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B-2016-1276CITY OF CUPERTINO BUILDING PERMIT BUILDINGADDRiiSS: CONTRACTOR: PERNITNOt B-2036-1276 19311STEVENS CREEK. BLVD CUPERTINO, CA 95014 (316 20 11'x) (DISCOUNT SIGNS) BURLINGAW CA 94010 OWPWR'SVAME. MAIN STREET CUPERTINO AGGREGATOR LLC DATE ISSUED: 0112912016 WPM RIS PHONE- 650.344-1500 PHONE NO; 650.333.6488 LICENSED CONTRACTOR'S DECLARATION, BUILDINGPERAUT INFO; License Class Lie. #759380 ContraGlor { i j, O 1NT SI GNJ ) pate 0112812016 Y BLDC'r _ELECT _PLUMB I hereby affirm thatI am licensat7 under the provisions of Chapter 9 (commencing _ ME, CH _ RESIDENTIAL $ COMMERCIAL with Section 7000) ofI)Ivision 3 of Ike Business do krofessions Codas and that my license Is in full force and effect. JOB .DESCRIPTION: TYFH IT'CHEN - INSTALS, 3 (N) ILLUMINATED WALL SIGNS I hereby attires under penalty of perjury one of the following two declarations.-(REPLACING CANCELLED PT�i MIT 15110041 1. I have -and will maintain a. certificate of oonsont to self-insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the •perPormanco of the, work for Which this permit is issued. 2. I have and will maintain Worker's Compensation Insurance, as liravided for by Section 3700 oftheL abor Code, for the perfbmrance ofthe work for which Sq. Ft Floor Area. Valuation-, $9000,00 this pormit is issued. AI ICANI P,91 T EtICATiON I cortify that I have read this application and state that the above information Is correct. I agree to comply with all city and county ArN Number., ticcatlsaney Type; ordinances and state laws relating to building construction, and hereby 316 24114 authorize representatives of this city to enter upah the shove mantloned properly for Inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and PERMIT EXk'iI2ES IF WORK IS NOT STARTED expenses which may accrue against said City In consequence of the 'fy�ri'FIF 190 DAYS OF PER"MI'P ISSUANCE OR of this permit. Additionally, the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal 150 DAYS FROM LAST CALLED INSPECTION. Gods, 5eotion 9.1 Issued by: MELISSAIV Signature Date 0112812016 Date: 01 28 015 OWNER�l3TiII Df R DRCT.gIZATION lAcreby affirm that I ant exompt frora the Contractor's License Law for one of the RE-ROOFS: All roofs sball be inspected prior to any roofing material being installed. If a roafis installed without first obtaining an Inspection, I agree to retnoye nit new materials for fnItosving hvo reasons; s 1, as owner ©fuse proporty, or my employees with wages as their sole inspection, compensation, will do the work, and the Structure 1e.flet intended or offorod. for sale (Seo,7044, Business & Professions Code) Signature of Applicant: 2, I, as owner of the property, am oxclusively contracting with licensed, Dato: 0112R/201 ownutors to constnret the project (Seo.7044, Business & Professions Code). I hereby affirm under penalty ofpes Jury one of the follawhtg three declarations; AIL ROOF COVERINGS TO BE CLASS "All OR )RETIER 1. S have and will maintain a Certificate ofConcont to mlf insu c for Workor's Componsaticn, as provided for by Section 3700 of the Labor Code, for the HAZARDOUS MATERIALS Di$CLOSURE performance of tato wank forwbich this permit is issued. I have read the hazardous inaterials requirements under Chapter 6.95 of the z, I have and will