14080215 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20803 STEVENS CREEK BLVD CONTRACTOR:ILLUMINART SIGNS PERMIT NO: 14080215
OWNER'S NAME:
SUNNYVALE,CA 94089 PHONE NO:(408)289-1883
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL E] COMMERCIAL ❑
QQ J SAICH WAY STATION-INSTALL 1 MONUMENT SIGN
License Class 1--�J I�� n Lic.# G p j o`t'o f
Contractor l (�I I\�f.�► 1 Date'O /
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:$4000
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:32632042.00 Occupancy Type:
fv�U 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.1 agree to comply with all city and county ordinances and state laws relating WITHIN 18015TY-SW 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 FRO ST 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: 14"
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.
00
Signature VV(
installed without first obtaim an inspection,I a ee o remove all new materials for
inspection. ((��`
OWNER-BUILDER DECLARATION $,�
❑ /V
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 C INGS O 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. 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(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 25505,25533,and 25534. 9 /
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date:(7 `
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
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
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
W'PERMIT
DDRESS: 20803 scb DATE: 08/20/2014 REVIEWED BY: Mendez
PN: BP#: *VALUATION: $4,000
PE: Building Permit ILIA t'111,,C /.r/'f:
PRIMARY PENTAMATION 1 CEAP5
USE: Sign PERMIT TYPE: i
WORK saich way station- install 1 monument sign
SCOPE
SIGN TYPE FEE ID QTY SIGN FEE
Ground Sign 1SIGNGR/RF 1 $359
TOTALS: $359.00
-lie �
X1'11110. flan Choc-% #Branch Circuits 1 $48.00
IESIGN Elec.Permit Fee: 1EPERMIT
/>•,• ,"l`trnzb. f':rmit 1,i�e':
Fee:
3f1�c;,";liech. fnv, 01,17 r Plumb Insp Other Elec.Insp. L0.Jo $48.00
NOTE: This estimate does not include fees due to other Departments(i.e.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 addn7 info.
FEE ITEMS (Fee Resolution 11-053 Ef. 7/f 1113) FEE QTY/FEE MISC ITEMS
Suppl. PCp Fee: (D Reg. 0 OT 0.0 hrs $0.00
'fir i{ f ":'I Lit rFe I h�c
Permit Fee: Hourly Only? 0 Yes (F)No $359.00
Suppl. Insp. Fee:Q Reg. 0 OT 0,0 1 hrs $0.00
PME Unit Fee: $48.00
PME Permit Fee: $48.00
:'sl�stxr�tI�r�t� "gra:
Work Without Permit? 0 Yes (F) No $0.00
Sign Master Plan: 0 Yes (E) No $0.00
Travel Documentation Fee: ITRAVDOC $48.00
Strong Motion Fee: 1BSEISMICO $1.12 0.0 hrs Inspections
Bldg Stds Commission Fee: IBCBSC $1.00 $0.00 Inspection,Hourly
LSr"' $505.12 $0.00 TOTAL FEE: $505.12
Revised: 07/10/2014