B-2016-1574I CITY OF CUPERTINO BUILDING PERMIT
IBUILDING ADDRESS: ISAN ORAE TOR: 5 IPERMIT NO: B-2016-1574
19066 STEVENS CREEK BLVD CUPERTINO, CA 95014-2522 (375 07 046) ALLEN SIGNS INC
CA
Ot3'NER'S NAME: UNITED POLARIS LLC
OWNER'S PHONE:
LICENSED CONTRACTOR'S DECLARATION
License Class EI ECTRICAL SIGNS Lic. #834580
Contractor ALLEN SIGNS INC Date 03/31/2018
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. >
I 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.
.z 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
permit is issued.
APPLICANT CERTIFICATION
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,perAe Cupertino Municipal Code, Section 9.18.
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
compensation, will do the work, and the structure is not intended or offered for
sale (Sec.7044 Business & Professions Code)
2. 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. 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 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.
APPLICANT CERTIFICATION
DATE ISSUED: 03/18/2016
PHONE NO: (408) 280-6500
BUILDING PERMIT INFO:
X BLDG —ELECT —PLUMB
_ MECH _ RESIDENTIAL X COMMERCIAL
JOB DESCRIPTION:
HI POT - INSTALL (2) ILLUMINATED SIGN
Sq. Ft Floor Area: Valuation: $2800.00
APN Number: Occupancy Type:
375 07 046 A (Tenant Improvements)
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.
Signature Date 3/18/201
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION..
Issued by: ABBY AYENDE
Date: 3/18/2016 09M 6�wctt
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: 3/18/2016
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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 Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store 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 Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, �fis505�aud534.
Owner or authorized agent. f
Date: 3118/20lf2
CONSTR/CTION 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 DECI ARATiON
understand my plans shall be used as public records.
Licensed
Professional
SIGN PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(cDcupertino orq aol( „
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PROJECT ADDRESS ' O
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OWNER NAME % I ._
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CONTACT NAME
PHONE
E-MAIL
STREET ADDRESS
CITY, STATE, ZIP
FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME Al((, i C
LICENSE NUMBER y l) �rO�
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ARCHITECT/ENGINEER NAME -
LICENSE NUMBER
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E-MAIL
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CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK _ l �� /� ;r, - C� ` a J
USE 01. SSFD or Duplex ❑ Multi -Family
ILLUMINATED
SIGN TYPE
NO. OF
SIGN AREA
VALUATION
STRUCTURE: I� t-ommercial
(Y/N)
(CODE)
SIGNS
(SQ. FT.)
(g)
SIGN TYPE CODES:
/
!/
B - BANNER SIGN M - MONUMENT (GROUND) SIGN
BL - BLADE SIGN P - PROJECTING SIGN
D - DEVELOPMENT ID SIGN SP - SPECIAL EVENT BANNER
DI - DIRECTIONAL SIGN T - TEMPORARY
E - ELECTRONIC W - WALL SIGN
READERBOARD WI - WINDOW SIGN
RECEIVEDB
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TOTAL VALUATION:
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By my signature below, I certify to each of the following: I am the property owner or authorized agent to act n the property owner's behalf. I have read this
application and the information I have provided is correct. I ha read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building constructio . thorize {epresentatives of Cupertino to enter the above-ide,�tifiedd pro erty for purposes.
/JL
E*ction
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INFORMATION RE UIRED
„g `?oF�>cE USE ori�,pp, , , `„ "'
Site Plan
- Elevations
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❑ EXPRESS ° .-,rt t >
q,0 BUILDING PIAN
_Sign Details- including UL listing(s) applicable
SCI sT Nnnxnrni3fi
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Structural Calculations (if applicable)
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— Copy of Planning Approval Letter or Meeting with Planningprior to
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submittal of Building Permit application.
