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B-2017-0455CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19240 STEVENS CREEK BLVD CUPERTINO, CA 95014-2504 (375 06 006) CONTRACTOR: NORTH WEST SIGNS PERMIT NO: B-2017-0455 INC SANTA CRUZ, CA 95060 OWNER'S NAME: HALL TOM L AND ELEANE TRUSTEE DATE ISSUED: 03/21/2017 OWNER'S PHONE: 408-888-7813 PHONE NO: (831) 469-8208 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class C-45 Lic. #786185 Contractor NORTH WEST SIGNS INCDate 08/31/2018 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, j JOB DESCRIPTION: I hereby affirm under penalty of perjury one of the following two declarations: LIGHTHOUSE BANK - INSTALL ONE (I) ILLUMINATED WALL 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 SIGN REV #1 - CHANGE SIZE OF SIGN - ISSUED 5/3/2017 performance of the work for which this is issued. permit r 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. Sq. Ft Floor Area: Valuation: $7600.00 APPLICANT CERTIFICATION I certify that f have read this application and state that the above ATN Number: Occupancy Type: information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize 375 06 006 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 this permit. Additionally, the applicant understands and will comply with all ll non -point WITHIN 180 DAYS OF PERMIT ISSUANCE OR source regulations per the Cupertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature -'� Date 5/3/2017 Issued by: ABBY AYENDE Date: 03/21/2017 OWNER -BUILDER DECLARATION i 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: 5/3/2017 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 ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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. 1 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 shall not employ any person in any manner so as to become subject to the material. Additionally, should I use equipment or devices which emit hazardous Worker's Compensation laws of California. If, atter making this certificate of 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 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: fly® APPLICANT CERTIFICATION I L 5/3/2017 (fir I 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 laws I 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 and will comply with all non -point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code, Section 9.18. 1 understand my plans shall be used as public records. Signature Date 5/3/2017 Licensed Professional El SIGN PERMIT APPLtcAT1oNREVISION # COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION —_ 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildina(7a ctl�ertino oro SignApp_ OlLdocr•evis'ed03/31111 PROIECTADDRESS /s, e�sYL !- L..1" �f \V APNN r�.^I Jt" E�Ca CLQ (a OWNERNAME Y�1 PHONE S 4OLY88e-�B �3 , -TOW 11 �� - ,�, STREET ADDRESS CITY, STATE, ZIP i _ �y FAX � �1�p NAME PHONE E-MAIL STREET ADDRESS CITY, STATE, M.Z,C% +❑ F Q OWNII2 ❑ O%W MR BUE.DER ❑ OWNIM AGENT IB CONTRAcTok ❑ CONTRACTOR Arun AR.CIII'tECT ❑ ENGINEER ©DEVELOPER ❑TENANT CONTRACTOR NAM�E J { 1 •- �o +seE,� LICENSE NUMBER -19( . I Sir Y LICENSE TYPEc -q5- nus. r rc #' COMPANYNAME 1, # `iJ - � E-MAIL FAX STREET ADDRESS I l spa ` �^,,� p� CTl'Y, STATE, ZIP bolo` y v 2, � ct V 60 PHONE Sit 469-2c s f1"1 �•1✓�7 ARCIRTECTAWGINE-RNAME LICENSENUEER M BUS. Lie OMPANYNAME IDESCRIPTIONOFIVORK E --MAIL rAX TREET' AnnREss CITY, STATE, ZR' PHONE ff ► i j )l { �� Div, ` :'C1(� � S �� �� rNente,Pew, kt-ieo USE or ❑ SPD or Duplex ❑ Muhl -Family STRUCTURE: [N Commercial ILLUMINATED SIGNTYFE NO. Or, SIGNAREA T VALUATION 2110 (CODE} SIGNS (SQ. FL) SIGN TYPE CODES. l�% tS, ^1 i'ff 11600-9'0 1 y ©0 . 9O 4 V B -• BANNER SIGN M - MONUMENT (GROUND) SIGN BI. - BLADE SIGN P PROTECTING SIGN ,D - DEVELOPMENTIDSIGN SP - SPECLUEVENT BANNER DI - DIRECTIONAL SIGN T - TEMPORARY E - ELECTRONIC W - WALLSIGN READERBOARD WI - WINDOW SIGN BY., TOT V� i1�[Q�^ - By ray signature beloNv. I certify to each ofthe following:. I am th tq act C, the property owner's behalf. I ha readd this and the information I have is correct. I have Description applicable provided read the of Work and verify it is accurate. I agree to comply with all pplicable local ordinances and state laws relating to building construction -I authorize representatives ofCopertino to enter the above -identified nm. ��y for inspection purposes. Signature of Applicant/Agent:�,err ,�.