14010155 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10879 N WOLFE RD CONTRACTOR:SUCCESS GRAPHIC PERMIT NO:14010155
SIGNS
OWNER'S NAME: CUPERTINO VILLAGE LP 1744 QUEENS CROSSING DR DATE ISSUED:01/29/2014
OWNER'S PHONE: 6507303236 SAN JOSE,CA 95132 PHONE NO:(408)667-1777
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL
CHOCO SALON-INSTALL ILLUMINATED SIGN
License Class_ Lic.#_ 6
Contractor �'S Date L IC—
I hereby affirm that I am licensed under the provisions o Chapter
(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:$1900
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:31605053 10879 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 FR T 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
granting of this permit. Additionally,the applicant understands and will comply Issued by: Date: 0�7,
with all non-point source tions per the Cupertino Municipal Code,Section
918.
RE-ROOFS:
Signature VA Date 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.
13OWNER-BUILDERDECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date:
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I,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
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections ,25533,an 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
Compensation laws of California. If,after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY
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
918.
Signature Date
SIGN PERMIT APPLICATION
Is COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 S`Utrf
CUPERTINO (408)777-3228•FAX(408)777-3333•building@_cupertino.org
V
PROJECT ADDRESS 109-741 tS ,. 1�S 10 . APN#
OWNERNAME 1 ^ w ,W` PHONE — -73 o— 3 E-MATT,
STREET ADDRESS �S W-fAA (n_r-TIC CITY,STATE, A /1,A_ FAX
CONTACT NAME l WX PHONE �( E-MAIL
STREET ADDRESS CITY,STATE,ZIP FAX
❑OWNER ❑ OWNER-BUDDER ❑ OWNER AGENT PXONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME ( W v' LICENSE NUMBER LICENSE TYPE BUS.LIC#
COMPANY NAME S u C Gem Q**0�.G n'�� E-MAIL S A (1 6/C /1 lu�`` � FAX
STREET ADDRESS
y/s b/• r�� C�,STATE,ZI$ Q G �a ,I/g �j 'PHOTy ,
ARCHITECT/ENGINEER NAME LICENSE NUMBER f 7 BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK ^ S , ( J C67 O / LITC
O Com,
USE OF ❑ SFD or Duplex ❑ Multi-Family ILLUMINATED SIGN TYPE NO.OF SIGN AREA VALUATION
STRUCTURE: ❑ Commercial (Y/N) (CODE) SIGNS (SQ.FT.) M
SIGN TYPE CODES: %4l
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
[TCEIDBY: TO ALU ION;
By my signature below,I certify to each of the following: I am the property owner or authorized ag t on the property owner's behalf. I have read this
application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I a ee to comply with all applicable local
ordinances and state laws relating to building cons �' Ou
sentatives of Cupertino to enter the above-iden fled pr perty fo inspection purposes.
Signature of Applicant/Agent: Date: I
SUPPLEMENTAL INFORMATION REQUIRED 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
101 ADDRESS: 10879 n wolfe rd DATE: 01/29/2014 REVIEWED BY: Mendez
APN: BP#: "VALUATION: 1$1,900
%PERMIT TYPE: Building Permit PLAN CHECK 7'YPE:
PRIMARY PENTAMATION 1 CEAP5
USE. Sign PERMIT TYPE: i
WORK choco salon-install illuminated sign
SCOPE
SIGN TYPE FEE ID QTY SIGN FEE
Wall Sign,Electric 1SIGNWELEC 1 $278
TOTALS: y $278.00 a
-Lk--h. Plan Check Phimb.Plan Check #Branch Circuits 1 1 $47.00
Xlech.Permit fee Plumb.Permit Fee: IESIGN Elee.Permit Fee: IEPERMIT
Ocher,llech.Insp. Other Plumb Insp. Other Elea Insp. 0.0 --L$47.00
Aletch. Insp. Fee: Plumb. Insp. Fee., Elec.Insp, Fee:
NOTE:This estimate does not include fees due to other Departments(i.a Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc.). These fees are based on the prelimina information available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 E . 711/13) FEE QTY/FEE MISC ITEMS
Plan Cheek Fee:
Suppl.PC Fee: Q Reg. ® OT 0.0 hrs $0.00
Plumb.11[ec;h./Elec
Permit Fee: $278.00
Suppl. Insp.Feer Reg. Q OT 0,0 hrs $0.00
PME Unit Fee: $47.00
PME Permit Fee: $47.00
Consiruction Tax:
Administrative Fee:
Work Without Permit? ®Yes (j) No $0.00
Sign Master Plan: ® Yes (E) No $0.00
Travel Documentation Fee: ITRAVDOC $47.00
Strong Motion.Fee: 1BSEISMICO $0.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
# RAM, $420.50 0.00 O $420.50
Revised: 01/15/2014
INSTALLATION CERTIFICATE (Part 1 of 2) SLTG-INST
PROJECT NAME: Choco Salon DATE:
PROJECT ADDRESS: 01-28-14
Building Pennit
10879 N WOLFE RD. CUPERTINO
Checked by/Date
Enforcement Agency Use
GENERAL INFORMATION
DATE OF BUILDING PERMIT I PERMIT#
BUILDING TYPE ® Outdoor Sign ❑ Indoor Sign
PHASE OF
CONSTRUCTION ❑ New Construction ❑ Addition ® Alteration
If more than one person has responsibility,for building construction, each person shall prepare and sign an Installation
Certificate document applicable to the portion of construction for which they are responsible;alternatively, the person with
chi.1'responsibility,for construction shall prepare and sign the Installation Certificate document(s)for the entire
construction.
