B-2017-0732CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
19429 STEVENS CREEK BLVD CUPERTINO, CA 95014 (316 20 115)
CONTRACTOR:
SIGN OF LIGHT&
PERMIT NO:
ROSEVILLE, CA 95678
6
OWNER'S NAME: MAIN STREET CUPERTINO
DATE ISSUED: ('yLLII ,
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OWNER'S PRONE:
PHONE NO: (916) 787-9445
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class C-10 Lic. #908191
Contractor SIGN OF LIGHT Date 11/30/2017
X BLDG —ELECT _PLUMB
MECH RESIDENTIAL X COMMERCIAL
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.
JOB DESCRIPTION:
RESIDENCE INN - INSTALL 2 ILLUMINATED BLADE SIGNS, I
I hereby affirm under penalty of perjury one of the following two declarations:
ILLUMINATED WALL SIGN
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.
z. I have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the perfonmance of the work for which this
Sq. Ft Floor Area:
Valuation: $17000.00
permit is issued.
APPLICANT CERTIFICATION
I 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
31620 115
316
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.
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally, the applicant understands and will comply with all non-point
source regulatio er the Cupertino Municipal Code, Section 9.18..
180 DAYS FROM LAST CALLED INSPECTION.
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Si rat re Date 7 / /
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Issued by:
g C (
Date:
OWNER-BU_LDER DECLARATION
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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
t. 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)
z. 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:
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 tinder 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
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
permit is issued.
3. I certify that in the performance of the work for which this permit is issued, I
Health & Safety Code, Section 25532(x) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the
air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California. If, after making this certificate of
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 & Sa Code, ctions 25505, 25533, and 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
Owner or authorized age/n.
APPLICANT CERTIFICATION
Date:
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.
Licensed
Signature Date
Professional
SIGN PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 85014-3255
(408) 777-3228 • FAX (408) 777-3333 • bu! 'Ing(a.cuoertino.orq
PROJECT ADDRESS 124-7q
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DESCRIPTION OF WORK
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❑ SF or Duplex El Multi -Family TLLUMQNATBD 9►GN TYPE NO.OP SIGN AREA VALUATION
USE OF
•i'( ommercial (YIN) (CODE) SIGNS FT-)
STRUCTURE:
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SIGN TYPE CODES:
B - BANNER SIGN M - MONUMENT (GROUND) SIGN P21 I 41 0.) [;
BL - BLADRSIGN P - PROIBCTBNGSION I 55 4.
D - DBVBLOPMFN►' ID SIGN SP - SPECIAL BVENT BANNER 1 4. J G�
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DI - DIRECTIONALSIGN 'T -- TEMPORARY
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B - ELECTRONIC W - WALL SIGN -
RQADERBOARD WI - WINDOW SIGN /� TOTAL VALUATION:
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RECHrVEDBY; I •� Q r ��,' jag&ML
te. I ty ownor's behalf. I have octad this
below, I certify to each of the following: I am the property owner or authorized agent to act n
is I agree to comply with all applicable local
cur
By my signature accurate.
application and the information I have provided is correct. I have read the Description of Work and verify it
ofCupertino to enter the above-identifiedr�arty for inspection purposes.
ordinances and state laws relating to building construction. [authorize representatives
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Date:
Signature ofApplicant/Agent:
OFF US¢ ONLY
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SUPPLEMENTAL INFORMATION REQUIRED
PLAN CHECK TYPE ROUTING 9LTP
Site Plan
❑ OVER THGCOUNTER ❑ BUILDING PLAN REVIEW
_ Elevations
I;XYRSSS PLANNING PLAN REVIEW
❑ ❑
Sign Details - including UL listing(s) applicable
—
Structural Calculations (if applicable) ❑ STANDARD El OTHERt
Copy of Planning Approval Letter or Meeting with Planning prior to ❑ LARGE
submittal of Building Permit application, ❑ MAaoR
Slgn/Ipp 2011,doc revised 03/31/11
I,47
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