B-2017-0697CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
19419 STEVENS CREEK BLVD STE 110 CUPERTINO, CA 95014 (316 20 112)
CONTRACTOR: PERMrr NO: B-2017-0697
SUPERIOR
ADVERTISING INC
LONG BEACH, CA
90813
OWNER'S NAME: MAIN STREET CUPERTINO DATE ISSUED: 05/02/2017
OWNER'S PHONE: 408-777-3081 PHONE NO: (562)495-3808
LICENSED CONTRACTOR'S DECLARATION ATION BUILDING PERMIT INFO:
License Class C-45 Lic. #271598
Contractor SUPERIOR ELECTRICAL ADVERTISING INCDate 02/2812019
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business & Professions Code and ;that my
license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations:
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.
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.
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
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 liabilities, judgments, costs, and expenses which
may accrue against said City in consequence of the granting of this permit.
Additionally, the applicant understands and will comply with all non -point
source requlations4er the Cupertino MunicindCode. Section 9.18.
Date 5/2/2017
X BLDG -ELECT _PLUMB
_ MECH _ RESIDENTIAL X COMMERCIAL
JOB DESCRIPTION:
PRESSED JUICERY - INSTALL 1 ILLUMINATED WALL SIGN;
INSTALL 1 NON ILLUMINATED WALL SIGN; INSTALL 1 NON
ILLUMINATED BLADE SIGN
Sq. Ft Floor Area: I Valuation: $5000.00
APN Number: Occupancy Type:
316 20 112
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
by: Abby Ayende
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
contractors to construct the project(Sec.7044, Business & Professions Code).
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
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
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.
3. I certify that in the performance of the work for which this permit is issued, I
shall not employ any person in any manner so as to become subject to the
Worker's Compensation laws of California. If, after making this certificate of
exemption, I become subject to the Worker's Compensation provisions of the
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
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 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 liabilities,
judgments, costs, and expenses which may accrue against said City in
consequence of the granting of this permit. Additionally, the applicant understands
and will comply with all non -point source regulations per the Cupertino Municipal
Code, Section 9.18.
Signature
Signature of Al
Date: 5/2/2017
It A 11
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code, Cha ter 9.12 and
the Health & Safety Code,?d9ns 2550 25533, and 4.
Owner or authorized agent:
Date: 5/2/2017
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance
of work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Date I
Licensed
SIGN PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-,3333 • building(8—cupertino org
PROJECT ADDRESS 0-0 �
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CONTACT NAME
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❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR )kCONTRACTORAGENT ❑ ARCHITECT [:]ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAMEAe
LICENSE NUMBER �1��
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LICENSE TYPE
BUS. LIC #211M
COMPANY NAME
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ARCHITECT/ENGINEER NAME LICENSE NUMBER
BUS. LIC #
COMPANY NAME
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STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK.
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USE OF ❑ SFD or Duplex ❑ Multi -Family
ILLUMINATED
SIGN TYPE
NO. OF
SIGN AREA
VALUATION
STRUCTURE: Commercial
(Y/N)
(CODE)
SIGNS
(SQ. FT.)
SIGN TYPE CODES:
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B - BANNER SIGN M - MONUMENT (GROUND) SIGNi
BL - BLADE SIGN P - PROJECTING SIGN
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D - DEVELOPMENT ID SIGN SP - SPECIAL EVENT BANNER
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DI - DIRECTIONAL SIGN T - TEMPORARY
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E - ELECTRONIC W - WALL SIGN
READERBOARD WI - WINDOW SIGN
RECEIVED BY: D
TOTAj,VA ATION:
V.IOL
Od
By my signature below, I certify to each of the following: I am the property owner or authorized age t to ac on the property owner's behalf I have read this
application and the information I have provided is correct. I ave read the scription of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building ns ction a esentatives of Cupertino to enter the above -identified property for inspection proposes.
Signature of Applicant/Agent: Date: /
SUPPLEMENTAL INFORMATION REQUIRED
OFFICE USE ONLY
PLAN CHECK TYPErODBUILDING
ROUTING SLIP
Site Plan
❑ OVER-THE-COUNTER
PLAN REVIEW
Elevations
Sign Details - including UL listing(s) applicableExPREss
NG PLAN REVIEW
Structural Calculations (if applicable)
❑ sTANDARD
Copy of Planning Approval Letter or Meeting with Planning prior to
❑ LARGE
submittal of Building Permit application.
❑ MAJOR
6'a'`,Wo SignApp_2011.doc revised 03131111