15050026 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10385 S DE ANZA BLVD CONTRACTOR:CITY SIGNS PERMIT NO: 15050026
OWNER'S NAME: BDC HAYWARD LP 1101 DOKER DR STE D DATE ISSUED:06/16/2015
OWNER'S PHONE: 9255882213 MODESTO,CA 95351 PHONE NO:(209)549-2412
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL E] COMMERCIAL E]
CHIPOTLE-INSTALL 2(N)ILLUMINATED WALL SIGNS&
License Class CY;F Lic.# :74,4,� REPLACE/RE-FACE(E)MONUMENT SIGN
Contractor G/yY Date
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:$4573
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:35917019.10385 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 DAYS FROM LAST CALLED INSP CTI 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
gIssued by: TWAD!9WVWJranting of this permit. Additionally,the applicant understands and will comply Date:
with all non-point so egulations er the Cup ino Municipal Code,Section
9 18.
�_ RE-ROOFS:
Signature Date �� iS 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
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. 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, d 25534
Section 3700 of the Labor Code,for the performance of the work for which this e, 6�L/
permit is issued. Owner or authorized agent: 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
indemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION
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
SIGN PERMIT APPLICATION - t
COMMUNITY DEVELOPMENT DEPARTMENT = BUILDING DIVISION
: . 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
Lima
°_
CVPERT INN (408) 777-3228• FAX(408)777-3333• building Qcupertino.or.
PROJECT ADDRESS APN#
10385 S De Anza Blvd.Cupertino,CA 95014 359-17-019
OWNER NAME PHONE Mbaitsbrowmandevelo
E- AIL ment.com
Browman Property Development. Inc. Manager:Brian Alta (925)588-2213 @ P
STREET ADDRESS 1556 Parkside Dr. CITY, STATE,ZIP Walnut Creek,CA 94596 FAX (925)588-2230
CONTACT NAME Richard Johnson PHONE (206)264-2932 E-MAIL rjohnson@tubeart.com
STREETADDRESS 2323 W Washington Ave. CITY,STATE,ZIP Yakima,WA 98903 FAX (509)469-7546
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT 2 CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME Veronica Munoz LICENSE NUMBER 769900 LICENSE TYPE Corp BUS.LIC#
COMPANYNAME City Signs Modesto E-MAIL veronica@citysignsmodesto.com FAX (209)549-2419
STREET ADDRESS 1101 DOker Dr. Suite D. CITY,STATE,ZIP Modesto, CA 95351 PHONE (209)549-2412
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK
Adding(2)illuminated signs to replace illuminated signs currently on building.Existing signs will be removed and disposed.Any extrusions
will be patched and painted to match building. Existing monument sign will remain-faces will be removed and replaced with new ones,no
structural changes will be made to the sign.
USE OF ❑ SFD or Duplex ❑ Multi-Family ILLUMINATED SIGN TYPE NO.OF SIGN AREA VALUATION
STRUCTURE: I Commercial (YIN) (CODE) SIGNS
(SQ.FT.) ($)
SIGN TYPE CODES: Y W 1 21.52 $1,846
B - BANNER SIGN M - MONUMENT(GROUND)SIGN Y W 1 21,552 $1,546
BL - BLADE SIGN P - PROJECTING SIGN
D - DEVELOPMENT ID SIGN SP - SPECIAL EVENT BANNER Y M-Reface 1 21.3 $881 (reface)
DI = DIRECTIONAL SIGN T - TEMPORARY
E - ELECTRONIC W - WALL SIGN
READERBOARD WI - WINDOW SIGN
F
ECEIVED BY: TOTAL VALUATION:
$4,573.00
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information I have provided is co I. I have re 1me Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating ui go nstm on. I auth " e 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 CHECK TYPE ROUTING SLIP
Elevations ❑ OVER-THE-COUNTER ❑ BUILDINGPLANM, IIEW
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: 10385 S DE ANZA BLVD DATE: 05/06/2015 REVIEWED BY: MELISSA
APN: 359 17 019 BP#: �� "VALUATION: 1$4,573
PERMIT TYPE: Building Permit PLAN CIIECK TYPE:
PRIMARY PENTAMATION
USE: Sign PERMIT TYPE: 1 CEAP
WORK 01POTLE - INSTALL 2 N ILLUMINATED WALL SIGNS & REPLACE/RE-FACE E MONUMENT
SCOPE N
SIGN TYPE FEE ID QTY SIGN FEE
Wall Sign,Electric 1SIGNWELEC 2 $572
Ground Sign,Alteration 1SIGNREWRK 1 $359
TOTALS: $931.00
Alech. Plan Check Plumb,Plan Check #Branch Circuits 1 $48.00
Afech.Permit Fce: Plumb.Per•anu Fee: IESIGN Elec.Permit Fee: 1EPERMIT
Othrr Arfech.Insp. 1-1
Other Plranth Lisp. Other Elec.Insp. 0.0 $48.00
AMA Insp.Fee: Plaranh. Imp. Fee: Elec. Insp. Fee:
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 prelinzinar information available and are only an estimate. Contact the De t for addit'l in o.