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SignApp_2011.doc revised 03/16/11
00
III POT RESTAURANT BUILDING SIGN ELEVATION 19066 STEVENS CREEK BLVD. CITY OF CUPERTINO, CA 95014
250 foot-lambert = 80 candela/foot2 / Sign area = 30 square feet
12 LED per letter x 20 lumen per LED = 240 lumen x 10 letters
= 2,400 lumen / 30 cq.ft. = 80 candela/fccV
51GN AREA = 3'x3'
= 9 sq.ft. SIGN AREA = 2.05x6'= 20.8 cq.ft.
36" 8'-0" o
r- SPICE POT RESTAURANT -.I'
5" THICK INDIVIDUAL CHANNEL LETTERS
LED FOR INTERNALLY ILLUMINATION
3/4" BLACK TRIM -CAP, RETURN BLACK COLOR
TOTAL SIGN AREA = 9 sq.ft. + 20.8 sq.ft. = 29.8 square feet
SCALE: 1/4"=V-0" DATE: MAR -2-2016
20'-0" STORE FRONTAGE —
NEW 51ON LOCATION —
BUILDING ELEVATION
A//en
Signs
N
HI POT Restaurant
w E 19066 Stevens Creek Blvd.
City Of Cupertino
S
iP.
P NS NECKED BY , M13 V
DATE
PLANNING DEPT
CUPERTINO
�»
,-• .�.,�,�• • � • �49- • —, 0- J L^?'•t;ENT DEPARTMENT
1wl�tJiN!G D!ViSION - CUPERTINO
APi'RO
`ED
•end spEcifications MUST be kept at the
!Istrtr";ion. It is unlawful to make any
0~ alZ&zt"ens on same, or to deviate
CONNECT TO EXIO TING CIRCELECTL JUNCICAL TION BOX ^�"' `out approval from the Building Official.
" IR of this plan and specifications SHALL NOT
P--: , rTit or to be an approval of the violation
"- :-Isis =ls of an Cif Ordinance or State Law.
Plywn&ackng C)pp (ul Y Y
Stuco, Fascia -
2- . 4'Stub
1 Ph,^Hood backing
5" Channel Letter Return i
—Primaryelectricaiso"GTct
Trim cap '!~Junction Box with':with':''i l w0• �'
it Disconnect Switch
• Pnwer Supply
#18 AWG Jumper Wire
#8x2.5` screw min. 3 per letter
REVIEWED FOR CODE COMPLIANCE
OFFICE COPY
1982 Stone Ave. San Jose, Ca. 95125 RW4981"90
AM designs & art works,
tE-mail.- Contractor
License
834 E
Allen Signs Inc. any dol
State Contractor License # 834580 prohibited -------- Copy r
Acr;lic Face --w` I
LED Strip —► .
Mounting Bracket --''
Trim Cap
:::
1'T Drain Hole --
CUPERTIN
&-!�Iding Department
• �k i
MAR 18 2016
• Pnwer Supply
#18 AWG Jumper Wire
#8x2.5` screw min. 3 per letter
REVIEWED FOR CODE COMPLIANCE
OFFICE COPY
1982 Stone Ave. San Jose, Ca. 95125 RW4981"90
AM designs & art works,
tE-mail.- Contractor
License
834 E
Allen Signs Inc. any dol
State Contractor License # 834580 prohibited -------- Copy r
STATE OF CALIFORNIA
CERTIFICATE OF COMPLIANCE, SIGN LIGHTING ;r
CEC-SLTG-1C (Revised 10/10) CALIFORNIA ENERGY COMMISSION
Certificate of Compliance (Sign Lighting)
(Page 1 of 4) SLTG-1C
Project Name:
Date:
t7
Project Address:
(P06b Z� eve" Irr4pf_1;1
Title 24, Parts 1 and 6 of the California Code of Regulations.
Location of Sign YOutdoor Signs ❑ Indoor Signs
this design on the other applicable compliance forms, worksheets, calculations, plans and specifications submitted to the
Phase of Sign Construction ❑ New Signs ❑ Sign Alterations
Name:
(A �ev, L-, v,
Type of Lighting Control ❑ New Lighting Controls ❑ Replaced Lighting Controls
❑ Not Installing Lighting Controls
Tlyis Certificate of Compliance includes the following components (check all that apply)
Address:f
f
Mandatory Measures (Lighting Controls) ❑ Maximum Allowed Lighting Power
❑ Specific Lighting Sources
1. Certificate of Compliance Declaration Statement (this maybe a C10, C45 or other eligible person)
• I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and
correct.
