B-2018-0068CITY OF CUPERTINO BUILDING PERMIT I
BUILDING ADDRESS:
CONTRACTOR;
PERMIT NO: B-2018-0068
10805 N WOLFE RD STE 104 CUPERTINO, CA 95014 (316 05 056)
ILLUMINART SIGNS
YUBA CITY, CA 95993
OWNER'S NAME: CUPERTINO VILLAGE LP
I DATE ISSUED: 0 1111/2018
OWNER'S PHONE: 650-279-8479 I PHONE NO: (408) 3864485
LICENSEDCONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
Class C-45 Lic. #678750
:or ILLUMINART SIGNS Date 1 0131/2 01 9
hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
ith Section 7000) of Division 3 of the Business & Professions Code and that my
cense is In full force and effect.
hereby affirm under penalty of perjury one of the fallowing two declarations:
r. 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. I have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the perfomrance of the work for which this
permit is issued.
APPLICANT CERTIFICATION
certify that I have read this application and state that the above
nformation Is correct. I agree to comply with all city and county ordinances
Ind state laws relating to building construction, and hereby authorize
epresentatives of this city to enter upon the above mentioned property for
nspectlon purposes. (We) agree to save indemnify and keep harmless the
;ity of Cupertino against liabilities, Judgments, costs, and expenses which
nay accrue against.sald"Cit`y If��,..c sequence of the granting of this permit.
kdditionally, I e applicanC' er I rids and will comply with all non -point
source regulations pert a C.1. , no Municipal Code, Section 9.18,
Date 1111 L2018
hereby affirm that I am exempt from the Contractor's License Law for one of the
Blowing two reasons:
1. 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 (Sce.7044, Business & Professions Code)
z. 1, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec.7044, Business & Professions Code).
hereby affirm under penalty of perjury one of the following three declarations:
r. 1 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,
z. 1 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
peril is issued.
s. 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.
artily that I have read this application and state that the above Information Is
rrect. I agree to comply with all city and county ordinances and state laws
ating to building construction, and hereby authorize representatives of this city
enter upon the above mentioned property for Inspection purposes. (We) agree
save Indemnify and keep harmless the City of Cupertino against liabilities,
Igments, costs, and expenses which may accrue against said City In
asequence of the granting of this permit. Additionally, the applicant understands
d will comply with all non -point source regulations per the Cupertino Municipal
)de, Section 9.18.
Date 11111201B
BLDG —ELECT —PLUMB
MECH _ RESIDENTIAL X COMMERCIAL
DESCRIPTION:
A POD - INSTALL (1) ILLUMINATED WALL SIGN
Sq. Ft Floor Area: I Valuation: $4900.00
APN Number: Occupancy Type:
316 05 056
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued
RE -ROOFS,
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without fast obtaining an inspection, I agree to remove all new materials for
inspection.
Signature of Applicant:
Date: 1111/2019
VIM
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which omit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Mu nicipal ode, Chapter 9.12 and
the Health & Safety Code,..Sectibi s355�0$,.Ts553 ,and 25534.
Owner or authorized a ant: 9
Date: 111112018
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
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records,
Licensed
Professional
oun
SIGN PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 IS
(408) 777-3228 • FAX (408) 777-3333 • buildinaVcuaertino.orp
PROJECT ADDRESS 10805 N. Wolfe Road, STE 104
APNu
OWNERNAME Robin McDonald
PHONE 650-279-8479
E-MAIL rbmcdonald1967@gmail.com
STREETADDRESS10805 N. Wolfe Road, STE 104
CITY, STATE, ZIP Cupertino, CA 95014
FAX
CONTACT NAME Thomas Butler
PHONE 707-469-3101
E-MAIL tbutler@signdesignlab.com
STREET ADDRESS 1430 Barbis Way STE 100
CITY, STATE, "'Concord, CA 94518-1220
FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENIN CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME Don De Luze
TICENSENUMBER 678750
LICENSETYPE C45
BUS. LICK
COMPANY NAME IIIuminart
E-MAIL illuminartsignco@att.net
FAX
STRBETADDRESS2543 Somerset Way
CITY, STATE,ZlPYuba City, CA 95993
P11408-386-1485
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC H
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
%�
DESCRIPTION OF WORK IAO `\, Yp 07
LED Lit Channel Letters
USE OF ❑ S D or Duplex ❑ Multi -Family
STRUCTURE: Vornmercial
ILLUMINATED
(Y/N)
SIGN TYPE
(CODE)
NO. OF
SIGNS
SIGN AREA
IS F'1')
VALUATION
($)
SIGN TYPE CODES:
B - BANNER SIGN M - MONUMEN'I'(GROUND) SIGN
BL - BLADE SIGN P - PROJECTING SIGN
D - DEVELOPMENT ID SIGN SP - SPECIAL EVENT BANNER
DI - DIRECTIONAL SIGN T - TEMPORARY
P. - ELECTRONIC W - WALL SIGN
READERROARD WI - WINDOW SIGN
RECEIVED BY:
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act ob the property owner's behalf. I have read this
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 stale laws relnting.to•batfd' Fctsnslructi I authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
s I /1 1 /
Signature ofApplican gent � Date: Or
SUPPLEMENTAL INFORMATION REQUIRED
Site Plan
_ Elevations
Sign Details - including DL listing(s) applicable
_ Structural Calculations (if applicable)
_ Copy of Planning Approval Letter or Meeting with Planning prior to
submittal of Building Permit application.
OFFICE
USE ONLY
PLAN CHECK TYPE
ROUTING SLIP
❑ OVER-THE-COUNTER
❑ EXPRESS
❑ STANDARD
❑ LARGE
❑ MAJOR
❑ BUILDING PLAN REVIEW
❑ PLANNING PLAN REVIEW
❑ O'T'HER:
SignApp_2011. doc revised 03/31/11