12050033CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20572 HOMESTEAD RD
CONTRACTOR: HUPP NEON
PERMIT NO: 12050033
OWNER'S NAME: CAMPUS PARK ASSOCIATES
70 LOREN AVE
DATE ISSUED: 05/04/2012
OWNER'S PHONE: 4084460700
CHICO, CA 95927
PHONE NO: (530) 345-7078
❑ LICENSED CONTRACTOR'S DECLARATION
F r
BLDG
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License Class J Lic. # G / 7
BUILDING PERMIT INFO: ELECT PLUMB
F_
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Contractor ate
MECH RESIDENTIAL COMMERCIAL
1 hereby affirm
firm t a I am licensed under the provisions o Chapter 9
JOB DESCRIPTION: RITE AID -INSTALLATION OF (14) WALL SIGNS FOR RITE
(commencing with ection 7000) of Division 3 of the Business & Professions
AID,(2) DIRECTIONAL SIGNS.
Code and that my license is in full force and effect.
THIS PERMIT DOES NOT INCLUDE THE 2 TEMPORARY SIGNS
1 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.
I have and will maintain Worker's Compensation Insurance, as provided for by
Sq. Ft Floor Area:
Valuation: $32095
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APN Number: 32610063.20572
Occupancy Type:
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 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
PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and ex p nses which may accrue against said City in consequence of the
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of is ermit. Additionally, the applicant understands and will comply
180 DAYS FROM LAST CALLED INSPECTION.
with all no po' t sou ce regulations per the Municipal Code, Section
�CuPertino
9.18. � Vt.�-- /
���/�
Signature Date
Issued by: /`7f7%GNT Date: �'Al lP
❑ OWNER -BUILDER DECLARATION
RE -ROOFS:
l hereby affirm that I am exempt from the Contractor's License Law for one of
All roofs shall be inspected prior to any roofing material being installed. If a roof is
the following two reasons:
installed without first obtaining an inspection, I agree to remove all new materials for
I, as owner of the property, or my employees with wages as their sole compensation,
inspection.
will do the work, and the structure is not intended or offered for sale (Sec.7044,
Business & Professions Code)
Signature of Applicant: Date:
I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
1 hereby affirm under penalty of perjury one of the following three
declarations:
I have and will maintain a Certificate of Consent to self -insure for Worker's
HAZARDOUS MATERIALS DISCLOSURE
Compensation, as provided for by Section 3700 of the Labor Code, for the
I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued.
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain
I have and will maintain Worker's Compensation Insurance, as provided for by
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Section 3700 of the Labor Code, for the performance of the work for which this
Safety Code, Section 25532(a) should 1 store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
permit is issued.
contaminants as defined by the Bay Area Air Quality Management District I will
I certify that in the performance of the work for which this permit is issued, I shall
main 'n compliance with the Cupertino Municipal Code, Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's
Heal Safety Co;e,ctions 25505,25533, and 25534.
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
Owne r uth r' t: I
` !/
forthwith comply with such provisions or this permit shall be deemed revoked.Date:
APPLICANT CERTIFICATION
C NSTRUCTION LENDING A ENCY
I certify that I have read this application and state that the above information is
I hereTyafr.rvm that there is a construction lending agency for the performance of mrk's
correct. I agree to comply with all city and county ordinances and state laws relating
for which this permit is issued (Sec. 3097, Civ C.)
to building construction, and hereby authorize representatives of this city to enter
Lender's Name
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
Lender's Address
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
ARCHITECT'S DECLARATION
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
1 understand my plans shall be used as public records.
Signature Date
Licensed Professional
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 20572 Homestead Road
DATE: 04/30/2012
REVIEWED BY: Sean
:..............
APN• 325 IQ 06.3
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BlL'#: LlQ J .
I ... ...:..i $32,095
*PERMIT TYPE: Building Permit
Re -roof
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Sign1
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CEAP5
WORK :
l:nstalla#ion a f. 14 wall i ns f r.R' d . r E io I gi
SCOPE :
�rxrf 1?!/J .PB f -. F i
SIGN TYPE ROOF AREA UNITS
1SIGNWELEC 0 14 $3,640
1SIGNDIRECT 2 $520
NOL$4,814.00
,NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
Urstrlcr etc.. d hose ees -apir
oases on ( e re!!mina
to ormatlon avaltagte
an. arg opt. n estimate. contact the ue t Qr apnn'! into.
FEE ITEMS Fee Resolution lI-053 Efj ,7/11It j :•
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FEE
QTYIF
NItSC TEEMS
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Seleet.a •Misc Bldg/Structure
Sewer, SanitaryT
$0.00
r";.i�i;r`; i'-=.`_:1-burly Only? Q Yes No
$4,814.00
.... .....................:......__.._....� ._
Q
Q
Q.�
$0.00
..
$44.00.
....
$44,00
---•--- • -
Commercial Items Q
Miscellaneous Items
. _ _ _ ............ ....:
......
$0 fjp
r' ....r..
$0.00
Select a Non -Residential Q
Miscellaneous Items Q
s < . ,....,....... - ...... ITRAVDOC
$44.00
IBSEISMICO
$6.74
2.0 lus
. $260.00
Inspections
ISTINSP Inspection, Hourly
.........................................................................
IBCBSC
$2.00
Lim
$4,954.74
$260.00
? .. ...... ..T(i��`Act:. EE :
$5,214.74
Revisea: U4/Ul/ZU1Z
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