The URL can be used to link to this page

B-2016-2958CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO B-2016-2958 19469 STEVENS CREEK BLVD CUPERTINO, CA 95014 (316 20 112) 'THAI BUI SAN JOSE, CA 95112 OWNER'S NAME: MAIN STREET CUPERTINO DATE ISSUED: 10/20/2016 OWNER'S PHONE: PHONE NO: (408) 298-9153 LICENSED ONT ACTORvS DECLARATION BUILDING PERMIT INFO: Class ELECTRIC SIGNS Lic. #796918 :or THAI BUI Date 06/30/2017 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 i' 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. 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 NMunicip PCode, Section 9.18. Date 10/20/2016 I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: I, as owner of the propertI4 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) 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. 1 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 Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 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 10/20/2016 X BLDG —ELECT _ PLUMB _ MECH _ RESIDENTIAL X COMMERCIAL JOB DESCRIPTION: INSTALL WALL SIGNS (4) PANINO GIUSTO Sq. Ft Floor Area: l Valuation: $6000.00 APN Number: Occupancy Type: 316 20 112 } PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. by: 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: 10/20/2016 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, Cyapter 9.12 and the Health & Safety Code, Sections 25505,233, au7"25534. ~' r Owner or authorized agent: _ ✓ "" " Date: 10/20/2016 CONSTRUCTION LENDING AGENCY hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (See. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION understand my plans shall be used as public records. Licensed CUPERTINO 5/0 SIGN PERMT APPLICATION CONBVII.INITY DEVELOPIVENT DEPARTNENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • Wldirxt =upertinaorq S >ROWl'A»s ICj&,6q , APN# OWNERNAIvE PHOTIFS>r STRWFADEWSS C LTY STATB, FAX CONFACT NAME V�1wLl- �". PRONE '10% 2 iii - tS B MAIL ucicySr Sap mt-00.CO'^ STREET ADDRESS 12-C-0 AIV -0- C'�, cny,, STATF, ZIP FAX SGA ' i b Cid 01P I L �/{ ❑ OWNER ❑ OWbUZ-M DM ❑ Ow MAGENr 1==1 CONrE ACIoR ❑ ouvn ACTORAGENT ❑ ARCHI= ❑ INGAmz ❑ DEVEC:OpER ❑ TR.L 1u CCN RACICXZ � LICENSENU MER LICEI�7SE BUS.LTC# 7 L CC &FANYNANE �g F -MAIL, FAX STREET' AL) XWSS I Cl PT 6 Wi �l G1 ( STALK ZL' Q S CW -11Z PHOPI E ARC:tjnTc,P NAME LICII~21SEENUNBM _ BUS. LIC# (XRvPANYNANE E-MAIL FAX S'IR=ADDRESS _ QTy, STATE, zu, PIIONE DFSCRE[1HON0F WORK 304 KC -lo l I I.e*e S �A tJ k 5 te--,-wk&A. -2 e-k�s�®uk- 1'-A r 6 o 00"I Ysv CO CA V1\ (� 11J1 •.. USE OF ❑. SFD or Duplex ❑ m& Farri1.Y ILLUNIIlrA'.D SIGNTYM No CF SICNARFA VALUATTCN STRUCTURE: -.. ❑ Cote=dal (Y/ M (CODE) SICK (SQ FE) SICNTYPECODFS: Y ui I2 �q i gt00 t. L7 �•®f°3 B - BAT ,1ERSICN M - NKMIVIENr(GROUND) SIGN BL - BLADE SIGN P - FROIBC:TMG SIGN .. D - EEVELCPACWIDSIGN SP - SPEC ALEVENFBAMSIER DI - DII=014AL SIGN T - TFIvFCRARY E - Ff BCIR MC W - WALL SIGN READERBOARD Wr - WAIDOW SIGN REC�dVIDB TOTAL VALUAMON 1 6 pQ© By nW sigrnatwebelow, I cff ifyto each oft -6- following I anLthe property owner or girth zed to act the gloperiyownees bemf. I have readthis application and the informa ionIlaveprovidediscorrect Ihave read the DesaiptionofWorkand verify itisa= ate. Iagree tocomply with all applicablelocal ordinalcesand state; laws rehdingtobLuldmgconstrL= I representatives ofCuperdwtoenrrteabovo-identifiedproperiyfor irspeCtionpiuposes. Sigrl—ofApplicaWAgent: Date: 10116116 SUPPI F,MFNf AT .INDPJVMnONREQUIRED OMCEiSE ONLY Site Plan PIAN CEIE K11TE ROULING IP _Elevations ❑ 0vJEP-THEC0UNHR P-BOBnmr-PLANPEv1EWA1b6A--J _ Sign Details - including UL lishrig(s) applicable ❑ EXMESS VREA I NIGPIAN REVIEW Structural Calc& -lions (if applicable) ❑ srAmmw ❑ p>Ma t May — Copy ofP mung Approval Letter or Maedi g withPlaruutgpriortO ❑ LARGE submittal of Buil&ng Penrit application ❑ M4IOR a 201Ldoc revised 03/31/11