08040217BUILDING DIVISION PERMIT
BUIL91 ApD0.E55:
lyg7U5 STEVENS CREEK BLVD
HENRY'S DESIGN & SIGN CO
PERMIT NO.
08040217
R'S NAME:
PERMIT ISSUE DATE
YAMAOKA COMPANY
04/30/2008
PHONE:
SANITARY NO. CONTROL NO.
(408)269-0888
ARCHTIEC (ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB - MECH
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION
]b Description
o
licensed under Provisof Chapter 9 (commencing
1 Malty of lmt Nu I am ion
P
with section 7000) of Division 7 of for Business and Proessiow Code, and my licensee
CHANNEL LETTERS
In full forte end effect.
License Clua 1 =gZzi L1.1 n
Dam Conuanor
7� ARCHf ecrs DECLARAT ON
1 underwnd my plans shall M used as public recorea
Licensed Professional
OWNER -BUILDER DECLARATION
1 Mrthy aRnn that I am attempt [rum the Commences License Law for 0m
following mason. (Section 7071.5, Business and Plofesdow Cade: Any city or county
which t mA. a Permit in conune4 alcor, improve, demolish, or repair any swmurt
Prior in its iou tr m. alts requires the applicant forsuch permit m file a signed ummcnt
that M m licensed mlire n or the contractor's U== Law(ehapter9
Sq. Ft. Floor Area
Valuation
pursuant
provisiom
2700
Rear encingoes.{ with sdmi 1000) of Division S of the Business and Rofcsimts Cod u or
that he Is eWnpt uCmfmm Nd VC Wam far the alleged caenlpdpL Any Aol.d. of
W LT
Occupancy Type
Section 7@31.5 by airy applicant fora permit subjects the Applicant to • civil Penalty Ofumber
tet come than five hundred dollm (500).
31620083 .
Q I,nw oratepmpcny,mmyemployeewithwagesudohtomcmnpenseumi,
Required Inspections
willdc, Newark and the uuctum m rot Gunned orolficam forsake (Sec. RN4, Badtm
and Profession Cade The Camraclor's License taw does net apply m an owner of
property who Mildsorimprovee thercan.andwho dues suchworkhi amifor Waugh his
own employers, provided that such imprawmms..at intended oraRered fmsma. If.
however, the building or Improvement lasold within am year ofcompletion. the Owner.
'
builder will Mve the burden of proving that he did not Mid or Improve for purpose of
um.).
Q L as Owner of the Property, am mGusively contracting with licensed contract. to
construct the project (Sec. 7044. Bummers and Profcsalons Cade:) The Conuaemr's U.
coma Law docs ani apply to in owner Of propemy who builds or improves Merton. and
whocontracu nonsuch projects with •contracmRa) licensed pursuant m the Combactoes
License Law.
am umapl undo See s B k P C far Nb reason
Data
WORKER'S COMPENSATION DECLARATION
1 thereby affirm under pmairy of perjury one of the following declarauan:
VMve and will mmnuin a Cault Of Consent m self -inure fm WorkefaCompn-
se mi, u provided fan by section 37M of the Labor Cann. far the performance of tM
work for which this permit in lensed.
❑ 1 Mve and will mainuie WorkeYs Compewtion Ituur . as u q.tred by Section
3700.17ft lsbm Come far the pedo.. Of the work for which this Permit is cooed.
.
My Waimea Compoutiom Werarum carrier and Policy mouser art:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
rntGsectlmi need nottecompleted Ban permit la formic hundred dollen ($100)
or mss)
1 ceNfy Net In the Performance of use wart for which this Permit is hound, l shall not
employ anyPesaan In any man �mMcome sebjwID the Worken'Comprnntlan
In mct�
a�c!Msubjcct
LawnofnyNnal
NO ICEtTO APPUCANrS If, 1 n= 2 m7Cenil%lR e(.GcmPuan, you mould
become subject in the workers Compmadon pmv sho, of lite Mbar Codc, you mum
foMwith comply with inch proviainn or this Permit shall be demand rocked.
CONSTRUCTION LENDING AGENCY
I thereby affirm that then U n construction landing agency far do performance of
sire work for which th s pomp Is issued (Sec. 3097, Civ. C)
Leader's Name
Lermea Address
1 cattily that 1 have rod this application and sum that the aMve Information Is
comm 1 agree an comply Mut an city and county ordinances and sum laws reading m
building construction. atW hereby osmesis rtpresmutives of this City m seta upon f
above -menu med Property for inspection Purport -
(WO) agree to save indemnify and keep harmless site City of Cupertino againn
Ilabilidn.jud{menu. cam and erpemu which may in any way scone against said City
in consegwnce of the swung of this Permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date—//
SOURCE RECULATI
Re -roofs
Type of Roof
Signature of App lcant/Cantrecmr Dem
HAZARDOUS MATERIALS DISCLOSURE
WIII do apPlieant ver fattens building aceupanl antro orhannla harallow maurid
fined by the Copanine Municipal Com, Chapter 9.13, and the Health and Safety
Sec0 an zs53z(.)7
❑Yn 14No
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
WIII the applicant or future building occupant lire equipment or mvicea which
colt havANous dr contaminants as defied by the Bay Ama Air Quailty Management
all new materials for inspection.
District?
❑Yes flu
I have read timhuaNausO daUmquimmrmmummr Chaplcr6.95ofWCalifor-
nWli,A]"Saimy Cam,Smtiw355I15.25533and2553d.lur4.0 WmmifNc Gilding
does Out currently ban a 4YIanl that it 4 my responsibility m wily dC accupanl of dC
rt mmmenm which mull be met pion he a f. Caditnmaroceulraney.
Signature of Applicant Date
All roof coverings to be Class'¢" or better
Owner
or authmind agent Dam
CITY OF CUPERTINO
BUILDING DIVISION PERMIT
CVT'It�iCTC1RItR1it1OiN, :a
BUILDING ADDRESS:
19705 STEVENS CREEK BLVD
HENRY'S DESIGN & SIGN CO
PERMIT NO.
08040217
OWNER'S NAME:
PERMIT ISSUE DATE
YAMAOKA COMPANY
04/30/2008
PHONE:
SANITARY NO. CONTROL NO.
(408)269-0888
ARCHITECTIENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
I hereby licensed Chapter 9
Job Description
p
affirm that I am under provisions of (commencing
with Section 7000) of Division 3 of the Business and Professions Code, and my license is
CHANNEL LETTERS S IZ,,`7
in full force and effect
License Class ^ r Lie. k 0
Date 6 Contractor
ARCHITECTS DECLARATION
I understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractors License Law for the
following reason. (Section 7031.5, Business and Professions Code: Any city or county
which requires a permit to construct, alter, improve, demolish, or repair any structure
prior to its issuance, also requires the applicant for such permit to file a signed statement
that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9
Sq. Ft. Floor AreaValuation
(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
$2700
that he is exempt therefrom and the basis for the alleged exemption. Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
�pj�j_Number
L
Occupancy Type
P Y
not more than five hundred dollars (5500).
31620083 .`1i1��
YP
❑ 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
Required Inspections
and Professions Code: The Contractors License Law dors not apply to an owner of
property who builds or improves thereon, and who does such work himself or through his
own employees, provided that such improvements are not intended or offered for sale. If,
however, the building or improvement is sold within one year of completion, the owner -
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
❑ I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec. 7044, Business and Professions Code:) The Contractor's Li-
cense Law docs not apply to an owner of property who builds or improves themon, and ,
who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's
License Law.
❑ I am exempt under Sec , B & P C for this mason
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
have and will maintain a Certificate of Consent to self-insum for Workers Compen-
satton, as provided for by Section 3700 of rhe Labor Code, for the performance of the
work for which this permit is issued.
❑ I have and will maintain Worker's Compensation Insurance, as required by Section
3700 of the Labor Codc, for the performance of the work for which this permit is issued.
'
My Worker's Compensation Insurance carrier and Policy number am:
.
Cartier. Polity No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars (3 100)
or less.)
1 cenifv that in the performance of the work for which this permit is issued, I shall not
employ any person in any man r1e soda to become subjtY the Workers Compensation
Y–
Laws of Californf Datc � --� — B
Applicant 7
NOTICE TO APPLICA . If, atter ng fhrs cThRea mpuon, you should
become subject to the Worker's Compensation provisions of the Labor Code, you must
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
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. C.)
Lender's Name
Lenders 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, costs and expenses which may in any way accrue against said City
in consequence of the gtaming of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
[�
Issued by: Date
SOURCE REGULATI
Re -roofs
SignazureofApplicanVContractor Date
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will the applicant or future building occupant stom or handle hazardous material
as defined by the Cupertino Municipal Codc, Chapter 9. 12. and the Health and Safety
Code, Section es 25532(a)?
Yes Qd No
All roofs shall be inspected prior to any roofing material being installed.
Will
If a roof is installed without first obtaining an inspection, I agree to remove
the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management
all new materials for inspection.
District?
❑ YC
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&SatctyCode,Scctions25505.25533and 25534.1understand that ifthc building
does not currently have a tenant that it is my responsihilfty to notify the occupant of the
requirements which must be met prior to issuance of a Certificate of Occupancy.
