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B-2018-0510 (2) CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0510 19499 STEVENS CREEK BLVD CUPERTINO,CA 95014(316 20 112) DISCOUNT SIGNS BURLINGAME,CA 94010 OWNER'S NAME:MAIN STREET CUPERTINO DATE ISSUED:03/27/2018 OWNER'S PHONE:408-777-3080 PHONE NO:(650)333-6688 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class,G�5 Lie.#Z5_9380 Contractor DISCOUNT SIGNS Date 02/28/2019 X BLDG—ELECT—PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9(commencing —MECH—RESIDENTIAL X COMMERCIAL with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. JOB DESCRIPTION: TARGET-INSTALL(3)ILLUMINATED SIGNS I hereby affirm under penalty of perjury one of the following two declarations: t. 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. 601 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 is issued. Sq.Ft Floor Area: Valuation:$6000.00 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 31620 112 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 pe Cupert o Municipal c Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature Date 3/2712018 Issued by:Abby Ayende Date:03/27/2018 OWNER-BUILDER DECLARATION 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.Ha crafts r. I,as owner of the property,or my employees with wages as their sole installed without Fust obtaining an inspection,I agree to remove all new materials for compensation,will do the work,and dze structure is not intended or offered for inspection. sale(Sce.7044,Business&Professions Code) z. I,as owner of the property,am exclusively contracting with licensed Signature ofAppleant. contractors to construct the project(Sce.7044,Business&Professions Code), Date;3/2712018 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER t. 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 z. 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 Cade,Sections 25505,25533,and 25534.I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the s. I certify that in the performance of the work for which this permit is issued,I Health&Safety Cade,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 became subject to the Worker's Compensation provisions of the the Health&Safety Cade,Serthms 25505,25533,and 2 34. Labor Cade,l must forthwith comply with such provisions or this perntit shall be deemed revoked. Owner or authorized agent: APPLICANT CERTIFICATION Date:3/27/2018 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 Ilabilitles, 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. Signature Date 3/2712018 Licensed Professional SIGN PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 IS GUPERTINS (408)777-3228•FAX(408)777-3333•buildinrl(dcupeflino.orp ) 01c) PROJECTADDRESS 1%(!.7q'�q .f46 �.�.r�� y'M+ APNN OWNERNAME ! VGPMAILL L• STR13ETADDRESS /h Q �il�k CITY,STATE,ZIP �!, FAX CONTACT NAME 7 PHONE 7 E-JMAaIL R o. S -ff E m STREET ADDRESS / CITY,STATE,-1 FAX ❑OWNER ❑OWNER-BUILDER ❑OWNERAGENT ❑CONTRACTOR VCONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME �V LICENSE NUMBER gO LICENSETYPEeV .BUS.LICK COMPANY NAME E-MNL FAX ! / !4.4ar4, STREETADDRESS/ , CITY,STATE P PHON O^ ' ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS,LIC I COMPANY NAME R-MAIL FAX STREET ADDRESS CITY,STATE,DP PHONE DESCRIPTION OF WORK iNS e�arN 3�lewys AA USE OF ❑SFD or Duplex: ❑Multi-Fatuily ILLUMINATED SIGN TYPE NO.OF SIGN AREA VALUATION STRUCTURE: Fj'Commercial (Y/N) (CODE) SIGNS (SQ.FT.) (S) SIGN TYPE CODES: Y -3 6gp B -BANNER SIGN M -MONUMENT(GROUND)SIGN BL -BLADE SIGN P -PROJECTING SIGN D - DEVEIAPMENTID SIGN SP -SPECIAL EVENT BANNER DI - DIRECTIONAL SIGN T -'TEMPORARY E - ELECTRONIC W -WALL SIGN READERBOARD WI -WINDOW SIGN RECEIVED BY: TITA VALUATION: I Oa By my signature below,I certify to each of the following; 1 am fhe property owner or auNnrized agent to act on iheproperty owner's behnlf.I have Iced this application and th lotbrmation I have p.I d a correct.I hav read tlw Description of Work mid verify it is accurate.I agree to comply with all applicable local ordinances and alm.laws relating to buil sg ct orize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of AppI entJAgmrt: /s Data: 1 SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY _ Site Plan PLAN CHECK TYPE ROUTING SLIP _Elevations ❑ OVER-rHE-COUNTTER ❑ BUMDING PLAN REVIEW 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 S1gnAj;jL2011.doe revised 03/31/!1