10120039 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20385 STEVENS CREEK BLVD CONTRACTOR:ALLEN SIGNS INC PERMIT NO: 10120039
OWNER'S NAME: AT&T 1982 STONE AVE DATE ISSUED: 12/07/2010
O"'NER'S PHONE: 4088074638 SAN JOSE,CA 95129 PHONE NO:(408)280-6500
Ed LICENSED CONTRACTOR'S DECLARATIONI—�t�¢.�� BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class �" Lic.# &3�7_'�_,Qy ___
MECH RESIDENTIAL COMMERCIAL
Contractor Date
I hereby affirm that 1 1 censed under the provisions of Chapter 9 JOB DESCRIPTION:AT&T STORE-INTERNALLY 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.
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: Valuation:$1500
permit is issued.
APPLICANT CERTIFICATION APN Number:31626090.20385 Occupancy Type:
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 PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM AST CALLED INSPECTION.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. �
7 , Issued by: Date:I Z 10
Signature6�n-f--
Date 'y
OWNER-BUILDER DECLARATION
RE-ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is
the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for
I,as owner of the property,or my employees with wages as their sole compensation, inspection.
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code) Signature of Applicant: Date:
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
I hereby affirm under penalty of perjury one of the following three
declarations: HAZARDOUS MATERIALS DISCLOSURE
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 I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material.
Additionally,should I use equipment or devices which emit hazardous air
permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will
I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534.
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 Ownerr th ized a ent: ,
forthwith comply with such provisions or this permit shall be deemed revoked. Date: �7
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's
correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.)
to building construction,and hereby authorize representatives of this city to enter Lender's Name
upon the above mentioned property for inspection purposes.(We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
and expenses which may accrue against said City in consequence of the
mg of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. 1 1 understand my plans shall be used as public records.
Signature / Date � 74 0 Licensed Professional
CITY OF CUPERTINO
6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 31626090 .20385
DATE ISSUED. . . . . . . : 12/07/2010
RECEIPT #. . . . . . . . . : BS000012163
REFERENCE ID # . . . : 10120039
SITE ADDRESS . . . . . : 20385 STEVENS CREEK BLVD
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . . AT&T
ADDRESS . . . . . . . . . . : 20385 STEVENS CREEK BLVD
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : KIMBERLY LIN
CONTRACTOR . . . . . . . : ALLEN LIN LIC # 22174
COMPANY . . . . . . . . . . : ALLEN SIGNS INC
ADDRESS . . . . . . . . . . : 1982 STONE AVE
CITY/STATE/ZIP . . . : SAN JOSE, CA 95129
TELEPHONE . . . . . . . . : (408) 280-6500
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 1, 500 . 00 1 . 00 0 . 00 1. 00 0 .00
1BSEISMICO VALUATION 1, 500 . 00 0 .50 0. 00 0.50 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 1. 00 253 .00 0.00 253 . 00 0 .00
1TRAVDOC FLAT RATE 1. 00 42 .00 0 .00 42 .00 0 .00
---------- ---------- ---------- ----------
TOTAL PERMIT 380 .50 0 .00 380 .50 0 .00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 380 .50 VISA
---------------
TOTAL RECEIPT 380 .50
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
101 FOUNDATION 103 UFER
104 REBAR 105 ANCHOR BOLTS
304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 20385 Stevens Creek BLVD DATE: 12/07/2010 REVIEWED BY: RDW
APN: BP#: *VALUATION: 1$1,500
xPERMITTYPE: Building Permit
PRIMARY FOO ! PENTAMATION
Sign
10EAP5
USE: PERMIT TYPE:
WORK
SCOPE
SIGN TYPE FEE ID QTY SIGN FEE
Wall Sign,Electric 1SIGNWELEC 1 $253
TOTALS: $253.00
#Branch Circuits 1 1 $42.00
IESIGN Elec.Permit Fee: IEPERMIT
LiOther Elec.Insp. 0. $$42.00
NOTE. Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addn'1 info.
FEE ITEMS (Fee Resolutiorn 09-051 Etf. 7%1;70 FEE QTY/FEE MISC ITEMS
Phar= (7tec'k F"cr
Suppl.PC Fee: E) Reg. 0 OT 0.0 hrs $0.00
Permit Fee: $253.00
Suppl. Insp. Fee-.0 Reg. 0 OT —0--01hrs $0.00
PME Unit Fee: $42.00
PME Permit Fee: $42.00
t" H' f N)11 I 1;1 0', F-1
Sign Master Plan: Q Yes E) No $0.00
Work Without Permit? 0 Yes 0 No $0.00
PiOi
Travel Documentation Fee: ITRAVDOC $42.00
Strong;Motion Fee: 1BSEISMICO $0.50 Select an Administrative Item
k
dg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $380.50 $0.00 TOTAL FEES $380.50
Revised: 12/07/2010