15060031 (2) CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10885 N WOLFE RD CONTRACTOR:SUCCESS GRAPHIC PERMIT NO: 15060031
SIGNS
OWNER'S NAME: CUPERTINO VILLAGE,LP 1744 QUEENS CROSSING DR DATE ISSUED:06/04/2015
DOWNER'S PHONE: 5033369202 SAN JOSE,CA 95132 PHONE NO:(408)667-1777
FRELICENSED CONTRACTOR'S DECLARATION rAlo
JOB DESCRIPTION:RESIDENTIAL COMMERCIAL
INSTALL(2)SIGNS OF CHANNEL LETTERS ON EXTERIOR
License Clas � + ic. F: � "^ OF BUILDING 1 LOCATED AT REAR& 1 LOCATED AT
� :..s c
Dateg�. rl FRONT OF BUILDING WITH 1 BRANCH CIRCUIT)
Contractor -
I hereby affirm that I am licensed under the provisions f 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:$3800
A/ 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 10885 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 180JDZYS FROM LAST CALLED INSPECT ON.
indemnify and keep harmless the City of Cupertino against liabilities,judgments, /costs,and expenses which may accrue against said City in consequence of theIssued b �c�i I v Date: lillf
granting of this permit. Additiona , e applicant understands and will comply y
with all non-point source re tionsifer the Cupertino Municipal Code,S ctio
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
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 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
1 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 Cup ' '�vlunicipal Code,Chapter 9.12 and
er
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 05,2N55339 and 2f534.
Section 3700 of the Labor Code,for the erformance of the work for which this
p Owner or authorized agent: Date: drd
permit is issued.
1 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 1 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
SIGN PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(408)777-3228 • FAX(408)777-3333•buildingQcupertino.org
CUPER,TINO
PROJECT ADDRESS i t�® a ( woL; ;1�(1 APN#� ®V�
OWNER NAME i /" 9i 'v $�eJPHO
j �k.� JE-MAIL r
STREET ADDRESS ., �� t i I CI Y, STATE,ZIP ^..{ c'0�,I(� c FAX
13
CONTACT NAME �(� PHONE ((� E-MAIL 1ICi
i
STREET ADDRESS CITY,STATE,ZIP FAX
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME q'a LICENSE NUMBER I i b'j1- LICENSE aYP BUS.LIC#
COMPANY NAME I�aJ"1 \ E-MAIL j� r (y/ FAX
STREET ADDRESSp 7�U '/� QWC CITY,STATE,ZIP � ./ PHONE �i, M,
ARCHITECT/ENGINEER NAME LICENSE NUMBER r' BUS.LIC#R. '�?
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK ryg�Tom
USE OF ❑ SFD or Duplex ❑ Multi-Family ILLUMINATED SIGNTYPE NO.OF SIGN AREA VALUATION
STRUCTURE: W Commercial (YIN) (CODE) SIGNS (SQ.FT.) M
SIGN TYPE CODES: vi
B - BANNER SIGN M - MONUMENT(GROUND)SIGN
BL - BLADE SIGN P - PROJECTING SIGN
D - DEVELOPMENT ID SIGN SP - SPECIAL EVENT BANNER
DI - DIRECTIONAL SIGNTEMPORARY
E - ELECTRONIC (W- WALL SIGN
READERBOARD WI - WINDOW SIGN
RECEIVED BY ; m �. TOT�VALUATION:1
By my signature below,I certify to each of the following: I am the property owner or au horized agent to act on the property own is behalf. 1 hav read this
application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree comply ith all applicable local
ordinances and state laws relating to building construct;�,.I authorize representatives of Cupertino to enter the above-id�ntifie property or ir�sp j urrposes.
