B-2017-0602CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-0602
10060 ORANGE AVE CUPERTINO, CA 95014-2816 (357 17 057)
MISSION CITY SIGNS
INC
CAMPBELL, CA 95008
OWNER'S NAME: ABOUNDING GRACE CHRISTIAN CH
DATE ISSUED: 04/17/2017
OWNER'S PHONE: 408-973-9012
PHONE NO: (408) 963-6587
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class, C-45 Lic. #1024994
Contractor MISSION CITY SIGNS INC Date 03/31/2019
X BLDG _ELECT _PLUMB1�
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
h�
"
license is in full force and effect.
JOB DESCRIPTION:
I hereby affirm under penalty of perjury one of the following two declarations:
ABOUNDING GRACE CHURCH - INSTALLS 2 WALL SIGNS
t. 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.
Sq. Ft Floor Area:
Valuation: $4480.00
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
APN Number:
Occupancy Type:
and state laws relating to building construction, and hereby authorize
357 17 057
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.
and
Additionally, the applicant understa ds and will comply with all non-point
WITIIIN 180 DAYS OF PERMIT ISSUANCE OR
source regulations per a Cu e o Code, Section 9.18._
180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 4/17/2017
Issued by: Abby& ende
Date: 04/17/2017
I hereby affirm th t 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: 4/17/2017
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
z. 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 Oevices which emit hazardous
air contaminants as defined by the Bay Area Air Q ty Management District I
Worker's Compensation laws of California. If, after making this certificate of
will maintain compliance with the Cu tino M c' al Code, Chapter 9.12 and
exemption, I become subject to the Worker's Compensation provisions of the
the Health & Safety Code ons 2 5 , 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: 4/17/2017
I certify that I have read this application and state that the above information is
LENDING AGENCY
correct. I agree to comply with all city and county ordinances and state laws
I hereby affirm that they a truction 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 expenseswhich 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.
Licensed
Signature Date 4/1712017
Professional
SIGN PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildingQcupertino.org
S
PROJECT ADDRESS
APN9 357-17-057
0(10060 ROrange /Ave. � `
OWNER NAME A1�0(JLN`�l(�6 43CActV C?.(j9A�(%1(V P ✓�C��1`�l� (�l
fJ
E-MAIL
STREETADDRESS i o ®,Rvm
CITY, STATE, ZIP
�v
FAX
CONTACT NAME Douglas Enns
PHONE 408 9636587
E-MAE-denns@missioncitysigns.com
sTREETADDREss 186 E. Sunnyoaks Ave Ste E
CITY, STATE, ZIP Campbell, CA 95008
FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTORNAME Douglas Enns
LICENSE NUMBER 1024994
LICENSE"C-45
BUS.LIC# %v-, 0
COMPANY NAME Mission City Signs
E-MAIL Doug@missioncitysigns.com
FAX 408 963-6590
STREET ADDRESS .186 E. Sunnyoaks Ave, Suite E
CITY, STATE, ZIP Campbell, CA 95008
PHONE 408 963-6587
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
/P,A. c4�
DESCRIPTION OF WORK Installation of .5" Painted PVC Sign C%CArktnt7+,(WA 6\ff `U �.. Uk,(
J
Mounted to existing wall with studs & silicon
USE OF ❑ SFD or Duplex ❑ Multi -Family
ILLUMINATED
SIGN TYPE
NO. OF
SIGN AREA
VALUATION
STRUCTURE 0 Commercial
(Y / N)
(CODE)
SIGNS
(SQ. FT.)
($)
SIGN TYPE CODES:
N
W
1
22 SQ. FT.
$2014
N
W
1
42 SQ. FT.
$2466
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 W - WALL SIGN
READERBOARD WI - WINDOW SIGN
[RECEIVED BY: y,,,rj p
TOTAL VALUATION:
$4480
By my signature below, I certify to each of the following: I am the roperty owner or authorized agent to act on the property owner's behalf. I have read this
application and the information I have provided is collect. a ad the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building cons ti orize representatives of Cupertino to enter the above-ide tified roperty for inspection purposes.
Signature of Applicant/Agent: Date: f % 1-7
SUPPLEMENTAL rq0 t &TION REQUIRED
OFFICE USE ONLY
PLAN CHECK TYPE
ROUTING SLIP
Site Plan
❑ OVER-THE-COUNTER
El BUILDING PLAN REVIEW
Elevations
Sign Details - including UL listing(s) applicable
❑ EXPRESS
(t
�PLANNING PLAN REVIEW Vt11��
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_201 Ldoc revised 03/31/11
461 t