15010096CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10100 S DE ANZA BLVD
CONTRACTOR: RAGO NEON
PERMIT NO: 15010096
OWNER'S NAME: ZANKICH MARTIN TRUSTEE
235 LAUREL AVE
DATE ISSIJED: 01/16/2015
OWNER'S PHONE: 4087399717
HAYWARD, CA 94541
PHONE NO: (510) 537 -1903
12 LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL
—
ARMADILLO WILLY'S - ADD (N) WALL ILLUMINATED
_
License Class Lic. #_ % �� Z Q
WALL
,
0 /1 c
SIGN AND RE -FACE (E) ILLUMINATED MONUMENT SIGN
Contractor ln t�o ee n 1A C-- Date �
&
I hereby affirm that I am licensed under the provisions of Chapter 9
CHANGE TO (N) LED LIGHTING
(commencing with Section 7000) of Division 3 of the Business & Professions
Code and that my license is in full force and effect.
1 hereby affirm under penalty of perjury one of the following two declarations:
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
Sq. Ft Floor Area:
Valuation: $7000
performance of the work for which this permit is issued.
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
APN Number: 36901001.00
Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
1 certify that l have read this application and state that the above information is
PERMIT EXPIRES IF WORK IS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
180 DA LED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
Issued f6 /
granting of this permit. Additionally, the applicant understands and will comply
Date:
with all non -point source re ulations per the Cupertino Municipal Code, Section
9.18.
%
RE- ROOFS:
Sign Date �6 I ��
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.
❑ OWNER - BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that 1 am exempt from the Contractor's License Law for one of
the following two reasons:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
1, as owner of the property, 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)
1, as owner of the property, am exclusively contracting with licensed contractors to
HAZARDOUS MATERIALS DISCLOSURE
construct the project (Sec.7044, Business & Professions Code).
I have read the hazardous materials requirements under Chapter 6.95 of the
California health & Safety Code, Sections 25505, 25533, and 25534. 1 will
I hereby affirm under penalty of perjury one of the following three
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
declarations:
Health & Safety Code, Section 25532(x) should I store or handle hazardous
I have and will maintain a Certificate of Consent to self - insure for Worker's
material. Additionally, should I use equipment or devices which emit hazardous
Compensation, as provided for by Section 3700 of the Labor Code, for the
air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued.
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
1 have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sect' S 25505, 25533, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
Owner or authorized a w —^-�— Date: �6
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
CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code, I must
I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked,
work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
APPLICANT CERTIFICATION
1 certify that 1 have read this application and state that the above information is
correct. 1 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,
ARCI IITECT'S DECLARATION
costs, and expenses which may accrue against said City in consequence of the
1 understand my plans shall be used as public records.
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
Licensed Professional
9.18.
Signature Date
CUPERTINO
SIGN PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION `
10300 TORRE AVENUE o CUPERTINO, CA 95014 -3255 V \
(408) 777 -3228 • FAX (408) 777 -3333 • building cDcupertino.orcl
°�6S
PROJECT ADDRESS / 80 I V
APN H 30- 61 - O Q
OWNER NAME
PHONE
E -MAI[
L$ 35 -5i/
STREET ADDRESS . �'� Z� CITY, A'�E v FA ,1 Q
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( V O
CONTACT NAME f� P E -MAIL
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STREET ADDRESS .y 7 ' ................... CrrY, T TE, ZIP
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❑ OWNER ❑ OWNER- BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
LICENSE NUMBER
LICENSE IYU
BUS. LIC H
COMPANY NAME
o.,
E-MAIL -4 ne0,1 • Corh
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On
STREET ADDRESS L(`(,(,�
CITY, STATE, ZIP
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ARCHITECTIENGINEER NAME
LICENSE NUMBER
BUS. LIC 9
COMPANY NAME
E -MAIL
FAX
STREET ADDRESS
CrrY, STATE, ZIP
PHONE
DESCRIPTION OF WORK rr
r`s�wll : liL,#' lACd Sr r t dim Ar l�o
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USE OF ❑ SFD or D ex ❑ Multi - Family
TLLUMINATID
SIGN TYPE
NO. OF
SIGN AREA
VALUATION
STRUCTURE: Commercial
(Y /N)
(CODE)
SIGNS
(SQ.FT.)