FEE ITEMS (Fee Resolution 11-053 E . 7/1/13) FEE QTY/FEE MISC ITEMS
Platt Check Fee:
Suppl.PC Fee: Reg. Q OT 0.0 hrs $0.00
Pl t nn f.T,/AI ec:lz./Gl ec
Permit Fee: $931.00
Suppl. Insp.Fee:E Reg. Q OT 0.0 hrs $0.00
PME Unit Fee: $48.00
PME Pen-nit Fee: $48.00
C017S11•1.1ctio77 TaX.
Achnaa'atstrutive Fee:
Work Without Pen-nit? 0 Yes No $0.00
Sign Master Plan: Q Yes No $0.00
Travel Documentation Fee: ITRA VDOC $48.00
Strong Motion Fee: 1BSEIS1vffC0 $1.28 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS:_' $11077.28 $0.00 TOTALFEE'. $1,077.28
Revised: 04/01/2015
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10385 S DE ANZA BLVD CONTRACTOR:CITY SIGNS PERMIT NO: 15050026
OWNER'S NAME: BDC HAYWARD LP 1101 DOKER DR STE D DATE ISSUED:06/16/2015
OWNER'S PHONE: 9255882213 MODESTO,CA 95351 PHONE NO:(209)549-2412
JOB DESCRIPTION:RESIDENTIAL COMMERCIAL
LICENSED CONTRACTOR'S DECLARATION CHIPOTLE-INSTALL 2(N)ILLUMINATED WALL SIGNS&
License Class _` Lic.# a :.mow"` REPLACE/RE-FACE(E)MONUMENT SIGN
ContractorVAN
Date FIRM
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:$4573
��. II 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:35917019.10385 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 FROM LAST CALLED INSP CTI 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 / h{/u�l /
granting of this permit. Additionally,the applicant understands and will comply Issued by: Date:
—,
with all non-point s egulations er the Cup ino Municipal Code,Section
9.18. .0
Si nature �3 #y Date RE-ROOFS:
g 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
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. 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 25505,255331 d
FDaterl-5/2Section 3700 of the Labor Code,for the erformance of the work for which this }`permit is issued. p Owner or authorized agent: ,e
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
indemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION
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.I8.
