13030077 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10055 N PORTAL AVE CONTRACTOR:ARTSIGNS PERMIT NO:13030077
ARCHITECTURAL
OWNER'S NAME: 10055 NORTH PORTAL LLC 532 MERCURY DR DATE ISSUED:04/09/2013
OWNER'S PHONE: 4083691800 SUNNYVALE,CA 94085 PHONE NO:(408)245-7133
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMI%IERCIALE]
License Class O-WJ3— Lic.# 001 F( �3 INSTALL DIRECTORY MONUMENT SIGN
Contractort� Date / 3
I hereby affirm that I am licensed under the provisions o 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:$6800
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:31621088.00 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 WIT80 AYS OF PERMIT ISSUANCE OR
to building constriction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 180 DA F OM 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 theDate: L-5 of this permit. Additionally,the applicant understands and will comply Issued by:
with all non-poin source regulations per the Cupertino Municipal Code,Section
9.18. 1 11
k14�9&ate
RE-ROOFS:
Signature ` f All roofs shall be inspected prior to any roofing material being installed.If a roof is
installed without first obtainingan inspection,I gree to remove all new materials for
P �
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 Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Secti 25505,25533,a 1 53 .
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Owner or authorized agent: t? ate:
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 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.
Signature Date
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
['.IADDRESS: 10055 N PORTAL AVE DATE: 03/14/2013 REVIEWED BY: mendez
APN: BP#: ! -;7 VALUATION: 1$6,800
7PERMIT TYPE: Building Permit f L.1 %CIiECK TYPE:
PRIMARY PENTAMATION
USE: Sig n PERMIT TYPE: 1 CEAP i
WORK INSTALL DIRECTORY MONUMENT SIGN
SCOPE
SIGN TYPE FEE ID QTY SIGN FEE
Ground Sign 1SIGNGR/RF 1 $334
TOTALS: $334.00
Meeh. plm2 ch',cl,- Plw,rb. pla:;Check #Branch Circuits 1 $45.00
�iaeh.Pcrmii Fee: phrmh,pen-nil Pee: IESIGN Elec.Permit Fee: IEPERMIT
C�the ,hee/a.hasp. Chhcy-plum./,hup, OtherElea Insp. 0.0 $45.00
3 1cch.ltssp.Foe: phimh. hasp,Fe-- Dec.Imp.Foe:
NOTE:This estimate does not include fees due to other Departments(Le.Planninb Public Works,Fire,Sanitary Sewer District,School
District,etC). These ees are based on the relimina information available and are only an estimate Contact the De t or addn'l info,
FEE ITEMS Fee Resolution 11-053 E . 7/1112 FEE QTY/FEE MISC ITEMS
Man Check,,Fee: = # Plumbing
Suppl.PC Fee: Q Reg. 0 OT 0.0 hrs $0.00 $0.00 IBPFIXTUAE Fixture or Trap
t him b../1LPch-.,,f lec 0 # Plumbing
Permit Fee: $334.00 $0.00 1PCSEWER Sewer, Sanitary
Suppl.Insp.Fee-(j) Reg. Q OT Q,0 hrs $0.00
PME Unit Fee: $45.00
PME Permit Fee: $45.00
Co .slt7[ciion T c7
-Ald 2i€?istrative
Work Without Permit? 0 Yes (2) No $0.00
Sign Master Plan: 0 Yes 0 No $0.00
Travel Documentation Fee: ITRAVD0C $45.00
Strong Motion Fee: IBSEISMICO $1.43 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $1.00
SUBTOTALS: $471.43 $0.00 TOTAL FEE: ' $471.43
Revised: 01/0112013