• I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the lighting design.
• This Certificate of Compliance identifies the lighting features and performance specifications required for compliance with
Title 24, Parts 1 and 6 of the California Code of Regulations.
• The design features represented on this Certificate of Compliance are consistent with the information provided to document
this design on the other applicable compliance forms, worksheets, calculations, plans and specifications submitted to the
enforcement agency for approval with this building permit application. i
r -
Name:
(A �ev, L-, v,
Signature
Company: j
Phone
Address:f
f
License umber (may be contractor's lic #)
permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand
b
City/State/Zip: _
Date }
Responsible Person's Name: ;� Responsible Person's Signature:
2. Installation Certificate (to be signed by responsible person after installation)
Permit number
Checked by/Date
(Enforcement Agency Use )
(Enforcement Agency Use
Installation Declaration statement
• I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and
correct.
• I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction, or an authorized
representative of the person responsible for construction.
• I certify that the installed features, materials, components, or manufactured devices identified on this certificate conforms to all
applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the
enforcement agency.
• I certify that the requirements detailed on this Certificate of Compliance have been met.
• I will ensure that a completed, signed copy of this Installation Certificate 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 signed copy of this Installation Certificate is required to be included with the documentation the builder provides to the
building owner at occupancy.
Company Name:
Responsible Person's Name: ;� Responsible Person's Signature:
License number (may be contractor's lie #)
Date Signed: Po ' ' n Coma ;
0
_ i
rI ■ ■ N `i "
%W#WV I
2008 Nonresidential Compliance Forms October 2010
STATE OF CALIFORNIA
CERTIFICATE OF COMPLIANCE, SIGN LIGHTING
CEC-SLTG-1C (Revised 10/10) CALIFORNIA ENERGY COMMISSION_,.
Certificate of Compliance (Sign Lighting) (Page 2 of 4) SLTG-1C
Project Name: �j ^�'� Date: f
017
�l 1 O L, 1 G1I� Y 1� I �'
3. Mandatory Sign Lighting Controls
NOTES.-
OTES.1.
1.The same responsible person may install both the sign lighting power and the sign lighting controls, or a different responsible
person may install the sign lighting controls than the responsible person installing the sign lighting power.
2. The Mandatory Measures (sign lighting controls) are required for compliance with the sign lighting Standards. If the person
responsible for installing the signn lighting power is not also responsible for the sign lighting controls, then the owner of the
sign, general contractor, or architect shall be responsible to have the sign lighting controls installed.
3. If more than one person has responsibility for compliance, each responsible person shall prepare and sign a Certificate of
Compliance and an Installation Certificate applicable to the portion of construction for which they are responsible;
alternatively, the person with chief responsibility for construction shall prepare and sign the Certificate of Compliance
Declaration Statement or the entire construction.
3a. Statements of Responsibility: Any person signing the Certificate of Compliance Declaration Statement on page 1 of
4 on this SLTG-1C shall complete Part 3a. Check Yes or No for all of the following statements:
1
I htive responsibility for installing the sign lighting controls
13 Yes, complete parts 3a and 3b of this form ❑ No, complete part 3a of this form
2
There are no existing sign lighting controls and I will be installing compliant sign lighting controls
NA
❑ Yes ❑ No
3
There are no existing sign lighting controls and someone else will be responsible to install compliant sign lighting controls
❑
❑ Yes ❑ No
There are existing sign lighting controls that do not comply with the applicable provision of § 119 and § 133 and I will be
4
installing compliant sign lighting controls
❑ Yes ❑ No
❑
There are existing sign lighting controls that do not comply with the applicable provision of §119 and §133 and someone else
5
will be responsible to install compliant sign lighting controls
Y
❑ Yes ❑ No
3b. Mandatory Sign Lighting Controls
If the person signing the Certificate of Compliance Declaration Statement on page 1 of 4 of this SLTG-1 C is responsible for
complying with the sign lighting control requirements, that person shall answer all of the following questions:
If there are construction documents, indicate where on the building plans the
mandatory measures (sign lighting control note block can be located:
1
§133(a)1. All indoor sign lighting is controlled with an automatic time switch control that complies with the
Y
N
NA
applicable requirements of § 119.
