B-2017-0283CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0283
19499 STEVENS CREEK BLVD CUPERTINO, CA 95014 (316 20 112) DISCOUNT SIGNS
BURLINGAME, CA
94010
OWNER'S NAME: MAIN STREET CUPERTINO I I DATE ISSUED: 02/21/2017 1
I OWNER'S PHONE: 408-777-3080 1 I PHONE NO: (650) 333-6688
License Class C-45 Lic. #759380
Contractor DISCOUNT SIGNS Date 02/28/2019
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
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.
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 2/21/2017
PERMIT INFO:
BLDG —ELECT —PLUMB
MECH _ RESIDENTIAL X COMMERCIAL
DESCRIPTION:
JET - INSTALL 3 ILLUMINATED WALL SIGNS
Sq. Ft Floor Area. I Valuation: $10000.00
APN Number: Occupancy Type:
316 20 112 1 A (Tenant Improvements)
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: Abby Aygnde
I hereby affirm that I am exempt from the Contractor's License Law for one of the I 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)
z. 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. 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
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
3. 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 2/21/2017
Signature ofApl
Date: 2/21/2017
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, Chapter 9.12 and
the Health & Safety Code, Sec ' 5505, 25533, and 34.
Owner or authorized agent:
Date: 2/2112017
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance
of work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed
Professional
SIGN PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildingacupertino.orp
PROJECT ADDRESS 1 W71�
I _APN# 0-0-11L
OWNERNAME l� PHONE pS r
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E-MAIL
STREET ADDRESS
CITY, STA ZIP
CONTACT NAME PHON
E-MAIL
STREET ADDRESS
CITY, S TE, ZI FAX
® OWNER ❑ OWNER -BUILDER ® OWNER AGENT ❑ CONTRACTOR CONTRACTORAGENT ® ARCHITECT ❑ ENGINEER ® DEVELOPER ® TENANT
CONTRACTOR NAME
LICENSE NUMBER
LICENSE TYPE
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BUS. LIC # of l
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COMPANY NAME
E-MAIL
FAX
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CITY, STATE, ZIP
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ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK
USE OF ❑ SFD or Duplex ❑ Multi -Family
ILLUMINATED
SIGN TYPE
NO- OF
SIGN AREA
VALUATION
STRUCTURE: Commercial
(Y / N)
(CODE)
SI�GyNS
(SQ. FT.)
M
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 - WINDOWSIGN
RECEIVED BY: _ TOTAL V1 T.UATION:
D
By my signature below, I certify to each of the following: I am the property owner or authorized ag nt to a t on the property owner's behalf. I have read this
application and the information I have provided is correct.have read tilp Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to build' co structi 001
. I resentatives of Cupertino to enter the above -identified property for inspection purposes,
�`
Signature of Applicant/Agent: Date:
SUPPLEMENTL FORMATION REQUIRED
OFFICE USE ONLY
PLAN CHECK TYPE
ROUTING SLIP
Site Plan
❑ OVER-THE-COUNTER
g��e
,P B�UILDING PLAN REVIEW
_ Elevations
Sign Details - including UL listing(s) applicable
❑ EXPRESS
❑ PLANNING PLAN REVIEW
Structural Calculations (if applicable)
❑ STANDARD
❑ OTHER--
THER:Copy
Copyof Planning Approval Letter or Meeting with Planning prior to
❑ LARGE
submittal of Building Permit application.
❑ MAJOR
Sign,4pp 201Ldoe revised 03131/11