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13060116 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10883 S BLANEY AVE CONTRACTOR:HENRY'S DESIGN& PERMIT NO:13060116 SIGN CO OWNER'S NAME: PACIFIC RIM PARK LLC 965 W WINTON AVE. DATE ISSUED:06/13/2013 OWNER'S PHONE: 4084700753 HAYWARD,CA 94545 PHONE NO:(408)269-0888 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL L1COMMERCIALE] License Class Gr Lic. INSTALL(1)LUMINATED CHANNEL LETTER SIGN, WALL Contractor' fs-�� Date es 1 /3 MOUNTED 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. 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:$2500 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:36934052.10883 Occupancy 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 F 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 Li granting of this permit. Additionally,the applicant understands and will comply Issy: Date: with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: g Si natuff" Date 13 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. ❑ OWNER-BUILDER.DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the follow] g two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I;as ownef a 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. I 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(x)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 I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized age 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. K 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 indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,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 `�0 10 SIGN PERMIT APPLICATION 0�' COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION h�0 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 ^„U CUPERTINO (408)777-3228•FAX(408)777-3333•building(cb-cupertino.org 1''I PROJECT ADDRESS/0 p p� -/R ` . B L� f- . APN# Q Q��Z r /O 'O OWNERNAME Q O ` ` P1qb i 7 U �- - E MALI. STREET ADDRESS �� CITY,STATE,ZIP FAX CONTACT NAME (� G w PHONE E-MAIL �r STREET ADDRESS S p ,( j-� • CITY,STATE,ZIP FAX , ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME �.�'N/�r GrHF��/ LICENSE NUMBER ' LICENSE TYTYPEBUS.LIC# `+ COMPANY NAME ��. s' G� E-MAIL L _ _ s+ , FAX STREET ADDRESS CITY,STATE, e>t /yQ'�•} PHONE *6 O ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK USE OF ❑ SFD or Duplex ❑ Multi-Family ILLUMINATED SIGN TYPE NO.OF SIGN AREA VALUATION STRUCTURE: M Commercial (Y/N) (CODE) SIGNS (SQ.FT.) ($) SIGN TYPE CODES: B - BANNER SIGN M - MONUMENT(GROUND)SIGN BL - BLADE SIGN P - PROJECTING SIGN D - DEVELOPMENT ID SIGN SP - SPECIAL EVENT BANNER DI - DIRECTIONAL SIGN T - TEMPORARY E - ELECTRONIC W - WALL SIGN READERBOARD WI - WINDOW SIGN RECE TOT4VALITATIQN, By my signature below,I certify to each of the following: I am the property owner or authorized agent to act e property owner's behalf. I havvee readd thiss application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building construe' . I authorize r presentatives of Cupertino to enter the above-ide tified property for inspection purposes. Signature of Applicant/Agent: Date: G � A SUPPLEMENTAL INFORMATION REQUHtED OFFICE USE ONLY Site Plan PLAN CHECK TYPE ROUTING SLIP Elevations ❑ OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW Sign Details-including UL listing(s)applicable ❑ EXPRESS ❑ PLANNING PLAN REVIEW Structural Calculations(if applicable) ❑ STANDARD ❑ OTHER: _Copy of Planning Approval Letter or Meeting with Planning prior to ❑ LARGE submittal of Building Permit application. ❑ MAJOR SignApp_2011.doc revised 03/31/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10883 S BLANEY AVE DATE: 06/13/2013 REVIEWED BY: MELISSA APN: 36934052.10883 BP#: "VALUATION: 1$2,500 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: PRIMARYPENTAMATION 1 CEAP5 USE. Sign PERMIT TYPE: i WORK INSTALL N LUMINATED CHANNEL LETTER SIGN WALL MOUNTED SCOPE SIGN TYPE FEE ID QTY SIGN FEE Wall Sign,Electric 1SIGNWELEC 1 $266 r-7 70M, TOTALS: $266 00 Xtec•h.Plan(,heck Plumb.flan Check #Branch Circuits 1 $45.00 > Plumb. Permit Fee: 1ESIGN Elec.Permit Fee: lEPERMIT titec,•h.I c>rrrtit 1�'cze: Ether Alech.Insp: 01her Plumb Insp. Other Elec.Insp. 0.0 $45.00 Atech.Insp.Fee: Plumb. Insp.Fee: Elec.Insp.Fee: NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc.). These fees are based on the prelfinina information available and are only an estimate Contact the Dept for addn'l info, FEE ITEMS (Fee Resolution 11-053 E . 