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Permit Number" 08100097
Status x
C - Closed
Master Number
Applied Value %
IQI Notes
Project
0
Calculated Value
Apply Date'
10/16/2008
Operator
Permit Issue Date
10/16/2008
Operator
Certificate Issued
11/26/2008
Operator
Certificate Type
CO - CERTIFICATE OF OCCUP
Certificate Number
Address' I 19750 STEVENS CREEK BLVD
City/State/Zip CUPERTINO
0 APN 36906008.00
IQI Unit
patg
patg (Owner Name'I KCR DEVELOPMENT
suew Use Default
Address Home -19750 STEVENS CREEK BLVD
Permit x Property Zoning Applicant Contractor " Defined Fields
Permit Details
Permit Type " 1 CEAP5 IQI
SIGNS, OUTLINE LIGHTING & MARQ
Usage Class `
N/A lCQ
NON APPLICABLE
Applied Value %
4000
SQUARE FT.
0
Calculated Value
01-
US C-404 Type
437 IQI
ALT: NON -RES, NON-HSKPG
Permit Form `
AUTOPERM - PERMIT
Ownership
1 - Private
Project Size
COUNTER -OVER THE COUNTER
'ermit issued 1011612008
anter the purpose or any special conditions for this permit
City/State/Zip CUPERTINO
Purpose/Special Conditions
INDVDL CHANNEL LETTER SIGN
FILMED 5/20111
CA 95014
CA 95014
I[OAdd Default T
W
I�OK I
14a Back
Imo. Contractors
Fees
Plan Reviews
Inspections
�,_h Print Permit
��:".' Adjustments
Holds
F:1 Copy Permit
Close Permit
•: Overrides
Supplemental Fields
Notes
'i Attachments
CITE' OF CUPERTINO T
BUILDING DIVISION PERI'�ltl]C�4�t1
...::..._ .. ..:::. ;r
BUILDING ADDRESS: PERMrr NO.
19750 STEVENS CREEK BLVD ALLEN SIGNS INC 08100097
OWNER'S NAME: PERMIT ISSUE DATE
KCR DEVELOPMENT 1982 STONE AVE 10/16/2008
PHONE: SANITARY NO. CONTROL NO.
(408)280-6500
ARCHITEC IENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
O p LICENSED CONTRACTOR'S DECLARATION
U P I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
< awith Section 7000) of Division 3 of the Business and Prof I as Code, and my license is
in full area and effec
= ? LicenseeClass &ARCHr�rE_CrS
Lia.tiDataContractor DECLARA ION
(z < 1 understand my plans shall be used as public records
\
�U
,a
O H Licensed Professional
y OWNER -BUILDER DECLARATION
I hereby alTirm that I am exempt from the Contractors License Law for the
:00 following reason. (Section 7031.5, Business and Professions Cade: Any city or county
m which requires a permit to construct, alter, improve, demolish, or repair any structure
Z 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
I=- G (commencing with Section 7000) of Division 3 of the Business and Professions Code) tar
a 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
not more than five hundred dollars ($500).
❑ 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
and Professions Code: The Contractor's License Law docs not apply to an owner of
property who builds or improves thereon, and who does such work himself or through his
own employees, provided that such improvements are not intended or offered for We. 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.).
❑ I, as owner of the property, am exclusively contracting with licensed contractors tm
construct the project (Sec. 7044, Business and Professions Code:) The Contractor's Li-
cense Law docs not apply to an owner of property who builds or improves thereon, and
who contracts for such projects with a conuactor(s) licensed pursuant to the Contractor's
License Law.
[3I am exempt under Sec , B & P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a Ccrtificate of Consent to self -insure for Worker's Compen-
sation, as provided for by Section 3700 of the Labor Code, for the performance of the
work for which this permit is issued.
❑ I have and will maintain Workers 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
Carrier. T, :Z2J_ r /Tri . J JL a Policy No.:
CERTIFICATE OF EXEMPTION FROM W CERS'
COMPENSATION INSURANCE
(Thissection need not be completed if the permitis for one hundred dollars (5100)
or less.)
