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B-2016-1315 Permit, App, Fee EstCITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-1315 11010 N DE ANZA BLVD CUPERTINO, CA 95014 (309 42 041) ( SIGN DESIGNS INC) MODESTO, CA 95352 NAME: CUPERTINO DE ORO CLUB, PO BOX 285, HOUSTON TX PHONE: Class Q-445 Lie. #268001 .or ( SIGN DESIGNS INC) Date 2/5/2016 hereby affirm that I am licensed under the provisions of Chapter 9 (commencing ,ith Section 7000) of Division 3 of the Business & Professions Code and that my cause is in full force and effect. hereby affirm under penalty of perjury one of the following two declarations: 1. 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. 2. 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. APPLICANT CERTIFICATION certify that I have read this application and state that the above nformation is correct. I agree to comply with all city and county rrdinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned )roperty for inspection purposes. (We) agree to save indemnify and keep [armless the City of Cupertino against liabilities, judgments, costs, and )xpenses which may accrue against said City in consequence of the Imnting of this permit. Additionally, the applicant understands and will :omply with all non -point source regulations per the Cupertino Municipal ,oil Section 9.18( Date 2102016 hereby affirm that I run exempt from the Contractor's License Law for one of the Blowing two reasons: 1. 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 (Sce.7044, Business & Professions Code) r. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code), I hereby affirm under penalty of perjury one of the following three declarations: 1. 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. 2. 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. 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 Compensation laws of California. If, after making this Certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. 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, 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. ISSUED: 02/05/2016 NO: 209-524-4484 BUILDING PERMIT INFO: BLDG —ELECT —PLUMB MECH _ RESIDENTIAL X COMMERCIAL JOB DESCRIPTION: CHEVRON - REMOVE (E) SIGN AND INSTALL (N) ILLUMINATED MONUMENT (GROUND) SIGN Sq. Ft Floor Area: I Valuation: $8500M Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. 1981 �(.,t�(W" RE -ROOFS: 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. Signature of Applicant: Date: 2/5/2016 HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Cade, Chapter 9.12 and the Health & Safety Cade, Section 25532(a) should I stare or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cup none Municipal Code, Chapter 9.12 and the Health & Safety Code S coons 25505, 2-553 , and 25534I/ Owner or authorized agent: Date: 2/5/2016 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit Is Issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Date 2/5/2016 Licensed CUPERTINO SIGN PERMIT APPLICATION bAi6l )'NJC, COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(o),cuoertino.org PROJECT ADDRESS/,)'j,rr//J APN4 ©JI (;ZA Y OWNERNAME jll 1FP I' 1� DFOR l /11 tj p I'�/ l-.•,tJJ W%]CITY, PHO .��,` E-MAIL STREEr ADDRESS. (�'t C��C STATE, ZIFHO( 1/y.�a J ' 4V� \-J ' l (�1 `(� /v CONTACT NAME PHONNE At j "L 1 �'J'K.tJ �.GZLi/lJ d C:. �..f hZ l Y-1 Y•Cc.�' k`. L- .!' �C'L'>a STREET ADDRES /} CITY STATE, ZIP PAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNBRAGENf ❑ CONTRACTOR ❑ CONTRACTORAGENr ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAMIR ilpGC LICENSENUMBER /ram, LICENSE TYPEn BUS. LIGA Jd' ' 7n-✓ T'T/✓ 1 lJ / (� COMPANYNAME" E-MAIL FAX r- STREET ADDRESS , , CITY,aTA s ram= fa PX/RTDn'•J a -•Fuss ARCHITECT/ENGINEER NAME LICENSENUMBER BUS. LIC$ COMPANY NAME P.-MAIL— FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK I — �l�a,,I.L,pc"--_���-�-" USE OF ❑ SFD or Duplex ❑ Multi -Family ILLUMINATED SIGN TYPE NO, OF SIGN ARG VALUATION STRUCTURE: ❑ Commercial (YIN) (CODE) SIGNS (So FT.) SIGN TYPE CODES: B - BANNER SIGN M - MONUMENT (GROUND) SIGN BL - BLADRSIGN P - PROJECTING SIGN D - DEVELOPMENT ID SIGN SP - SPECIAL EVENT BANNER DI - DIRECTIONAL SIGN T - TEMPORARY B - ELECTRONIC W - WALL SIGN READERBOARD WI - WINDOW SIGN RECEIVED H : ( �fl, Zj,y(' 1 TOTAL VALUATION: By my signature below, I certify to each of the following: I am the property owner or airii0rizod agent to act on the property owner's behalf. I have read this application mid the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with ail applicable local ordinances and state laws relating hi ding construction. ,I(a}�thorize representatives of Cupertino to enter (liegabove-identified property for inspection purposes. `�%2ta--. Signature ofApp-is------ n[: f J126a �n-� Date:.�+.-�,jf; / SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY PLAN CFIECK Tyrr; ROUTING SLIP Site Plan _Elevations OVER-THE-COUNTER �-/ Up BUILDINGPLANREVIEW ` Sign Details - including UL listing(s) applicable E EXPRESS / PLANNING J'LAARW� IY Structural Calculations (if applicable) ❑ STANDARD El OTHER: _ Copy of Planning Approval Letter or Meeting with Planning prior to ❑ LARGE submittal of Building Permit application. ❑ MAJOR SignApp_201 I. doe revised 03131111 CITY OF CUPERTINO B a®l6 131g. FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 11010 N. DE ANZA BLVD DATE: 02/06/2016 APN: 369 42 041 BP#: REVIEWED BY: PAUL "VALUATION: $8,500 *PERMIT TYPE: Building Permit P1..1N:(:IIECIiT1PE: PRIMARY USE: Sign PENTAMATION PERMIT TYPE: 10EAP5 WORK CHEVRON - REMOVE E SIGN AND INSTALL N ILLUMINATED MONUMENT GROUND SIGN SCOPE SIGN TYPE FEE ID QTY SIGN FEE Ground Sign 1SIGNGR/RF 1 $359 TOTALS: r $359.00 1,1ecn. Pl m heck PLviA Plan C.`wec A Branch Circuits 1 $48.00 iferh. Permit fee: Phtmb. Permit Fee: IESIGN Flee. Permit Fee: ]EPERMIT Other .i'hch kip. Other Pluurb fasp, Other Elec. Insp. 0.0 $48.00 Meet Inge, lit": 1,12N1b. Irt$U, i 28: J."Iec IRS . I"ev, NOTE: This estimate does not include fees clue to other Departments (i.e. Planning, Public Works, Fire, Sanitay Server District, School District. etc.). These fees are based on the nreliminav information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution ll-OS3 E . 711113 FEE QTY/FEE MISC ITEMS Plant t:lseck F'ee: e Suppl. PC Fee: (D Reg. 0 OT 0.0 hrs $0.00 PlrtrnC3.CRferft.!Isle:[: Permit Fee: $359.00 Suppl. Insp. Fee:(j) Reg. ® OT I 0.0 I hrs $0.00 PME Unit Fee: $48.00 PME Permit Fee: $48.00 Construction 74V: .r do'linistrafive Fee, Work Without Permit? ® Yes (F) No $0.00 Sign Master Plan: 0 Yes (E) No $0.00 d Travel Documentation Fee: ITRAVDOC $48.00 Strong Motion Fee: IBSEISMICO $2.38 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS:' $506.38 $0.00 TOTALF EE:- $506.38 Revised: 01/01/2016