711112) FEE QTY/FEE MISC ITEMS Plan Check Fee: Suppl.PC Fee: Reg. ® OT 0.0 hrs $0.00 Plumb.11fech./Elec: Permit Fee: $266.00 Suppl. Insp.Fee-0 Reg. ®OT 0.0 hrs $0.00 PME Unit Fee: $45.00 PME Permit Fee: $45.00 Consttzlction Tar: Administrative 1*ee: Work Without Permit? ®Yes No $0.00 Sign Master Plan: ® Yes (E) No $0.00 Travel Documentation Fee: 1TRAVDOC $45.00 i Strong Motion Fee: IBSEISMICO $0.53 Select an Administrative Item Btdz Stds Commission Fee: IBCBSC $1.00 $402.53 $402.53 Revised: 04/29/2013 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: ! P 1?3 PERMIT# OWNER'S NAME: - PHONE# GENERAL CONTRACTOR: BUSINESS LICENSE.# ADDRESS: Z !� Tr►i�/�A.,s L. S • J p,J- CITY/ZIPCODE: *Our municipal code requires all businesses working in the city to have a City of Cuper'tina business license: NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTIONS) WILL,-"BE'SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE ;OBTAINED_A-CITY OF CUPERTINO BUSINESS LICENSE. 6, ^ I am not using any subcontractors: 10 Signature Date Please check applicable subcontractors and complete the following information: &/ 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 A2 l3 Owner/ ontractor Signature Date LETTER SECTION PCL-LED FACE LIT = „ INTERNALLY ILLUMINATED PAN CHANNEL LER- be S to make Wly yep set of pans an This trk—flan' . " .063ALUM. BACK ,nb site durWi�i CO- n! -� -- ne.Or to ciev Sal - 801.ercL, iildinoc ©ficial. .040ALUM. RETURN Vat I the Bt. n.)I --s ,jtj,,c,ut apIpTo'Jat I theretr0m, pe" ns SHALL N' , Ificato ,,,I,plan-and - TRIM CA Jpin(I d -e qiola-�'ion p .,proval of th 'The 9 ,' or to bo La',Af be he to d,,nanre 0r State lions ACRYLIC FAC of an Prc\�`Gtons WE PERMff NO. LEST 3 EACH PER LETTER rr_P—W-0111RIN "WORK DISCONNECT SWITCH TO BR AKER LEDs 12 V DC POWER SUPPLY W LL CUP RTINO #8 x1-1/2 EXTERIOR SCREW wilding epartment JUN Oi NOT TO SCALE �EVEMEUD FOR CODE COMPLIANCE Reviewed By SIGN LOCATION -r-r'1-1r-W-� r f R f T-r'1ri • i R f_ -r r*-T r7r• • • n • • ■ M w • ` ■ • n • • • n • • • n • • • n . . . n . . • n . . . . . 'qR ^ p River of Life -+-+- -_ Christian Academy Nwi ;L 4A °0 A FRONTAGE IS 25" PROPOSED 4" DEEP INDIVIDUAL CHANNEL LETTERS SIGN. ?~` WPERTINO i Building oapatnent ILLUMINATED BY WHITE LED . ALL LETTERS ARE TO BE FABRICATED BY 22 GAUGE :. JUN 13 2013 SHEET METAL, THE FACE OF SIGN IS 3/16" THICK ACRYLIC REVIEWE4) FOR CGDE COMPUANCE WITH VINYL ART WORK, THE COLOR AS SHOWING AS Reviewed B DRAWING . THE TRIM CAPS ARE 3/4" WIDE WITH GOLD COLOR. ALL RETURNS COLOR ARE BRONZE ALL ELECTRICAL ' COMPONENTS & ASSEMBLY ARE TO BE U.L RATED / pLIYI PLANt� 12,— 10„ C>LCKW BY - 3)-811 ;� o PLANNING DEPT. V � OATE River of Life 16 O 18 RW: r.D . DEPT _ Q'p 'Rj a - Christian Academy ACCOUNT RIVER OF LIFE CHRISTIAN ACADEMY LOCATION 10883#A S.BLANEY_AVE DRAWER HENRY'S SIGN CO. DATE 6115-2013 n i STATE OF CALIFORNIA CERTIFICATE OF COMPLIANCE, SIGN LIGHTING CEC-SLTG-1C(Revised 10/10) CALIFORNIA ENERGY COMMISSION Certificate of Compliance (Sign Li hi in (Page 1 of 4) SLTG-1C Project Names, ;' / 1/� 4 G' '/r'IF! &A. C/r4� Date: Project Address: 20 Location of Sign Iff Outdoor Signs 0 Indoor>&s s Phase of Sign Construction 0 New Signs 0 Sign Alterations Type of Lighting Control 0 New LightingControls 0 Replaced Lighting Controls 0 Not Installing Lighting Controls TI Certificate of Compliance includes the following components(check all that apply) Mandatory Measures(Lighting Controls) 11 Maximum Allowed Lighting Power 0 Specific Lighting Sources 1. Certificate of Compliance Declaration Statement(th 10,C45 or other eli*lt N, R • I certify under penalty of i s i 5 - co ertif p ty pe��'under the laws of the State of Qijiforl�a W a information Mt 'v&d op3is f rrm is true and • I am eligible under Division 3 of the California Business and Prof" ;e tokept s bility for the lighting design. ii5� 1� • This Certificate of Compliance identifies the lighting features and pe ante s cdti n uired for compliance with Title 24,Parts I and 6 of the California Code of Regulations. PL• The design features represented on this Certificate of Compliance are consts�ten'#wt e m o rovic1e to