Signature Date
SIGN PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 O
CVPERTIN® 1 (408)777-3228•FAX(408)777-3333•building cupertino.org
PROJECT ADDRESS APN#
10385 S De Anza Blvd.Cupertino,CA 95014 359-17-019
OWNER NAME PHONE E-MAIL baita@browmandevelopment.com
B wman Pro a Development.Inc. Manager Brian Aita (925)588-2213
STREET ADDRESS 1556 Parkside Dr. CITY, STATE,ZIP Walnut Creek,CA 94596 FAX (925)588-2230
CONTACT NAME Richard Johnson PHONE (206)264-2932 E-MAIL rjohnson@tubeart.com
STREETADDRESS 2323 W Washington Ave. CITY,STATE,ZIP Yakima,WA 98903 FAX (509)469-7546
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ® CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT' ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME Veronica Munoz LICENSE NUMBER 769900 LICENSE TYPE Corp BUS.LIC#
COMPANY NAME City Signs Modesto E-MAIL veronica@citysignsmodesto.com FAX (209)549-2419
STREETADDRESS1101 Doker Dr. Suite D. CITY,STATE,ZIP Modesto,CA 95351 PHONE (209)549-2412
ARCHITECTIENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK
Adding(2)illuminated signs to replace illuminated signs currently on building.Existing signs will be removed and disposed.Any extrusions
will be patched and painted to match building. Existing monument sign will remain-faces will be removed and replaced with new ones,no
structural changes will be made to the sign.
USE OF ❑ SFD or Duplex ❑ Multi-Family ILLUMINATED SIGN TYPE NO.OF SIGN AREA VALUATION
STRUCTURE: Commercial (Y/N) (CODE) SIGNS (SQ_FT.) ($)
SIGN TYPE CODES: Y W 1 21.52 $1,846
B - BANNER SIGN M - MONUMENT(GROUND)SIGN y W 1 21,52 $1,546
BL - BLADE SIGN P - PROJECTING SIGN
D - DEVELOPMENT ID SIGN SP - SPECIAL EVENT BANNER Y M-Reface 1 21.3 $881 (reface)
DI DIRECTIONAL SIGN T - TEMPORARY
E - ELECTRONIC W - WALL SIGN
READERBOARD WI - WINDOW SIGN
RECEIVED BY: TOTAL VALUATION:
$4,573.00
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information I have provided is corcpt. 1h re a Description of Work and verify it is accurate. I agree to comply with all applicable local
-ordinances and state laws relating ui g c nst 6 Ion. I auth a representatives of Cupertino to enter the above`identified property for inspection purposes.
Signature of Applicant/Agent: Date: �J
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_2 011.doc revised 03/31/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 10385 S DE ANZA BLVD DATE: 05/06/2015 REVIEWED BY: MELISSA
APN: 35917 019 BP#: �� `VALUATION: 1$4,573
*PERMIT TYPE: Building Permit PL.4NCHECKTYPE:
PRIMARY Sin
g PENTAMATION 1 CEAP5
USE. PERMIT TYPE: A
WORK CHI POTLE- INSTALL 2 N ILLLIMINATED WALL SIGNS & REPLACE/RE-FACE E MONUMENT
SCOPE SIGN
SIGN TYPE FEE ID QTY SIGN FEE
Wall Sign,Electric 1SIGNWELEC 2 $572
Ground Sign,Alteration 1SIGNREWRK 1 $359
TOTALS: $931.00
Mech. Phm Check Phnnh..Plan Check #Branch Circuits 1 $48.00
19ech.Permit Tee: P/mmh.Permit Fee: IESIGN Elec.Permit Fee: IEPERMIT
Other Mech.Insp. Other Plumb Imsp, Other Elec.Insp. 0.0 $48.00
Alec•h.Insp.Fee: Ph.mnb.Insp. Fee: Elec.Lap.Fee:
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 preliminar information available and are only an estimate. Contact the Dept-for addn I info.
FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13) FEE QTY/FEE MISC ITEMS
Plan Check Fee.•
Suppl.PC Fee: EReg. 0 OT 0.0 hrs $0.00
Plunih./Alech./Elec
Permit Fee: $931.00
Suppl. Insp. Fee-E) Reg. Q OT 0.0 hrs $0.00
PME Unit Fee: $48.00
PME Permit Fee: $48.00
Constriletion Tae:
Adininistt•ative Fee:
Work Without Permit? C) Yes C No $0.00
Sign Master Plan: Q Yes C• No $0.00
Travel Documentation Fee: ITRAVDOC $48.00
Strong Motion Fee: IBSEISMICO $1.28 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $1,077.28 $0.00 TOTAL FEE: 1 $1,077.28
Revised: 04/01/2015