maintain Worker's Compensation Insurance, as provided for Caltfornla health & ,SafeiyCodu, Sections 25505, 25533, and 25534• Twill by Section 3700 of the Labor Code, for the performance of it. work forwhioh maintain compliance with the Cupertino Municipal Code, Chapter 9:12 and the Anis permit is Issued, health & Safety Code, Section 25532(x) should I store or handle hazardous R. I certify that in the performance of tho work for wI>ich this perastt is issued, I material. Additionally, should I use equipment or devices whids enait hazardous air contaminants as de fined by the Bay Area Air Quality ManagasnontDistrict I shall not employ any parson in sasymwnsor so as to became subject to the Will snabstnto lance with rise Cupertino Municipal Code, Claapt4r 9.I2 and Worker's Compensation laws of California. If, after making this certificate of p S rite Health & SafoYy Cad ,-;;etc -vns 25505, 25533, and S 4. salt axemption, I become aubjeot to the Workor's Compensation provisions of the y Labor Code, I must forthwith comply with such provisions or this pernsit shall Owner or authorized agent: be deemed revoked. Date: 0112812015 APPLiCANT CERTIFICATION I ca ifythat I have read this application and state that the above Inforinstlon Is (INCTRUCTION ]LIMI)MG AGENCY i hereby affirm that there Is a construction lending agency for the performance correct, l agree to complywith all city and county ordinances and state laws of work's for which this permit Is issued (Sec. 30137, Civ C.) relating to building construction, and hereby authorize representatives of this clty Land,e?, Nome to enter.upon the above mentioned properly for Inspection purposes, (We) agree lJender's Address to save Indemnify and keep harmless the City of Cupertino against llablllties, judgments, costs, and expenses which may accrue. against said City In ARf Iii fECT�S DECI ARATION consequence of the granting of this permit. Additionally, the applicant I understand my plans shall be used as public records. understands and will complywith all non-point source regulations per the Cupertino Municipal Code, Section 9.18. Licensed Signature hate t7ij2812018 Proieasfanal SIGN PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 4 10300 TORRE AVENUE a CUPERTINO, CA 95014-3255 G1P1rRTi[�A (408) 777-3228 - FAX (408) 777-3333 • building@cupertino.orsJ ._ 2- f PROJECI'ADDREBs q221 APN# 316 20 112 � Y OWNER NAME f� yk,/'`/�4JbTM7AL fj e PHONE' f�� %7 "- r. 7 V CITY, STATE � 'FAX STIMTADDRESS n z CONTAC'r .NAME PHONE E-MAII. �+ R STREET ADDRESS CiTY,,4TATR. QIP PAX El ownk ® Ownit-BUILDER 11 OWNHRAOnWV © CDN'rRACTOR NTRAC ORACENT 13 ARCBITRCr 13 ENGNEBR E3 DEV-13LOPE L ❑ WANT CONTaAC'rORNAME LICENSENUMBER,y77C% LICENBETYP6 j� j'1 Bus.lie F �j COMPANY NAME R -MAIL VAX r f1r (i STREETADDRESS CITY, KATE, ZIP PHONE r�ra --- ARCBITECT/ENGINEERNAME LICENSE NUMBER FNS. L1C it COMPANY NAME E-MAIL FAX STRSRT ADDRESS CITY, STALE, ZIP PHONE DESCRIPTION QPWORY „) /Ut4M,1AW15 rSh' /rtic105i-.." �'� �y - USE. OF Q SFD or Duplex ❑ Multi -Family ILLUMINATED SIGN TYPE NO. OF SIGN AREA VALUATION. . RulyfuRE: 19 Commercial (YIN) (CODS) SIGNS (SQ.IF]%) M SIGN TYPE CODrab; �ijr (p• j B - BANNER SION M - MONUMENT (GROUND) SIGN ' BL •- ELADR SIGN P - PROJECTING SIGN .. D - DEVELOPMENT ID SIGN SP - SPECIAL EVENT BANNER +� Q �� (' f