B-2016-3276CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2016-3276
19620 STEVENS CREEK BLVD STE 190 CUPERTINO, CA 95014 (369 06 010)
LEE'S SIGNS INC
OAKLAND, CA 94606
OWNER'S NAME: EVERSHINE VI, LP
DATE ISSUED: 12/15/2016
OWNER'S PHONE: 408-343-1088
PHONE NO: (5 10) 452-1420
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class C-45 Lic. #556289
Contractor LEE'S SIGNS INC Date 03/31/2018
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 WALL SIGN•= GARLIC
I hereby affirm under penalty of perjury one of the following two declarations:
MEDITERRANEAN GRILL
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
performance of the work for which this permit is issued:
2% `I have and will maintain Worker's Compensation Insurance, as provided for by
ti Section 3700 of the Labor Code, for the performance of the work for which this
Sq. Ft Floor Area:
Valuation: $2400.00
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application "and state that the above
APN Number:
Occupancy Type:
information is correct..) agree to comply with all city and county ordinances
369 06 010
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 againstliabilities, 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 Cupertino Municipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 12/15/2016
Issued by: ABBY AYENDE
Date: 12115/2016
01AINE DECLARATION
I hereb affirm that I am exempt from the Contractor's License Law for one of the
RE-ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
following two reasons:
i. I, as owner of the properly, 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)
I
z. I, as owner of the property; am exclusively contracting with liceised
Signature ofApplicant:
contractors to construct the project (Sec.7044, Business & Professions Code).
Date: 12/15/2016
I hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS "A" 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
performance of the work for which this permit is issued.
2. I have and will maintain Worker's Compensation Insurance, as provided for by
HAZARDOUS MATERIALS DISCLOSURE
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
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
a. 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 become subject to the
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, 25533, 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: 12/15/2016 r
I certify that I have read this application and state that the above information is
I hereby affirm that there is onstrulending ction lendagency for the performance
ng
correct. I agree to comply with all city and county ordinances and state laws
issu. Civ C.)
of work's for which this per ed (Sec
relating to building construction, and hereby authorize representatives of this city
relating
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
ARCHITECT'S DECLARATION
and will comply with all non-point source regulations per the Cupertino Municipal
I understand my plans shall be used as public records.
Code, Section 9.18.
,
Licensed
Signature Date 12/15/2016
Professional
CUPERTINO
b 3�
SIGN PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildingP—cupertino.Org
PROJECT ADDRESS 0 �
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STREET ADDRESS
CITY, STATE, ZIP'S
CONTACT NAME
PHONE `rE-MAIL
STREET ADDRESS
CITY, STATE, ZIP
FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ARcmrECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
LICENSE NUMBER
LICENSE TYPE
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS �'
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CITY, STATE, ZIP �j^�f _ CA C,�„ 46
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PHONE
ARCHITECT/ENGINEERNAME
LICENSE NUMBER
BUS. LIC # '
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK
1f/ F /�
USE OF ❑ SID or Duplex Multi -Family
STRUCTURE: Commercial
ILLUMINATED
(Y/N)
SIGN TYPE
(CODE)
NO. OF
SIGNS
SIGN AREA
(SQ. FT.)
VALUATION
($)
SIGN TYPE CODES:
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:
TOTAVUATION:
By my signature below, I certify to each of the following: lam the property owner or authorized agent to act & the property owner's behalf I have read this
application and the infonnation I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to buildin onstmction. I authorize representatives of Cupertino to enter the above -identified property for inspec ' purposes.
Signature of Applicant/Agent: Date: i
SUPPLEMENT ORMATION REQUIRED
_ Site Plan
_ Elevations
Sign Details - Including UL listing(s) applicable
Structural Calculations (if applicable)
_ Copy of Planning Approval Letter or Meeting with Planning prior to
submittal of Building Permit application.
OFFICE USE ONLY
PLAN CHECK TYPE
ROUTING SLIP
❑ OVER-THE-COUNTER
❑ EXPRESS
❑ STANDARD
❑ LARGE
❑ MAJOR
❑ BUILDING PLAN REVIEW
❑ PLANNING PLAN REVIEW
❑ OTHER:
SignApp_2011.doc revised 03131111