—. Date: SUPPLEMENTAL INFQRMA m REQUIRED OFFICE USE ONLY Site Plan PLAN CHECKTYPE ROUTINGSLIP ❑ OVIM-THE•COUNI'M © BUILDINGPLANREVIEW Elevations Sign Details - including UL liking(S) applicable ❑ EMPRESS © PLANNING PLAN PWVIESV Structural Calculations (ifapplicablc) ❑ SrWDARD ❑ OTMR; — Copy of Planning Approval Letter or Meeting with Planning prior to ❑ LARGE submittal ofBuilding Permit application. ❑ MAJOR SignApp_ OlLdocr•evis'ed03/31111 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19240 STEVENS CREEK BLVD CUPERTINO, CA 95014-2504 CONTRACTOR: PERMIT NO: B-2017-0455 (375 06 006) NORTH WEST SIGNS INC SANTA CRUZ, CA 95060 OWNER'S NAME: HALL TOM L AND ELEANE TRUSTEE DATE ISSUED: 03/21/2017 PHONE NO: (831) 469-8208 OWNER'S PHONE: 408-888-7813 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: - License Class C45 Lic. #786185 Contractor NORTH WEST SIGNS INCDate 08/31/2018 X BLDG —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: I hereby affirm under penalty of perjury one of the following two declarations: LIGHTHOUSE BANK - INSTALL ONE (1) ILLUMINATED WALL s. I have and will maintain a certificate of consent to self -insure for Worker's SIGN Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 0A, 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: $7600.00 APPLICANT CERTIFICATION 1 certify that I have read this application and state that the above APN Number: Occupancy Type: information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize 375 06 006 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 this permit. Additionally, the applicant understands and will comply with all ll non -point WITHIN 180 DAYS OF PERMIT ISSUANCE OR source regulations per the Cupertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. SignatureDate 03/21/2017 Issued by I - Date: Date: 03/21/2017 OWNER -BUILDER DECLARATION 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: 03/21/2017 I hereby affirm under penalty of perjury one of the following three declarations:ALL 1. I have and will maintain a Certificate of Consent to self -insure for Worker's ROOF COVERINGS TO BE CLASS "A" OR BETTER 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 shall not employ any person in any manner so as to become subject to the material. Additionally, should I use equipment or devices which emit hazardous Worker's Compensation laws of California. If, after making this certificate of air contaminants as defined by the Bay Area Air Quality Management District I exemption, I become subject to the Worker's Compensation provisions of the will maintain compliance with the Cupertino Municipal Code, Chapter 9,12 and 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: ; APPLICANT CERTIFICATION Date: 03/21/2017 , 1 certify that I have read this application and state that the above information is CONSTRUCTION LEND -IN AGENCY correct. I agree to comply with all city and county ordinances and state laws I 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 and will comply with all non -point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code, Section 9.18. 1 understand my plans shall be used as public records. Signature Date 03/21/2017 Licensed Professional SIGN PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 - FAX (408) 777-3333 PROJECT ADDRESS # OXVNERXAME -Towl L_ E-MAIL I SITZEETADDRESS CITY STATE_ZJP L-r4we 05w�cov FAX CONTACT NAAM 1,E PHONE E-MAIL STREET'ADDRESS GA tCrfy, STATE, ZIP C T CIV7. CA %Q0 FAX 0 OWNER 0 OWNER BUILDER 0 1111R A111,1 CONTRACTOR 0 CONTRACTOR AGENT ARCHTMCT 0 EMNUMEER 0 El TEINIANr DM HMO T ;7 CON'TRACrORMAME `LICENSE NUM"E"t '796 LICENSETYPEC-q5, 5 nus. Lie COMPANYWAAM E-MAIL - FAX STREETADDRESS tajo CITYSTATEZIP �AOGU24C-A CfW60 PHONE 4aVjq6q_,0Z()e ARCE11TECIAEUGHSTEER.100M LICENTSENUAMER Bus"Licl� BUS. LIC 4 COW -ANY NAME F -MAH, FAX STREET ADDRESS CITY, STATE,23P PHONE Ww'% Icier rDESCRUMONIOFWORK USE OF E] SFDorDuplex 0 Multi -Family [N Commercial ILLUMINATED SIGNTYPE NO. OF SIGNAPX-A VALUATION I (YIN) (CODE) SIGNS (SQ -FT} (S) SIGN TYPE CODES- y A. boo B, - BANNER SIGN M MONMM4T (GROUND) SIGN 13L - BL.%DEsiGN P PROJECTING SIGN -D - DEVELOP1,1ENTID SIGN SP SPECIAL EVENT BANNER DI - DIRECMONALsIGN TEMPORARY E - ELECTRONIC W - W -AIL SIGN READERBOARD WI - XVINDOWSIGN --- BY: TQT - A O I �e By my signature below- I certify to each ofthe following- law Ih a t to act on the property owner's behalf Iread this application and the information I have providedis correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local Ordinances and state laws relating tobuilding construction- I authorize representatives of Cupertino to enter the above-identffied property for inspection purposes. Signature -fApplicant/Agent- Date: SUPPLEMENTALINFORMATTONREQURIED Site Plan IN I OFIFICEUSEONLY Elevations 1441�vvl_ /', I -, e7' PLAN CHECK TYPIE R07U11NG SLIP El OVER TM-COUNYM 1111ILDINC-PLAINRUVIEW IDIN -Sign Details- including -UL listing(s) applicable eVSO_ 11 EXPRESS PLANNINGPL_A.XRnM1V Structural Calculations (if applicable) la 0 STANDAIM ❑ OTHM- Copy of Planning Approval Letter or Meeting with Planning prior to 0 LARGE samittal of Building Permit application. Q MAJOR S1v*p__.,201Ldoc revised 03131111