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B-2016-2127CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR:- PERMIT NO: B-2015-2127 10001 N DE ANZA BLVD CUPERTINO, CA 95014-2263 (326 34 074) ADIMPACT CORPORATE SIGNAGE IRVINE, CA 92606 OWNER'S NAME: TAMBELLINIDEANZAPROPERTIES LLC DATE ISSUED: 06/14/2016 OWNER'S PRONE: 408-427-2143 PHONE NO: (949) 476-0015 1 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class ELECTRICAL Lic. # 9A 0124, Contractor ADIMPACT CORPORATE ,SIGNAGE Date 06130/20'18 LDG X.BI AO ELECT —PLUMB X RESIDENTIALUM COMMERCIAL I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing _ with Section 7000) of Divlslon 3 of the Business & Professions Code and that my license is in full force and effect, JOB DESCRIPTION: INSTALL (N) NON -ILLUMINATED MONUMENT SIGN (1) - APPLE 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 REV # 1 - CHANGE SIGN FOOTING TO BOLTED TO SLAB - ISSUED Compensation, as provided for by Section 3700 of the Labor Code, for the 8/3/16 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. Sq. Ft Floor Area: Valuation: $5000,00 APPLICANT CERTIEMAT1021 I certify that I have read this application and state that the above APN Number; Occupancy Type: information is correct. I agree to comply with all city and county ordinances 326 34 074 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 [[abilities, judgments, costs, and expenses which PERMIT EXPIRES IF WORD IS NOT STARTED may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally, the applicant understands and wilt comply with all non -point 9.18. 180 DAYS FROM LAST CALLER INSPECTION. source regulations pert e.Ono unicipal Code, Section Signature - Date 9510=01 6 Issued by: MELI °� I➢atela� ER- R O I Isercby affirm that i am exempt from the Contractor's License Law for one of the 9tF-ROOTSa Alt roofs shall be inspected prior to any roofing material being installed. If aroof is fallowing two reasons: installed wfirst obtaining an inspection, I agree to remove all new materials for iwithout i. I, as owner of the property, or my employees with wages as their solo inspection, compensation, will do the work, and the structure is not intended or offered for sale (See.7044, Business_& Professions Code) i. L as owner of the properly, am exclusively contracting with licensed Signature of Applicant: contractors to construct the project (Sce.7044, Business & Professions Code). Date: 0 810 3 /20 1 6 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS 91APl OR BETTER i. 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 HAZARDOUS MATERIALS DISCLOSURE performance of the work for which this permit is issued. z. I have and will maintain Worker's Compensation Insurance, as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the Safety Code, Sections 25505, 25533, and 25534. I will Section 3700 of the Labor Coda, for the performance of the work for which this California Health & maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the permit is issued. Health & Safety Code, Section 25532(a) should I store or handle hazardous s. I certify that in the performance of the work for which this permit is issued, I material, Additionally, should I use equipment or devices which emit hazardous shall not employ any person in any manner so as to became subject to the Compensation laws of California. If, after making this certificate of 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 Worker's exemption, I become subject to the Worker's Compensation provisions of the the Health do Safety Code, Sections 25505,25s33, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall y be deemed revoked Owner or authorized Date: 08f03J2016 APDL ICANT C +MIF C.ATIO-N I certify that I have read this application and state that the above information is {'nNSTRU 'pI N I ENDING. AGENCY m thatthere is a construction lending agency for the performance I hereby affirm tha correct. I agree to comply with all city and county ordinances and state laws of work's forthis permit is issued {Sec, g7, Civ C.)t relating to building construction, and hereby