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B-2016-3155 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-3155 19968 HOMESTEAD RD CUPERTINO,CA 95014-0556(316 03 039) HOMEOWNER BUILDER OWNER'S NAME: GONG WAYNE YOUNG AND MARY MICHELLE TRUSTEE DATE ISSUED:11/21/2016 OWNER'S PHONE:408-306-4980 PHONE NO: LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class Lic.# Contractor HOMEOWNER BUILDER Date X BLDG _ELECT _PLUMB MECH RESIDENTIAL X COMMERCIAL- 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. JOB DESCRIPTION: INSTALL 1 ILLUMINATED WALL SIGN-CUPERTINO I hereby affirm under penalty of perjury one of the following two declarations: ACUPUNCTURE i. I have and will maintain a certificate of consent to self-insure for Worker's nCompensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. c, /2. 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. Sq.Ft Floor Area: Valuation:$1800.00 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 APN Number: Occupancy Type: and state laws relating to building construction,and hereby authorize 316 03 039 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 PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature Date 11/21/2016 Issued by:Abby Ayende /< ! Date: 11/21/2016 OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS: following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is 1. I,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for compensation,will do the work,and the structure is not intended or offered for inspection. sale(Sec.7044,Business&Professions Code) 2. --'I,as owner of the property,am exclusively contracting with licensed Signature of Applicant: y contractors to construct the project(Sec.7044,Business&Professions Code). Date:11/21/2016 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER i. 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. HAZARDOUS MATERIALS DISCLOSURE 2., I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the Section 3700 of the Labor Code,for the performance of the work for which this0 California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the permit is issued. s. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should I store or handle hazardous material.Additionally,should I use equipment or devices which emit hazardous shall not employ any person in any manner so as to become subject to the air contaminants as defined by the Bay Area Air Quality Management District I Worker's Compensation laws of California. If,after making this certificate of will maintain compliance wi ; i,•C . 1,o- unicipal Code,Chapter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the Health&Sa • '•- .1 , ,.:d 25534. Labor Code,I must forthwith comply with such provisions or this permit shall !'® be deemed revoked. Owner or authorized agent: APPLICANT CERTIFICATION Date:11/21/2016 I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,Civ C.) to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name to save indemnify and keep harmless the City of Cupertino against liabilities, judgments,costs,and expenses which may accrue against said City in Lender's Address consequence of the granting of this permit. Additionally,the applicant understands ARCHITECT'S DECLARATION and will co a no p point source regulations per the Cupertino Municipal Code,Ski oln "`"�► I understand my plans shall be used as public records. Licensed Signatures Z. Date 11/21/2016 Professional d1 — 1 SIGN PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISIONS �,‘ . 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408)777-3228•FAX(408)777-3333•buildinqRcupertino.orq CUPERTINO PROJECT ADDRESS I el /i r ) e,24 C. pe,,A APN# 61(0,_0.b....(89 OWNER NAME. Y a/ ,t��, �j PHONE t4O%` Bob' & EMAIL . , 6_,_. )j NJ STREET ADDRESS t �{ + 1►, „y CITY,,STATE,ZIP i ` �'r'V FAX CONTACT NAME041,9'M , j�,' QI'L PHO E-MAIL v y�ir,b L 141 , ,�`�J k�i.t't�. de,� I . STREET ADDRESS L -tier) !.ry I CITY,ST,TE,ZI FAX J �� , WNER 0 OWNER-BUILDER 0 OWNER AGENT .0 CONTRACTOR 0 CONTRACTOR AGENT 0 ARCHITECT 0 ENGINEER 0 DEVELOPER 0 TENANT CONTRACTOR NAME /Se/.1 f LICENSE NUMBEt ° l 1 LICENSE TYPE BUS.LIC# f� li COMPANY NAME 1®1 iiiefittfrAz to 6gr,,` E-MAILIA) FAX �J e � c C STREET ADDRESS j C{C�-�� 1`� i C Y,ST ��► f eiv p Y e ( 0�+ `4+1,e0 ARCHITECT/ENG EER NAMIV 1 v+vim'' LICENSE NUMBER e C 3 BUS.LIC# COMPANY NAME `�! E-MAIL FAX c STREET ADDRESS tell-12, CITY, ATE, P ��Ul'1 t iettrG�1.