B-2016-2190BUILDING ADDRESS: CITY OF CUPERTINO BUILDING PERMIT
10555 S DE ANZA BLVD CUPERTINO, CA 95014-4400 359 18 058 CONTRACTOR; PERK
( ) CITY SIGNS
MODESTO, CA 95351
OWNER'S NAME: ABC DEANZAPLAZA PARTNERS DATE
OWNER'S PHONE: 844-564-6487
LICENSED CONTRACTOWS DECLARATION
License Class C-45 Lic. #769900
Contractor CITY SIGN 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:
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.
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 CERIIFICAXION
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, Cupertin (Municipal ode, Section 9.18.
Date 6/22/2016
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
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,
BUILDING PERMIT INFO:
NO: B-2016-2190
SUED: 06/22/2016
):(209)549-2412
X BLDG —ELECT _ PL
_ MECH _ RESIDENTIAL COMMERCIAL
JOB DESCRIPTION:
INSTALL (2) WALL ILLUM TED SIGNS - ENGENIUS
Sq. Ft Floor Area:
$6000.00
APN Number: Occupacy Type:
359 18 058
PERMIT EXPIRES
WITHIN 180 DAYS
180 DAYS FROM L.
Issued by: Abby Ayende
WORK IS NOT STARTED
F PERMIT ISSUANCE OR
T CALLED INSPECTION.
All roofs shall be inspected prior tj any roofing material being installed. If a roof is
installed without first obtaining an ispection, I agree to remove all new materials for
inspection.
Signature ofApl
Date: 6/22/2016
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
I have read the hazardous mate 'als requirements under Chapter 6.95 of the
California Health & Safety Co le, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cu ertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 5532(a) should I store or handle hazardous
material. Additionally, should I me equipment or devices which emit hazardous
air contaminants as defined by th Bay Area Air Quality Management District I
will maintain compliance with th Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Co e, , on 25505, 25533, and 25_V+
Owner or authorized agent:
Rate: 6/2 2/2016
N T LENDING AGENCY
I hereby affirm that there is a con 3truction lending agency for the performance
of work's for which this permit is i 3sued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
I understand my plans shall be u4ed as public records.
Licensed
Signature Date 6/22/2016 Prnfaccie
SIGN PERMIT IT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
CUPERTINO (408) 777-3228 • FAX (408) 777-3333 building@cupertino.org ``P_ % i o
PROSECT ADDRESS /� � �/ APN#
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❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR 'PI:EONTRACTOR.AGENT ❑ ARCHITECT ❑ FNGINEER ❑ DEVELOPER 13 TENANT
CONTRACTOR NAME
LICENSE NUMBERiLICENSE TYPE
-
BUS. LIC #
4Id S,\ l
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONEb
ARCHITECTIENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK / ♦ /
N 1-l. 2 1. t. V ♦ / �� �L�l%% 1l Ke
USE OF ❑ SFD or Duplex ❑ Multi -Family
ILLUMINATED
SIGN TYPE.
NO. OF
SIG 11 AREA
VALUATION
STRUCTURE: Commercial
(Y/N)
(CODE)
SIGNS
( .FT.)
($)
SIGN TYPE CODES;
/
r
/
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:
TOIL VALUATION:
t7
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property c wner's behalf. I have read this
application and the information I have provid iscorrect. I have read the Description of Work and verify it is accurate. I ag to comply with all applicable local
ordinances and state laws relating to 1) r g c nstrucf on. uthorize g0fresentatives of Cupertino to enter the above-identific d property for inspection purposes.
oe
Signature of Applicant/Agent; ' Date: 44iL
SUPPLEMENTAL INFORMATION REQUIRED
OFF CE USE ONLY
PLAN CHECK TYPE
ROUTING SLIP
Site Plan
❑ 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
F-] LARGE
submittal of Building Permit application.
El MAJOR.
i9m4pp^2011. doc revised 03/31/11