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15040195 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20803 STEVENS CREEK BLVD CONTRACTOR:VISIBLE GRAPHICS PERMIT NO: 15040195 OWNER'S NAME: SAICH WAY STATION LLC DATE ISSUED:06/16/2015 OWNER'S PHONE: 4085217110 CANOLA PARK,CA 91304 PHONE NO:(818)787-0477 MI LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL F]�^ ,,��- THE MELT-INSTALL 3 NON ILLUMINATED WALL SIGNS License Class �� Lic.# 7yS�d,> & �� G G� 2 NON ILLUMINATED PROJECTING SIGNS Contractor i P�� Date �G�/� 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:$7500 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: 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 WITFIIN 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 D S FROM LAST CALLED INSPECTI N. 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: C/ ' Date: O�l/r tt with all non-point so regulations per the Cupertino Municipal Code,Section 9 18. �� RE-ROOFS- Signature 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. ❑ OWNER-BUILDER DECLARATION 1 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,Sectio 05,2553 ,and 255 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Owner or authorized agent: Z Date: 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 l SIGN PERMIT APPLICATION 00 COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUP{sRTiNG , (408) 777-3228• FAX(408)777-3333•buildina(acuoertino.orn PROJECT ADDRESS 7 ,�J APN# L ' A r OWNER NAME PHONE ~/1� E-MAIL STREET ADDRESS CITY, STATE,ZIPFAX CONTACT NAME PHONE E-MAIL Y STREET ADDRESS CITY,STATE,ZIP FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ACONTRACTORAGENT ❑ ARCHrrECr ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME LICENSE NUMB LICENSE TYPE BUS.LIC# eV4-� COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE 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: Commercial (Y/N) (CODE) SIGNS (SQ.FT.) (s) SIGN TYPE CODES: B BANNER SIGN M - MONUMENT(GROUND)SIGN QBLADE SIGN P - PROJECTING SIGN (� D - DEVELOPMENT ID SIGN SP - SPECIAL EVENT BANNER A[ L '7� /1 DI - DIRECTIONAL SIGN T - TEMPORARY / E - ELECTRONIC W - WALL SIGN READERBOARD WI - WINDOW SIGN EI TOT4 VALUATION: By my signature below,I certify to each of the following: I am the prop o r authorize ent to act on the property owner's behalf. I have ead this application and the information I have pr . d is co t. 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 din i st :tion. I a ze representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY Site Plan PLAN CHECKTYPE ROUTING SLIP Elevations ❑ OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW Sign Details-including UL listing(s)applicable ❑ ERPRESs ❑ PLANNING PLAN REVTEW Structural Calculations(if applicable) ❑ STANDARD ❑ OTHER: Copy of Planning Approval Letter or Meeting With Planning prior to ❑ LARGE submittal of Building Permit application. ❑ MAJOR Sigm4pp_2011.doc revised 03/31111 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 20803 STEVENS CREEK BLVD DATE: 04/27/2015 REVIEWED BY: MELISSA APN: 326 32 042 BP#: 0 *VALUATION: 1$7,500 "PERMIT TYPE: Building Permit PLAN CHECK 7TPF:: PRIMARY Sign PENTAMATION 10EAP USE. SiPERMIT TYPE: WORK THE MELT- INSTALL 3 NON ILLUMINATED WALL SIGNS & 2 NON ILLUMINATED PROJECTING SCOPE SIGNS SIGN TYPE FEE ID QTY SIGN FEE Wall Sign,Non-Electric 1SIGNWNONE 5 $1,430 TOTALS: $1,430.00 i j YI 1 �, t r ti s a t rx r. 4. T T t •, i H 3 h^s t .a w oR r r ilfech. Pian Check Plumb. Plan('heck #Branch Circuits 0 $0.00 ;b1aclt. Permit Fee: Plumb.Permit Fee: Elec.Permit Fee: Other Atech. Imp. Other Plumb Insp. Other Elec.Insp. 0.0 $0.00 ildech Insp.Fee: Plumb. Insp. Fee: Elec.Insp.Fire: NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). Thesefees are based on the prelfmWdna information available and are only an estimate. Contact tl:e De t or addn'1 info, FEE ITEMS (Fee Resolution 11-053 Lff. 7/1/13) FEE QTY/FEE MISC ITEMS Plan Cheek Fee: Suppl.PC Fee: (j) Reg. 0 OT 0.0 I hrs $0.00 1'hrmb.!!lIc ch.r'Tlec Permit Fee: $1,430.00 Suppl. Insp.Fee:Q Reg. 0 OT F0,01 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 L'0107'LlCtiO)7 Tcax: Administrative Fee: Work Without Permit? 0 Yes (j) No $0.00 Sign Master Plan: Q Yes (D No $0.00 Travel Documentation Fee: ITRA VDOC $48.00 Strong Motion Fee: IBSEISMICO $2.10 Select an Administrative Item Bld.p Stds Commission Fee: IBCBSC $1.00 , SUBTOTALS $1,481.10 $0.00 �� s 7" TOTAI�rFE;E $1,481.10 Revised: 04/01/2015