B-2017-0650C�
I
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-0650
10845 N WOLFE RD CUPERTINO, CA 95014-0614 (316 05 052)
PHOENIX SIGNS LLC
SAN JOSE, CA 95112
OR'NER'S NAME: CUPERTINO VILLAGE LP
DATE ISSUED: 04/25/2017
it
OWNER'S PHONE: 415-656-6605
PHONE NO: (408) 573-9300
LICENSED CONTRACTOR'S DECLARATION ATION
BUILDING PERMIT INFO:
I
License Class Ste`; Lic. #924806
Contractor PHOENIX SIGNS LLC Date 01/31/2019
X BLDG —ELECT —PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
— MECH X RESIDENTIAL COMMERCIAL
—
with Section 7000) of Division 3 of the Business & Professions Code and that my
license is in full force and effect.
JOB DESCRIPTION:
LONGEVITY ACUPUNCTURE - INSTALL 1 ILLUMINATED WALL ;<
I hereby affirm under penalty of perjury one of the following two declarations:
SIGN
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 of the work for which this permit is issued.
_i-2:_ —1-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
Sq. Ft Floor Area:
Valuation: $2730.00
9 permit is issued.
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
316 05 052
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�mq City in consequence of the granting of this permit.
Additionally, thea plicant understands and-[ill comply with all non-point
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
source regulations pe atnL Cupertino Municipal'Code, Section 9,18.
180 DAYS FROM LAST CALLED INSPECTION.
Signature r ate 4/25/2017
Issued by: AbbyA ey n I
Date: 04/25/2017
OWNER-B MDERDE
I herebyrr.affirm that I am exempt from the Contractor's License Law for one of the
follow tw reasons:
RE-ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is,
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 foij
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 ofApplicant:
contractors to construct the project (See.7044, Business & Professions Code).
Date: 4/25/2017
I hereby affirm under penaltyof perjury one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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.
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 :I
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 .I
permit is issued.
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
s. 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
air contaminants as defined by the Bay Area Air Quality Managemgnt District III
Worker's Compensation laws of California. If, after making this certificate of
will maintain compliance with the CupertinoIunicipal Code, Chapter 9.12 and
exemption, I become subject to the Worker's Compensation provisions of the
the Health & Safety Code tictrc on�5505, 25533d 255 4.
Labor Code, I must forthwith" comply with such provisions or this permit shall
be deemed revoked.
Ovimer or authorized agent:
APPLICANT CERTIFICATION
Date: 4/25/2017
I certify that I have read this application and state that the above information is
I hereby affirm that there a - struction lending agency for the
correct. I agree to comply with all city and county ordinances and state laws
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.) ;I
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.
Licensed
Signature Date 4/25/2017
Professional
•
Zot_- o(A-0
SIGN PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408).777-3333 • buildingAcupertino.org
PROJECT ADDRESS 10845 N
�N #
Wolfe Rd
OWNER NAME
Kimco Realty415.656.6605
PHONE
E- ganicete@kimcorealty.com
STREET ADDRESS
Southgate Ave
CITY, STATE, ZIP
Dal Cit CA. 94015
FAX
CONTACT NAME
HUNG TRAN'
PHONE
408-835-0614
&MAIL
inf0@ph0enixsigns11c.com
STREET ADDRESS
446 QUEENS LANE
CITY, STATE, ZIP
SAN JOSE, CA 95112
FAX
1 408-573-9301
❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT W CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME HUNG TRAN
ER
LICENSE NUMB924806
LICENSE TYPE
C-45
BUS. LIC
COMPANY NAME
PHOENIX SIGNS, LLC.
nfo@phoenixsignsllc.com
FAx 408-573-9301
STREET ADDRESS
446 QUEENS LANE
CITY, STATE, ZIP
SAN JOSE, CA 95112
PHONE
408-835-0614
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK
Install [1] set of internally LED lit channel letters on raceway
attached to wall (see drawing)
USE OF ❑ SFD or Duplex ❑ Multi -Family
ILLUMINATED
SIGN TYPE
NO. OF
SIGN AREA
VALUATION
STRUCTURE: X❑ Commercial
(Y/N)
(CODE)
SIGNS
(SQ. FT.)
($)
SIGN TYPE CODES: Y W 1 9.1 2730
B - BANNER SIGN M - MONUMENT (GROUND) SIGN
BL - BLADE SIGN P - PROJECTING SIGN
D - DEVELOPMENT ID SIGN SP - SPECIALEVENT BANNER
DI - DIRECTIONAL SIGN T - TEMPORARY ,
E - ELECTRONIC W - WALL SIGN -
READERBOARD WI - WINDOW SIGN r• -�
00
1
By my signature below, I certify to each of the following: I am the property owner or: _<<fie property owner's behalf. I ha(v'eread this
application and the information I have provided is correct. I have read the Description or We-- t is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building construction. I authorize representatives of CLI, ,noFio ehter the above -identified property for inspection purposes.
Signature of Applicant/Agent: Date: 1/24/2017
SUPPLEMENTAL INFORMATION REQUIRED
OFFICE USE ONLY
PLAN CHECK TYPE
ROUTING SLIP
Site Plan
❑ OVER-THE-COUNTER
❑- BUILDING PLAN REVIEW
Elevations
Sign Details - including UL listing(s) applicable
❑ EXPRESS
❑ PLANNING PLAN REVIEW
Structural Calculations (if applicable)
❑ sTANDmw
❑ OTHER:
Copy of Planning Approval Letter or Meeting with Planning prior to
❑ LARGE
submittal of Building Permit application.
❑. MAJOR
SignApp_201 1. doc revised 03/31/11 .