Master Plan: 0 Yes Q No
$0.00
Travel Documentation Fee: ITRAVDOC
$44.00
Strong Motion Fee: IBSEISMICO
$0.53
Select an Administrative Item
Bldg Stds Commission Fee.: 1BCBSC
$1.00
SUBTOTALS:
$393.53
$0.00 TOTAL FEE:
1 $393.53
Revised: 09/02/2011