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B-2016-3109 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-3109 1505 S DE ANZA BLVD CUPERTINO,CA 95014-5321(366 10 121) JOHNSON UNITED INC MODESTO,CA 95356 OWNER'S NAME: COOPER WILLIAM A TRUSTEE&ET AL DATE ISSUED:11/14/2016 OWNER'S PHONE:408-691-9511 PHONE NO:(209)543-1320 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class C-45:B Lic.#718965 Contractor JOHNSON UNITED INC Date 02/28/2018 X BLDG _ELECT _PLUMB MECH_RESIDENTIAL X COMMERCIAL 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. JOB DESCRIPTION: INSTALL 1 ILLUMINATED MONUMENT SIGN AND 1 ILLUMINATED I hereby affirm under penalty of perjury one of the following two declarations: WALL SIGN-KELLY MOORE PAINTS a. 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. Sq.Ft Floor Area: Valuation:$30000.00 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 APN Number: Occupancy Type: and state laws relating to building construction,and hereby authorize 366 10 121 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 PERMIT EXPIRES IF WORK 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 will comply with all non-point source regulations gerihe ppprtino ip rade,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. � ,signature Date 11/14/2016 Issued by:Abby Ayen de Date: 11/14/2016 OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS: following two reasons: All roofs shall be inspected prior to any roofmg material being installed.If a roof is 1. I,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for compensation,will do the work,and the structure is not intended or offered for inspection. sale(Sec.7044,Business&Professions Code) 2. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant: contractors to construct the project(Sec.7044,Business&Professions Code). Date:11/14/2016 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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. HAZARDOUS MATERIALS DISCLOSURE 2. 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 Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the 3. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should I store or handle hazardous shall not employ any person in any manner so as to become subject to the material.Additionally,should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 25505,255 and 25534. Labor Code,I must forthwith comply with such provisions or this permit shall ; be deemed revoked. Owner or authorized agent:�' - - _AL APPLICANT CERTIFICATION r Date:11/14/2016 I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,Civ C.) to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name to save indemnify and keep harmless the City of Cupertino against liabilities, judgments,costs,and expenses which may accrue against said City in Lender's Address consequence of the granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code,Section 9.18. I understand my plans shall be used as public records. Licensed Signature Date 11/14/2016 Professional *. 10q / SIGN PERMIT APPLICATION ...VCOMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISIONS .e94. 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408)777-3228•FAX(408)777-3333•buildinq(a�cupertino.orq CUPERTINC PROJECT ADDRESS //�� /� `�„^, S lf_4- /zeL APN# pry_ 'O-\LI OWNER NAME //I s Y! 4- J/44(1224 ( ,Nc9 �-Q:f PHONE`it 1/ li Off^_TAATr ',7 STREET ADDRESS CI STATE,ZIP FAX . /6 ©S"6 GK.()er,w v© kol. oval-c— d-e.r4r►(9. C4 ci So?% CONTACT NAME PHONE E-MAIL STREET ADD S CITY,STATE,ZIP FAX 2 09 - �)‹ T2P hiobt-= 11 '3,53 523- 'J9 Ei OWNER ❑ OWNER-BUILDER El OWNER AGENT 0 CONTRACTOR CQ ITRACTOR AGENT 0 ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME) ) N, ^ ,, LICENSE NUMBS LICEIy TY? BUS.LIC# &FP j14 vem-een (‘9'1 cAN P..re1S °�\ too CSI 2� COMPANY NAMEc/'Cl'1 ,tyl 0f V` t e E MAII vAY�t� ori Ph✓ G sv/,�R�j. P ��(a STREET ADDRESS CITY,STATE,ZIP ✓ PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK Vn an 4MAgrer + ` (kiS-040,-L LeD 'Al Ow c st A Q, )_).,e,1-3 c1 ' 0 (Intl GtOklb�e- &ce_ci i\l vvn (LEP) itvv%hkpn A- &J19.) V USE OF ❑ SFD or Duplex ❑ Multi-Family ILLUMINATED SIGN TYPE NO.OF SIGN AREA VALUATION STRUCTURE: ❑ Commercial (Y/N) (CODE) SIGNS SIGN TYPE CODES: 'V B - BANNER SIGN M - MONUMENT(GROUND)SIGN f BL - BLADE SIGN P - PROJECTING SIGN 1 D - DEVELOPMENT ID SIGN SP - SPECIAL EVENT BANNER DI - DIRECTIONAL SIGN T - TEMPORARY E - ELECTRONIC W - WALL SIGN READERBOARD WI - WINDOW SIGN RECEIVED BY: Ctavt i.^ j A TOTAL VALUATION: By my signature below,I certify to each of the following: I am the property owner or authorized agent to act ot.dthe property owner's behalf. I have read this application and the information I have provided is correct. I have re.d I: :•scription of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to buil.'.g ci 3 s .chon -sentatives of Cupertino to enter the abo e-id lied property for inspection purposes. Signature of Applicant/Agent: _ _,9r_ 1 _t r^e ' Date: `1 SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY Site Plan PLAN CHECK TYPE ROUTING SLIP Elevations .. D OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW Sign Details-including UL listing(s)applicable 0 EXPRESS El PLANNING PLAN REVIEW Structural Calculations(if applicable) ❑ STANDARD El OTHER: Copy of Planning Approval Letter or Meeting with Planning prior to ❑ LARGE submittal of Building Permit application. ❑ MAJOR SignApp_2011.doc revised 03/31/11