09080184Permit ` Property
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SIGNS, OUTLINE LIGHTING & MARQ
Usage Class
i
Fcirrph irltnrilb=fL61-1
NON APPLICABLE
Applied Value x
Permit Number
09080184
0
Calculated Value
Status
E - Expired
437 ICI
Blaster Number
Permit Form x
14I
Notes 0
Project
Project Size
COUNTER -OVER THE COUNTER
ICI
Apply Date
08!19!2009
Ilt
Operator patg
Permit Issue Date
r
08/19/2009
Operator patg
Certificate Issued
02/19/2010
Operator
Certificate Type
Certificate Number
EXPIRED
Permit ` Property
Zoning Applicant Contractor ` Defined Fields
Permit Details
Permit Type `
10EAP5 ICI
SIGNS, OUTLINE LIGHTING & MARQ
Usage Class
NIA ICI
NON APPLICABLE
Applied Value x
5000
SQUARE FT.
0
Calculated Value
01--11
US C-404 Type
437 ICI
ALT: NON -RES, NON-HSKPG
Permit Form x
AUTOPERM - PERMIT
Ownership
1 - Private
Project Size
COUNTER -OVER THE COUNTER
f.
i
Permit issued 08J19J2009
Enter the purpose or any special conditions for this permit
Lui_aLO11 ll.. �sr. r ;`,
Address x I 19620 STEVENS CREEK BLVD
City/State/Zip CUPERTINO
APN 36906010.00
Unit
�-�!^JI i2. �rlit,' �iliC �Ciai'a=rl
(Owner Name xl EVERSHINE VI &ANNIE CHAN
Use Default ❑
Address Home -19770 STEVENS CREEK BLVD
City/State/Zip CUPERTINO
CA 95014
CA 95014
Purpose/Special Conditions
INSTALL 3 NEW RACEWAY MOUNTED SIGNS
NO INPSECTIONS, PERMIT EXPIRED 2/19/2010
FILMED 6/20111
l[OAdd Default T
OK
141* Back
lC, Conti
Fees
I> Plan
181 nspE
Irk Print
IC7 Copy
CIOSE
Over
Supp
'' INote
lC]Attac
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19620 STEVENS CREEK BLVD
CONTRACTOR: JOHNSTON ELECTRIC
PERMIT NO: 09080184
SIGN CO.
OWNER'S NAME: EVERSHINE VI & ANNIE CHAN
3627 MT VERNON RD
DATE ISSUED: 08/19/2009
OWNER'S PHONE: 4083431080
SEBASTOPOL, CA 95472
PHONE NO: (707)829-7332
❑ LICENSED CONTRACTOR'S DECLARATION
I— T_
U C, e e—, C_( y
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class � Lic. # _(
r—r—
p j ,..
Contractor _Tf Y � ./ `4'7;7" Date r5' r 11 � eld:\
MECH RESIDENTIAL COMMERCIAL�
I hereby affirm that I am licensed under the provisions of Chapter 9
JOB DESCRIPTION: INSTALL 3 NEW RACEWAY MOUNTED SIGNS
(commencing with Section 7000) of Division 3 of the Business & Professions
Code and that my license is in full force and effect.
1 hereby affirm under penalty of perjury one of the following two declarations:
1 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
Sq. Ft luati :$5000
performance of the work for which this permit is issued.
WW,,!X
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
APN N 90 ,:0 ancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
PERMIT EXPIRES IF WORK IS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
180 DAYS FROM LAST CALLED INSPECTION.
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
Issued by: Date:
with all non-point source regulations per the Cupertino Municipal Code, Section
C�
9.18.
Signature (stA Date '6
RE-ROOFS-
E-ROOFS:All roofs shall be inspected prior to any roofing material being installed. If a roof is
Al I
❑ OWNER-BUILDER DECLARATION
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
Signature of Applicant: Date:
1, 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)
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
HAZARDOUS MATERIALS DISCLOSURE
I hereby affirm under penalty of perjury one of the following three
I have read the hazardous materials requirements under Chapter 6.95 of the
declarations:
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
I have and will maintain a Certificate of Consent to self-insure for Worker's
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Compensation, as provided for by Section 3700 of the Labor Code, for the
Safety Code, Section 25532(a) should I store or handle hazardous material.
performance of the work for which this permit is issued.
Additionally, should 1 use equipment or devices which emit hazardous air
I have and will maintain Worker's Compensation Insurance, as provided for by
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
Section of the Labor Code, for the performance of the work for which this
Health & Safety Code, Sections 25505, 25533, and 25534.
permit is issued.
issu
I certify that in the performance of the work for which this permit is issued, I shall
Ow r author'idejf gent: o�
not employ any person in any manner so as to become subject to the Worker's
!/ Date:
Compensation laws of California. If, after making this certificate of exemption, 1
become subject to the Worker's Compensation provisions of the Labor Code, I must
CONSTRUCTION LENDING AGENCY
forthwith comply with such provisions or this permit shall be deemed revoked.
