Loading...
B-2016-2129CITY OF CUPERTINO BUILDING PERMIT BUILDINGADDRESS: CONTRACTOR: PERMIT NO: B-2016-2129 10101 N DE ANZA BLVD CUPERTINO, CA 95014 (326 34 071) �ADRAPACT SIGNAGE IRVINE, CA 92606 OWNER'S NAME: WATERDRAGON 289 LLC ISSUED: 06/14/2016 OWNER'S PHONE: 408-427-2143 1 f PHONE NO: (949) 476-0015 License Class ELECTRICAL Lic. #490124 Contractor AD IMPACT CORPORATE SIGNAGE Date 06/30/2016 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. 2. 1 have and will maintain Worker's Compensation Insurance, as provided for by t/ Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APPLICANT CERTIFICATION 1 certify that 1 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__ ypertino Municipal Code, Section 9.18. Sig BUILDING PERMIT INFO: X BLDG —ELECT _ PLUMB MECH RESIDENTIAL X COMMERCIAL JOB DESCRIPTION; INSTALL (N) NON -ILLUMINATED MONUMENT SIGN (1) - APPLE REV # 1 - CHANGE SIGN FOOTING TO BOLTED TO SLAB - ISSUED 8/3/16 Ft Floor Area: I Valuation: $5000.00 APN Number: Occupancy Type: 326 34 071 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Date 08/03/2016 Issued Date: I 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. 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 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 08/03/2016 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 ofAppiicant: Date: 08/03/2016 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; Sections 25505, 25533, and 25534, Owner or authorized agent: Date: 08/03/2016 CONS TRUC��_"ING A EN 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 SIGN PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISIO , 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 - FAX (408) 777-3333 - building0—cupertino.org PROJECTADDRESS �q f/ / `(O �/` nJ ry �_ APN# G/ -7 OWNER NAME a /�1 / I--6� 6 +N' -,74 Jost✓✓ waw_ PHONE � �� EMAIL STREET ADDRES! j� A �' L/f� CITY, STATE, ZIP-/ ^ t O � ,f � f� I FAX CONTACT NAMED) PHONE E-MAIL STREETADDRESS CITY, STATE, ZIP FAX ❑ OWNER. ❑ OWNER BUILDER ❑ OWNER AGENT i[.-eONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME " LICENSE ER 1,7 LICENSE TYP BUS. LIC # �i%✓3 7 i COMP AME 7— E-MAIL FAX STREET RESSCITY, STATE, ZIP 7 AV PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC t# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRD>TION OF WORK USE OF SFD or Duplex Multi -Family ILLUMINATED SIGN TYPE NO. OF SIGN AREA VALUATION STRUCTURE: U'n Commercial (Y/N) (CODE) SIGNS (SQ. FT-) {$} 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 TOT ALUATION: Y: Zroa By my signature below, I certify to each of the following: I am the property owner ororiz to act on the property own alfa I have read this application and the information I have provided is correct. I have read the Description d verify it is accurate. I agree to comply w1 plicable local ordinances and state laws relating to build mg s tion. I authorize representatives o Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENT INF ZMATION REQUIRED OFFICE USE ONLY Site Plan PLAN CHECK TYPE ROUTING SLIP ❑ OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW Elevations _ Sign Details - including UL listing(s) applicable ❑ EXPRESS ❑ PLANNING PLAN REVIEW _ Structural Calculations (if applicable) ❑ STANDARD ❑ OTHER: _ _ Copy of Planning Approval Letter or Meeting with Planning prior to ❑ LARGE submittal of Building Permit application. 0 DIAJOR SignApp_2011.doc revised 03131111 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-2129 10101 N DE ANZA BLVD CUPERTINO, CA 95014 (326 34 071) ADIMPACT CORPORATE SIGNAGE IRVINE, CA 92606 OWNER'S NAME: WATERDRAGON 289 LLC OWNER'S PHONE: 408-427-2142 LICENSED CONTRACTOR'S DECLARATION License Class Q-45 Lic. #429LU4 Contractor ADIMPACT CORPORATE SIGNAGE Date 06/30/2016 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. 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 1 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. Signatu Date OWNER -B R DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: t. I, as owner of the properly, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (See.7044, Business & Professions Code) 2. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (See.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. z. 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. 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. Signature Date ISSUED: 06/14/2016 PHONE NO: (949) 476-0015 PERMIT INFO: BLDG —ELECT —PLUMB MECH _ RESIDENTIAL X COMMERCIAL JOB DESCRIPTION: INSTALL (I) NON -ILLUMINATED MONUMENT SIGN (1) -APPLE Sq. Ft Floor Area: Valuation: $5000.00 APN Number: Occupancy Type: 326 34 071 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Phuong Devries Date: 06/14/2016 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: 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, Sections 25505, 25533, and 25534. Owner or authorized agen Date: —Ill -16 CON TR TIO F.NDING 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 CUPERTINO SIGN PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(acupertino.or4 -Zvr6- 21 z 1_ PROJECT ADDRESS N ` D/ {G n� APN # r -O PHONE E-MAILOWnN Lz4� LiZ7-2/ `tZ D O+ZL ` STREE-1 ADDRESS Q ' , O fb 2QCITY, STATE, ZIp _ ,S FAX jC CONTACT NAME, �J O / �J /✓ %ONL . OV� 00/1(J E-MAIL? STREET/1DD }S� �� / // ` t I�❑ CITY, STATE, ZIPS-/ pTj� � ��2 f-0 !�❑' FAX ❑ OWNER OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME, z J LENSENUMBER V 910Z LICENS�Ec. BUS, ��a rIC COMPANY E-MAIL FAX STREET Ei l- SS 5 �G ®11 %/ CITY, STATE, ZIP �o / C/ PHONE 7 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK USE OF SFD or Duplex ❑ Multi -Family ILLUMINATED SIGN TYPE NO, OF SIGN AREA VALUATION STRUCTURE: Commercial (Y /N) (CODE) SIGNS FT.) SIGN TYPE CODES: / v a�(SQ. ,// !!�� //��M ©o 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 RECEIVED BY ;; TO U TION: By my signature below, I certify to each of the following: I am the property owner or aut o i age t to act on the property owner's behalf. I have read this application and the information I have provided is c ct. I have read the Description of k and rify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to build' g struc on. I au size re resentatives of Cupe o to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL RMATION REQUIRED OFFICE USE ONLY PLAN CHECK TYPE ROUTING SLIP Site Plan ❑ OVER-THE-COUNTER ❑ NUMBING PLAN REVIEW Elevations _ Sign Details - including UL listing(s) applicable ❑ ExPREss ❑ PLANNING PLAN REVIEW Structural Calculations (if applicable) ❑ STANDARD ❑ OTHER: _ Copy of Planning Approval Letter or Meeting with Planning prior to ❑ LARGE submittal of Building Permit application, ❑ MAJoR Sign,4pp_201 1. doe revised 03/31/11 -O,j IC41'I