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08010022Z �0 Q Z) Z J 0 �s �H -ti cn J Z CITY OF CUPERTINO BUILDING DIVISION PERMIT r �p BUILD ' TMMSSSTEVENS CREEK BLVD TBD TO BE DETERMINED PERMITNO. 08010022 OWNER'S NP a^F- PERMIT ISSUE DATE ' C,IZ �� 01/03/2008 SANITARY NO. CONTROL NO. PHONE: ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION I hereby I licensed Chapter 9 (commencing Job Description affirm that am under provisions of with Section 7000) of D. isi n3ofdhc Businessaq rpfes�ns�de,3n ,license is in full force and effec yl' `f`�1 �0 INSTALL (2) SET OF INTERNALLY ILLUMINATING License Class Lic.# W/REVERSE CHANNEL LETTER, KC BISTRO GLOBAL Date— Contractor ARCHITECTS DECLARATION CUISINE I understand my plans shall be used as public records SUCCESS GRAPHIC SIGN PD BSL 1/3/08 , Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the - following reason. (Section 7031.5, Business and Professions Code: Any city or county' which requires a permit to concoct, alter, improve, demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 Sq. Ft. Floor Area Valuation (commencing with Section 70Do) of Division 3 of the Businessand Professions Code) or $4800 that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3 6 9 0 6 0 0 9A' 1� Number Occupancy P Y Type not more than rive hundred dollars ($500). ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the struclum is notiintended or offered forsale (Sec. 7044, Business Required Inspections and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own emp;:oyees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner - builder will have the burden of proving that he did not build or improve for purpose of sale.). ❑ 1, as inviter of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code:) The Contractor's Li- cense Law dors not apply to an owner of property who builds or improves thereon, and who contracts for such projecs with a contractor(s) licensed pursuant to the Contractor's License Law. ❑ 1 am exempt under Sec. , B & P C for this reason Owner Date - _ WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: I have and will maintain aCertifitate of Consent to self -insure for Workcr'sCompen- ' a, as provided for by Section 3700 of the Labor Code, for the performance of the coo (or which this permit is issued. ❑ I have and will maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued My Worker's Compensation Insurance carrier and Policy number are: Carrier. _ Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE . ()his section need not be completed if the permit is formic hundred dollars ($100) - or less.) I cenify that in the performance of the work for which this permit is issued, I shall not employ aay person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Worker's Compensation provisions of the Labor Code, you must forebwilh comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (See. 3097, Civ. C-) - Lender's Name ' Lender's Address 1 certify that I have mad 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 authorim representatives ofthis 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. judgmer s, costs and expenses which may in any way accrue against said City in consequence of the gtantirhgaC'thirpcgrhit. APPLICANT UNQgRSTANDS AND WILL COMPLY WITH ALL NON -POINT p Issued by: Date SOURCE REGU / _ f) Re -roofs Type of Roof Signature of ApplicanUComractor Dare HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant slam or handle hazardous material as defmcd by the Cupertino Code, Chapter 9.12, and the Health and Safety code, Section 25532(a)? ❑Yes Mun-c'al All roofs shall be inspected prior to any roofing material being installed. Will If a roof is installed without first obtaining an inspection,agree to remove - the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management .l all new materials for inspection. District? CI Yrs o I have read the hazardous materials requiremer s under chapter 6.95 of the Califor- nia Health & Safety Code, Sectio 505,25533 and 25534.1 understand that if the building docs not currently have ant,that it is my responsibility to notify the occupant of the requirements whic exec x met priorw is vane, of a Certificate of Occupancy. Signature of Applicant Date All roof coverings to be Class "B" or better g Owner - or authorize agent nate - CITY OF CUPERTINO SIGN CITY OF CUPEkTINO PERMIT APPLICATION FORM 6e5o /CO2, Z. APN # Date: �q �v Building Address: Mailing Address (if different from building address): Owner's Name: Phone #: R ry Contractor: Phone #: C ✓ r S g G /tl S Fax #: v "7/ Z3 -2— Contractor License #: Cupertino Business License #: Contact: Phone #: Fax #: Building Permit Info: Bldg ❑ Elect ❑ Monument ❑ Mounted on Building Residential ❑ Commercial Job Description: Valuation (cost of project): r e CITY OF CUPERTINO eek{ SIGN CUPERTINO FEE SCHEDULE Quantity Fee ID Fee Description - Fee Group Permit 'Type 1 SIGNDIRECT Directional B 1SIGN/RF Ground/Roof/Projecting Signs B 1SIGNMASCK Master Plan Sign Check B 1SIGNREWRKG Rework of any existing Ground Sign . B 1 SIGNOTHER Other Sign B 1 SIGNREINSP Re -inspection Fee B J,SIGNWNONEL. ' Wall/Awning Sign,.Non- Electric B 1 SIGNWELECWall, Electric E 1ESIGN Sign, Outline Lighting System or Marquee supplied from one branch E 10EAP5 IESIGNADD Additional Branch Circuit on Same Sign, Outline System or Marquee E 10EAP6 1 ELCPLNCK Plan Check Fee E EPERMITFEE Electric Permit Fee' E BSEISMICOM Seismic Commercial B BSEISMICRE Seismic Residential B / TRAVDOC Travel & Documentation B BUSLIC Business License B