B-2016-1936CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-1936
19379 STEVENS CREEK BLVD CUPERTINO, CA 95014 (316 20 112) HERSCHEND CORP
SAN BRUNO, CA 94066
OWNER'S NAME: MAIN STREET CUPERTINO AGGREGATOR LLC
OWNER'S PHONE: 408-777-3081
LICENSED CONTRACTOR'S DECLARATION
License Class C-45 Lic. #1002588
Contractor HERSCHEND CORP Date 04/30/2017
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:
t. I have and will maintain a certificate of consent to self -insure for Worker's
ISSUED: 05/12/2016
PHONE NO: (650) 646-8777
BUILDING PERMIT INFO:
X BLDG —ELECT —PLUMB
_ MECH _ RESIDENTIAL X COMMERCIAL
JOB DESCRIPTION:
INSTALL (3) (N) ILLUMINATED SIGNS'ALEXANDER'S
STEAKHOUSE'
Compensation, as provided for by Section 3700 of the Labor Code, for the
rformance of the work for which this permit is issued.
2 ave 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 pqmply with all non -point
source regulations qer the CupertinoVunicip de, Section 9.18.
Signature////V/v _ 1 Date 5/12/2016
Sq. Ft Floor Area: I Valuation: $7800.00
APN Number: Occupancy Type:
316 20 112
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST ALLED INSPECTION.
Issued by: Alex Vallelunea
Date: 05/12/2016
i
I hereby affirm that I am exempt from the Contractor's License Law for one of the RE -ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material being installed. If a roof is
i. I, as owner of the property, or my employees with wages as their sole installed without first obtaining an inspection, I agree to remove all new materials for
compensation, will do the work, and the structure is not intended or offered for inspection.
sale (Sec.7044, Business & Professions Code)
2. I, as owner of the property, am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project (Sec.7044, Business & Professions Code). Date: 5/12/2016
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.
s. 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.
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 per the Cupertino Municipal
Code, Section 9.18.
Date 5/12/2016
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 QuaptAManagement District I
will maintain compliance with the Cupe lino u ic' al ode, Chapter 9.12 and
the Health & Safety Code, S t' n /� OS 5 3, and 25534.
Owner or authorized agent:
Date: 5/12/2016
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.
Licensed
Professional
CUPERTINO
SIGN PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildina(a cupertino.org
PROJECT ADDRESS
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APN # %� r / f j
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OWNER NAME PHO
E-MAIL(/
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STREET ADDRESS CITY, STATE, ZIP FAX
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CONTACT NAME
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E-MAIL
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STREET ADDRESS
CITY, STATE, ZIP
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❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE
1602 S
BUS. LIC #
COMPANY NAME E-MAIL
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FAX
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STREET ADDRESS �i3
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Y, STATE, ZIP
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PHONE
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ARCHITECT/ENGINEER NAME LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK
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USE OF ❑ SFD or Duplex ❑ Multi -Family
ILLUMINATED
SIGN TYPE
NO. OF
SIGN AREA
VALUATION
STRUCTURE: ComInercial
(Y / N)
(CODE)
SIGNS
(SQ. FT.)
(S)
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
C1~IVED.&`'^:-xpe
_
TOTALLY ATION:
600
By my signature below, I certify to each of the foil ing: I am the property owner or authorized ageritto act on the properly owner's behalf. 1 have read this
application and the information I have provided i correc I ve read t escription of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to buildin co stru aut riz presentatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: Date: 2all,
INFORMATION REQ D
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Site Plan
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_Elevations
Sign Details including UL listing(s)
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Structural Calculations (if applicable)
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Copy of Planning Approval Letter or Meeting with Planning prior to
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submittal of Building Permit application.f�Y
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SignApp_201 1. doc revised 03/16/11
05/12/16
B-2016-1936
Alex Vallelunga