[Ja? t�% 0i t , 0 1 tLti,e 6 DESCRIPTION OF WORK � 0(ace A c 9` L4,471--0 p g r 4o j P> 0-0 eL� rvr q AitetK - I USE OF ❑•SFD or Duplex ❑ Multi-Family ILLUMINATED SIGN TYPE NO.OF SIGN AREA VALUATION STRUCTURE: R Commercial ��t(Y/N) (CODE) SIGNSp (SQ.FT.) (I) SIGN TYPE CODES: y l I I `� i SOC,---- B - BANNER SIGN M - MONUMENT(GROUND)SIGN / BL -BLADE SIGN P - PROJECTING SIGN D - DEVELOPMENT ID SIGN SP - SPECIAL EVENT BANNER DI - DIRECTIONAL SIGN T - TEMPORARY E - ELECTRONIC W - WALL SIGN �l 1��� ¢'READERBOARD READERBOARD WI - WINDOW SIGN � V 3 At L'--, RECEIVED BY TOTAL V UATcp 0 By my signature below,I certify to each of the following: I.+.+the property owner or authorize.agent to act on .e property owner's behalf. I have read this application and the information I have pro%^-d is correct. I have -ad the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to bit..a .• , i ction. I autho- representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: /Or' Date: 11'/t"7 /ifillift ., ..Ili$ ONLY SUPPLEMENTAL INFORM ► ► QUIRED OFFICE USE, Site Plan PLAN CHECK TYPE ROUTING SLIP _✓ �v/Elevations u OVER-THE-COUNTER 0 BUILDING PLAN REVIEW Sign Details-including UL listing(s)applicable 0 EXPRESS ❑ I�PLANNING PLAN REVIEW Structural Calculations(if applicable) 0/4 0 STANDARD ❑''OTHER:. Copy of Planning Approval Letter or Meeting with Planning prior to 0 LARGE submittal of Building Permit application. ❑ MAJOR SignApp_2011.doc revised 03/31/11 l OWNER-BUILDER DISCLOSURE FORM .......,,,Ch"-\. COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 0./.,, 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUPERTINO (408)777-3228•FAX(408)777-3333•'buildinq(c�cupertino.orq 'll Dear Property Owner(s): An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at: SITE ADDRESS 9'/ e t `APN .5- 6S�•, / , �y BP# ; W- OWNER NAME nOWNER ADDRESS t Ti 7 a s _ e_ 1 t /7,_ DESCRIPTION OF WO K: e4,C 2 11". bat/B t )1- y ""/,rt 4 s• -7 ( r PeA CJ We are providing you with an Owner-Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner-Builder. We will not issue a building permit until you have read, initialed your understanding of each provision,signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you,the property owner,obtain the prior approval of the permitting authority. 1 OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION (DIRECTIONS:Please read and initial each statement below to signify you understand or verify this information.) V`r i. I understand a frequent practice of unlicensed persons is to have the property ownerlllobtain an"Owner- Builder"building permit that erroneously implies that the,property owner is providing his or her own labor and material personally. I, as an Owner-Builder, may be held liable and subject to serious financial risk for, any injuries sustained by an unlicensed person and his or her employees whileworking on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner-Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. 1`i7 2. I understand building permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. 3. I understand as an "Owner-Builder" I am the responsible party of record on the permit. I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. z. 4. I understand Contractors are required by law to be licensed and bonded in California,and to list their license numbers on permits and contracts. v5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the t�6tal value of my construction is at least five hundred dollars($500), including labor and materials, I may be Viian"employer"under state and federal law. i 6. I understand if I am considered an "employer"under state and federal law,I must register with the state and federal government,withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. N Poi . I understand under California Contractors'ctors' State License Law,an Owner-Builder who builds single-family 1-sidential structures cannot legally build them with,the-intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year,or all of the work is performed under contract with a licensed general building Contractor. )8. I understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for atfy financial or personal injuries sustained by any subsequent owner(s)that result from any latent construction defects in the workmanship or materials. OwnerBuilderForm 2010.doc revised 04/14/10 ,- 9. I understand I may obtain more information regarding my obligations as an"employer"from the Internal revenue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board(CSLB)at 1-800-321-CSLB(2752)or www.cslb.ca.gov for more information about licensed contractors. W10. I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am the party legally and financially responsible for proposed construction activity at the site address listed above. 11. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide b all applicable laws and requirements that govern Owner-Builders as well as employers. C12. I agree to notify the issuer of this form immediately of any additions,deletions, or changes to any of the information I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an.unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. If you obtain a permit as Owner-Builder and wish to hire Contractors,you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. CONSTRUCTION LENDING AGENCY (DIRECTIONS:Please complete the following construction lending agency information.) I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097 Civ.) Lender Name: ���' Lender Address: Before a building permit can be issued,this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note:A copy of the property owner's driver's license, form notarization, or other verification acs-. a. e t. he city maybe required to be presented when the permit is issued to verify the property owner's si.natur Property Owner's Signature: ��� Date: tJIU %► yr ‘10111111, (NOTE: The following Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner-Builder). AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner,the execution of w,ich I understand ' y personal responsibility, I hereby authorize the following person(s)to act as my agent(s)to a••ly for, sign, a : ile the documents',necessary to obtain an Owner-Builder Permit for my project. v jf Mt Scope of Construction Project(or Description of Work).• P 'Ti C6 6I)� � ��5 Project Location or Address: litibe j : # f ape-1w6 ! 8 Name of Authorized Agent: Tel No Address of Authorized Agent: I declare under penalty of perjury that I am the pro,erty owner for the address listed above and I personally filled out the above information and certify its accuracy. Note:A copy of the property owner's driver's license,'form notarization,or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: OwnerBuilderForm_2010.doc revised 04/14/10 STATE OF CALIFORNIA CERTIFICATE OF COMPLIANCE, SIGN LIGHTING CEC-SLTG-1C(Revised 10/10) CALIFORNIA ENERGY COMMISSION Certificate of Compliance (Sign Lighting) (Page 1 of 4) SLTG-1C/ Proect Name: f� 1 (Cid IL I.t t ���������i1 1 mrrb ,,f NYS. I�r Iy4Ioyi,-- e (3u{Ar i14 �C. t�1 1�1�Date; Project eG: ► t TI 19 Location of Sign 'Outdoor Signs 0 Indoor Signs Phase of Sign Construction 0 New Signs 0 Sign Alterations Type of Lighting Control 0 New Lighting Controls 0 Replaced Lighting Controls 0 Not Installing Lighting Controls This Certificate of Compliance includes the following components(check all that apply) Mandatory Measures(Lighting Controls) 0 Maximum Allowed Lighting Power 0 Specific Lighting Sources 1. Certificate of Compliance Declaration Statement(this maybe a Clo C45 or other eligible p � g� a person) • I certify under penalty of perjury,under the laws of the State of California,,the information provided on this form is true and correct. • I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the lighting design. • This Certificate of Compliance identifies the lighting features and performance specifications required for compliance with Title 24,Parts 1 and 6 of the California Code of Regulations. • The design features represented on this Certificate of Compliance are consistent with the information provided to document this design on the other applicable compliance forms,worksheets,calcula'0 1 .lans and specifications submitted to the enforcement agency for approval with this building permit applic.. e Name: tAltu f t-.et/t Signature 'O� t M®"- l : 0 Q Companyti� ttt - Phone IL' p 1 1 (� F Address: i 1 U License numbem