11100038CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20803 ALVES DR CONTRACTOR: ILLUMINART PERMIT NO: 11100038
OWNER'S NAME: YMCA OF SILICON VALLEY 1206 OLD MTN VIEW ALVISO RD STE D DATE ISSUED: 10/06/2011
OWNER'S PHONE: 4083711526 SUNNYVALE, CA 94089 PHONE NO: (408)289-1883
or ^LI(C�ENSED CONTRACTOR'S DECLARATION
ril-
License Class Lic. k 276
Contractor Date
1 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 urce regulations per the Cupertino Municipal Code Section
9.18.
SignatureDate�fo�
❑ 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)
1, 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.
l 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.
BUILDING PERMIT INFO: BLDG I— ELECT r— PLUMB r—
MECH r— RESIDENTIAL r— COMMERCIAL r—
JOB DESCRIPTION: INSTALL NON -ILLUMINATED MONUMENT SIGN
Sq. Ft Floor Area: I Valuation: $4200
APN Number: 32632039.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 0 DAYS OF PERMIT ISSUANCE OR
180 D ROM jLAST CALLED INSPECTION.
Issued by: �/ Date:
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
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 Health &
Safety Code, Section 25532(a) should 1 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, 255339 and 255
O*--� thorized agent:
Date: �D
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.
Signature Date
Licensed Professional
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 20803 alves dr. I DATE: 10/06/2011 REVIEWED BY: bobs.
APN: I BP#: 'VALUATION: 1$4,200
*PERMIT TYPE: Building Permit
PRIMARY SiPENTANIATION
Sign USE: PERMIT TYPE:
WORK install non illuminated monument sign
SCOPE
1 CEAP5
SIGN TYPE
FEE ID
QTY
SIGN FEE
Ground Sign J
1 SIGNGR/RF
1
$327
TOTALS:
$327.00
# Branch Circuits 1 $44.00
JESIGN -nit Fee: IEPER Elec. Pen MT
F-1
ET
Other Elec. Insp. LLOJ $44.00
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
Diviriet ole ) Thovo foot aro haeod nn thp nrply'"d"arw infnrmaiinn awdinhipand nro nniv an oclimalp Cnn1af4 1hp Dont Mraddpi'l info_
FEE ITEMS (I,ee Resolution 11-053 Eff 7/1/111
FEE
QTYIFEE
MISC ITEMS
-he(
Suppl. PC Fee: 0 Reg. 0 OT 10.0
hrs
$0.00
Permit Fee:
$327.00
Suppl. Insp. Fee.0 Reg. 0 OT
F-
0
hrs
$0.00
PME Unit Fee:
$44.00
PME Permit Fee:
$44.00
Work Without Permit? C) Yes (D No
$0.00
Sign Master Plan: C) Yes (E) No
$0.00
A
Travel Documentation Fee: I TRA VDOC
$44.00
Strong Motion Fee: IBSEISAECO
$0.88
Select an Administrative Item
1
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$460.88
$0.00 TOTAL FEE:
$460.881
Revised: 10/01/2011