authorize representatives of this city Lender's Name to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Address judgments, costs, and expenses which may accrue against said City In consequence of the granting of this permit. Additionally, the applicant understands ARC MCT'S DECLARATTI_O,N and will comply with all non -point source regulations per the Cupertino Municipal I understand my plans shall be used as public records. Cade, Section 9.48. Licensed Signature Date 0814312046 Professional SIGN PERMIT" APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3256 CVPERTINQ (408) 777-3228 - FAX (408) 777-3333 - bllildinaCcl7,cunerlino.orq PROSECT ADDRESS ®Lr ,.„. / _ Y� / l/ Y4° �..,ry y f/ 4 ' :[AIN cf j fk / (/OWNERDIA( 1 `mssmoi(f li E1 � k)r PHH �r J E IvfA]L{ STREBTADDRESS -Z'-� ,�rr CiTY , TA IP S.%-L� 'e/ - FAX CONTACT NAME PITON$ &MAIL STRBETADDRESS CITY,STATE, ZIP FAX ® OWNER ® OWNIZ]BUiLDER ❑ OWNER AGENT 4(CONTRACTOR 13 CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINBRR ID DEVELOPER ® TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE AUS. LIC N COMP N E-MAIL FAX STREE ADDRBSSCITY TA B /t!�1— q 7;7 c PHONE _ t3 cit` ARCHrTECTMKGINEER NAME LICENSE NUMBER BUS. LTC S COMPANYNAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK ,79 -"2-/ --7 USE OF ❑ SFD or Dup1ex ❑ Multi-l+ainily ILLUMINATED SIGN TYPE No. OF SIGNAREA VALUATION STRUCTURB: mmBTClaI Ly/N) (CODE) SIGNS (SQ FT.) M SIGN TYPE CODES: E - BANNER SIGN M - MONUMENT (GROUND) SIGN BL - BLADE SIGN P - PROJECTING SIGN D - DBVBLOPMENTIDSIGN SP - SPECIAL EVENT BANNER DI - DIRECTIONALSIGN T - TEMPORARY E - ELECTRONIC W - WALL SIGN RHADERBOARD WI - WINDOW SIGN EIV TOS L VvALEIATION: By Iny signature below, I certify to each of the following: I am the property owner or authori to act on the property owner's behalf—I have read this application and the information I have provided is correct. I have read the Description ofWork and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building cc tion. 1. nthorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of ApplicantlAgent: Date:—Y-- 3 ':Z,6 SUPPLEMENTA144ORMATION REQUIRED OFFICE USE ONLY PLAN CHECE: TYPE ROUTING SLIP Site Plan ❑ OV ER-THJP -COUNTER © BUILDING PLAN REVIEW _ Elevations Sign Details - including UL listing(s) applicable ❑ FxPPSSS ❑ PLANNING PLAN REVIEW _ Structural Calculations (i£ applicable) ® STANDARD © 0T.HER. Copy of Planning Approval Letter or Meeting with Planning prior to ❑ LARGE submittal of Building Permit application. ❑ MAJOR SignApp 2011.doc revised 03131111 .ACI iI-EVEM EINT ENGINEMRING I P1 ORP Date: September 06, 2016 Proiect No: 2780 Chief Building Official City of Cupertino Subject: Dear Sir Structural Steel Welding For Apple Sign 10001 De Anza Blvd. Cupertino, CA 95014 Permit #: B-2016-2127 Based on owner representative's request we visited the job site on August 05, 2016 and observed the completed structural steel welding for two new framing for apple sign by following details: HSS 2"x2"x1/4" were connected to Base plate using %4" fillet weld then were connected to existing concert using (6) '/"x5 '/" Red Head wedge with 4 '/2n embedment for each one per plan sheets 1 and 2 dated 06/07/2016 In general work was in compliance with approved plan sheets 1 and 2 dated 06/07/2016 Inspection was performed periodically and on call basis as requested by the owner's representative. We claim no responsibility or liability for damages from improper use of the results or findings. We do not undertake the guarantee of construction nor do we relieve the contractor of his primary responsibility to produce a completed project in accordance with plans and specifications. Our findings refer to locations that were inspected by Achievement Engineering representative. If you have any questions or need any additional information, please feel free to call us at your convenience. Sincerely Yours, Sing Hooshdar, P.E. State of California Licensed Civil Engineer Address: 2455 Autumnvale Drive, Unit E, San Jose, CA 95131 - Tel: (408) 217-9174, Fax: (408) 217-9632 www.achieveng.com Form R-11