a�J> cgp'—C" or''s]lic#) cj. City/State/Zip: fhb ‘ILP r CA E 5-011+ Date ,'l / yi 2. Installation Certificate(to be signed by responsible person after installation) Permit number, ,: . ' Checl d ate - nforceinent:Agency Tse) Ai ; r ;, , (I#iforc,:rittnf Agency use .. Y",ll. Installation Declaration statement • I certify under penalty of perjury,under the laws of the State of California,the information provided on this form is true and correct. . • I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction,or an authorized representative of the person responsible for construction. • I certify that the installed features,materials,components,or manufactured devices identified on this certificate conforms to all applicable codes and regulations,and the installation is consistent with the plans and specifications approved by the enforcement agency. • I certify that the requirements detailed on this Certificate of Compliance have been met. • I will ensure that a completed,signed copy of this Installation Certificate shall be posted,or made available with the building permit(s)issued for the building,and made available to the enforcement agency for all applicable inspections. I understand signed copyrequired documentation the builder provides to the that a si ed of this Installation Certificate is re aired to be included with the building owner at occupancy. Company Namei � ka tit ,i4P AIIIIP Responsible erson's ame: Respq.nns le Person's 1. ,e ��`` VVCt License numbe be contr r s lic#) Date gne' : Position With Company: �..._ nix' t t tibIov 2008 Nonresidential Compliance Forms October 2010 • STATE OF CALIFORNIA CERTIFICATE OF COMPLIANCE, SIGN LIGHTING CEC-SLTG-1C(Revised 10/10) CALIFORNIA ENERGY COMMISSION ,031.4 Certificate of Compliance (Sign Lighting) (Page 2 of 4) SLTG-1C Project Name: Dater 1 egitl:f RITAVeiVrtif af-AHtitol) AatruitrAUtt 3.Mandatory Sign Lighting Controls NOTES: 1. The same responsible person may install both the sign lighting power and the sign lighting controls, or a different responsible person may install the sign lighting controls than the responsible person installing the sign lighting power. 2. The Mandatory Measures(sign lighting controls)are required for compliance with the sign lighting Standards.If the person responsible for installing the sign lighting power is not also responsible for the sign lighting controls, then the owner of the sign,general contractor,or architect shall be responsible to have the sign lighting controls installed. 3. If more than one person has responsibility for compliance, each responsible person shall prepare and sign a Certificate of Compliance and an Installation Certificate applicable to the portion of construction for which they are responsible; alternatively, the person with chief responsibility for construction shall prepare and sign the Certificate of Compliance Declaration Statement for the entire construction. 3a. Statements of Responsibility:Any person signing the Certificate of Compliance Declaration Statement on page 1 of 4 on this SLTG-1 C shall complete Part 3a.Check Yes or No for all of the following statements: 1 ha ye responsibility for installing the sign lighting controls [ es,complete parts 3a and 3b of this form 0 No,complete part 3a of this form 2 I'e.Ees sign gh. g 0 No compliantlighting controls The -are no existinglighting controls and I will be installing sign 3 There are no existing sign lighting controls and someone else will be responsible to install compliant sign lighting controls DYes 0 N There are existing sign lighting controls that do not comply with the applicable provision of§119 and§133 and I will be 4 ins alling compliant sign lighting controls E1Yes ❑No There are existing sign lighting controls that do not comply with the applicable provision of§119 and§133 and someone else 5 wiltbe responsible to install compliant sign lighting controls 'Yes ❑No 3b.Mandatory Sign Lighting Controls If the person signing the Certificate of Compliance Declaration Statement on page 1 of 4 of this SLTG-1 Cis responsible for complying with the sign lighting control requirements,that person shall answer all of the following questions: If there are construction documents,indicate where on the building plans the mandatory measures(sign lighting control)note block can be located: 1 applicable requirementsAllor lightingis controlled with an automatic time switch control that complies with the Y N NA ( ) sign � p ppl § [ 0 0 §133(a)1 and 2. All outdoor sign lighting is controlled with an automatic time switch control plus a photo Y N NA 2 control,or an outdoor astronomical time switch,that comply with the applicable requirements of§119. E3" Exception to§133(a)2. Outdoor signs in tunnels or large covered areas that require illumination during Y NA daylight hours. 