B-2017-1374CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-1374
10555 S DE ANZA BLVD STE 150 CUPERTINO, CA 95014-4464 (359 18 058) SUCCESS GRAPHIC
SIGNS
SAN JOSE, CA 95132
OWNER'S NAME: ABC DEANZA PLAZA PARTNERS
OWNER'S PHONE: 408=355-4100
LICENSED CONTRACTOR'S DECLARATION
ti
License Class C45 Lic. #898458
Contractor SUCCESS GRAPHIC SIGNS Date 05/31/2019
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:
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
erformance of the work for which this permit is issued.
Ihave 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 regulations per the Cupertino Municipal Code, Section 9.18.
Lel./ Date 08/17/2017
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
t. - I, as owner of the property,or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered for
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,isissued. i
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 an6 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 Date 08/17/2017
DATE ISSUED: 08/17/2017
PHONE NO: (408) 667-1777
BUILDING PERMIT INFO:
X BLDG —ELECT -PLUMB
_ MECH _ RESIDENTIAL X COMMERCIAL
JOB DESCRIPTION:
NO. 1 FOOT SPA - RELOCATE (2) ILLUMINATED SIGNS
Sq. Ft Floor Area: I Valuation: $1200.00
APN Number: Occupancy Type:
359 18 058
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
by: Kim Dunbar
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
His 0
Signature of Applicant:
Date: 08/17/2017
CLASS "A" OR BETTER
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 Cupertin icipal Code, Chapter 9.12 and
the Health & Safety Code, S ons 25505, 225533,, and 25534.
Owner or authorized agent:
Date: 08/17/2017
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
I understand my plans ill be osed as public records.
Licensed
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SIGN PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE CUPERTINO, CA 95014-3255
(408) 777-3228 ^ FAX (408)777-3333 • buildingncuDertino.or a
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❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT CONTRACTOR ❑ CONTRACTOR AGENT -❑ ARCHTTECT ❑.ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
LICENSE NUMBER t LICENSE T
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DESCRIPTION OF WORK (-
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USE OF ❑ SFD or Duplex ❑ Multi -Family
Lr LUMINATEDSIGN
TYPE
NO. OF
SIGN AREA '.
I VALUATION
STRUCTURE: El Commercial
(Y /N)
(CODE)
SIGNS
(SQ. FF.)
SIGN TYPE CODES:
V
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 - iEMPORARY
E - ELECTRONIC W - WALL SIGN
READERBOARD WI - WINDOW SIGN
RECEIVED.B
O V�ALU/P$jlBji�
By my signature below, I certify to each of the following: I am the property owner orauth rued agent to act on the property owner's behalf. I ave read this
application and the information I have provided is correct • ad the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building consfn. I authorize repres tatives of Cupertino to enter the above-iden ' ed pro erty for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INFORMA N REQUIRED
OFFICE USE ONLY
Site Plan !
PLAN CHECK TYPE
I ROUTING SLIP
❑ OVER-THE-COUNTER
❑ BUILDING PLAN REVIEW
Elevations
Sign Details - including UL listing(s) applicable
❑ EXPRESS
❑ PLANNING PLAN REVIEW
Structural Calculations (if applicable)
❑ STANDARD
❑ OTHER:
_ Copy of Planning Approval Letter or Meeting with Planning prior to
❑ LARGE
submittal of Building Permit application.
❑ MAJOR
SignApp_2011.doc revised 03131/11