❑
❑
❑
§133(a)l and 2. All outdoor sign lighting is controlled with an automatic time switch control plus a photo
Y
N
NA
2
control, or an outdoor astronomical time switch, that comply with the applicable requirements of § 119.
ly
❑
❑
Exception to §133(a)2. Outdoor signs in tunnels or large covered areas that require illumination during
Y
NA
daylight hours.
❑
❑
§133(a)3. All outdoor signs are controlled with a dimmer that provides the ability to automatically reduce
Y
N
NA
sin power by a minimum of 65 percent during nighttime hours.
❑
❑
❑
Exception 1 to §133(a)3. Signs illuminated for less than one hour per day during daylight hours.
Y
NA
3
❑
❑
Exception 2 to §133(a)3. Outdoor signs in tunnels or large covered areas that require illumination during
Y
NA
daylight hours.
❑
❑
Exception 3 to §133(a)3. Only metal halide, high pressure sodium, cold cathode, or neon lamps used for
Y
NA
illuminating signs or parts of signs.
❑
❑
§133(a)4. An Electronic Message Center (EMC) having a new connected lighting power load greater than
15 kW has a control installed capable of reducing the lighting power by a minimum of 30 percent when
Y
❑
N
❑
N/A
❑
4
receiving a demand response signal that is sent out by the local utility.
Exception to §133(a)4. EMC required by a health or life safety statue, ordinance, or regulation, including
Y
NA
but not limited to exit signs and traffic signs.
❑
❑
Field Inspector Notes:
2008 Nonresidential Compliance Forms October 2010
STATE OF CALIFORNIA
CERTIFICATE OF COMPLIANCE, SIGN LIGHTING
CEC-SLTG-1C (Revised 10/10) CALIFORNIA ENERGY COMMISSIONr!At '0
Certificate of Compliance (Sign Lighting) (Pa iye 3 of 4) SLTG-1C
Project Name:;
Date:
4. Maximum Allowed 0ghting Power Method of Compliance
Certificate of Compliance and Field Inspection Energy Checklist
Complete this part if there are signs using the maximum allowed lighting power method of compliance. (Complete part 5
of this Certificate of Compliance if there are signs using the S ecific lighting sources method of com liance
A
B
C
D E I F G
H
I
J
O
Allowed
Watts
Design
Complies?
w
Watts
Y / N
�°
ti
� 3
>
Field"
Ua
o
o
Q N N
Y
Inspector
o
w
a.
`� w
3
Check that
Qo
N
X
Q
-o
�°
Sign
Complies
3
y
E
O
..
0
U
Description
✓
A
Symbol or code used on the plans (when plans are required) and other documents.
B
A narrative description of the sign, or location of sign on the building; and the location of sign on construction documents.
OPTIONAL - Check this box only if this sign has a permanent, pre-printed, factory -installed, ENERGY VERIFIED label, confirming that
the sign complies with the Section 148 of the California 2008 Title 24, Part 6 Standards, using the Maximum Allowed Lighting Power
method of compliance. The only labels that will be recognized for this purpose are ENERGY VERIFIED Certification Marks authorized
C
by Underwriters Laboratories (UL) or other Product Certification Body accredited to ISO/IEC Guide 65 by the American National
Standards Institute in accordance with ISO/IEC 17011. Surveillance by the Accredited Certification Body shall be an ongoing annual
inspection program carried out by a Type A Inspection body in accordance with ISO/IEC 17020. For signs with such an ENERGY
VERIFIED label, columns `D' through `I' are not required to be filled out. Note: Using an ENERGY VERIFIED label is an optional
method to validate compliance. An ENERGY VERIFIED label is not needed for compliance.
D
The sign area insquare feet.
