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11020015 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10129 S DE ANZA BLVD CONTRACTOR: $E PERMIT NO: 11020015 D�F�TFRMIT�TFTI OWNER'S NAME: AMBINDER MONTE AND THERESA TRU 6N) n DATE ISSUED:02/03/2011 NER'S PHONE: 4082549500 1 PHONE NO: LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL License Class Lic.# I LOVE BENTO---INSTALL LETTER CHANNEL SIGN Contractoregz Date L I hereby a irm that I am 1 ensed 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. Sq.Ft Floor Area: Valuation:$800 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 Number:35910015.10129 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above informati 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 Issued by,*, -Date: 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. RE-ROOFS: Signature � �1� Date 2 � 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. ,J OWNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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 HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. 1 will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and 1 have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date. .� 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 CONSTRUCTION LENDING AGENCY 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 I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address 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 ARCHITECT'S DECLARATION iemnify and keep harmless the City of Cupertino against liabilities,judgments, ,is,and expenses which may accrue against said City in consequence of the I 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 CITY OF CUPERTINO 7 ITEMS OF 7 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot : APN 35910015 . 10129 DATE ISSUED. . . . . . . : 02/03/2011 RECEIPT #. . . . . . . . . BS000012638 REFERENCE ID # 11020015 SITE ADDRESS . . . . . : 10129 S DE ANZA BLVD SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : AMBINDER MONTE AND THERESA TRU ADDRESS 26078 EUCALYPTES LN CITY/STATE/ZIP . . . : LOS ALTOS HILLS, CA 94022 RECEIVED FROM . . . . : STAR NEON SIGNS CONTRACTOR TBD - TO BE DETERMINED LIC # 00096 COMPANY TBD - TO BE DETERMINED ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : , TELEPHONE . . . . . . . . : FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ----- 1BCBSC VALUATION 800 .00 1. 00 0 . 00 1 . 00 0 . 00 1BSEISMICO VALUATION 800 . 00 0. 50 0 . 00 0 . 50 0. 00 1BUSLIC FLAT RATE 1 .00 115 . 00 0 .00 115 . 00 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 1SIGNGR/RF EACH 1 . 00 317. 00 0 . 00 317 . 00 0 . 00 1TRAVDOC FLAT RATE 1 .00 42 . 00 0 . 00 42 . 00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 559 . 50 0 . 00 559. 50 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 559 . 50 CHK --------------- TOTAL RECEIPT 559. 50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- --------------------------- 101 FOUNDATION 103 UFER 104 REBAR 105 ANCHOR BOLTS 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR / SUBCONTRACTOR LIST JOB ADDRESS: VCT S , D 2 ; D, PERMIT# a-©c) j OWNER'S NAME: ) v PHONE# CW Z.S -� 5 v v GENERAL CONTRACTOR: STAVQ N Sj Iii BUSINESS LICENSE # ADDRESS: hi , 0 I CITY/ZIPCODE: SHIN s e " 57.s—/ j *Our municipal code requires all li sinesses 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. I am not using any subcontractors: 3 Si re Date Please check applicable subcontractors and complete the following information: V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical 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 6 Owner/Contractor nature Date ' Warn � A M } a. U z ° ¢ �► = o ¢ w At LL o �--� O W W L7 :sem 0-1 F- � � ` � � wa o z ° ° How u z oxa � Zoo wad' O ao d- F�., � W `'' Uakn . U . vs � Ua o x x � c-0) kn In x Z oIn o0 � pAH V NCO In zaw Qa L O ZF k. C7 U x � z W � zw M �vON --- qac � zona OLA E o _ Q z C p S LOD = N O M a moi. 12 Z c0 O U. cam' ,2��c$2 O19 k O 'u O ^ . . x � co 'IS r rn z a z ~ E ^1 M � W cu cu L Oo Q cu M cu cn I � � y Cn L �> O 7 J N Of O PLW O C(J j CL co O j3 a J U Cc o o U E v U N z E �E -0 CL CD g o o X co 4 Y AIa� 44U ML ti IL qk UL f � x a.n i , Y 4* 5 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 10129 S. DeAnza DATE: 02/03/2011 REVIEWED BY: RDW APN: BP#: "VALUATION: $800 xPERMIT TYPE: Building Permit PRIMARY PENTAMATION 1 CEAP5 USE: Sign PERMIT TYPE: WORK SCOPE SIGN TYPE FEE ID QTY SIGN FEE Roof Sign 1SIGNGR/RF 1 $317 TOTALS: 1 $317.00 T7 #Branch Circuits 1 $42.00 IESIGN Elec.Permit Fee: IF.PERMIT Other Elec.Insp. 0.0 $42.00 NOTE. Thesefees are based on the preliminarqy in ormation available and are only an estimate. Contact the De t or addn'l info, FEE ITEMS (Tee Resolution 09-051 E(f '%lit 0) FEE QTY/FEE MISC ITEMS P1017 C hcc/, Fee,. Suppl. PC Fee: (F) Reg. 0 OT 0.0 hrs $0.00 PhIn7f) (,it.""r 1 'c P/tai C'l"c t Permit Fee: $317.00 Suppl. Insp. Fee-.0 Reg. 0 OT0.0 hrs $0.00 PME Unit Fee: $42.00 PME(Permit Fee: $42.00 Sign Master Plan: 0 Yes (F) No $0.00 Work Without Permit? 0 Yes (F) No $0.00 1'lctttttl�t�T f:�"t:`�': Travel Documentation Fee: ITRAVDOC $42.00 Strong Motion Fee: IBSEISMICO $0.50 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $444.50 $0.00 TOTAL FEE: $444.50 Revised: 01/15/2011 CITY OF CITY OF CUPERTINO M4 SIGN CUPERTINO PERMIT APPLICATION FORM APN C�- Date: 5 Building Address: 5 , c— 4Al2-4 , i.'s�--> Mailing Address (if different from building address): Owner's Name: Arv,3� N C>ed2 Phone #: ( q ©0 :; " , ����, Contractor: Ph ref o #: a o -2-Y' Fax#: n� f Z Contractor License #: Cupertino Business License #: Contact: Phone #: 4 6 — Y Fax/e-mail: Building Permit Info: Bldg ❑ Elect ❑ Monument ❑ Mounted on Building Residential ❑ Commercial Job Description: C N lAtx tit rJ a E a - c -v��y, Valuation (cost of project): Project Size: Counter ET"-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. Revised 12/06/10