0 [ice §133(a)3. All outdoor signs are controlled with a dimmer that provides the ability to automatically reduce Y N NA sign power by a minimum of 65 percent during nighttime hours. 0 0 CV Exception 1 to§133(a)3.Si s illuminated for less than one hourper dayduringdaylight hours. Y NA P � � ❑ ig" 3 Exception 2 to§133(a)3. Outdoor signs in tunnels or large covered areas that require illumination during Y NA daylight hours. 0 LEP Exception 3 to§133(a)3.Only metal halide,high pressure sodium,cold cathode,or neon lamps used for Y NA illuminating signs or parts of signs. §133(a)4. An Electronic Message Center(EMC)having a new connected lighting power load greater than Y N N/A response g by lighting power by percentwhen 0 ISK 4 receivinga demand signal that is sent out the local utility. 15 kW has a control installed capable of reducing �life safety u o regulation,30 Y NA Exception to§133(a)4.EMC required by a eastatue,ordinance, including but not limited to exit signs and traffic signs. 0 [ Field Inspector Notes: 2008 Nonresidential Compliance Forms October 2010 STATE OF CALIFORNIA CERTIF�CATE10OF COMPLIANCE, SIGN LIGHTING/10) CALIFORNIA ENERGY COMMISSION , Certificate of Compliance (Sign Li hting) (Pa e 3 of',4) SLTG-1C Project Name: , x - Le/ ✓ '�--, ' iaii/i� 1 iYIinY / C A t`+ r, Date: r V 11/ 4 4.Maximum Allowed Lighting Power Method of Compliance Certificate of Compliance and Field Inspection Energy Checklist Complete this part if there are signs using the maximum allowed lighting power method of compliance.(Complete part 5 of this Certificate of Compliance if there are signs using the S ecific lighting sources method of compliance) A B C D EIF G H I Allowed Watts Design Complies?lies? ; 1, Watts ' Y/N t 4. -a Field 3L Inspector z _ 0 a` at Check that t w xo v Sign o 0 ee07c'i CD A e � r" N AComplies rn ON a 0 f III o II t �4 tearW Q c a, Uo '° o ° E" Description El 11 A 13 ❑ D 0, A Symbol or code used on the plans(when plans are required)and other documents. ,B A narrative description of the sign,or location of sign on the building;and the location of sign on construction documents. OPTIONAL-Check this box only if this sign has a permanent,pre-printed,factory-installed,ENERGY VERIFIED label,confirming that the sign complies with the Section 148 of the California 2008 Title 24,Part 6 Standards,using the Maximum Allowed Lighting Power method of compliance. The only labels that will be recognized for this purpose are ENERGY VERIFIED Certification Marks authorized C by Underwriters Laboratories(UL)or other Product Certification Body accredited to ISO/IEC Guide 65 by the American National Standards Institute in accordance with ISO/IEC 17011.Surveillance by the Accredited Certification Body shall be an ongoing annual inspection program carried out by a Type A Inspection body in accordance with ISO/IEC 17020.For signs with such an ENERGY VERIFIED label,columns`D'through`I'are not required to be filled out.Note:Using an ENERGY VERIFIED label is an optional method to validate compliance.An ENERGY VERIFIED label is not needed for compliance. D The sign area in square feet. E List"I"if the sign is internally illuminated. List"E"if the sign is externally illuminated. F Allowed watts per square foot. Enter 12 if the sign is listed as"I"in column E.Enter 2.3 if sign is listed as"E"in column E. G Multiply the square footage in column D times the allowed Lighting Power Density(LPD=watts)in column F. H Show the total installed watts in the sign,as determined according to the applicable provisions of§130(d or e). I Enter Y if the number in column H is less than or equal to the number in column G. Otherwise,the sign does not comply. J This page doubles as a field inspection checklist. Field Inspector Notes: 2008 Nonresidential Compliance Forms October 2010