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12050186CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10101 N WOLFE RD CONTRACTOR: NORTHWEST SIGNS PERMIT NO: 12050186 OWNER'S NAME: SEARS ROEBUCK AND CO 120 ENCINAL ST DATE ISSUED: 05/24/2012 OWNER'S PHONE: 8472867538 SANTA CRUZ, CA 95060 PHONE NO: (831)469-8208 ❑ LICENSED CONTRACTOR'S DECLARATION License Class 4 Lie. Contract _ Date 3 /2 1 hereby affirm that I am licensed under the provisions of 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. 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. 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signatu ! Date cSsh 7 ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1, 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) 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I 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 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 Section 3700 of the Labor Code, for the performance of the work for which this 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 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. 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. BUILDING PERMIT INFO: BLDG F ELECT r— PLUMB r MECH F RESIDENTIAL F COMMERCIAL I— JOB DESCRIPTION: STE 100 - BAY CLUB & STARBUCKS - INSTALL TWO LETTER SETS ILLUMINATED BY LED READING THE BAY CLUB AND TWO LOGOS ILLUMINATED BY LED READING BYA Sq. Ft Floor Area: I Valuation: $10000 APN Number: 31620080.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by Date: S2 (r -f 'L RE -ROOFS: 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. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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 emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. Owner or orized agent: S /Z Date: Z 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. Date I Licensed Professional Fm-� CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION SIGN TYPE ADDRESS: 10101 n. wolfe road DATE: 05/24/2012 REVIEWED BY: larry s Chcc— APN: BP#: 'VALUATION: j$10,000 *PERMIT TYPE: Building Permit PL „r%."I11 C'K TYPE: PRIMARY USE: Sign C?rh:'.'. phjerr. !r;: PENTAMATION PERMIT TYPE: 10EAP5 WORK install two letter sets illuminated by led reading THE BAY CLUB and two logos illuminated by led SCOPE reading BAY CLUB and STARBUCKS SIGN TYPE FEE ID QTY/FEE QTY Chcc— SIGN FEE IESIGN Wall Sign, Electric 1SIGNWELEC Elec. Permit Fee: 1EPERMIT 4 C?rh:'.'. phjerr. !r;: $1,040 Permit Fee: $1,040.00 Suppl. Insp. Fee.0 Reg. Q OT0,0 hrs $0.00 PME Unit Fee: $44.00 PN/IE Permit Fee: $44.00 { •(m,ariiction Tax: t-�C•lfiili7i.CZl"'C1tIL'C' l"('f': Work Without Permit? 0 Yes (F) No $0.00 TOTALS: $0.00 A ",;/;;,.�; =;:, $1,040.00 ;T3ts}�, s •;•:-r �r�.�+.ice i C,_ t v�..r.s• r•< ;:i:�:. �..;,.. •M1M1 �..::.� _�� M1M1 ,:: �:::=::�r.. t : M1 rrr.��'.i; OM1..--•• - •M1M1 rM1„-.r. •• �:::::..� e: .i S.,..1 .. �:^., ...:: �,J.c.l..:::+• G• FEE QTY/FEE # Branch Circuits 1 $44.00 Chcc— IESIGN Suppl. PC Fee: (F) Reg. Q OT 0.0 1 Elec. Permit Fee: 1EPERMIT $0.00 C?rh:'.'. phjerr. !r;: Other Elea Insp.0.0 $44.00 Permit Fee: $1,040.00 Suppl. Insp. Fee.0 Reg. Q OT0,0 hrs NOTE: This estimate does not inchide fees due to other. Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'l into. FEE ITEMS (Fee Resolution 11-053 E . 7/1/11) FEE QTY/FEE MISC ITEMS Chcc— Suppl. PC Fee: (F) Reg. Q OT 0.0 1 hrs $0.00 Permit Fee: $1,040.00 Suppl. Insp. Fee.0 Reg. Q OT0,0 hrs $0.00 PME Unit Fee: $44.00 PN/IE Permit Fee: $44.00 { •(m,ariiction Tax: t-�C•lfiili7i.CZl"'C1tIL'C' l"('f': Work Without Permit? 0 Yes (F) No $0.00 Sign Master Plan: Q Yes 0 No $0.00 A Travel Documentation Fee: 1TRAVDOC $44.00 Strong Motion Fee: IBSEISMICO $2.10 r' Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 ': ti i �: ::•::1 :: iii � i = :`. `�.:/f :'M1k f S3 J.'•ri"�; J `•:e,4 �S r:� 1 175.10 ili'r'ii-:irjs';:•:5:::'�i:: ;f rrr.3>''i•,:.r:G�i:Lti �� 'iiiy<. �.�s5,"• $0.00 . ,;,;.r;•:::.:;.:,.,:.:: + . • >' :- :'< $1,175.L Revised: 05/01/2012