B-2017-1194CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-1194
10963 N WOLFE RD CUPERTINO, CA 95014-0617(316 05 05 1)
SUCCESS GRAPHIC
SIGNS
SAN JOSE, CA 95132
OWNER'S NAME: CUPERTINO VILLAGE LP
DATE ISSUED: 07/24/2017
OWNER'S PHONE: 408-667-1777
PHONE NO: 415-656-8805
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class C45 Lic. #52B45$
Contractor SUCCESS GRAPHIC SIGNS Date 05/31/2019
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:
HAPPY LEMON - INSTALL (1) NEW ILLUMINATED SIGN
I tieah5Saffirni under penalty of perjury one of the -following two declarations:
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 have and will maintain Worker's Compensation Insurance, as provided for by
400
Section 3700 of the Labor Code, for the performance of the work for which this
Sq. Ft Floor Area:
Valuation: $2000.00
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
"N Number:
Occupancy Type:
and state laws relating to building construction, and hereby authorize
316 05 051
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 of this permit:
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally, the applicant understands and will comply with all non -point
source regulations per•the rtino Municipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Signatu'r Date 07-24-2017
Issued by: Kim Dunbar
OWNER -BUILDER DECLARATION
Date: 07/24/2017
I hereby affirm that I am exempt from the Contractor's License Law for one of the
RF 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 ofApplicant:
contractors to construct the project (Sec.7044, Business & Professions Code).
Date: 07-24-2017
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
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
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 & Safety Code, Sec ' , 5533, and 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
1\
be deemed revoked.
Owner or authorized age `r
APPLICANT CERTIFICATION
Date: 07-24-2017
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 07-24-2017
Professional
e
I SIGN PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
lid
CUPEEMNO (408) 777-3228,- FAX (40.8) 777-3333 - building
Cakupertino.org
PROJECT ADDRESS
OWNER NAME HON_
P >
STREET ADDRESS ZIP �
C Y, STATE 00
CONTACT NAME PHONE'
E-MAIL
STREET ADDRESSF
S TATE, ZIP FAX
-Crry,
❑ OWNER El OWNER -BUILDER' ❑ OWNER AGENT CONTRACTOR 11 CONTRACTOR AGENT ❑ ARCHITECT 11 ENGINEER El DEVELOPER 1:1 TENANT
CONTRACTOR NAMEq
LICENSE NUMBER LIC!ME
ilioIV
gep piw
--
COMPANY NAMEF-MAIL FAX
T
STREET ADDRESS
&'4,0V �w CITY, STATE, ZIP
PHONE
1744
ARCHIT'ECT/ENGINEER NAME I , 1 LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONEI
DESCRIPTION OF WORK
ce
USE OF E] SFD1 or Duplex ❑ Multi -Family
ILLUMINATED
SIGN TYPE
NO.OF
SIGN AREA ':-VALUATION
STRUCTURE: E] Commercial
(Y/N)
(CODE)
SIGNS
(SQ. FF.)
1TV
SIGN TYPE CODES:
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 L: WALL SIGN
READEPBOARD WI. WINDOW SIGN
REC
11d, i
TOTA1J'VALUATION:
By my signature below,.1 certify.to:each of the fbllowmi;;�-+am the property owner ofauthorized agent to act on the property owner's behalf. I have reaalihisi .1
application and the information I Have provided is 59rfZct. I hare read the Description ofWork'and verify it is accurate. I agree t? comply with all appiic'Aic local
ordinances and state laws relating to build* g co ction. I a orize representatives of Cupertino to enter the above-identifiedroperty fl rs;:ctio u Toses
.
Signature ofApplicant/Agent: 1 11 Date: `7
SUPPLEMENTAL INFORMATION REQUIRED
OFFICE USE ONLY
PLAN CHECK TYPE
ROUTING SLIP
Site Plan
El OVER-THE-COUNTER
El BUILDINGPLANREVIEW
Elevations
Sign Details - including UL listing(s) applicable
E EXPRESS
❑ PLANNING PLAN REVIEW
Structural Calculations (ii, applicable)
El STANDARD
El OTHER:
Copy of Planning Approval 'Lettdr or Meeting with Planning prior to
El LARGE
submittal of Building Permit application.
1:; ., i
, 1:1. MAJOR
a
SignApp_,2011.doc revised 03131111