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07040022CITE' OF CUPERTINO 1 r T 1 , "d � T CUPERTINO PERMIT APPLICATION FORM 0 70 q-©Va APN # X09 60,? Date: Energy BUILIDNG Building A ress: Owner s ame, ho ne #: kc.,'r?, -- _ Contrac or-. cp� - - - License #: F0 0 /`� p Contact: � Phone #: _ Applicant /Contra or: YOOY7 Building Permit Info: Bldg ct Plumb Mech Job Description: M �c l�C-► Residential:' 1 ommercial: Sq.Ft. Floor Area: $ /Sq.Ft.: Architect/Engineer: Cost of Project- Type of ConstructionS : Occupancy oup: Qty. if Annlicable Fee ID Fee Description Fee Group BENERGY Energy BUILIDNG BPERMFEE Bldg Permit Fees BUILIDNG / BPLANCHK Plan Check Fee BUILIDNG BSEISMICOM Seismic Commercial BUILIDNG EPERMITFEE Elect Permit Issuance ELECTRICAL BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Rmdl Signs, Marquee ELECTRICAL BUSLIC Business License BUILIDNG I Y Ur 4:UrEK1 IINU BUILDING DIVISION PERMIT JILDING ADDRESS: PERMIT NO. A)? PEA ARC HITECifENGI NEER: LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing u with Section 7000) of Division 3 of the Business and Professions Code, and my license is a in full force and cffecL Z License Class Lic. N in Dam Contractor r'( ARCHITECTS DECLARATION Z O .r 7 Z O r-r U IJa V) Z I understand my plans shall he used as puhlic records OWNER - BUILDER DECLARATION I hcrchy affirm that I am exempt from the Contractor's Liccnsc Law for the following reason. (Section 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). ❑ 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 and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner- builder will have the burden of proving that he did not build or improve for purpose of on 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code:) The Contractor's Li- cense Law does not apply to an owner of property who builds or improves thereon, and. who contracts for such projects with a contractor(s) licensed pursuant to the Contractors License Law. ❑ lam exempt udder B & P C fror)his reason Owner !,�_/ — Date 7t J t:ER'S COM NSATION DECLARATION 1 hereby pafrto under penalt of perjury one of the following declarations: ❑ I 4ve an II m ' tain a Ceyfficate of Consent to self -insure for Worker's Compcn- sation, rovided for 6 on 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 required by Secton 3700 of the Labor Code, for the performance of the work for which this permit is issued My Worker's Compensation Insurance carrier and Policy number are: Carrier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE Cntis section need not be completed if the permit is for one hundred dollars ($100) or less.) 1 certify that in the performance of the u ork for which this permit is issued, t shall not employ any person in any nnet s s c� 'ercft c Workeri Compensation Laws of California. Date Applicant NOTICE TO AP tc of Exemption, you should become sub' tot is Com C. U, provisions c Lahor Code, you must forthwith omply w' such provisio or this permit shall be deemed revoked. LeCO ION LENDING AGENCY of i m that there is a construction lending agency for the performance of the work for which this permit is issued (See. 3097, Civ. C.) Lender's Name Lender's Address 1 certify that I 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 iiabilitics,judgments.costs and expenses which may in any way accrue against said City inconsequence of the gran�o,(Lhu' ermit. AP PLICANT UN L MPLY WITH ALL NON -POINT SOURCE REGI, Ns Udcriby p Conuaaor Datc HAZARD- S MATERIALS DISCLOSURE ap icant or fut building occupant store or handle hazardous material he Cu ino unicipal Code. Chap ter 9.12, and the Health and Safety 25532(a)? ❑ Yes /[Sao Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District? ❑ Yes -aft 1 have mad the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health & Safety Code, Sections 25505.25533 and 25534.1 understand that if the building does not currently hove a t;,67 that itfylp notify the oast of the requirements w l ryo n rtif ate of Occup J Date LETTER SIGN Sq. Ft. Floor Area APN Number Issued by: Re -roofs Type of Roof Job Description Required Inspections CONTROL NO. BUILDING PERMIT INFO ELECT PLUMB Valuation Occupancy Type Date ' 'el-1"' 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. Signature of Applicant Date All roof coverings to be Class "B" or better �y r CITY Of C U PEkTINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777 -3228 Fax (408) 777 -3333 Building Department JOB ADDRESS: / %�s I PERMIT # C/� '7 O OWNER'S NAME: PHONE # GENERAL CONTRACTOR: FAX # –/ 0 —. 0­6-2_0S_ I am not using any subcontractors: -2 i e bate Please check applicable subcontractors and complete the following information: Owner / Contractor Signature Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner / Contractor Signature Date F'KOF'05RL WMING EOM 'MEKLION'' TOTAL 43,8SQFT Ivf"eet" MAP Id t5G GG i rrW05AL VIEW UILDIN G DIMMEN51011 SITE P_AN 1Nt, I ALAI lUN VC I AIL 3" DEEP REVERSE CHANNEL -- - --`.. LETTER IN CUSTOM COLOR, 12 VOLTSGOLDEN DULES. -- G -- L E D LIGHT MODULES. TS -I.5 ALUM TUBE IOP X 12" 3J76" THICK CLEAR tEXAN BACKING. — 3" X 6° STEEL TUBE, NECT SWITCH CLASS POWER HI SIGNS COMPANY 1680 W. WINTON AVE p7 HAYWARD, CA 94545 TEL: 510 -264 -1281 XT229 FAX :510 -940 -0205 ALL RIGHTS RESERVED an ana��w; 4M NIS p� �a Hie.n en euuiauua Project MERLION Address 1962£3 STEVENSCREEK BL Salesperson TOMMY YCON Client Approval t Landlord Approval Scale 10,= Drawn By TOMMY YCON Date 112212007 Revision By . Art ■ PIex/A— Vinyl ■ Paint .elect. ■Install Non Elect. E3Shp.1Rec, R 'g a. MAP Id t5G GG i rrW05AL VIEW UILDIN G DIMMEN51011 SITE P_AN 1Nt, I ALAI lUN VC I AIL 3" DEEP REVERSE CHANNEL -- - --`.. LETTER IN CUSTOM COLOR, 12 VOLTSGOLDEN DULES. -- G -- L E D LIGHT MODULES. TS -I.5 ALUM TUBE IOP X 12" 3J76" THICK CLEAR tEXAN BACKING. — 3" X 6° STEEL TUBE, NECT SWITCH CLASS POWER HI SIGNS COMPANY 1680 W. 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