E
List "I" if the sign is internally illuminated. List "E" if the sign is externally illuminated.
F
Allowed watts per square foot. Enter 12 if the sign is listed as "I" in column E. Enter 2.3 if sign is listed as "E" in column E.
G
Multiply the square footage in column D times the allowed Lighting Power Density (LPD = watts) in column F.
H
Show the total installed watts in the sign, as determined according to the applicable provisions of § 130(d or e).
I
Enter Y if the number in column H is less than orequal to the number in column G. Otherwise, the sign does not comply.
J
This page doubles as a field inspection checklist.
Field Inspector Notes:
2008 Nonresidential Compliance Forms October 2010
STATE OF CALIFORNIA
CERTIFICATE OF COMPLIANCE, SIGN LIGHTING
CEC-SLTG-1C (Revised 10/10) CALIFORNIA ENERGY COMMISSION
Certificate of Compliance (Sign Lighting) (Page 4 of 4) SLTG-1C
Project Name: � j r � Date:
5. Specific Lighting Source Method of Compliance
Certificate of Compliance and Field Inspection Energy Checklist
Complete this part if there are signs using the Specific lighting source method of compliance. (Complete part 4 of this
Certificate of Compliance if there are signs using the maximum allowed lighting ower method of compliance)
A
B
C
D
E,
OPTIONAL
ENERGY
Specific light source used for
Field
Symbol
VERIFIED
compliance
Inspector
or
Description
label
Shall include only lighting
Check that
Code
(see instructions
technologies listed below
Sign
below
List all that apply
Co � lies
❑
❑
❑
❑
A
Symbol or code used on the plans (when plans are required) and
other documents.
B
A narrative description of the sign, or location of sign on the building; and the location of sign on construction documents
C
OPTIONAL - Check this box only if this sign has a permanent, pre-printed, factory -installed ENERGY VERIFIED label, confirming that
this sign complies with the Section 148 of the California 2008 Title 24, Part 6 Standards, using the Specific Lighting Source Method of
Compliance. The only labels that will be recognized for this purpose are ENERGY VERIFIED Certification Marks authorized by
Underwriters Laboratories (UL) or other Product Certification Body accredited to ISO/IEC Guide 65 by the American National Standards
Institute in accordance with ISO/IEC 17011. Surveillance by the Accredited Certification Body shall be an ongoing annual inspection
program carried out by a Type A Inspection body in accordance with ISO/IEC 17020. For signs with such an ENERGY VERIFIED label,
column `D' is not required to be filled out. Note: Using an ENERGY VERIFIED label is an optional method to validate compliance. An
ENERGY VERIFIED label is not needed for compliance.
Specific Light Source Compliance Method. The sign(s) identified above use only the following lighting technologies:
List all applicable numbers (1 through 10) that apply in column D above for each row.
1
High p ressure sodium lamps
2
Pulse start or ceramic metal halide lamps served by a ballast with > 88% efficiency
3
Pulse start metal halide lamps that are:5 320 watts, are not 250 watt or 175 watt lamps, and are served by a ballast
with > 80% efficiency
4
Neon or cold cathode lamps with transformer or power supply efficiency>_ 75% with rated output current < 50 mA
S
Neon or cold cathode lamps with transformer or ower supply efficiency>_ 68% with rated output current > 50 mA
D
6
Fluorescent lamps with a minimum color rendering index (CRI) of 80
(Note: when using electronic ballasts for compliance, lamps with a CRI < 80 may be used)
7
Light emitting diodes (LEDs) with a power supply with > 80% efficiency
Single voltage LED external power supplies designed to convert 120 volt AC input into lower voltage DC or AC
8
output, having a nameplate output power less than or equal to 250 watts, and certified to the Energy Commission as
complying with the applicable requirements of the Appliance Efficiency Regulations (Title 20
9
1 Compact fluorescent lamps that do not contain a medium screw base sockets (E24/E26
10
1 Electronic ballasts with a fundamental output frequency > 20 kHz
E
This page doubles as a field inspection checklist.
Field Inspector Notes:
2008 Nonresidential Compliance Forms October 2010