B-2016-3262CITY OF CUPERTINO BUILDING PERMIT
BUILDINGADDRESS:
CONTRACTOR:
PERMIT NO: B-2016-3262
20520 STEVENS CREEK BLVD STE A CUPERTINO, CA 95014-2120 (359 08 018)
ARROW SIGN CO
OAKLAND, CA 94601-
4436
OWNER'S NAME: MARDESICH COMPANY CROSSROADS LLC
DATE ISSUED: 02/27/2017
OWNER'S PHONE: 408-355-3042
PHONE NO: (510) 533-7693
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class C45 Lic. # 13 4794
Contractor ARROW SIGN CO Date 10/31/2018
XBLDG _ELECT _PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
MECH RESIDENTIAL X COMMERCIAL
with Section 7000) of Division 3 of the Business & Professions Code and that my
license is in full force and effect.
JOB DESCRIPTION:
STARBUCKS - (l) 3 EXTERIOR ILLUMINATED WALL SIGNS, 1
I hereby affirm under penalty of perjury one of the following two declarations:
INTERIOR WINDOW SIGN
r. 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.
z. /1 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: $6675.00
APPLICANT CERTIFICATION
I certify that 1 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
359 08 018
A (Tenant Improvements)
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 Cupertino Municipal Code, Section 9.18.
SPECN.
180 DAYS FROM LAST C TIO
Signature :?,:., �Cs�-.... + Date 02/27/2017
Issued by: MELI �
OWNER -BUILDER DECLARATION
Date: 02/27/2017
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)
z. I, as owner of the property, am exclusively contracting with licensed
Signature of Applicant:
contractors to construct the project (Scc.7044, Business & Professions Code).
Date: 02/27/2017
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
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`A--lw. —•m= -
APPLICANT CERTIFICATION
Date: 02/27/2017
1 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 lawsI
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
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 02/27/2017
Professional
SIGN PERMIT APP"., CATI0N
COMMUNITY DEVELOPMENT DEPARTMENT " BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
CUPERTINO (408) 777-3228 • FAX (408) 777-3333 • buil.dina(ftuperlino.ora
PROJECT ADDRESS'� APN #
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DESCRIPTIO,OF R`Q
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USE OF [] SFDorDuplex ❑ Multi -Family.
ILLUMINATED
SIGNTYPE
NO. OF
SIGN AREA
VALUATION
STRUCTURE: OM Commercial
(YIN)
(CODE)
SIGNS
(SQ. Fr.)
t
f (s)
SIGNTYPECODES:
`4
B - BANNER SJGN M - MONUMENT (GROUND) SIGN
BL - BLADESIGN P - PROJECTING SIGN
y
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D - DEVELOPMENT 1D SIGN SP - SPECIAL EVENT BANNER
DI - DIRECTIONAL SIGN 'J' - TEMPORARY
E - ELECTRONIC W - WALLSIGN
RFADERBOARD WI - WJNDOWSIGN
RECEIVED
T TAL VgA�JON�
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By my signature below, l certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf, I have read this
application and the information I have provided is correct. I have read the Description of Work and verify it is accmnate. I agree to comply with all applicable tocol
ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of ApplicanUAgent: lam— +t? R �-- -- Date:t -, E
SUPPLEMENTAL INFORMATION REQUIRED
OFFICE USE ONLY
PLAN CHECK TYPE
ROUTING SLIP
Site Plan
❑ OVER-THE-COUNTER
❑ BUILDING PLAN REVIEW
Elevations
Sign Details - including UL listing(s) applicable
❑ EXPRESS
❑ PLANNING PLAN REVIEW
Structural Calculations (if applicable)
❑ STANDARD
❑ OTHER:
Copy of Planning Approval Letter or Meeting with PIanning prior to
❑ LARGE
submittal of Building Permit application.
❑ MAJOR
Signtlpp 2011.docrevised.03131/11
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