12110059 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10165 N DE ANZA BLVD CONTRACTOR:INFINITE LOOP HOTEL PERMIT NO:12110059
LLC
OWNER'S NAME: INFINITE LOOP HOTEL LLC 20660 STEVENS CREEK BLVD DATE ISSUED:01/11/2013
OWNER'S PHONE: 4089312693 CUPERTINO,CA 95014 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL El COMMERCIALS
License Class Lic.# ALOFT HOTEL-INSTALL 2 ILLUMINATED SIGNS- 6/1/2
ILLUMINATED CHANNEL LETTER SIGN,MONUMENT
Contractor Date SIGN ON
I hereby affirm that l`am licensed under the provisions of Chapter 9 MAIN ENTRY OF HOTEL
(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:$20590
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 APN Number:32634057.00 Occupancy Type:
permit is.issued.
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 WITIIIN 18 D YS 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 M LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the
Date:
granting of this permit. Additionally,the applicant understands and will comply Issued by: // J
with all non-point source_regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS-
Signature Date 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:
I 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)
I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). I 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 I 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 C erfino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sectio 255 ,255P,and 25534. /
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent Date:
permit is issued.
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.'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 ARCHITECT'S DECLARATION
indemnify and keep harmless She 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.
grantingof this pe it.Additionally,the applicant understands and will comply
with all non-poi ource Tegulatiorif per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date f
SIGN PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 \o
CUPERTINO (408)777-3228•FAX(408)777-3333•h2u dil)q� u eetns .orq �\
PROJECT ADDRESS APN#
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OWNER NAME PHONE 7
E-MAIL
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STREET ADDRESSQ CITY,STATE,ZIP FAX
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CONTACT NAME PHONE E-1
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STREET ADDRESS ` � CITY,STATE,ZIP FAX
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❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHr1•ECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAM o O LICENSE NUMBED LICENSE TYPE BUS.LIC#
COMPANY NAME i�1QUST llI E MAII,$ ��fl INDUS 1��5• FAX
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STREET ADDRESS ` �vEti OF CITY,STATE, PHO
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ZIPS A� E C k Q a071 G\ _L\L\s
ARCHITECT/ENGINEERNAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK Q uyLG C__ y �Q ,n
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USE OF ❑ SFD Or Duplex ❑ Multi-Family ILLUMINATED SIGN TYPE NO.OF SIGN AREA VALUATION
STRUCTURE: X Commercial (Y/N) (CODE) SIGNS (SQ`.FT.) (`(S)
SIGN TYPE CODES: y 1 6
B - BANNER SIGN M - MONUMENT(GROUND)SIGN \/
BL - BLADE SIGN P - PROJECTING SIGN r
D - DEVELOPMENT ID SIGN SP - SPECIAL EVENT BANNER
DI - DIRECTIONAL SIGN T - TEMPORARY
E - ELECTRONIC W - WALL SIGN
READERBOARD WI - WINDOW SIGN
RECEIVED B 1,/I c TO �4Lpuq✓I'
By my signature below,I certify to each of the follo I am the property owner or authorized agent to act on the property owner's behalf I bave read this
application and the information I have provided' o ct. have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to bui o . I authorize representatives of Cupertino to enter the above,,ide'ntified property for inspection purposes.
Signature ofApplicant/Agent: Date: kk F[��?jEVL 0 ,,aMa
SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY
_Site Plan PLAN CHECK TYPE ROUTING SLIP
Elevations ❑ OVER-TAE-COUNTER BUILDING PLAN REVIEW
_Sign Details-including UL listing(s)applicable REss PLANNING PLAN REVIEW
Structural Calculations(if applicable) ❑ STANDARD ❑ oTAER:
Copy of Planning Approval Letter or Meeting with Planning prior to ❑ LARGE
submittal of Building Permit application.
❑ MAJOR
SignApp 2011.doc revised 03/31/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 10165 N DE ANZA BLVD DATE: 11/09/2012 REVIEWED BY: MENDEZ
APN: BP#: / *VALUATION: 1$20,590
*PERMIT TYPE: Building Permit PLAN`CHECK i)SPE:
PRIMARY Sig n PENTAMATION 1 CEAP5
USE: PERMIT TYPE:
WORK ALOFT HOTEL- 6/1/2 ILLUMINATED CHANNEL LETTER SIGN MONUMENT SIGN ON MAIN
SCOPE ENTRY OF HOTEL
SIGN TYPE FEE ID QTY SIGN FEE
Wall Sign,Electric 1SIGNWELEC 1 $266
Ground Sign 1SIGNGR/RF 1 $334
TOTALS: $600.00
A'Tech.Plan Check Phwih,Plan Claeck #Branch Circuits 1 $45.00
Nfech.Permit Fee,., Plumb.po-?nil Fee: 1ESIGN Elec.Permit Fee: IEPERMIT
Other Afec11.hasp. 0117er Plumb hasp. Other Elec.Insp. FoA $45.00
Rlech.Insp,Fee: Phunh. hrsp.Fee: Glee.Insp.Fee_
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc.). Theseees are based on the relimina information available and are only an estimate Contact the Dept or addn'Z info.
FEE ITEMS (Fee Resolution 11-053 Eff. 711/12) FEE QTY/FEE MISC ITEMS
l lar? Chuck 1"e e:
Suppl.PC Fee: (D Reg. ® OT 1 0.0 1 hrs $0.00
phnnb.11 ecb.lflec
Permit Fee: $600.00
Suppl. Insp.Fee:Q Reg. ® OT0.0 hrs $0.00
PME Unit Fee: $45.00
PME Permit Fee: $45.00
Constrzrction Tax:
Adinhiiszr atice Fee:
Work Without Permit? 0 Yes (j) No $0.00
Sign Master Plan: 0 Yes (j) No $0.00
Travel Documentation Feer ITRAVDOC $45.00
Strong Motion Fee: IBSEIS11IC0 $4.32 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $740.32 $0.00 TOTAL FEE: $740.32
Revised: 10/01/2012