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.)
APPLICANT CERTIFICATION
Lender's Name
1 certify that 1 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
Lender's Address
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
1 understand my plans shall be used as public records.
granting of this permit. Additionally, the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code, Section
Licensed Professional
9.18.
Signature Date
gam,
CITY OF
CUPEf�TINO
CITY OF CUPERTINO
SIGN
PERMIT APPLICATION FORM
09 0 4F 0) N
APN #
Date:
�9
Building Address:
15 L09 5 (Q�l��
c�oc IC alr v�
Mailing Address (if different from building address):
Owner's Name:
Phone#:
S�ILIP
Contractor:
Phone #: 707 c� Z 1 733 Z
J 515n
Fax #- %G2 46LI Ta --J
Contractor License #:
Cupertino Business License #:
Contact:
Phone #: 7 (/ 7 cc 7-5 ? 3 3 Z
,T-6dW J
Fax#. ?U? C6 T
Building Permit Info:
Bldg Elect
Monument ❑ Mounted on Building
Residential ❑
Commercial [�—
Job Description:
Valuation (cost of project): SdGG �i
Project Size: Express ❑ Standard. ❑
Large ❑ Major ❑
Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the
application or if applicable,
include in plan set & the sheet index.
L-Pu� `7?? 321`6
Revised 01/07/09
1.
I11-
.
CITY OF
CUPERTINO
CITY OF CUPERTINO
SIGN
FEESCHEDULE
Quantity
Fee ID
Fee Description
Fee
Group
Permit Type
1 SIGNDIRECT
Directional
i
B
1SIGN/RF
Ground/Roof/Projecting Signs
I
B
1 SIGNMASCK
Master Plan Sign Check
B
1 SIGNREWRKG
Rework of any existing Ground
Sign
B
1 SIGNOTHER
Other Sign
B
1 SIGNREINSP
Re -inspection Fee
i
B
1 SIGNWNONEL
Wall/Awning Sign, Non-
Electric
B
1 SIGNWELEC
Wall, Electric
E
3
IESIGN
1 Sign, Outline Lighting System
j or Marquee supplied from one
branch
E
10EAP5
IESIGNADD
Additional Branch Circuit on
Same Sign, Outline System or
Marquee
E
10EAP6
IELCPLNCK
'Plan Check Fee
E
PERMITFEE
Electric Permit Fee
i
E
1 BCBSC
Cal Bldg Standards Commision
!Fee
B
ALL PERMIT TYPES
/-ff3SEISMICRE
SEISMICOM
Seismic Commercial
B
Seismic Residential
B
jjYRAVDOC
Travel & Documentation
B
I!MUSLIC
Business License
B
CITY OF
CU?EkTINO
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
Building Department
JOB ADDRESS:
�re���►s C�. �i� gc��lG12
PERMIT #
OWNER'S NAME:
PHONE # 7 d-) .1 7 3 7 2
GENERAL CONTRACTOR: '-10 efd j o T aj
FAX # -7c/ -2 C6 2 1. 5 a S
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
O er/Contractor Signature
$-(5a'I
Date
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
O er/Contractor Signature
$-(5a'I
Date
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19620 STEVENS CREEK BLVD
OWNER'S NAME: EVERSHINE VI & ANNIE CHAN
O � _R'S PHONE: 4083431080
❑ LICENSED CONTRACTOR'S DECLARATION
License Class
o Ci
j� Lic. # �' 5
/�
Contractor (i ,�a J 6�7 f�C� Date d
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.
1 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
1 certify that 1 have read this application and state that the above information is
correct. 1 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 (/tet/ Date k^6 ^11-G
❑ OWNER -BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
1, 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 (See.7044, Business & Professions Code).
1 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
ur 'Ie above mentioned property for inspection purposes. (We) agree to save
ii ify 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
CONTRACTOR: JOHNSTON ELECTRIC
PERMIT NO: 09080184
SIGN CO.
3627 MT VERNON RD
DATE ISSUED: 08/19/2009
'iEBASTOPOL, CA 95472
PHONE NO: (707)829-7332
.3UILDING PERMIT INFO: BLDG r
ELECT I— PLUMB
MECH r RESIDENTIAL f— COMMERCIAL
JOB DESCRIPTION: INSTALL 3 NEW RACEWAY MOUNTED SIGNS
.Sq. Ft Floor Area:
Valuation: $5000
.APN Number: 36906010.00
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:
-y-
RE-ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, 1 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. 1 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 1 will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505, 25533, and 25534.
Owi r author' agent:
/
Date:
CONSTRUCTION LENDING AGENCY
1 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
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional