10120022I CITY OF CUPERTINO BUILDING PERMIT I
BUILDING ADDRESS: 19626 STEVENS CREEK BLVD
OWNER'S NAME: JOO-DONG KIM
OWNER'S PHONE: 4083147703
L LICENSED CONTRACTOR'S DECLARATION
License Class Lic. #
Contractor
Date
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.
CONTRACTOR: JOO-DONG KIM PERMIT NO: 10120022
19626 STEVENS CREEK BLVD DATE ISSUED: 12/03/2010
CUPERTINO, CA 95014 PHONE NO:
BUILDING PERMIT INFO: BLDG r ELECT F PLUMB F
MECH F_ RESIDENTIAL I— COMMERCIAL F
JOB DESCRIPTION: KONG TOFU & BBQ - SIGN (ILLUMINATED SIGN) IN
FRONT
& ONE IN BACK
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 Sq. Ft Floor Area:
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 Code, Section
9.18.
Signature.
Date
/ OWNER -BUILDER DECLARATION
I 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 (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, 1 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,
cngts, and expenses which may accrue against said City in consequence of the
ing of this permit. Additionally, the applicant understands and will comply
all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Signature Date \ /
Valuation: $5000
APN Number: 36906009.19626 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 12— - '7.
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.
Owneauth zed agent:
t '7 Date: «�3
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
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
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: cel^S' CVS g �v
PERMIT # Z 6 z 2—L_
OWNER'S NAME: 1Cri,-
PHONE # 41 % ;1 4 - 770
GENERAL CONTRACTOR:
BUSINESS LICENSE #
ADDRESS:
CITY/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. C�
I am not using any subcontractors: l
Signature
Please check applicable subcontractors and complete the following information:
Date
Owner / Contractor Signature
Date
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
V
Electrical
s S��►^ S'
; ��61�
Excavation
Fencing
Flooring / Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner / Contractor Signature
Date
CUPERTINO
OWNER -BUILDER DISCLOSURE FORM
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 - FAX (408) 777-3333 - building(alcupertino.org
Dear Property Owner(s):
An application for a building permit has been submitted in your name listing yourself as the builder of the property
improvements specified at:
SITE ADDRES APN BP �L
Vee
OWNER NA EI OWNER ADDRESS
:Ttbt�wt k,DESCRIPTION OF WORK:
We are providing you with an Owner -Builder Acknowledgment and Information Verification Form to make you aware of
your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner -Builder. We
will not issue a building permit until you have read, initialed your understanding of each provision, signed, and
returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless
you, the property owner, obtain the prior approval of the permitting authority.
OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION
(DIRECTIONS: Please read and initial each statement below to signify you understand or verify this information.)
1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -
Builder" building permit that erroneously implies that the property owner is providing his or her own labor and material
personally. I, as an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by
an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not
provide coverage for those injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my
insurance coverage for injuries to workers on my property.
�, 2. 1 understand building permits are not required to be signed by property owners unless they are responsible for
the construction and are not hiring a licensed Contractor to assume this responsibility.
L_3. I understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may
protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her
name instead of my own.
y__-1_4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license
numbers on permits and contracts.
�L_5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the
total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be
considered an "employer" under state and federal law.
C6. I understand if I am considered an "employer' under state and federal law, I must register with the state and
federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to
unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject
me to serious financial risk.
��_7. 1 understand under California Contractors' State License Law, an Owner -Builder who builds single-family
residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by
licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work
is performed under contract with a licensed general building Contractor.
�8. 1 understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for
any financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction
defects in the workmanship or materials.
OwnerBuilderFonn 2010.doc revised 04/14/10
9. I understand I may obtain more information regarding my obligations as an "employer" from the Internal
Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments,
and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State
License Board (CSLB) at 1-800-321-CSLB (2752) or www.csib.ca.gov for more information about licensed
contractors.
�10. I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that
am the party legally and financially responsible for proposed construction activity at the site address listed above.
11. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide
by all applicable laws and requirements that govern Owner -Builders as well as employers.
�12. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the
information I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If
you contract with someone who does not have a license, the Contractors' State License Board may be unable to
assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed
Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or
employee of that individual or firm is injured while working on your property, you may be held liable for damages. If
you obtain a permit as Owner -Builder and wish to hire Contractors, you will be responsible for verifying whether or not
those Contractors are properly licensed and the status of their workers' compensation insurance coverage.
CONSTRUCTION LENDING AGENCY
(DIRECTIONS: Please complete the following construction lending agency information.)
hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued
(Sec 3097 Civ.)
