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B-2016-3129
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS:: CONTRACTOR: PERMIT NO:B-2016-3129 19068 STEVENS CREEK BLVD CUPERTINO,CA 95014-2522(375 07 046) ALLEN SIGNS INC SAN JOSE,CA 95125 OWNER'S NAME: UNITED POLARIS LLC DATE ISSUED:11/16/2016 OWNER'S PHONE:408-905-8798 PHONE NO:(408)280-6500 LICENSED CONT A' TOR' D AR ATION BUILDING PERMIT INFO: License Class C45 Lic.#834580 Contractor ALLEN SIGNS INC Date 03/31/2018 X BLDG _ELECT _PLUMB M — ECH_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 ONE(1)ILLUMINATED WALL SIGN TO(E)BRANCH I hereby affirm under penalty of perjury one of the following two declarations: CIRCUIT-AMAIVII SUSHI 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 ;1performance 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:$2800.00 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 375 07 046 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 per the Cupertin. •nicipal Code,Section 9.18. 180 DAYS FR p1,AipI[N 1 SPECTION. Signature% Date 11/16/2016 Issued by:MELI •lvlo Date:11/16/2016 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 roofing 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:11/16/2016 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 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 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 s. 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 25 I r'33,and 25534. Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked Owner or authorized agent ' APPLICANT CERTIFICATION Date:11/16/2016 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 11/16/2016 Professional V • Tr - CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION '' • 10300 TORRE AVENUE• CUPER T INO,CA 95014-3255 IIP=R E � (408)777-3228 FAX(408)777-3333. buildinoZ,cuoertino.oro 6-2-6.1‘ -- 3/2-,- E1 NEW%CONSTRUCTION0 ADDITION ❑ -L T ERkTiON i TI E RE\%iSION I DEFERRED ORIGINAL PERMIT= PROTECT ADDRESS Q 6 tJ ! e V j11e.e, EF - . ,-- o — r,6 OWNER NAME E b //7(y('jp/ PLY /`/! PHO?E ql'r''' f� E-MAIL � W.o re ✓LYiS L,1--, Y a STP.EET:DDPESS (Q�� l Cg`-' CITY, ST? ZIP a FAX r jj rrl ElD CONTACT NAME /� tr PHO i „ '1 't ; F-2-gD` ` F'-^`�G1 reo 41 'v14@ pih ooe Crow STREET ADDRESS 1/1(!. CITY,_STATE,ZIP - '"�� a • ��> / c i GjU FAX cd�'"b u I] OVX 0 OWNE -BUDDER 0 OW'I. tAGENT 0 CONTRACTOR. 0 CONTRACTOR AGENT 0 ,R.ciaiECT 0 ENG?\' 0 DEVELOPER 0 TENANT CONTRACTOR OR NAME (I 1 pik. LICENSE NTT' 'R LICENSE TYPE e^i!5BUS.LIC r y `° (�/ f�9i,) Ly I _ r!, , -r- F C0 tPAYIAZE �1FrV1 7 f E-SAIL �L ! FAX FQ moi ` � S' .4. l �v„'Jr STREET ADDRESS ' CTf.STATE.ZIP HO\i "RCr-,GTECT/ENGLNEERNAME /A ,LICENSE?NUMBER I BUS,LIC 4 ' COMPANY NAME EMAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DGSCRPTIO'.\T OF WCP,I: 1>11)iviDUAL /�61/A1U�' 1'LLv/41,u k p c fRry e C. I . EXISTING L'SE _/ PROPOSED USE CONSTR.iY STORES STES i , Rec�jv / -.j U I P6SIXviz (6-Ai I USE TYPE OCC. SQ.FT. VALUATION(5) EXISTG NEW FLOOR DEMO TOTAL. ,t-- I r AREA AREA ARIA NET AREA 2�j,17 411.G Zig ?'°?'°I'� BATHROOM KITCHEN OTHER I REMODEL A.REA REaMODELAREA REMODEL AREA PORCH AFIrAREA DECK AREA TOTAL DEC_KPOR.CH AREA GARAGE AREA: I]DETACH ❑ATTACH D\I ELLOIG UNITS: ISA SECOND UNIT DYES SECOND STORY DYES L\ - I ® I BEG ADDED? ONO ADDITION ONO PRE-APPLICATION ❑`ES E YES PROVES COPY OF IS THE BLDG AN 0 YES : „_ , 1 TOTAL\ 6LL4tQ :PLA\y.1a?t. ❑NO ar-\"\D\G._5RO\&L LETTER EICHLERHO .E? '� .,, ., � U © F -' ,b:_..•t ic.•d. I � i• c _ .i i -i it -mg: I as the prop �? o,� �o_au` ooze. ag. rhe atop -'y etiner s b-halAhave read his ; application and the info cation I haVe provided is con_c, I have read theDescription of Work k and.\e_.y it is accurate I agree to comply with all applicable local ordinances and state laws relating to building cor .'on. I authorize representatives of Cupertino to enter theabove-3n _tined propel'I for inspection purposes. ice/ J Signstueof.Applicant/Agent: C (i'l —*(6 .. -.or Date. SUPPLEMENTAL INF REQUIRED PT 4 £F_ECIs T1PE„ ..., w<_ '• Th G SLIP_ Kew SFD or}Multi cnll\%d\\ellt-Rs Apply or demolition per'tit for i I O\ER Ti-;F COL'�TEF. I� F'I B • exist Pa bUn gl(S). Demolition permit is required prior to issuance Or building r _ pe mit for ne ;building. \PRESS I '4e I \ - Commercial 3.d Provide a CCHteed Hazardous Materials Disclos_re . CT--.\-D 1D I ,BLC\ OR�c - form if any Hazardous Materials are being,used aspall of this project. - L_RGE U FIRE DEPT Copy of Planning Approval Leiter or t\'l eettpg.A nth Planning prior t0 L - y u submittal Of Building.Permit appli ai:on ❑ ALJOR :� q -S�Nfi.A s.iin --gTRICT - _1 B '� c �,.r.:,..-. „-_. . .� ',:_r ,.:� <'j�_Ehl-IRO?,'',�ER`T L£ESi'i'iIam-.; Bld, cp_201 f doc revised 06/21/11