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13020028CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 23000 HOMESTEAD RD CONTRACTOR: SIGNTECH ELECTRICAL PERMIT NO: 13020028 ADVERTISING OWNER'S NAME: SAN DIEGO, CA 92102 PHONE NO: (619)527-6100 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL II License Class C�IS� Lic. # y072yOL WELLS FARGO**REPLACE & UPDATE 2 (E) LUMINATED WALL Contractor. X,e-�elw Date •? SIGNS (2.6AMPS/140.8WATTS) & REPAHU"COVER (E) I hereby affirm that I am licensed under the provisions of Chapter 9 AWNING (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 Sq. Ft Floor Area: Valuation: $4000 performance of the work for which this permit is issued. 1 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: 32601026.00 Occupancy Type: APPLICANT CERTIFICATION 1 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 WITHIN 180 DAYS 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 D S FR LED INSPEC T ION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, �180 costs, and expenses which may accrue against said City in consequence of the 5 / granting of this permit. Additionally, the applicant understands and will comply Date: with all non -point source regulations per the Cupe o Municipal Code, Section 9.18. i Signatur DateJ 114 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. ❑ 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) 1, 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. 1 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 1 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, 34. 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, ARCHITECT'S DECLARATION 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 Fm'-1 FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 23000 HOMESTEAD RD DATE: 02/07/2013 REVIEWED BY: MELISSA APN: 326 01 026 BP#: 15 01--?Q `VALUATION: 1$4,000 PERMIT TYPE: Building Permit PLAN C11ECK TYPE: PRIMARY USE: --TSign PENTAMATION PERMIT TYPE: 10EAP5 WORK WELLS FARGO""REPLACE & UPDATE 2 E LUMINATED WALL SIGNS 2.6AMPS/140.8WATTS & SCOPE REPAIR/RECOVER (E) AWNING SIGN TYPE FEE ID QTY SIGN FEE Wall Sign, Electric 1SIGNWELEC 2 $532 TOTALS: $532.00 Phwib. Plap Check #Branch Circuits 1 $45.00 stile& Plan Check ,hrch. Pe-rwil Fee: Plumb. Permit Fee: 1ESIGN Elec. Permit Fee: 1EPERMIT Other Afech. Insp. Other Plumb Insp. Other Elea Insp. 0.0 $45.00 Afech. Fee: Pltrcub. bsp. Fee: Elec. Insp. Fee: 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 preliminary information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 1I-053 E . 7111122 FEE QTY/FEE MISC ITEMS Plan Check Fee Suppl. PC Fee: Q Reg. Q OT 0.0 hts $0.00 P1umh.1AJech.7Elec Permit Fee: $532.00 Suppl. Insp. Fee-.0 Reg. ©OT 0.0 hrs $0.00 PME Unit Fee: $45.00 PME Permit Fee: $45.00 Construction Tax: Adrninistrative Fee: Work Without Permit? 0 Yes (E) No $0.00 Sign Master Plan: Q Yes 0 No $0.00 Travel Documentation Fee: ITRAVDOC $45.00 Strong Motion Fee: 1BSEISMICO $0.84. Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC 1 $1.00 SUBTOTALS: $668.84 $0.00 TOTAL FEE: $668.84 \t . Revised: 01/01/2013