DECLARATION STATEMENT
I certity 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(responsible person).
I certify that the installed features,materials,components,or manufactured devices identified on this certificate(the installation)
conforms to all applicable codes and regulations,and the installation is consistent with the plans and specifications approved by the
enforcement agency.
1 reviewed a copy of the Certificate of Compliance approved by the enforcement agency that identifies the specific requirements for
the installation. I certify that the requirements detailed on the Certificate of Compliance that apply to the installation have been met.
I will ensure that a completed,signed copy of this Installation Certificate shall be posted,or made available with the building
pen-nit(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: Success Graphic Signs
Responsible Person's Name: Responsible Perso ' gnature:
sean wu
Lic.# Date Signed: Position With Company: owner
896458 01-28-14
SCOPE OF RESPONSIBILITY
Enter the date of'approval by enforcement agency of the Certificate of'Compliance that provides Date:
the specifications,far the energy efficiency measures for the scope of responsibilityfor this
Installation Certificate:
In the table below identify all applicable construction documents that specify the requirements for the scope of
responsibility for this Installation Certificate.
Date Approved By
Document Title or Description Applicable Sheets or Pages,Tables,Schedules,etc. the Enforcement
Agency
2008 Nonresidential Compliance Forms August 2009
699 lewelling Blvd#112A
Certificate of Compliance (Sign Lighting) (Page 2 of 4 SLTG-1C
Project Name: Choco Salon Date: 01-28-14
3. Mandatory Sign Lighting Controls
NOTES:
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 insialling.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 I of
4 on this SLTG-I C shall complete Part 3a. Check Yes or No for all of the following statements:
1 1 ve responsibility for installing the sign lighting controls
QYes,complete parts 3a and 3b of this form ❑No,complete part 3a of this form
2 ere are no existing sign lighting controls and I will be installing compliant sign lighting controls
4Yes ❑No
3 There are no existing sign lighting controls and someone else will be responsible to install compliant sign lighting controls
Yes ❑No
TI ere 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 ❑No
There are existing sign lighting controls that do not comply with the applicable provision of§119 and§133 and someone else
5 wil be responsible to install compliant sign lighting controls
Yes ❑No
3b. Mandatory Sign Lighting Controls
If the person signing the Certificate of Compliance Declaration Statement on page I of 4 of this SLTG-1 C is responsible for
complying with the sign lighting control requirements,that person shall answer all of the followingquestions:
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)l. 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 photo Y N NA
2 control,or an outdoor astronomical time switch,that comply with the applicable requirements of§119. 16 ❑ ❑
Exception to§133(a)2. Outdoor signs in tunnels or large covered areas that require illumination during Y NA
daylight hours. ❑
§133(a)3. All outdoor signs are controlled with a dimmer that provides the ability to automatically reduce Y N NA
sin power by a minimum of 65 percent during nighttime hours. ❑ ❑
Exception I to§133(a)3. Signs illuminated for less than one hour per day during daylight hours. ti' NA
3 Exception 2 to§133(a)3. Outdoor signs in tunnels or large covered areas that require illumination during Y N
daylight hours. ❑
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. ❑
§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. ❑
Field Inspector Notes:
2008 Nonresidential Compliance Forms October 2010
Certificate of Compliance (Sign Lighting) Pa ae 3 of 4 SLT G-1C
Project Name: Date:
Choco Salon 01-28-14
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 Com liance if there are signs using the S ecific lighting sources method of com liance)
A B C D E I F G H I J
o Allowed Watts Design Complies?
w Watts Y/N
c� 3
W � i
; w
o z �" �; a � � u 3 Z
3 x Field
.= Q cd N Q
'7 N
E Q �, 3 cd Inspector
Z E Check that
¢ U Sign
o Complies
Description
INTERNALLY ILLUMINATED (� I 60 Y ❑
Channel letters -
❑ ❑
❑ ❑
❑ ❑
❑ ❑
A Svmbol or code used on the plans when plans are re wired and other documents.
B A narrative description ofthe sign,or location of si n 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 1
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 tilled 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 insquare feet.
