B-2016-1141CITE' OF CUPERT NO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT B-2016-1141
19369 STEVENS CREEK BLVD CUPERTI O, CA 95014 (316 20112)
(AD ART INC )
SAN FRANCISCO, CA
94134
OWNER'S NAME: MAIN STREET CUPERTINO AGGREGATOR LLC
DATE ISSUED: 01111120/6
OWNER'S PHONE:
PHONE NO:
LWENSED ONTRACTOR'S DECLARATION
BUILDING PERMIT INFO.
License Class Lic #,
Contractor (AD ART INC l Rate � �' � ` !�
X BLDG _ELECT ^ PLUMB
I Hereby affirm. that I am licensed ander the provisions of Chapter 9 (commencing
_ MECII _ RESIDENTIAL X COMMERCIAL
with Section 7000) of Division 3 of the Business & Professions Code and that my
license 1s in felt force and effect.
JOB DESCRIPTION:
Install (2) new illuminated signs - Eureka!
I hereby affirm under penalty of perjury one of the following two declarations:
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 ofthe 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.
Sq. Ft Floor Area: !Valuation: $600tt.00
APPLICANJ (ERTIPTt TION
I certify that I have read this application and state that the above
information is correct. I agree to comply with all city and county
APN Number: Occupancy type:
1A
ordinances and state laws relating to building construction, and hereby
316 20112 (Tenant improvements)
authorize representatives of this city to enter upon the above mentioned
property for inspection purposes. (We) agree to save indemnify and keep
harmless the City of Cupertino against liabilities, judgments, costs, and
T�+
PERMIT EXPIRES IF WORK IS NOT STARTED
expenses which may accrue against said City In consequence of the,
granting of this permit, Additionally, the applicant understands and will
DAYS OF PERMIT UE OR
comply with all non -point source regulations per the Cupertino Municipal
180 BAYS FROM LAST CALLED INSPECTION.
Code, Section 9.18.
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'd'
Issued y: 4
t
Signature Date'. -.-� {
I)a€e, t
0_MT J -$iT1 J)ER 111ACLARA31M
I hereby affirm that I ani exempt from the Contractor's License Law for one of the
RE:B
All roofs shall be inspected prior to any roofing material being installed, If a roof is
following two reasons:
installed without first obtaining an inspection, I agree to remove all new materials for
a. 1, as owner of the property, or any employees with wages as their sale
inspection.
compensation, will do the work, and the structure is not intended or coffered
for sale (Sec.7044, Business & Professions Code)
Signature ofApplicant:
1 I, as owner of the property, am exclusively contracting with licensed
Date:
contractors to construct the protect (Sec.7M, Business & Professions Code).
'
I hereby affirm under penalty of perjury one of the following three declarations:
A>j J. ROOF COVERINGS TO BE CLASS "A" OR BETTER
L 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
HAZARDOUS MATERIALS DISCLOSURE
performance of the work for which this permit is issued.
I have read the hazardous materials requirements under Chapter 6.95 of the
2. I have and will maintain Worker's Compensation Insurance, as provided for
California Health & Safety Cade„ Sections 25505; 25533, and 25534. 1 wilt
by Section 3700 of the Labor Code, for the performance of the work for which
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
this permit is issued.
health & Safety Code, Section 25532(x) should I store or handle hazardous
3. 1 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
air contaminants as defined by the Bay Area Air Quality Management District I
shad not employ any person xi any manner so as to become subject to the
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
Worker's Compensation laws of California. If, after making this certificate of
the Health & Safety Cs de, S€€t! 25505, 25533, and 25534.
exemption, I become subject to the Yorker's Compensation provisions of the
Labor Code, I must forthwith comply with such provisions or this permit shall
Owner or authorized ageiai
be deemed revoked
Date; , . p>.
P AGE NCY
APPLICANT CERTIFICATION
C(}IVSEIti3Clitli IrEbD—IN
I certify that I have read this application and state that the above information is
I hereby affirm that there is a construction lending agency for the performance 6
correct. I agree to comply with all city and county ordinances and state laws
of works for which this permit is issued (Sec. 3097, Cin+ C.)
relating to building construction, and hereby authorize representatives of this city
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,
Lendsr's Address
judgments, costs, and expenses which may accrue against said City in
�iRCl3IT C 1'S DECI ARAi[t)lil
consequence of the granting of this permit. Additionally, the applicant
I understand my plans shall be used as public records.
understands and will damply with all nein-point source regulations per the
Cupertino Municipal Code, Section 9.18,
Licensed
Professional
Signature bats
SIGN PERMIT APPLICATION
10
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PROJECTADDRESS
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AP3 i t€
OWNERNANIE
PIS -
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STREET ADDRESS CITY, ST'NTE,ZIP
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CONT NAME
PHONE E.IaIAIL
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STRE rADDREcS
CITY,STATE, ZIP
FAX
0OWNE'R ®fit'YNER.BUR.DER 134giNERA w - 7? crop ®co Ci8AcioitAGENT ® ARC'HFITCT E.ENGiNEER 11 DEVELOPER 11 TENANT
CONTRACTORNAW LICENSE NUMBER
LICENSE TYPE BUS, LIC 4
-lam
I ,, aj I -C}
STREET ADDRESSj- y
CITY,STATE jlp PHONE
ARCHITECTIEIYGINFERN.3.ME
LICENSENUMBER BUS. LIC0
COMPANY NAME
E-MAIL FAX
STREET ADDRESS
CITY,STATE ZI.P PHONE
DESCRIPTION OF WORM
USE OF ® SFD or Duplex ® Multi -Family
ILLUMINATED
SIGN TYPE
N OF
SiG AREA VALUATION
STRUCTURE:IImmercial
(V!N)
(CODE)
SIGNS
(SQ. FT-) ($)
SIGN TYPE CEDES:
$ 0 �-C'
{ � �
{
( � p
B - BANNERSIGN M -- MONUMENT (GROUND) SIGN
BL -- BLADESIGN P - PROJECTINGSIGN
D - DEVELOPMENT ID SIGN SP - SPECIAL EVENT BANNER
DI - DIRECTIONALSIGN T - TEMPORARY
E - ELECTRONIC w - ii ALL SIGN
READERBOARD WI - WINDOWSIGN
RECEIVED iIY. TOTALVALUATIOM.
By my signature below, I certify to each of the following: I am the property owner or authorized agent to t le property owner's beltal£ I Have read this
application and the information I have provider) is correct. I have read the Description of oris and werit, it is accurate, i agree to comply with all applicable Intal
ordinances and state laws relating to bui . 8 co c ' tAborize representatives of Cupertino to enter the above -identified property for inspection purposes.
SignatureolFApplicant/Agent: Bate f
SUPPLEME L ()IiMATIONREQUIRED
OFFICE USEONI-V
Site Platt
PLAN CHECK TYPE ROUTINGSLIP
Q VTR-` HF -COUNTER 0 BUILDINGPLANRE6°IEW
_ Elevations
® Sign Details - including UL listing(s) applicable
0 EXPRESS 0 PLANNING PLAN REVIEW
— Structural Calculations (ifapplicable)
Q STA"ARD OTHER.
Copy of Planning Approval Letter or Meeting with Planning pricer to
0 LARGE
submittal ofBuilding Permit application.
0 AUJOR
SigrOpp�01 1. doe revised 03131111