DI' - D1RECl'iONAL SIGN 'r - TEMPORARY B - ELECTRONIC W WALL SIGN - 79 READPRBOARD wI - WINDOW SION _ DBM TO'IALVALUATION: sy niyaignafiro bolvly, I acrti£y fa aaoli of Itis follo r�inL : i ant tl operty owner o ionized n ei t 4 ie pwporLy owner's be ia' . iwe read this applioatinit rind [lie inforinatinll I have provldod44 onnoot. I linve Ira C1ts oseiiptia nr - and verify it is accnrate. I agree to comply wide all applieable local ordionou and state Iowa relating to builds OOn. hUttouf I wither• ivepreaeniatives of Cnperlim to enter the Above-idcn, t/ificd rAupcity for Inspcotion jmrpoaes, Signature of ApplioanttAgcnt:- 8UPj1LE1V1EiqrAL, WORMATION REQii1RRD OFI?ICL USE ONLY PLAN CHECIZTYP6 ROUTING -SLIP '.-- Site flan ❑ oV910111ii-COUNT]ER. El nIUILDWG PLAN RRVIF1V Flavations Sign Dolans - hicluding UL Bgfilig(s) applicable ❑ rxrxFSR ❑ FLANP1ItYf. ri.AiY3tE;VIL�'tk' Struulural Calaulatioas (if applicable) ❑ STANI)ARD ❑ O-nrr i Copy of PlantuDg Approval Letter or Meeliag with Plnnniug prior to ❑ LARGI; Submittal of BuildingNnuit application. ❑ MAJOR 3ignA_pp 201I.dbc revised t13131,1I1 CITY OF CUPERTINO IM -M -FEE E' ESTIMATOR -- BUILDING DIVISION SIGN TYPE ADDRESS. 19390 STEVENS CREEK BJ,VD DATRi 0112812016 RE'VIE'WED DY; MELISSA Monk Play: Cheek APN: 316 20 112 , 'Ch. Nnvil Fee. I'We 1 *VALUATION: 1$9,000 *PERNIT TYPE; Building Permit pill. -k", 11TE(11.9 71.7r, PRIMARY Sign USE: ©cher ilea LISP. ��.$�4800 PENTAMATION - PE RMIT TYPE. ICEAP5 AVORK 'I LYFE KITCHE N-INSTALL3( ILLUMINATED WALL SIGNS scorv, I Suppl. Insp. Fee:a) Reg. C) OT SIGN TYPE F) U, ID (2TY1F7rE1 QTY Monk Play: Cheek SIGN FE E, , 'Ch. Nnvil Fee. I'We Wall sign, Electrie 18]GNWELEC oxherkleeh. hisp. 3 ©cher ilea LISP. ��.$�4800 AfmLh. 111-1p, F,7e ! hetjfb, Imp. Foy-,., $858,00 Suppl. Insp. Fee:a) Reg. C) OT 10.0-71. ins $0,00 PMR Unit Fac $48.00 PMB Permit Fee- $48.00 Construrtior? Taw 'Idminkh-wire Fee; W o4i Without Perj-nA7 0 yes 9 NO $0.00 Sign Master Plan-, 0 Yes (B No TOTALS: A Travel -Dommentation Fee: ITRAMDOC $48.00 $858,00 $2.62 M SEE.; F E, B (2TY1F7rE1 A-fech, Check Monk Play: Cheek ft, Brandi CIF011 Its 1 $48.00 , 'Ch. Nnvil Fee. I'We PorW Fam". IESIGN Elec. Perillit'Feo: 7EPERA11T oxherkleeh. hisp. other- Phlynb b-'sp. ©cher ilea LISP. ��.$�4800 AfmLh. 111-1p, F,7e ! hetjfb, Imp. Foy-,., IVOTZ- This estimate (Ives riot include fees ducto other Departmeafs Cz.o. Maiming, Public Works, Fire, Sanitary Sewer District, School DiviAel a&0. TAmys A -a.9 fri-a haNad ()w file? ni'alb"111111-v hifinvaildon rivallfibla fiord am 9121v int esirmate. Contact ilia Daw for addit'l info. /L L4 -1j) F E, B (2TY1F7rE1 MISC ITFMS Pkm (heck Suppl. PC Fee: (D Reg. 0 OTE001 firs $0,00 perillit Fee- $858,00 Suppl. Insp. Fee:a) Reg. C) OT 10.0-71. ins $0,00 PMR Unit Fac $48.00 PMB Permit Fee- $48.00 Construrtior? Taw 'Idminkh-wire Fee; W o4i Without Perj-nA7 0 yes 9 NO $0.00 Sign Master Plan-, 0 Yes (B No $0.00 A Travel -Dommentation Fee: ITRAMDOC $48.00 Stroh a Motion Fee, 1133HISMIC0 $2.62 Select ani Administrative hem Bldg Stds Cominission Fee: 113C733C $1.00 $1,005.521 $0.0.0 -T TA $1,005.52 Revised: 0110112016 STATE OF CALIFORNIA SIGN LIGHTING f:FC_NRRI_I TG01 tp—i—i mv;N (:AI IF(IRNIIA FRIFR(,Y r.r)hAh41CSI(1NI z CERTIFICATE OF INSTALLATION NRCI-LTS-01-E Sign Lighting (Page 1 of 2) Project Name: Lyfe Kitchen Enforcement Agency: Permit Nu8er2016-127 6 Project Address: 19399 Stevens Creek Blvd City: Cupertino Zip Code: GENERAL INFORMATION DATE OF BUILDING PERMIT PERMIT# B-2016-1276 LOCATION OF SIGN(S) Outdoor Sign(s) ❑ Indoor Sign(s) TYPE OF CONSTRUCTION New Sign(s) ❑ Sign Alteration SCOPE OF RESPONSIBILITY Enter the date of approval by enforcement agency of the Certificate of Compliance that provides Date. the specifications for the energy efficiency measures for the scope of responsibility for this 1/28/2016 Installation Certificate. In the table below identify all applicable construction documents that specify the requirements for the scope of responsibility reported by this Installation Certificate (continued). Date Document Title or Description Applicable Sheets or Pages, Tables, Schedules, etc. I Ithe E Permit # B-2016-1276 I Sign permit 1 1/28/2016 2013 Nonresidential Compliance Forms May 2015 STATE OF CALIFORNIA SIGN LIGHTING CEC-NRCI-LTS-01 (Ravisarl ONVIS) nAi —.—A � CERTIFICATE OF INSTALLATION NRCI-LTS-01-E Sign Lighting (Page 2 of 2) Project Name: I "fe Kitchen Enforcement Agency: Permit Number. Project Address: 19399 Stevens Creek `ity: Cupertino - Zip Code: - DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. I certify that this Certificate of Installation documentation is accurate and complete. Documentation Author Name: Isaac: Lee Documentation Author Signature: Documentation Author Company Name* 'Discount Signs .& Neon Date Signed; 2-25-201.6 Address: 1317 N Carolan Ave CEA Certification Identification (If applicable): City/State/Zip: Burlingame CA 94010 Phone: 650-333-6688 RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Installation is true and correct. 2. I am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction, or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of installation and attest to the declarations in this statement (responsible builder/installer), otherwise I am an authorized representative of the responsible builder/installer. 3. The constructed or installed features, materials, components or manufactured devices (the installation) identified on this Certificate of Installation conforms to all applicable codes and regulations, and the installation conforms to the requirements given on the plans and specifications approved by the enforcement agency. 4. I reviewed a copy of the Certificate of Compliance approved by the enforcement agency that identifies the specific requirements for the scope of construction or installation identified on this Certificate of Installation, and I have ensured that the requirements that apply to the construction or installation have been met. 5. 1 will ensure that a completed signed copy of this Certificate of Installation shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a completed signed copy of this Certificate of Installation is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Builder/Installer Name: Isaac Lee Responsible Builder/Installer Signature: �. Company arne: (Installi g ybcontrac r r General Contractor or Builder/Owner) �Iscoun S�Igns g Aeon Position With Company (Title): President Address: 1317 N Carolan Ave. CSI_B License: 759380 City/State/Zip: Burlingame CA 94010 Phone 650-333-6688 Datesigned: 2-25-2016 2013 Nonresidential Compliance Forms May 2015