Signature of Applicant/Agent: Date: $9(r�
SUPPLEMENTAL SQUIRED_Site Plan F,LAN',CHECK TYPE ,. ROUT]VGShIP,„,�
_ElevationsIN rArrvri4w
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Sign Details-including UL listing(s)applicable sTANDAIW, t ti rLrrNNnvcrtANREVIEw r
PA, w' 7w - ii i s s 5 z
Structural Calculations(if applicable) �,:I,ARGE ;
❑ OTHER a � -
Copy of Planning Approval Letter or Meeting with Planning prior to
submittal of Building Permit application. , n
SignApp_2011.doc revised 03116111
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 10885 N WOLFE RD DATE: 06/04/2015 REVIEWED BY: PAUL
IQAPN: 316 05 053 BPA. 31 "VALUATION: $3,800
%PERMIT TYPE: Building Permit PIAN CHECK 1'YPh:
PRIMARY ---TAE
NTAMATION 1 CEAP5
USE: Sign PERMIT TYPE: i
WORK INSTALL 2 SIGNS OF CHANNEL LETTERS ON EXTERIOR OF BUILDING 1 LOCATED AT REAR
SCOPE & 1 LOCATED AT FRONT OF BUILDING WITH 1 BRANCH CIRCUIT)
SIGN TYPE FEE ID QTY SIGN FEE
Wall Sign,Electric 1SIGNWELEC 2 $572
TOTALS: $572.00
,1<Iech. Plan Check Plunrb. Plan Check #Branch Circuits 1 $48.00
IESIGN Elec.Permit Fee: IEPERMIT
1fech. Permil Fee: Plumb. Permit Fee:
Other Afech. Insp. Other Plumb Insp. Other Elea Insp. 0.0 $48.00
Me&Insp.Fee: Plumb. hrsp. Fee: Oec.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 prelimina information available and are only an estimate..Contact the De t or addn't info.
FEE ITEMS (Fee Resolution 11-053 E . 7ff /1/13) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00
Phan b.!Mech.;Elec
Permit Fee: $572.00
Suppl. Insp.Fee-.(F) Reg. Q OT 0,0 hrs $0.00
PME Unit Fee: $48.00
PME Permit Fee: $48.00
Construction Tax:
Administrative Fee:
Work Without Permit? 0 Yes Q No $0.00
Sign Master Plan: 0 Yes (E) No $0.00
Travel Documentation Fee: ITRAVDOC $48.00
Strong Motion Fee: 1BSEISMICO $1.06 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00 —
SUBTOTALS- $718.06F $0.00 . TONAL FEE:.
Revised: 05/07/2015
C., JUN. 0 4 2015
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gin 5"Aluminium Return(.040)
BUILDING IVISION -LTTPERTfN #10 x 3 112"Drive screws :,
PROVED minimum t per
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This set of tans a 5 eClfl 1 T kept t at the � w/sleper letter
eves for stand-off Eectrical ce
p p 3207 Rubber brushing ! plies���jjjjjj of¢e'Ysf�
job site during con tfUC1lon. It Is unlawful to make any Acrylic Face J Class2lowvoltage
changes or aIle ati�ils oo-�� �e toA- 31
�� ' _ I t QED lMnng
n s ; " a 1 � ry aNote No conduit ort/ex
therefrom,wlthocl val �h' n � lbiat; t���� tr�u .2, a tr 2® mgmredperclass2low
J '�, ) �-i' m J o J. J J J Trim Cap 3/4 I: voltage wiring guideline
The Stamping of chi pi I specifications SHALL NOT
be held to permit to be an approval of the violation
114"Drain Hole Power Supply
of an 1 rovisio any , Ord'nance or State Law. (1120-277VAC)c> o '
v�/ Disconnected Switches
BY Sign Type: (1)Internally illuminated L.E.D individual Channel Letters Sign.
DATE Letter Face: 1/8"Thick acrylic face color as shown
PERf,"ITv ' .f
Letter Returns: 5"White with.040 Aluminum
Trim Cap: 3/4"gold
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Project Location Approval
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• 1 . 1744 Queens Crossing Drive San Jose—CA 95132 4
� I 10885 N Wolfe Rd I
T.' (408) 667-1777 E-mail.swu1966@gmail.com
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