Lender Name: Lender Address:
Before a building permit can be issued, this form must be completed and signed by the property owner and
returned to the agency responsible for issuing the permit. Note: A copy of the property owner's driver's license,
form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued
to verify the property owner's si natu e
Property Owner's Signature: Date:
----------------------------------------------------------------------------------------------------- -- -- ---- ---- - - ----- --
(NOTE. The following Authorization Form is required to be completed by the property owner only when designating an
agent of the property owner to apply for a construction permit for the Owner -Builder).
AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF
Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby
authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an
Owner -Builder Permit for my project.
Scope of Construction Project (or Description of Work):
Project Location or Address:
Name of Authorized Agent:
Address of Authorized Agent:
Tel No
I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the
above information and certify its accuracy. Note: A copy of the property owner's driver's license, form notarization, or other
verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's
signature.
Property Owner's Signature:
Date:
Owne7BuilderFonn 2010.doc revised 04114110
CITY OF CUPERTINO
6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg
COPY # : 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 36906009.19626
DATE ISSUED.......: 12/03/2010
RECEIPT #......... BS000012142
REFERENCE ID # ...: 10120022
SITE ADDRESS 19626 STEVENS CREEK BLVD
SUBDIVISION ......
CITY .............. CUPERTINO
IMPACT AREA ......
OWNER JOO-DONG KIM
ADDRESS ..........: 19626 STEVENS CREEK BLVD
CITY/STATE/ZIP ...: CUPERTINO, CA 95014
RECEIVED FROM JOODONG KIM
CONTRACTOR .......: LIC # *OWNER*
COMPANY JOO-DONG KIM
ADDRESS ..........: 19626 STEVENS CREEK BLVD
CITY/STATE/ZIP ...: CUPERTINO, CA 95014
TELEPHONE .........
FEE ID
UNIT
QUANTITY
AMOUNT
PD -TO -DT
----------
THIS REC
--
NEW BAL
----------
1BCBSC
-------------
VALUATION
----------
5,000.00
----------
1.00
0.00
1.00
0.00
1BSEISMICO
VALUATION
5,000.00
1.05
0.00
1.05
0.00
1EPERMITFE
FLAT RATE
1.00
42.00
0.00
42.00
0.00
1ESIGN
UNITS
1.00
42.00
0.00
42.00
0.00
1SIGNWELEC
EACH
2.00
506.00
0.00
506.00
0.00
1TRAVDOC
FLAT RATE
1.00
42.00
0.00
----------
42.00
----------
0.00
----------
TOTAL PERMIT
----------
634.05
0.00
634.05
0.00
METHOD OF PAYMENT
-----------------
CREDIT CARD
TOTAL RECEIPT :
AMOUNT
---------------
634.05
---------------
634.05
VOICE ID DESCRIPTION
-------- ----------------------------
101 FOUNDATION
104 REBAR
REFERENCE NUMBER
--------------------
AMEX
VOICE ID DESCRIPTION
-------- ----------------------------
103 UFER
105 ANCHOR BOLTS
304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL
CITY OF CUPERTINO
Jl!!I 1V1VU FCTI<MATf)R — RTTIT,DING DIVISION
SIGN TYPE
ADDRESS: 19626 stvns. crk. blvd.
-
DATE: 12/03/2010
REVIEWED BY: bob s.
12
APN:
BP#:
*VALUATION: J$5,000
*PERMIT TYPE: Building Permit
�' �l ` .'i1 r ^ I ),P"
PRIMARY
USE: Sign
7-01
JI'LL 1
PENTAMATION 1 CEAP5
PERMIT TYPE:
WORK
Permit Fee:
SCOPE
Suppl. Insp. Feer Reg. 0 OT
SIGN TYPE
FEE ID
QTY/FEE
QTY
I'/'m (Chc' k f c -<r-
SIGN FEE
Elec. Permit Fee: IEPERMIT
I
Wall Sign, Electric
1 SIGNWELEC
hrs
2
-LA
$506
Permit Fee:
$506.00
Suppl. Insp. Feer Reg. 0 OT
0.0
hrs
$0.00
PME Unit Fee:
$42.00
PME Permit Fee:
$42.00
Con'wrnclion Fa\
r
Sign Master Plan: 0 Yes No
$0.00
Work Without Permit? 0 Yes 0 No
$0.00
TOTALS:
Travel Documentation Fee: 1TRAVDOC
$506.00
Strong Motion Fee: IBSEISMICO
_ __ Contact the Dept for addn'l into.
iyuiz: [nese Lees bre based or[ [rre /eLb -w- ..s
FEE ITEMS (Fee ResoltItion 09-051 El. %i1%Inj
IF,:.