document this design on the other applicable compliance forms,worksheets ceaiculati&& ,P the enforcement agency for approval with this building permit application. Name: f� Signature /'7 �✓I'j Phonl,,, Company:��'/r/�� rs .40 Z- $l 4N Address: License number(may be contractor's lic#) >--40 yrs 9AEV,4 A,-S City/State/Zip: Date 6 S? CJ .1 /2 2. Installation Certificate(to be signed by responsible person after installation) Penna number �{ 6977 �; M-W-,- z ` {Pfaigemegt CIs *.,s Installation Declaration statement • I certify under penalty of perjury,under the laws of the State of California,the information provided on this form is true and correct. • I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction,or an authorized representative of the person responsible for construction. • I certify that the installed features,materials,components,or manufactured devices identified on this certificate conforms to all applicable codes and regulations,and the installation is consistent with the plans and specifications approved by the enforcement agency. • I certify that the requirements detailed on this Certificate of Compliance have been met. • I will ensure that a completed,signed copy of this Installation Certificate shall be posted,or made available with the building permit(s)issued for the building,and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Installation Certificate is required to be included with the documentation the builder provides to the building owner at occupancy, Company Name: Responsible Person's Name: Responsible Person's Signature: Cier he-Ok-4 License number(may 6e contractor's lic#) Date Signed: Position With ompany: } � l9 � 8 6 3 - 13 2008 Nonresidential Compliance Forms October 2010 STATE OF CALIFORNIA CERTIFICATE OF COMPLIANCE, SIGN LIGHTING CEC-SLTG-1 C(Revised 10/10) CALIFORNIA ENERGY COMMISSION Certificate of Com fiance (Sign Lighting) (Page 2 of 4 SLTG-1C Project Name: _ Date: 3.Mandatory Sign Lighting Controls NOTES.- 1. OTES.1. The same responsible person may install both the sign lighting power and the sign lighting controls, or a different responsible person may install the sign lighting controls than the responsible person installing the sign lighting power. 2. The Mandatory Measures(sign lighting controls) are required for compliance with the sign lighting Standards. If the person responsible for installing the sign lighting power is not also responsible for the sign lighting controls, then the owner of the sign,general contractor,or architect shall be responsible to have the sign lighting controls installed. 3. If more than one person has responsibility for compliance, each responsible person shall prepare and sign a Certificate of Compliance and an Installation Certificate applicable to the portion of construction for which they are responsible; alternatively, the person with chief responsibility for construction shall prepare and sign the Certificate of Compliance Declaration Statement or the entire construction 3a. Statements of Responsibility:Any person signing the Certificate of Compliance Declaration Statement on page 1 of 4 on this SLTG-1C shall complete Part 3a.Check Yes or No for all of the following statements: 1 I have responsibility for installing the sign lighting controls ❑Yes,complete parts 3a and 3b of this form A No,complete part 3a of this form 2 There are no existing sign lighting controls and I will be installing compliant sign lighting controls ❑Yes ANo 3 There are no existing sign lighting controls and someone else will be responsible to install compliant sign lighting controls ❑Yes 16 No There are existing sign lighting controls that do not comply with the applicable provision of§119 and§133 and I will be 4 installing compliant sign lighting controls ❑Yes JANo There are existing sign lighting controls that do not comply with the applicable provision of§119 and§133 and someone else 5 will be responsible to install compliant sign lightingco trols ❑Yes No 3b. Mandatory Sign Lighting Controls If the person signing the Certificate of Compliance Declaration Statement on page 1 of 4 of this SLTG-1C is responsible for complying with the sign lighting control requirements,that person shall answer all of the following uestions: If there are construction documents,indicate where on the