(S)
PE CODES:
N 1/
t
5 �j. 3
} Q C9
7SIGN
ANNER SIGN M - MONUMENT (GROUND) SIGN
LADE SIGN P - PROJECTING SIGN
`
D - DEVELOPMENT m SIGN SP - SPECIAL EVENT BANNER
DI - DIRECTIONAL SIGN T - TEMPORARY
E - ELECTRONIC W - WALL SIGN
READERBOARD WI - WINDOW SIGN
x
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oab
By my signature below, I certify to each of the following: I am the property owner or auth e e roperty owner's behalf. 1 have read this
application and the information I have provided is correct. I have read the Description o and 76enter Is accurate. to comply with all applicable local
ordinances and state laws relating to buildin ns t' . I authorize representatives of the above - identified prop or inspection purposes.
Signature —
of Applicant/Agent: ` .� ----- Date:
SUPPLEMENTAL INFORMATION REQUIRED
r, £e oFricEUSE,oNtsyw
.
,..,_._. 1'LAN:CEIECICrTYPE a' .4
_f ,R017;TINGSLIP
Site Plan
Elevations
❑ ryIF%R,ESsk Cz # k
CZ BUII DING PLAN REVIEW
_Sign Details - including UL listing(s) applicable
i Ks'1
❑" sTnNDAJin,PLnrrnvcP
NMI, REViEw
r
_Structural Calculations (lfapplicable)
OTHER' F..:
Copy of Planning Approval Letter or Meeting with Planning prior to
❑', arnaoRi
submittal of Building Permit application.
SignApp_2011.doe revised 03116111
CITY OF CUP EIE8TINO
I
FEE ESTIMATOR - BUMI)ING DIVISION
SIGN TYPE
AD DRESS: 90100 S DE ANZA BLVD
DATE: 09/96120'15
REVIEWED BY: MELISSA
APN: 369 01 001 BP #: S��D(j� - VALUATION: 1$7,000
"PERMIT TYPE: Building Permit
PRIMARY
Sign
USE:
Wall Sign, Electric
PENTAMATION
PERMIT TYPE: 1 CEAP5d
WORK
ARMADILLO WILLY'S - ADD N WALL ILLUMINATED WALL SIGN AND RE -FACE E ILLUMINATED
SCOPE
MONUMENT SIGN (N) LED LIGHTING
SIGN TYPE
FEE ID
QTY
MISC ITEMS
SIGN FEE
Wall Sign, Electric
1SIGNWELEC
1
hrs
$286
Ground Sign, Alteration
1SIGNREWRK
Permit Fee:
1
Suppl. Insp. Fee-.(D Reg. ®OT
$359
hrs
$0.00
PME Unit Fee:
$48.00
PME Permit Fee:
$48.00
TOTALS:
$0.00
Sign Master Plan: ® Yes (E) No
$0.00
$645.00
Travel Documentation Fee: ITRAVDOC
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11 -053 E f 711113)
FEE
QTY/FEE
MISC ITEMS
Suppl. PC Fee: Q Reg. 0 OT
0.0
hrs
$0.00
Permit Fee:
$645.00
Suppl. Insp. Fee-.(D Reg. ®OT
0.0
hrs
$0.00
PME Unit Fee:
$48.00
PME Permit Fee:
$48.00
Work Without Permit? ® Yes (D No
$0.00
Sign Master Plan: ® Yes (E) No
$0.00
a
Travel Documentation Fee: ITRAVDOC
$48.00
Strong Motion Fee: IBSEISMICO
$1.96
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS;
$791.96
$0.00 TOTAL FEE:
$791.96
Revised: 01!0612015
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