QTY/FEE
# Branch Circuits 1 $42.00
I'/'m (Chc' k f c -<r-
Elec. Permit Fee: IEPERMIT
I
F-7IESIGN
-,
0.0
hrs
$0.00
-LA
Other Elec. Insp. 0.0 $42.00
Permit Fee:
$506.00
Suppl. Insp. Feer Reg. 0 OT
0.0
hrs
_ __ Contact the Dept for addn'l into.
iyuiz: [nese Lees bre based or[ [rre /eLb -w- ..s
FEE ITEMS (Fee ResoltItion 09-051 El. %i1%Inj
FEE
QTY/FEE
MISC ITEMS
I'/'m (Chc' k f c -<r-
Suppl. PC Fee: E) Reg. 0 OT
0.0
hrs
$0.00
P/mill'.=;Vc,ch"'L/Cc; P ilii C hec;
Permit Fee:
$506.00
Suppl. Insp. Feer Reg. 0 OT
0.0
hrs
$0.00
PME Unit Fee:
$42.00
PME Permit Fee:
$42.00
Con'wrnclion Fa\
r
Sign Master Plan: 0 Yes No
$0.00
Work Without Permit? 0 Yes 0 No
$0.00
f'lLttJJ'Itf7,�1`t'c'.ti-
Travel Documentation Fee: 1TRAVDOC
$42.00
Strong Motion Fee: IBSEISMICO
$1.05
Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC
$1.00
SUBTOTALS:
$634.05
$0.00 TOTAL FEE:
F $634.05
Revised: 11/08/2010
IMPAC COMMUNICATION STORE SIGN ELEVATION: 20385 STEVENS CREEK BLVD. CITY OF CUPERTINO
� m
Audimted5" THICK INDIVIDUAL CHANNEL LETTERS, INTERNALLY ILLUMINATION
3/4 51LVER COLOR TRIM -CAP, RETURN PAINTED SILVER COLOR.
ALL LETTER WILL BE WHITE PLASTIC COLOR
SCALE: 1/4"=1'-0" DATE: 5EP-17-2010
20'-0" STORE FRONTAGE
NEW 51GN LOCATION
BUILDING ELEVATION:
Approval: Date:
llekd sign no% (consisle
of O*k" booq, inwhding
dwm. Oak hoe, alba
suppers and d anr* aNMr)
suk" for outdoor
lo=tion unim madmd
for Indoor 0*
Tuba support
par NEC t109.33(b).
Nom tube,
3pecirge maw"
per spacing tib•
P4m* if"
Electrode buulati g
Lefler boot 7,6001 r IaaddNg
skew provided Y& sign.
Drain toles
A used outdoor.
Wd vu as in
ttddoeies and
mallow
Listing maks:
Lletko mart sign section label shall
be on each letter and transformer
enclosure.
The Arlt blank space idimlill os Me
number of each sign section. The
second black spa= mdicales
tlu Intal number of spm sections.
LISTED
by qualified electrical
testing laboratory
ELECTRIC SIGN SECTION
NO. XX•123468
U of 0
!10 x S' lag screws
Mk. 3 per leCer
U.L 2161 POWER SUPPLY
3M In, mWnn listed Asx (metal ahem)
and RaW OTO cable (secondary skte
on* will to the nod salon WW.
NEC 110-3(b) & 90431.
Wire nonftedlon 120 Y Ift
Olsewnt
switch
Installation of signs Rated per UL48
Note: Installation requirementsonly.
Manufacturing requirements contained in U1.48.
ILLUIMNATED CHANNEL LETTER
INSULATING SOOT AND SLEEVE
Data: October 1994
scalaNom
This sign is intended to be installed in accordance with the requirements of Article 600 of the National Electrical Code
and/or other applicable local codes. This includes proper grounding and bonding of the sign
APPROVED
IN ACCONUANC..1 VvITH THE CITY OF
CUPERTINO COOLS AND ORDINANCES
DATE
SIGNED_
This set of plans and specifications MUST
be kept on the lob at all times and it is
unlawful to make any changes or alterations
on same without written permission from
the Building DeF,:inrnent City of Cupertino.
The stamping of this plan and specifications
SHALL NOT b,� held ru permit or to be an
approval of the /lolaiion of ary provisions
of any City ()rdinancf, -.x ;t, 1e Law
IMPAC COMMUNICATION
20385 5TEVEN5 CREEK BLVD.
CITY OF CUPERTINO
m
I
z
STEVENS CREEK BLVD.
SITE PLAN
OFFICE
All designs & art works belong to Allen Signs, Inc. Any duplication is prohibited. COPY RIGHT 2010
N
CWE
S
SUBMITTAL
#1
�cElvEr�
DEC 0 71010
RY/Pn
Sigma
All designs & art works belong to Allen Signs,
any duplication is probibited COPYRIGHT 2010
E-mail address. allensigns@yahoo.com
Te1:4081280-6500 Fax:4081280-6700
1982 Stone Ave. San Jose, Ca. 95125 State Lic. # 834580