Signature of Applicant Date
t
� 14
All roof coveringso be Class".. ., or better
Owner or authorized agent Date �
CITY OF CUPERTINO
SIGN
CUPEI�IFINO PERMIT APPLICATION FORM
APN #
(,,)
Date:
Building Address:
I gjo5 S 11 v H 5 Cl��=�1� B w9,
Mllf*Mo, rA
Mailing Address (if different from building address): .
10m �,uu-m-, kVA 16o CUV'�KTO�
, (4_
J
Owner's Name: ,4 CZj
Phone #:
3
Contractor: }j r �` ISS r�l\1 /'
Phone #: q g
Fax #:
Contractor License #:
Cupertino Business License #:
\ 71�- �� o
Contact:
Phone #: �{ o g 3 6$ X 0
"l U- q )
Fax #: �09 �-� 6 Py
Building Permit Info:
Bldg �. Elect Monument ❑
Mounted on Building
Residential ❑ Commercial
Job Description:
Valuation (cost of project):
Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the
application or if applicable, include in plan set & the
sheet index.
CITY OF CUPERTINO
ZSIGN
OF
CUPEVIINO FEE SCHEDULE
Quantity
Fee ID
Fee Description
Fee
Group
Permit 'Type
1SIGNDIRECT
Directional
B
1SIGN/RF
Ground/Roof/Projecting Signs
B
1 SIGNMASCK
Master Plan Sign Check
B
1 SIGNREWRKG
Rework of any existing Ground
Sign
B
1 SIGNOTHER
Other Sign
B
1 SIGNREINSP
Re -inspection Fee
B
1 SIGNWNONEL
Wall/Awning Sign, Non-
Electric
B
_
1 SIGNWELEC
Wall, Electric
E
IESIGN
Sign, Outline Lighting. System
or Marquee supplied from one
branch
E
10EAP5
IESIGNADD
Additional Branch Circuit on
Same Sign, Outline System or
Marquee
E
10EAP6
1 ELCPLNCK
Plan Check Fee
E
EPERMITFEE
Electric Permit Fee
E
/
BSEISMICOM
Seismic Commercial
B
BSEISMICRE
Seismic Residential
B
TRAVDOC
Travel & Documentation
B
f
BUSLIC
Business License
B
5
1
CITY OF
CUPEQ'INO
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
Building Department
JOB ADDRESS: 9 ) ,
PERMIT #
OWNER'S NAME:
PHONE # -fe-o a 0 8 8
GENERAL CONTRACTOR:
FAX # <-.
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
Owner/ Contractor Signature Date
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
ar
Cement Finishing
Electrical S�
'S s>
Excavation
Fencing
Flooring: Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/ Contractor Signature Date
File Edit Actions Details Links Favorites Help
JW 4
Permit Number "
08040217
APN
31620083.DNTL
NO INPSECTIONS
^f Overrides
Status
F
E - Expired
Unit
Master Number
FILMED 5/2011
Notes 0
e Project
Fees
Apply Date "
04/30/2008
Operator patg
Permit Issue Date
04/30/2008
Operator patg
yl...� Inspections
Address
Certificate Issued
Operator
Certificate Type
I� Print Permit
CitylState/Zip
Certificate Number
Adjustments
Permit x Property
Zoning Applicant
Contractor x Defined Fields
Permit Details
Permit Type "
1 CEAP5
QI
SIGNS, OUTLINE LIGHTING & MARQ
Usage Class x
N/A
IQI
NON APPLICABLE
Applied Value x
2700
SQUARE FT.
0
Calculated Value
0 ISI
US C-404 Type
437
IQI
ALT: NON -RES, NON-HSKPG
Permit Form "
AUTOPERM - PERMIT
Ownership
I
1 - Private
f Project Size
Permit issued 0413012008
Enter the purpose or any special conditions for this permit
Address x I 19705 STEVENS CREEK BLVD I a/OK
City/State/Zip CUPERTINO CA 95014
I4* Back
APN
31620083.DNTL
NO INPSECTIONS
^f Overrides
PERMIT EXPIRED 10/30/08
Jr- Contractors
Unit
Supplement
FILMED 5/2011
Fees
Attachment:
(Owner Name
xI YAMAOKA COMPANY
(;,Plan Review
Use Default
yl...� Inspections
Address
Other - 20200 LUCILLE AVE #60
I� Print Permit
CitylState/Zip
CUPERTINO CA 95014
Adjustments
Purpose/Special Conditions
L:opy Hermit
ILLUMINATING SIGN CHANNEL LETTERS
I Close Permi
NO INPSECTIONS
^f Overrides
PERMIT EXPIRED 10/30/08
Supplement
FILMED 5/2011
Notes
Attachment:
ILW' -- - -.--.. .