B-2017-1861 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1861
21731 STEVENS CREEK BLVD CUPERTINO,CA 95014-1119(326 20 060) J B SIGNS INC
• UNION CITY,CA 94587
•
OWNER'S NAME: FREELAND URI AND BATIA TRUSTEE DATE ISSUED:10/31/2017
OWNER'S PHONE:650-823-4543 PHONE NO:(510)441-1801
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-45 Lic.#807564
Contractor J B SIGNS INC Date 06/30/2019 X BLDG _ELECT _PLUMB
MECH X RESIDENTIAL 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:
STARBUCKS-INSTALL 2 NON ILLUMINATED SIGNS AND 1
I hereby affirm under penalty of perjury one of the following two declarations: BLADE SIGN
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
erformance of the work for which this permit is issued.
,,eii ave and will maintain Worker's Compensation Insurance,as provided for by
1427 Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$10790.00
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 APN Number: Occupancy Type:
and state laws relating to building,construction,and hereby authorize 32620 060
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 regulationa4aer the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
I;w gnatur �® Date 10/31/2017 Issued by:Abby Ayende
® Date: 10/31/2017
OWNER-BUILDE t I ECLARATION
i 1
I herebyaffirm 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.
•
i, sale(Sec.7044,Business&Professions Code)
2. ,' I,as owner ofthe,property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date: 10/31/2017
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'. 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 wit •• upertino Municipal Code,Chapter 9.12 and
• exemption,I become subject to the Worker's Compensation provisions of the the Health&S. •ty Code ons 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. ��
er or authorized ag:.
APPLICANT CERTIFICATION �uDate: 10/31/2017
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. I understand my plans shall be used as public records.
Signature Date 10/31/2017 Licensed
Professional
-7,0 q- l' (°1
\\ t/� SIGN PERMIT APPLICATION ....
VCOMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION .S
,'Js 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUPERTINO (408)777-3228•FAX(408)777-3333•buildingecupertino.orq
PROJECT ADDRESS .2 I.3 I Wv S ,J�7�M lA s (r-c - �` /V'•, CA--
# 32l^ _23" n( _D
OWNER NAME % PHONE O. $23.4543' -��trr crE,I ee-tiBv.c4)-r,
STREET ADDRESS CITY,STATE, ^- ' %c iJ'ah{ •.
11�0O Seem 'AYPA�.
CONTA NAME 1A PHO5110-441w1161
'^ 1+1 T61 JN 10
621.
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STREET ADD { CITY,STATE,ZIP FAX 1 1�D 4-
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❑OWNER 0 OWNER-BUILDER 0 OWNER AGENT,.,, rJ CONTRACTOR 0 CONTRACTOR AGENT 0 ARCHITECT 0 ENGINEER 0 DEVELOPER 0 TENANT' .•
CONTRACTOR NAME 15 SI 4�/ 1 n r /V LICENSE N�4BE4504._ LICENS�TYPE BUS.LTC if w 35 '
COMPANY NAME Tis 310,8,„ 1•IL i ,E-M I� -,,,V5 &s 3106a. .
STREETTAD✓-iZf'S wi•6 1'f tl a �/MfO/Y �/� J �I t �f-fSU. PH O.Tf'`.Lea
ARCHITECT/ENGINEER NAME N/ LICENSE NUMBER BUS.LIC
'
COMPANY NAME I E-MAIL FAX
STREET ADDRESS 'CITY,STATE,ZIP 4 PHONE '
DESCRIPTION OF WORK I•4AW� A?'t4Mti' I kIs i-t klC i) 4ot ie tape �l
516N AIVIi ) S day&, tn91ncj Logo blsr_ 1not--II)kminaiFtvt lna.nyint, '1try slop J
) r! — I S� (0�� Q(, L�.bbl'+'5 t Inst A ( I) hey,– I lu.w�Vic- 5lh"I-c.
SIGNr 4 ��� (t'bhGrsG� s w►stwl-L,.I) nok7-( ton I ►
Irk act It it rscvt on 43L ne., '
USE OF '0 SFD or Duplex 0 Multi-Family ' ILLUMINATED SIGN TYPE NO.OF SIGN AREA 'VALUATION
STRUCTURE: Commercial Ct IN) W(CODE) SIGNS (SQ.Fr.) �`i (a)
SIGN TYPE CODES: 1v) N I 2114 I/JQco '�'
B - BANNER SIGN M - MONUMENT(GROUND)SIM, � �1 / - A^O
BL - BLADE SIGN P - PROJECTING SIGN /�[l%� -�+�
D - DEVELOPMENT ID SIGN SP - SPECIAL EVENT BANNER, J�� i / li I, -4- ,
DI - DIRECTIONAL SIGN T - TEMPORARY I ' " ��' /D00
E - ELECTRONIC W - WALL SIGN
READERBOARD WI - WINDOW SIGN ,i '
RECEIVED BY: °LaCAAj\ OTAL VALUATION:
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. Ihave;read this; I!
application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all,applicable local
ordinances and state laws relating tong co r, tion. I authorize representatives of Cupertino to enter the above-identified property,for inspection purpoes.
Signature of Applicant/Agent: _�� Date: Q-1''f ®4• ,2-Q 1977 ii
SUPPLEMENTAL •' •TION REQUIRED OFFICE USE ONLY I! !
_Site Plan PLAN CHECK TYPE-., , . ROIITIkG SLIP i
_Elevations •❑ OVER-THE-COUNTER � BUILDING PLANREVIE1y Y_a Y\
Sign Details-including UL listing(s)applicable 0 EXPRESS PLANNINGPL REL. VIEW ClkA II
Structural Calculations(if applicable) 0 STANDARD 0 OTHER: '
Copy of Planning Approval Letter or Meeting with Planning prior to 0 LARGE
submittal of Building Permit application. ;
D MAJOR
SignApp 2011.doc revised 03/31/11