I cenify that in the performance of the work for which this permit is issued, f shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California. Date
Applicant
NOTICE TO APPLICANT: 11, after making this Certificate of Exemption, you should
become subject to the Worker's Compensation provisions of the Labor Code, you must
J ;G, forthwith comply with such provisions or chis permit shall be deemed revoked.
CCn CONSTRUCTION LENDING AGENCY
�+ w 1 hereby affirm that there is a constructinn lending agency for the performance of
(1+ 5 the work for which this permit is issued (Sec. 3097, Civ. C.)
FLS Lenders Name
Dr Lenders Address
r�
® 1 certify that I have read this application and state that the above information is
Ua t" correct 1 agree to comply with all city and county ordinances and state laws relating to
0U building construction, and hereby authorize representatives of this city to enter upon the
U above-mentioned property for inspection purposes
a (We) agree to save, indemnify and keep harmless the City of Cupertino against
r -n Cs] liabilities, judgments. costs and expenses which may in anyway accrue against said City
[� Z inconsequence of the granting of this permit.
a -a APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
SOURCE REG ONS, t�
Signature o Appl anV n actor arc
ARDOUS MATERIALS DISCLOSURE
Will the appli nt or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety
Code, Section 25532(a)?
❑Yes No
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management
District?
❑YesNu
I have read the ha7.a no materials requirements under Chapter 6.95 of the Califor-
nia Heal th & Safety Code, Sections 25505, 25533 and 25534.1 understand that if the building
does not currently have a tenant, that it is my responsibility to notify the occupant of the
requiret must be t prior to issuance of a Certificate of Ccty an
Owner or
Job Description
INDVDL CHANNEL LETTER SIGN
Sq. Ft. Floor Area $4000 Valuation
3690.6008`.
Required Inspections
Issued by:
Re -roofs
Type of Roof
Date �Gl
��
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'`' or better
CITY OF
CU PEkTINO
CITY OF CUPERTINO
SIGN
PERMIT APPLICATION FORM
US/000`l7
APN #
Date:
2(0 C/o toot)?, d(:)
Building Address:
Mailing Address (if different from building address):
Owner's Name:
Phone #:
KGS �mS-
X63- 73
Contractor:
Phone #:j
`1 S7 C
Fax #: - —( p r-)
Contractor License
Cupertino Business License #:
8-346-U
Phone #:
Fax #:
Building Permit Info:
Bldg ❑ Elect 19-� Monument ❑ Mounted on Building
Residential ❑ Commerci4KE�--
Job Description:
U\ -v - "0- dv-,6 Ad
Valuation (cost of project):
Project Size: Express Standard ❑ Large ❑ Major ❑
Green Building: Please complete relevant portion of the Green Building Checklist & attach, to the
application or if applicable, include in plan set & the sheet index.
Revised 6/16/08
CITY OF
CUPEK rINO
CITY OF CUPERTINO
SIGN
FEESCHEDULE
Quantity
Fee ID
Fee Description
Fee
Group
Permit Type
1 SIGNDIRECT
Directional
B
1SIGN/RF
Ground/Roof/Projecting Signs
B
�.4,1ANMASCK
Master Plan Sign Check
B
1 SIGNREWRKG
Rework of any existing Ground
Sign
B
1SIGNOTHER
Other Sign
B
1SIGNREINSP
Re -inspection Fee
B
1SIGNWNONEL
Wall/Awning Sign, Non-
Electric
B
1SIGNWELEC
Wall, Electric
E'
IESIGN
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
/
IELCPLNCK
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
Community Development
10300 Tone Avenue
Cupertino CA 95014
Telephone (408) 777-3228
CIT1(OF Fax (408) 777-3333
CUPEkTINO
Building Department
U
I am not using any subcontractors:
gn ture Date
PIease check applicable subcontractors and c plete the following information:
JOB ADDRESS:
s
PERMIT #
f 6bo
BUSINESS NAME
OWNER'S NAME: C (I-- ,
PHONE #
Cabinets & Millwork
GENERAL CONTRACTOR: S'
FAX #
U
I am not using any subcontractors:
gn ture Date
PIease check applicable subcontractors and c plete the following information:
Owner/ Contractor Signature
Date
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum / Wood
Glass / GIazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/ Contractor Signature
Date