12110151CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20682 STEVENS CREEK BLVD
CONTRACTOR: HUPP SIGNS & LIGHTING,
PERMIT NO: 12110151
INC
OWNER'S NAME: BYER PROPERTIES
70 LOREN AVE
DATE ISSUED: 11/28/2012
OWNER'S PHONE: 4156262937
CHICO, CA 95928
PHONE NO: (530) 345-7078
CONTRACTOR'S DECLARATION
I— r r
(LICENSED
License Class C�-1 Lic. # CM -(e(gg
BUILDING PERMIT INFO: BLDG ELECT PLUMB
r" r I-
LkV4,
MECH RESIDENTIAL COMMERCIAL
Contractor
1 hereby affirm that I a icensed un r the p visions oC Chapter 9
JOB DESCRIPTION: BOUDIN BAKERY - INSTALL 3 ILLUMINATED CHANNEL
(commencing with Section 7000) of Division 3 of the Business & Professions
LETTER SIGNS- WALL MOUNTED
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: S40000
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.
APN Number: 35908020.20682
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
PERMIT EXPIRES IF WORK IS NOT STARTED
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs, and expenses which may accrue against said City in consequence of the
180 DAYS FROM LAST CALLED INSPECTION.
granting of th' permit. Additionally, the applicant understands and will comply
with all non o t ource regulations per the Cupertino Municipal Code, Section
9.18.
Issued bye DatgY/'Z�%2
SignaturWDate ( 1 �
❑ NER-BUILDER DECLARATION
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
I hereby affirm that 1 am exempt from the Contractor's License Law for one of
installed without first obtaining an inspection, I agree to remove all new materials for
the following two reasons:
inspection.
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,
Signature of Applicant: Date:
Business & Professions Code)
1, 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:
HAZARDOUS MATERIALS DISCLOSURE
I have and will maintain a Certificate of Consent to self -insure for Worker's
1 have read the hazardous materials requirements under Chapter 6.95 of the
Compensation, as provided for by Section 3700 of the Labor Code, for the
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain
performance of the work for which this permit is issued.
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
1 have and will maintain Worker's Compensation Insurance, as provided for by
Safety Code, Section 25532(a) should I store or handle hazardous material.
Section 3700 of the Labor Code, for the performance of the work for which this
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 1 will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
I certify that in the performance of the work for which this permit is issued, I shall
Heal Safety Code, Sections 25505, 25533, and 25534.
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
Ow er or ut o d t , t „ �, �2
become subject to the Worker's Compensation provisions of the Labor Code, 1 must
Date:_
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION
I hereby a that there is a construction lending agency for the performance of mwrk's
I certify that I have read this application and state that the above information is
for which this permit is issued (Sec. 3097, Civ C.)
correct. I agree to comply with all city and county ordinances and state laws relating
Lender's Name
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
Lender's Address
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
ARCHITECT'S DECLARATION
with all non -point source regulations per the Cupertino Municipal Code, Section
I understand my plans shall be used as public records.
9.18.
Licensed Professional
Signature Date
CITY OF CUPERTINO
RM-1 FEE ESTIMATOR - BUILDING DIVISION
KIM
ADDRESS: 20682 stvns crk blvd.
DATE:
REVIEWED BY: bobs.
APN:
BP#:
*VALUATION: 1$40,000
PERMIT TYPE: Building Permit
PLAN CHECK TYPE. -
PRIMARY
USE: Sign
PENTAMATION
PERMIT TYPE: 1 CEAP5
WORK
install 3 illuminated chennel letter signs wall mounted.
SCOPE
SIGN TYPE
FEE ID
QTY
SIGN FEE
Wall Sign, Electric
1SIGNWELEC
3
$798
TOTALS:
$798.00
PIW.Nh. Plan C ;hc<G
#Branch Circuits 1 $45.00
Ifech. Plan Check
.Wech. 1,c>rmil F"c°e.
Phanih. Aermi! Fee
IESIGN Elec. Permit Fee: IEPERMIT
Other Afer. h. Insp,
011wr Numb layl). ED
Other Elec. Insp. 0.0 $45.00
Mcch. /nsp. Fee:
Ph',mh. h1sp. fee
Ela.Insp. Free:
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District. eta). These fees are based on the Dreliminary information available and are only an estimate Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 E . 711112)
FEE
QTYIFEE
MISC ITEMS
Plan Check Fee:
Suppl. PC Fee: (E) Reg. 0 OT
0.0
hrs
$0.00
Plurnb.111ech./Elec
Permit Fee:
$798.00
Suppl. Insp. Fee-.0 Reg. Q OT
0.0
hrs
$0.00
PME Unit Fee:
$45.00
PME Permit Fee:
$45.00
Consovelion Tax: -T7
Adini.nistrative Fee:
Work Without Permit? 0 Yes 0 No
$0.00
Sign Master PIan: 0 Yes 0 No
$0.00
Travel Documentation Fee: ITRAVDOC
$45.00
Strong Motion Fee: IBSEISMICO
$8.40
Select an Administrative Item
BldgStds Commission Fee: IBCBSC
$2.00
SUBTOTAL &
$943.401
$0.00 TOTAL FEE:
$943.40
Revised: 10/01/2012