B-2017-1325G
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-1325
20735 STEVENS CREEK BLVD CUPERTINO, CA 95014 (326 32 054)
SIGN OF LIGHT
ROSEVILLE, CA 95678
OWNER'S NAME: LAU ALLAN CHOOKYEEAND LINDA YIM SEUNG ET
DATE ISSUED: 08/10/2017
OWNER'S PHONE: 408-761-1127
PHONE NO: (916) 787-9445
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class CA 0 Lic. #906191
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:
THE HABIT BURGER GRILL - INSTALL (2) WALL ILLUMINATED
I hereby affirm under penalty of perjury one of the following two declarations:
SIGN; REPLACE TENANT PANEL
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.
ve and will maintain Worker's Compensation Insurance, as provided for by 5�
Code, for for this
Section 3700 of the Labor the performance of the work which
permit is issued.
Sq. Ft Floor Area:
Valuation: $5000.00
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
326 32 054
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 Cupertino Municipal e-, s'action 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
ure Date 8/10/2017
Issued by: Abby Ayende
i
Date: 08/10/2017
O D + C RAT O
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
Signature of Applicant:
contractors to construct the project (Sec.7044, Business & Professions Code).
Date:8/10/20 1
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. 1 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 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, Sections 25505, 25533, and 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
��
be deemed revoked.
eatL:8/10/2017 or authorized agerf<t:PLICANT
CERTIFICATION
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 8110/2017
Professional
CUPERTINO ,
SIGN PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(Qcupertino.org
PROJECT ADDRESSAPN #
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OWNER NAME�
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STREET ADDRESS
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CITY ZIP
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❑ OWNER . ❑ OWNER-BUE.DER �❑ OWMERAGENT X'ONTRACTOR ❑ CONTRACIORAGENT ❑ ARCIBTECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR'
LICENSE NUMBER C / ?
;LICENSE TY (E4
BUS. LIC #
COMPANY NAME C! � / ' I
EMAIL �
FAX
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STREET ADDRESS 330 S(JuG�Ge���
CITY, ST60-)Vu/j CA ,,7,S610
ARCHITECT/ENGINEER NAME
7.LICENSE NUMBER
BUS. LIC #'
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK
Z An A- 11-0 -fid,:'' ;
S ►� ill �� � .. '
USE OF D .,SFD or Duplex ❑ Multi -Family
ILLUMINATED
SIGN TYPE
NO. OF
SIGN AREA
VALUATION
STRUCTURE: ��''Commercial .
(Y / N)
(CODE)
SIGNS
(SQ. FT.)
I ($)
SIGN TYPE CODES:
Lo
B - BANNER SIGN M - MONUMENT (GROUND) SIGN
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"L
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BL - BLADE SIGN P - PROJECTING SIGN
1
D - DEVELOPMENT ID SIGN SP - SPECIAL EVENT BANNER'
DI - DIRECTIONAL SIGN T - TEMPORARY
E - ELECTRONIC W - WALL SIGN
READERBOARD WI - WINDOW SIGN
RECEIVED BY:
TOTAL VALUATION:
_.,
o il'z
By my signatore below, I certify to each of the following: I am the pwperty'owner or authorized ag t to act 6 the property owner's behalf. I have read this 1
application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. Iagree to comply withiall applicable local
ordinances and state laws relating to building cons tro n. I authorizer esentatives of Cupertino to enter the above -identified property foT inspection purposes.
7
Signature ofApplicant/Agen : Date:
SUPPLEMENTAL INFORMATION REQUIRED
OFFICE USE' ONLY
PLAN CHECK TYPE
I� ' !'i,t,' ROUTING SLIP
Site Plan
_ Elevations
❑ OVER-THE-COUNTER
❑ BUILDING PLAN REVIEW
Sign Details -including UL listings) applicable
❑ EXPREss
❑r ,CANNING PLAN REVIEW
Structural Calculations (if applicable)
❑ STANDARD
❑ on' ]Eju
Copy of Planning Approval Letter or Meeting with Planning prior to
❑ LARD
submittal of Building Permit application.
❑ MAJOR
SignA* 2011,.doc revised 03/31/11