10020116 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10831 N WOLFE RD CONTRACTOR:ALLEN SIGNS INC PERMIT NO: 10020116
OWNER'S NAME: KIMCO PROPERTIES 1982 STONE AVE DATE ISSUED:02/22/2010
l ER'S PHONE: 5107903720 SAN JOSE,CA 95129 PHONE NO:(408)280-6500
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG I— ELECT r— PLUMB
License Class (—* J Lic.# r")
MECH RESIDENTIAL COMMERCIAL r
Contractor t( � -0 Date r21
I hereby affirm that I am lice sed under the provisions of Chapter 9 70B DESCRIPTION:(I)INDIVIDUALCHANNEL LETTER SIGN-ILLUMINATED
(commencing with Section 7 0)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:$2000
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. APN Number:31605052.10831 Occupancy Type:
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 PERMIT EXPIRES IF WORK IS NOT STARTED
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR
indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION.
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 Issued byr G-- Date:
9.18. , ''
Signature Date_T
i
RE-ROOFS:
D OWNER-BUILDER DECLARATION 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
I hereby affirm that I am exempt from the Contractor's License Law for one of inspection.
the following two reasons:
I,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date:
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 ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
construct the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE
declarations: I have read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
performance of the work for which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material.
I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air
Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
P Health&Safety Code,Sections 25505,25533,and 25534.
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 Owner o�aLujhorized age
Compensation laws of California. If,after making this certificate of exemption,I � —� Date:
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. J CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.)
I certify that I have read this application and state that the above information is Lender's Name
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 Lender's Address
upon the above mentioned property for inspection purposes.(We)agree to save
mnify and keep harmless the City of Cupertino against liabilities,judgments,
.s,and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION
granting of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. r 1 Licensed Professional
�_ 11
Date
Signature
ti
CITY OF CUPERTINO
6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk : Lot:
APN . . . . . . . . : 31E05052 .10831
DATE ISSUED. . . . . . . : 02/22/2010
RECEIPT #. . . . . . . . . BSC00009793
REFERENCE ID # . . . : 1OC20116
SITE ADDRESS . . . . . : lOE31 N WOLFE RD
SUBDIVISION . . . . . .
CITY CUPERTINO
INO
IMPACT AREA . . . . . .
OWNER KIMCO PROPERTIES
ADDRESS lOE31 N WOLFE RD
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : KIMBERLY LIN
CONTRACTOR . . . . . . . : ALLEN LIN LIC # 22174
COMPANY ALLEN SIGNS INC
ADDRESS . . . . . . . . . . : 19E2 STONE AVE
CITY/STATE/ZIP . . . : SAlf JOSE, CA 95129
TELEPHONE . . . . . . . . : (4(,8) 280-6500
FEE ID UNIT QUANTITY ],MOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- -- -------- ---------- ---------- ----------
1BCBSC VALUATION 2, 000 . 00 1 . 00 0 . 00 1 . 00 0 . 00
1BSEISMICO VALUATION 2, 000 . 00 0 . 63 0 . 00 0 . 63 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
1SUPPKFEE HOURS 1 .00 63 . 00 0 .00 63 . 00 0. 00
1TRAVDOC FLAT RATE 1. 00 42 . 00 0 .00 42 . 00 0. 00
-- -------- ---------- ---------- ----------
TOTAL PERMIT 190 . 63 0 . 00 190 .63 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 190 . 63 VISA
---------------
TOTAL RECEIPT 190 .63
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
101 FOUNDATION 103 UFER
104 REBAR 105 ANCHOR BOLTS
304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL
CITY OF CUPERTINO
SIGN
CITY OF
CUPEkTINO PERMIT APPI-41CATION FORM
APN # Date:
Building Address:
Mailing Address (if different from building addr.-ss):
Owner's Name: Phone#:
Contractor: Phone #: _L :
Fax#:
Contractor License Cupertino Business License #:
Contact: Phone #:
Fax#:
Building Permit Info:
Bldg E!r� Elect 4onument ❑ Mounted on Building
Residential F1 Commercial
Job Description:
Valuation (cost of project):
Project Size: Express n---�StandartrgeE] MajorEl
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 07/06/09
CITY OF C UPERTINO
fil 51
SIGN
CITY CUPEI�TINO FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Group
1 SIGNDIRECT Directional B
1 SIGN/RF Ground/Roof/R-ojecting Signs B
1SIGNMASCK Master Plan Si€p Check B
1 SIGNREWRKG Rework of any existing Ground B
Sign
I SIGNOTHER Other Sign B
1 SIGNREINSP Re-inspection Fee B
1 SIGNWNONEL Wall/Awning c ign,Non- B
Electric
1 SIGNWELEC Wall, Electric E
IESIGN Sign, Outline Lighting System E 10EAP5
or Marquee supplied from one
/ branch
1 ESIGNADD Additional Branch Circuit on E 10EAP6
Same Sign, Outline System or
Marquee
1 ELCPLNCK Plan Check Fe E
1 EPERMITFEE Electric Permi-:Fee E
1 BCBSC Cal Bldg Standards Commision -B ALL PERMIT TYPES
Fee
/ 1BSEISMICOM Seismic Commercial B
/ 1BSEISMICRE Seismic Residential B
/ 1 TRAVDOC Travel & Doc nnentation B
Business License B
41BUSLIC