E List"I"if the sign is internally illurninated. List"E"if the sign is externally illuminated.
F Allowed watts per square foot. Enter 12 if the sign is listed as"I"in column E.Enter 2.3 if si n is listed as"E"in column E.
G Multiply the square footage in column D times the allowed Lighting Power Density(LPD=watts)in column F.
H Show the total installed watts in the sign,as determined according to the applicable provisions of§1 30(d or e).
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
Certificate of Compliance (Sign Lighting) (Page 4 of 4 SLTG-1C
Project Name: Choco Salon Date:
01-28-14
5. Specific Lighting Source Method of Compliance
Certificate of Compliance and Field Inspection Energy Checklist
Complete this part ifthere are signs using the Specific lighting source method of compliance. (Complete part 4 of this
Certificate of Compliance if there are signs using the maximum allowed li liting power method of com liance)
A B C D E
OPTIONAL Field
ENERGY Specific light source used for
Symbol VERIFIED compliance Inspector-
or Description label Shall include only lighting Check that
Code (see instructions technologies listed below Sign
below) List all that apply Complies
V
install 1 set internally illuminated 7 ❑
channel letters
❑ ❑
❑ ❑
A Symbol or code used on the plans when plans are required)and other documents.
B A narrative description of the sign,or location ofsi n on the building,and the location of si n on construction documents
C OPTIONAL-Check this box only if this sign has a permanent,pre-printed,factory-installed ENERGY VERIFIED label,confirming that
this sign complies with the Section 148 of the California 2008 Title 24,Part 6 Standards,using the Specific Lighting Source Method of
Compliance. The only labels that will be recognized for this purpose are ENERGY VERIFIED Certification Marks authorized 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,
column 'D' is 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
Specific Light Source Compliance Method. The sign(s)identified above use only the following lighting technologies:
List all applicable numbers I through 10 that apply in column D above for each row.
/ High ressure sodium lamps
2 Pulse start or ceramic metal halide lamps served by a ballast with >88%efficiency
3 Pulse start metal halide lamps that are<320 watts,are not 250 watt or 175 watt lamps,and are served by a ballast
with>80%efficiency
4 Neon or cold cathode lamps with transformer or power supply efficiency>_ 75%with rated output current<50 mA
U 5 Neon or cold cathode lamps with transformer or power supply efficiency>_68%with rated output current>50 mA
6 Fluorescent lamps with a minimum color rendering index(CRI)of 80
(Note:when using electronic ballasts for compliance, lamps with a CRI <80 may be used)
7 Light emitting diodes(LEDs)with a power supply with > 80%efficiency
Single voltage LED external power supplies designed to convert 120 volt AC input into lower voltage DC or AC
8 output, having a nameplate output power less than or equal to 250 watts,and certified to the Energy Commission as
complying with the applicable requirements of the Appliance Efficiency Regulations(Title 20)
9 1 Com act fluorescent lamps that do not contain a medium screw base sockets(E24/E26)
/0 1 Electronic ballasts with a fundamental output frequency>20 kHz
E f'his pa e doubles as a field inspection checklist.
Field Inspector Notes:
2008 Nonresic(ential Compliance Forms October 2010
Simon Vuong
From: Sean Wu [swul966@gmail.com]
Sent: Wednesday, January 29, 2014 10:12 AM
To: Simon Vuong
Subject: Fwd: RE: Choco Sign need your approve.
Hi Simon
F.y.i
Sean
---------- Forwarded message----------
From: "Henry, Deena" <Deena.henr kIa mcorealtcom>
Date: Jan 28, 2014 1:14 PM
Subject: RE: Choco Sign need your approve.
To: "Sean Wu" <swu1966kgmail.com>
Cc: "Loewenberg, Erica" <eloewenberg2kimcorealty.com>
This is approved -thanks
Deena J. Henry,CSM
Property Manager
15 Southgate Avenue,Suite 2011 Daly City,CA 94015 Office (650)756-21621 Mobile (650)730-32361 Fax 650 756-
3390 deena.henry@kimcorealty.com
From: Sean Wu [mailto:swu19660gmail-com1
Sent: Tuesday, January 28, 2014 1:09 PM
To: Henry, Deena
Subject: Fwd: Choco Sign need your approve.
---------- Forwarded message----------
From: "Sean Wu" <swu1966(a�grnail.com>
Date: Jan 24, 2014 3:46 PM
Subject: Choco Sign need your approve.
i
To: "Cupertino Village" <Deena.henrygkimcorealty.com>, "Sean Wu" <swu1966(a,�mail.com>
Cc:
Hi Deena
Attached sign rendering for you to approve,Please let me know if you have any question, and email or fax
letter approval to me ASAP.
so I can get sign permit soon !
Thank you much
This email and any attached files may contain content that is considered proprietary and/or confidential.All email content and files are
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2
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