13020056CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20686 STEVENS CREEK BLVD
CONTRACTOR: NORTHWEST SIGNS
PERMIT:NO: 13020056
OWNER'S NAME: BYER PROPERTIES LP,
120 ENCINAL ST
DATE ISSUED: 02/12/2013
OWNER'S PHONE: 4156267844
SANTA CRUZ, CA 95060
PHONE NO: (831)469-8208
JOB DESCRIPTION: RESIDENTIAL COMMERCIALS
❑ LICENSED CONTRACTOR'S DECLARATION
LIS # 1 p
**PHILZ COFFEE**INSTALL 2 NEW ILLUMINATED
License Class Li..
y+�
a i 'r1 'a Date - % s 3
WALL
MOUNTED CHANNEL LETTER SIGNS
Contractory" "I,
I 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.
Sq. Ft Floor Area:
Valuation: $4800
I have and will maintain Worker's Compensation Insurance, as provided for by
APN Number: 35908020.20686
Occupancy Type:
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
PERMIT EXPIRES IF WORK IS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save .
180 DAYS FROM f' LED INSPEC ION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
_
9 r
costs, and.expenses which may accrue against said City in consequence of the
Issu d� — Date:
granting of this permit. Additionally, the applicant understands and will comply
s — -
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
,�, �
� � � �
RE -ROOFS:
being installed. If a roof is
''
Signature � 1 " '4 Date
All roofs shall be inspected prior to any roofing material
_
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
❑ OWNEWBUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
I, as owner of the property, or my employees with wages as their sole compensation,
will do the work, and the structure is not intended or offered for sale (Sec.7044,
Business &Professions Code).
1, as owner of the property, am exclusively contracting with licensed contractors to
HAZARDOUS MATERIALS DISCLOSURE
construct the project ($ee.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
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sections 25505, 25533, d 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
/
r Dater A 7 "f 3
Owner or authorized agent: Ac
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
CONSTRUCTION LENDING AGENCY
Compensation laws of California. If, after making this certificate of exemption, I
I
I hereby affirm that there is a construction lending agency for the performance of
become subject to the Worker's Compensation provisions of the Labor Code, must
work's for which this permit is issued (Sec. 3097, Civ C.)
forthwith comply with such provisions or this permit shall be deemed revoked.
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
0-H Trr, r, crrrntr A rr(llD _ RITII .-nIN(: IIIVICION
- 1' 1Jl'J iJ1.1111. y-i a v
--
ADDRESS; 20686 STEVENS CREEK BLVD
DATE: 02/12/20.13
REVIEWED BY: MELISSA.
I'm
APN: 35908028.20686
BP#: !�
VALUATION: $4,800
PERMIT TYPE: Building Permit
1`L<1-�,- C:HEX-'E I'1 PE:
PRIMARY
PENTAMATION 1 CEAP5
Sign
PERMIT TYPE: i
USE:
WORK
**PHILZ COFFEE**INSTALL 2 NEW ILLUMINATED WALL MOUNTED CHANNEL LETTER SIGNS
SCOPE
SIGN TYPE .
FEE ID
QTY
SIGN FEE
Wall Sign, Electric
1SIGNWELEC
1
$266
TOTALS:
1
$266.00
t j'ec,t. hart Check
I'fid}rtl>, I°ftlrt C Ir:°c%
#Branch Circuits 1 $45.00
I'irttnb. I'craiit Fee:
IE5IGN Elec. Permit Fee: IEPERMIT
{3tf:e7/ceh. ht;f.
t.�tfacr f'fartrtl> f, i'
Other Elec. Insp. 0.0. $45.00
;'t�tBClt.:f?7.Sj7..F e.
Pf7unb. IffS;C" F" ";
.Qrbnnl
NOM 1 his estimate noes /tot utctuae fees aue to oturr uepurury. 4- j...• _ .........•6t - ^�•-- • • -• ••-, - - -
_.info -
District, eta). lliese ees are oasea on the reunuuui
FEE ITEMS (Fee Resolution 11-053 Elf. 7111112)
try wrnus.v.. ur......v.c
FEE
........,
QTY/FEE
------------ --
MISC ITEMS
1'j�m C>1teck Pee:
Suppl, PC Fee: � Reg, Q OT
0.0
hrs
$0.00
Permit Fee:
$266.00
Suppl. Insp. Fee:Q Reg. Q OT
0•0
hrs
$0.00
PME Unit Fee:
$45.00
PME Permit Fee:
$45.00
t `r��isfr=ru.°tirrst �'cza':
siL'17Y177Pr:St7"cfflL'@' t�`-E.'L`:
Work Without Permit? 0 Yes (j) No
$0.00
Sign Master Plan: Q Yes (F) No
$0.00
A
Travel Documentation Fee: ITRAVDOC
$45.00
Strong Motion Fee: 1BSEISMICO
$1.01
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$403.01
$0.00 TOTAL FEE: `
$403.01
01, Revised: 01i01t20-1s