15090196 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10191 S DE ANZA BLVD CONTRACTOR:GOLDEN GATE SIGN CO PERMIT NO: 15090196
OWNER'S NAME: HEINE MARYLOU A TRUSTEE&ET AL 711 INDEPENDENT RD DATE ISSUED:09/29/2015
OWNER'S PHONE: 2489488786 OAKLAND,CA 94621 PHONE NO:(510)366-3838
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
'J q // STERLING BANK&TRUST-INSTALL 2(N)ILLUMINATED
C NJ Lic.# /4[��6 3 WALL SIGNS TO(E)BRANCH CIRCUITS
License Class /C
Contractor y Date
1 hereby affir tha 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.
1 hereby affirm under penalty of perjury one of the following two declarations: Esq.1•t Floor Area: Valuation:$10000
t. 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 k WN N u in ber:35910015.10191 Occupancy Type:
performance of the work for which this permit is issued.
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
permit is issued. PERMIT EXPIRES IF WORK IS NOT STARTED
APPLICANT CERTIFICATION WITHIN 180 DAYS OF PERMIT ISSUANCE OR
I certify that I have read this application and state that the above information is 180 DAYS FR D INSPECTION.
correct.1 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 fi /
upon the above mentioned property for inspection purposes. (We)agree to s ue te:
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 with RE-ROOFS:
all non-point source regu ns per Cupertino Municipal Code,Section 9.18.
All roofs shall be inspected prior to any roofing material being installed.If a roof is
Signature Date 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 ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
the following two reasons:
1 1,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 HAZARDOUS MATERIALS DISCLOSURE
sale(Sec.7044,Business&Professions Code) I have read the hazardous materials requirements under Chapter 6.95 of the
2 1,as owner of the property,am exclusively contracting with licensed contractors to California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
construct the project(Sec.7044,Business&Professions Code). compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Safety Code,Section 25532(a)should I store or handle hazardous material.
I hereby affirm under penalty of perjury one of the following three declarations: Additionally,should 1 use equipment or devices which emit hazardous air
i 1 have and will maintain a Certificate of Consent to self-insure for Worker's contaminants as defined by the Bay Area Air Quality Management District I will
Compensation,as provided for by Section 3700 of the Labor Code,for the maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Health&Safety Code,Sections 25505,25533,and 25534.
performance of the work for which this permit is issued.
2 1 have and will maintain Worker's Compensation Insurance,as provided for by Owner or d a t:
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. r
a. 1 certify that in the performance of the work for which this permit is issued,I shall CONSTRUCTION LENDING AGENCY
not employ any person in any manner so as to become subject to the Worker's
1 hereby affirm that there is a construction lending agency for the performance of work's
Compensation laws of California. If,after making this certificate of exemption,1 for which this permit is issue
become subject to the Worker's Compensation provisions of the Labor Code,I d(Sec.3097,Civ C.)
Lender's Name
must forthwith comply with such provisions or this permit shall be deemed
revoked. Lender's Address
APPLICANT CERTIFICATION ARCHITECT'S DECLARATION
I certify that I have read this application and state that the above information is I understand my plans shall be used as public records.
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 Licensed Professional
upon the above mentioned property for inspection purposes.(We)agree to save
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 with
all non-point source regulations per the Cupertino Municipal Code,Section 9.18.
tiienature Date
SIGN PERMIT APPLICATION
12 COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
C U P E RTI N O (408)777-3228 • FAX (408)777-3333 • building(c-cupertino.org
PROJECT ADUIiLSS J L V,/� APN#
OWNER NAMETis PHONE � 6i y t j�7 e . MAII.
STREET ADDRESS /O V C I i Y`�if P A,5 (�0 FAX
CONTACT NAME/ �j) PHONE �! 5 -( E-MAIL
STREET ADDRESS CITY,�S]AJE, ZIP FAX
Whl
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT-
C!= ENANTCO TO NAM / LIC/E7 E NUMBER —� LICENSE TT PE - ` BUS.LIC#
COMP AME l E-MAIL 1 FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
GTi��Gi 33 6 -34 �
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME L-MAIL FAX
STREET ADDRESS CITY.STATE,ZIP
DF-.SCRIPTION OF WORK C _
�7rY 6A1AVL_
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: W� ' / �- L Ui C)
B - BANNER SIGN M - MONUMENT(GROUND)SIGN 1
BL - BLADE SIGN P - PROJECTING SIGN
D - DEVELOPMENT ID SIGN SP - SPECIAL EVENT BANNER
DI - DIRECTIONAL SIGN T - TEMPORARY
E - ELECTRONIC 1 j- WALL SIGN
READERBOARD WI - WINDOW SIGN
RECEIV TEAL VALUATION
By my signature below,I certify to each of the following: I am the property o ora nz nt to act on the property owner's behalf. ve read this
application and the information 1 have provided is correct. I h ve read the escripti ork and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building c ction. authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: ' Date: C
� - 2 --�
SUPPLEMENTAL INFORMATION REQUIRED OFFICE Use ONLY
Site Plan PLAN CHECK T1 PE 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
WAPN:
DDRESS: 10191 S DE ANZA BLVD DATE: 09/29/2015 REVIEWED BY: MELISSA
35910015.10191 BP#: *VALUATION: $10,000
PERMIT TYPE: Building Permit P1 I\ ( ///.,( K /)/Ii
PRIMARY PENTAMATION
USE: 7 Sign PERMIT TYPE. 10EAP
WORK STERLING BANK & TRUST- INSTALL 2 N ILLUMINATED WALL SIGNS TO E BRANCH
SCOPE CIRCUITS
SIGN TYPE FEE ID QTY SIGN FEE
Wall Sign, Electric 1SIGNWELEC 2 $572
TOTALS: $572.00
Tech. Plan Check #Branch Circuits 1 1 1 $48.00
.flee/, Permit IESIGN Elec. Permit Fee: IEPERMIT
11erh. /nsp Lj Other Elea Insp. 0.0 $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. . Thesefees are based on the prelintinarj information available and are onhy an estimate. Contact the De t or addn 7 info.
FEE ITEMS (/-ec Resolution 11-053 /--ff 7 1 131 FEE QTY/FEE MISC ITEMS
Suppl. PC Fee: Q Reg. OOT 0.0 hrs $0.00
Wool,
Permit Fee: $572.00
Suppl. Insp.Feee Reg. Q OT p,p hrs $0.00
PME Unit Fee: $48.00
PME Permit Fee: $48.00
I,ltnini.strative Fec
Work Without Permit? Yes (F) No $0.00
Sign Master Plan: Q Yes 0 No $0.00
Travel Documentation Fee: ITRA 6DOC $48.00
Strong Motion Fee: IBSEISMICO $2.80 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $719.801 $0.00 TOTAL FEE: $719.80
Revised: 07/02/2015
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