15100097 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10955 N WOLFE RD CONTRACTOR:DISCOUNT SIGNS PERMIT NO: 15100097
OWNER'S NAME: CUPERTINO VILLAGE,LP 1320 MARSTEN RD UNIT E DATE ISSUED: 10/13/2015
OWNER'S PHONE: 9165802541 BURLINGAME,CA 94010 PHONE NO:(650)333-6688
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
INSTALL(1)ILLUMINATED WALL SIGN FOR CRICKET.
License Class_ Lic.# 01
01
Contract /345a 9v7�G'(2!9 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.
Sq.Ft Floor Area: Valuation:$2500
I hereby affirm under penalty of perjury one of the following two declarations:
i. I have and will maintain a certificate of consent to self-insure for Worker's APN Number:31605051.10955 Occupancy Type:
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued.
2. I have and will maintain Worker's Compensation Insurance,as provided for by
ction 3700 of the Labor Code,for the performance of the work for which this PERMIT EXPIRES IF WORK IS NOT STARTED
permit is issued. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
APPLICANT CERTIFICATION 180 DAYS FROM LAST CALLED INSPECTION.
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 Issued by: ,5 � fG,g 1 Date:
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 he applicant understands and will comply with RE-ROOFS:
all non-points eg lations p e Cupertino nicipal Code,Section 9.18. 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
Signature Date/003 inspection.
Signature of Applicant: Date:
❑ OWNER-BUILDER DECLARATION ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
1. I,as owner of the property,or my employees with wages as their sole HAZARDOUS MATERIALS DISCLOSURE
compensation,will do the work,and the structure is not intended or offered for I have read the hazardous materials requirements under Chapter 6.95 of the
sale(Sec.7044,Business&Professions Code) California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
2. I,as owner of the property,am exclusively contracting with licensed contractors to compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
construct the project(Sec.7044,Business&Professions Code). Safety Code,Section 25532(a)should I store or handle hazardous material.
Additionally,should I use equipment or devices which emit hazardous air
I hereby affirm under penalty of perjury one of the following three declarations: contaminants as defined by the Bay Area Air Quality Management District I will
1. I have and will maintain a Certificate of Consent to self-insure for Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Compensation,as provided for by Section 3700 of the Labor Code,for the Health&Safety Code,Sections 25505,25533,and 25534.
performance of the work for which this permit is issued. Owner an oriz a e t:
2. I have and will maintain Worker's Compensation Insurance,as provided for by Date:,
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. CONSTRUCTION LENDING AGENCY
3. 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 I 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,I for which this permit is issued(Sec.3097,Civ C.)
become subject to the Worker's Compensation provisions of the Labor Code,I Lender's Name
must forthwith comply with such provisions or this permit shall be deemed Lender's Address
revoked.
ARCHITECT'S DECLARATION
APPLICANT CERTIFICATION I understand my plans shall be used as public records.
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 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,
Signature Date
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 10955 N Wolfe Rd TDATE: 10/13/2015 REVIEWED BY: Sean
APN: BP#: *VALUATION: 1$2,500
PERMIT TYPE: Building Permit PIAN CHECK TYPE:
PRIMARY Sig n PENTAMATION 1 CEAP5
USE: PERMIT TYPE:
WORK Install 1 illuminated wall sign for Cricket.
SCOPE
SIGN TYPE FEE ID QTY SIGN FEE
Wall Sign,Electric 1 SIGNWELEC 1 $286
TOTALS: $286.00
aile h' Plan("heck Plumb.Pian(,heck #Branch Circuits 1 $48.00
.1fech.1'ermitFee: Plumb. Permlr Pee: IESIGN Elec.Permit Fee: IEPERMIT
Other iV.Aech.Insp. Other Plumb Irish. Other Elec.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. . These ees are based on therelimina information available and are only an estimate. Contact the De t or addn'l info,
FEE ITEMS (Fee Resolution 11-053 E . 7/1113) FEE QTY/FEE MISC ITEMS
Suppl. PC Fee: 0 Reg. C) OT 1 0.0 1 hrs $0.00
Permit Fee: $286.00
Suppl. Insp.Fee: Reg. OT 10.01 hrs $0.00
PME Unit Fee: $48.00
PME Permit Fee: $48.00
r7l
.:Ic/rl7ifri.sttfc"tlit,c>Fc��a•
Work Without Permit? 0 Yes No $0.00
Sign Master Plan: Q Yes No $0.00
Travel Documentation Fee: ITRA VDOC $48.00
Strong Motion Fee: V IBSEISMICO $0.70 Select an Administrative Item
Bldg Stds Commission Fee: V'IBCBSC $1.00
SUBTOTALS: $431.70 $0.00 TOTAL FEE:7$431.70
Revised: 10/01/2015