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14070099 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20558 STEVENS CREEK BLVD CONTRACTORr-TBD-TO-BE PERMIT NO: 14070099 1�TER , OWNER'S NAME: MARDESICH CO CROSSROADS LLC DATE ISSUED:07/22/2014 OWNER'S PHONE: 4082553042 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL G, SPROUTS,INSTALL(4) ILLUMINATED SIGNS License Class ✓ Lic.# 119.5w Contractor Date 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 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. Sq.Ft Floor Area: Valuation:$5000 1 have and will maintain r is Compensation Insurance,as provided for by Section 3700 oft for the performance of the work for which this APN Number:35908018.20558 Occupancy Type: permit is issue . APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS F M AST CALLED INSPECT O 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 Issued by: Date: with all non-p=ZT7 o Municipal Code,Section 9.18. RE-ROOFS: SignatureDate 7,2, �/ 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 inspection. ❑ OWNER-BUILDER DECLARATION Signature of Applicant: Date: 1 hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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) 1,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). 1 have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should 1 use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code.for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Section 55 1,,1/255C3,and 25534. (/ Section 3700 of the Labor Code,for the performance of the work for which this �^%%� ' A3, Date: 2 / permit is issued. Owner or authorized agent: 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 CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address I certify that I have read this application and state that the above information is correct. l 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 ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Date SIGN PERMIT APPLICATION rrAA� COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION U� 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 � GV PERTINU (408)777-3228• FAX(408)777-3333•building a1cupertino.org \ PROJECT ADDRESSr �7L U S + APN H 35 q o G C j� '1� i Qa OWNER ME RG C� 1.\(�r�(l[-A e&-t Pt7V O�✓J JU � E-MAIL IL S DFLIr t / ^ CI Y, STATE,ZIP, FAX CONTAAC ((, � C,4., L' ` P G ErLL C1 Yto FAX ❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT 0 CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACT R NAME LI EN S ER LICENSE TYPE BUS.LIC B COMPANY NAME E-MAIL FAX - ICd Y1 STREET ADDRESS CITY,STATE,Z r /1.../a C PH4 ARCHITECTIENGINEER NAME LICENSE NUMBER BUS.LIC @ /VY' COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK / Glc Cin USE OF ❑ SFD or Duplex ❑ Multi-Family ILLUMINATED SIGN TYPE NO.OF SIGN AREA VALUATION STRUCTURE: Commercial (YIN) (CODE) SIGNS (SQ.Fr.) (S) SIGN TYPE CODES: L� �V 5 U00— B - BANNER SIGN M - MONUMENT(GROUND)SIGN X3-1 BL - BLADE SIGN P - PROJECTING SIGN D - DEVELOPMENT ID SIGN SP - SPECIAL EVENT BANNER DI - DIRECTIONAL SIGN T - TEMPORARY E - ELECTRONIC W - WALL SIGN , READERBOARD WI - WINDOW SIGN R)SCIIVEDBY " TOTVAIFIArL.J z By my signature below,I certify to each of following: I am the property owner or a or agent to act on the property owner's behalf. I have read this application and the information I have pr ided is correct. I have read the Description o tea verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to bu'ding co s ' n. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. 7 Signature of Applicant/Agent: /, Date: -?:P SUPPLEMENTAL INFORMATION QUIRED oFFICEusE.ONL k Site Plan PLAN CHECK TVPE, t w,.a ROIJIINGSLTP xy%, ,� v Elevations ❑ EXPRESS BUII DING PLAN REVIEW 05, ❑ STANDARDxl ' 1Y PiA1GPLANREV]EKSign Details-including UL listing(s)applicable r _Structural Calculations(if applicable) ❑ Laxc� ❑ oTat x _Copy of Planning Approval Letter or Meeting with Planning prior to 0 roR submittal of Building Permit application. SignApp_2011.doc revised 03/16/11 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 20558 scb DATE: 07/22/2014 REVIEWED BY: Mendez APN: BP#: "VALUATION: 1$5,000 PERMIT TYPE: Building Permit PRIMARY PENTAMATION USE: Sign PERMIT TYPE: 10EAP WORK sprouts, install 4 illuminated signs SCOPE SIGN TYPE FEE ID QTY SIGN FEE Wall Sign,Electric 1SIGNWELEC 4 $1,144 TOTALS: $1,144.00 #Branch Circuits 1 $48.00 IESIGN Elec.Permit Fee: IEPERMIT Other Elec. Insp. 0.0 $48.00 NOTE: This estimate does not include fees clue to other Departments(i.e.Planning,Public Works, Fire,Sanitary Sewer District,School District,etc. . These ees are based on the preliminary information available and are only an estimate. Contact the De t or addn'l info. FEE ITEMS (l-,ee Resolution 11-053 Eff.' 7%1:13 FEE QTY/FEE MISC ITEMS Suppl. PC Fee: Q) Reg. Q OT0.0 hrs $0.00 Permit Fee: $1,144.00 Suppl. Insp. Fee-(F) Reg. Q OTQ,Q hrs $0.00 PME Unit Fee: $48.00 PME Permit Fee: $48.00 T-7- Work Without Permit? © Yes (j) No $0.00 Sign Master Plan: 0 Yes (j) No $0.00 Travel Documentation Fee: I TRA VDOC $48.00 A Strong. Motion Fee: IBSEISMICO $1.40 Select an Administrative Item Bldg,Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: 1 $1,290.40 $0.00 TOTAL FEE: F$1,290,401 Revised: 0711012014