building,plans the mandatory measures(sign lighting control note block can be located: 1 §133(a)1.All indoor sign lighting is controlled with an automatic time switch control that complies with the Y N N applicable requirements of§119. ❑ §133(a)l and 2. All outdoor sign lighting is controlled with an automatic time switch control plus a photoY� N❑ N❑A 2 control or an outdoor astronomical time switch,that comply with the applicable requirements of 119. Exception to§133(a)2. Outdoor signs in tunnels or large covered areas that require illumination during Y NA daylight hours. CR ❑ §133(a)3. All outdoor signs are controlled with a dimmer that provides the ability to automatically reduce Y N NA sin power b a minimum of 65 percent during nighttime hours. ❑ ❑ Exception 1 to§133(a)3. Signs illuminated for less than one hour per day during daylight hours. Y NA Is ❑ 3 Exception 2 to§133(a)3. Outdoor signs in tunnels or large covered areas that require illumination during Y NA daylight hours. 0 ❑ Exception 3 to§133(a)3.Only metal halide,high pressure sodium,cold cathode,or neon lamps used for Y NA illuminating signs or parts of signs. a ❑ §133(a)4. An Electronic Message Center(EMC)having a new connected lighting power load greater than Y N N/A 15 kW has a control installed capable of reducing the lighting power by a minimum of 30 percent when ❑ ❑ ❑ 4 receiving a demand response signal that is sent out by the local utility. Exception to§133(a)4.EMC required by a health or life safety statue,ordinance,or regulation,including Y NA but not limited to exit signs and traffic signs. [2$\ ❑ Field Inspector Notes: 2008 Nonresidential Compliance Forms October 2010 STATE OF CALIFORNIA CERTIFICATE OF COMPLIANCE, SIGN LIGHTING CEC-SLTG-1 C(Revised 10/10) CALIFORNIA ENERGY COMMISSION Certificate of Compliance (Sign Lighting) (Page 3 of 4 SLTG-1C Project Name: Date: 4. Maximum Allowed Lighting Power Method of Compliance Certificate of Compliance and Field Inspection Energy Checklist Complete this part if there are signs using the maximum allowed lighting power method of compliance.(Complete part 5 of this Certificate of Compliance if there are signs using the S ecific light!nZ sources method of compliance A B C D E I F G H I J A Allowed Watts Design Complies? w Watts Y/N 3 4° Field Inspector Vw o ° -° a :10-, vl Check that -o Sign a .>~ 3 N (U A Complies 0 ° II II o II � 2 o Description ❑ /i /2 j w13 ❑ ❑ ❑ o ❑ o ❑ ❑ A Symbol or code used on the plans when plans are required)and other documents. B A narrative description of the sign,or location of sign on the building;and the location of sign on construction documents. OPTIONAL-Check this box only if this sign has a permanent,pre-printed,factory-installed,ENERGY VERIFIED label,confirming that the sign complies with the Section 148 of the California 2008 Title 24,Part 6 Standards,using the Maximum Allowed Lighting Power method of compliance. The only labels that will be recognized for this purpose are ENERGY VERIFIED Certification Marks authorized C by Underwriters Laboratories(UL)or other Product Certification Body accredited to ISO/IEC Guide 65 by the American National Standards Institute in accordance with ISO/IEC 17011.Surveillance by the Accredited Certification Body shall be an ongoing annual inspection program carried out by a Type A Inspection body in accordance with ISO/IEC 17020.For signs with such an ENERGY VERIFIED label,columns`D'through`I'are not required to be filled out.Note:Using an ENERGY VERIFIED label is an optional method to validate compliance.An ENERGY VERIFIED label is not needed for compliance. D The sign area in square feet. E List"I"if the sign is internally illuminated. List"E"if the sign is externally illuminated. F Allowed watts per square foot. Enter 12 if the sign is listed as'T'in column E.Enter 2.3 if sign is listed as`B"in column E. G Multiply the square footage in column D times the allowed Lighting Power Density PD=watts in column F. H Show the total installed watts in the sign,as determined according to the applicable provisions of§130(d ore . I Enter Y if the number in column H is less than orequal to the number in column G. Otherwise,the sign does not comply. J This page doubles as a field inspection checklist. Field Inspector Notes: 2008 Nonresidential Compliance Forms October 2010