B-2017-0339CITY OF CUPERTINO BUILDING PERMIT
BUILDINGADDRESS:
10225 S DE ANZA BLVD CUPERTINO, CA 95014-3007 (359 10 060)
OWNER'S NAME: SHTEIN PROPERTIES LLC
OWNER'S PHONE: 408-691-3527
LICENSED CONTRACTOR'S DECLARATION
License Class C=45 Lic. #913842
Contractor AINOR SIGNS INC Date 04/30/2018
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
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 regulationgper the Cupertino Municipal Code, Section 9.18.
Date 2/28/2017
CONTRACTOR: PERMIT NO: B-2017-0339
AINOR SIGNS INC
SACRAMENTO, CA
95842
DATE ISSUED: 02/28/2017
PHONE NO: (916) 348-4370
PERMIT INFO:
BLDG —ELECT —PLUMB
MECH _ RESIDENTIAL X COMMERCIAL
JOB DESCRIPTION:
MATTRESS FIRM - INSTALL 1 ILLUMINATED WALL SIGN
Sq. Ft Floor Area: I Valuation: $1500.00
"N Number: Occupancy Type:
359 10 060
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: Abby Aygnde
Date: 02/28/2017
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)
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: 2/28/2017
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 2/2812017
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, Qf ctions,25505, 25533, and 25534.
Owner or authorized agent
Date: 2/28/2017
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
ARCIl_ITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed
SIGN PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTI.NO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building aacupertino.org
PROJECT ADDRESS
10225 S. DEANZA BLVD.
APN# �(,®
OWNER NAME
• o 5 LLC-
7A a
1�
PHONE p,r�y✓5 n L�
LJ•
E-MAIL
7 De;?Gi�
STREET ADDRESS
/
CITY, STATE, ZIP
FAX
CONTACT NAME CHRISTIE LAWRENCE
PHONE 916-34,8�43�70 x 30
E-M�IIA'IL CLAWRENCE@AINORSIGNS.CON
STREET ADDRESS 5443 STATIONERS WAY
CITY, STATE, ZIP SACRAMENTO, CA 95842
FAX 916-3484375
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTORNAME AINOR SIGNS, INC.
LICENSE NUMBER 913842
LICENSE TYPE C45
1
BUS. LIC# _3694- p`®01
COMPANY NAME
AINOR SIGNS, INC.
E-MAIL
CLAWRENCE AINORSIGNS.CO
FAX
916-348-4375
STREETADDREss 5443 STATIONERS WAY
CITY, STATE, ZIP SACRAMENTO, CA 95842
PHONE 916-348-4370 X 303
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK
REMOVE 1 EXISTING ILLUMINATED SIGN, INSTALL 1 NEW ILLUMINATED SIGN.
USE OF ❑ SFD Or Duplex ❑ Multi -Family
ILLUMINATED
SIGN TYPE
NO. OF
SIGN AREA
VALUATION
STRUCTURE: Commercial
(Y/N)
(CODE)
SIGNS
(SQ FT.)
(S)
SIGN TYPE CODES:
Y
W
1
38.36
1500.00
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 QW WALL SIGN
READERBOARD WI - WINDOW SIGN
[TCEIVEDBY
TOTAL VALUATION:
By my signature below, I certify to each of the following: I am the property owner or authorized agent to acl on the property owner's behalf. I have read this
application and the information I have provide is c ect. I have read t ascription of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to buildin s ction. I authorizer re entatives of Cupertino to enter the above-ident'fie�d,pr rty for inspection purposes.
Signature of Applicant/Agent:%Date:G/ Cl
SUPPLEMENTAL INFORMATION REQUIRED
OFFICE USE ONLY
PLAN CHECK TYPE
ROUTING SLIP
Site Plan
_
Elevations
❑ OVER-THE-COUNTER
BUILDING PLAN REVIEW
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 Planning prior to
❑ LARGE
submittal of Building Permit application.
❑ MAJOR
SignApp_2011.doc revised 03/31/11
Paul O'Sullivan
03/01/17
03/01/17
B-2017-0339
Abby Ayende
Paul O'Sullivan
03/01/17
Paul O'Sullivan
03/01/17
Paul O'Sullivan
03/01/17
Paul O'Sullivan
03/01/17
Paul O'Sullivan
03/01/17
Paul O'Sullivan
03/01/17
Paul O'Sullivan
03/01/17