12080333 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20670 STEVENS CREEK BLVD CONTRACTOR:NORTHWEST SIGNS PERMITNO: 12080333
OWNER'S NAME: DYER PROPERTIES 1.1, 120 ENCINAL ST DATE ISSUED:001/2012
OWN 'S PIIONF,: 4156267844 SANTA CRUZ,CA 95060 PRONE NO:(831)169-8208
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL.0 COMJIERCIAL
13
License Class C S Lic.9 -?8(D 95 EAST WEST YOGA INSTALL ILLUMINATED SIGN
,
Contractor /Vl1�tW-QI+ SIQAi Datc 0'7 � -� Z EXTERNAL
hereby affirm that 1 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 perjursone of the following two declarations:
1 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:$2800
I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for die performance of the work for which this APN Number:35908020.20670 Occupancy Type:
permit is issued.
APPLICANT CERTI FIC TION
I certify that I have read this application and state dial 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 DA ' OM LAST CALLED INSP TION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accme against said City in consequence of the 197
granting of this permit. Additionally,the Tplicanl understands and will comply Issued by': � / " r Date: 3�
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
v . ;�'. ) L RE-ROOFS:
Signature Date V All roofs shall be inspected prior to any rooting material berg installed.If a roof is
installed without first obtaining an inspection,I agree to remove all new materials for
inspection.
❑ ONVNER-BUILDFR DECLARA'T'ION
Signature of Applicant: Date:
hereby affirm that I am exempt from the Contractor's License Law for one of
the following tyro reasons: AI,1,ROOF COVERINGS TO RE CLASS"A"OR BE'1-I'F.R
I,as owner of the property,or my cuployms 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)
I,as owner of the property,am exclusively contracting with licensed contractors to IIAZARDOIIS DIATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
California Ilealth&Safety Code,Sections 25505.25533,and 25534. I will
1 hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: Ilealth&Safety Code,Section 25532(n)should 1 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 dhe Labor Code,for the air contaminants as defined by the Bay.Area Air Quality Management District I
performance of the work for whichdhis permit is issued will maintain compliance with the Cupertino Dlunicipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Cade,Sections 25505,25 3,ym.125534.
Section 3700 of the Labor Code,for die performance of the work for which this J 31 7t
Owner or authorized ogagent: Date: l�
permit is issued
I certify that in the performance of the work for which this permit is issued,I shall
not employ any person many manner so as to become subject to the Worker's
Compensation laws of California. If,after making this certificate ofexemption,1 CONS'T'RUCTION LENDING AGENCY
become subject to die 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
A PPLI CAN-f CERTI FICTION Lender's Address
1 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, ARCIIITECT'S DECLARATION
costs,and expenses which may accrue against said City in consequence of dm 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
BYER PROPERTIES 66 OAVENUE
SAN FRANCISCO, CA 94103
PHONE(415) 626-2937 FAX(415)626-2767
August 29, 2012
City of Cupertino
Cupertino, CA 95014
Re: East West Yoga
20670 Stevens Creek Blvd., Cupertino
This is regarding the new sign going up for East West Yoga. The electricity feeding this
sign is Title 24 Compliant.
Thank you.
Sincerely,
Raissa
Property Manager
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 20670 stvns crk blvd. DATE: 08/23/2012 REVIE\VED BY: bobs.
APN: BP#: 'VALUATION: $2,800
*PERMITTYPE: Building Permit PLAN CHECK TYPE:
PRh',IARY PENTANIATION 10EAP5
USE: Sign PERMITTYPE:
WORT: install illuminated sign external.
SCOPE
SIGN TN,Pi,' FEE ID QTY SIGN FEE
Wall Sign, Electric 1SIGNWELEC 1 $266
TOTALS: $266.00
Xlech.Plan Check Plumb.Plan Check # Branch Circuits 1 $45.00
Mech. Perwil Fee: Plumb,Permit Fee: IESIGN Elec. Permit Fee: IEPERhl1T
Oder,l1cch.Insp. Orhrr Plumb lnsp. LJ
Other Elec. Insp. 0.0 $45.00
Mech. ln.sp.Fee: Plumb. htsp. Fee: Elce.Insp.roe:
A'OTE: This estimate Anes not includefees due to atter Departments(i.e:Planning, Public Works, Tire,Sanitary Sewer District,School
District, etc.). These feev are based on rte prelinanan information available and are onh,an estimate. Contact rite Dept for addn'I in a.
FEE ITEMS (Fee Resolution 11-053 Eff 71111 U FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Suppl. PC Fee: Q Rcg. Q OTFO-OThrs $0.00
Plumb.hllech./Elec
Permit Fee: $266.00
Suppl. Insp. Fee0 Reg. Q OT 0,0 hrs $0.00
PME Unit Fee: $45.00
PME Permit Pee: 7-17 $45.00
Consltvction Tax:
Administrative Fee:
Work Without Permit? O Yes (F) No $0.00
Sign Master Plan: Q Yes (D No $0.00
Travel Documentation Fee: ITRA I DOC $45.00
Strove Motion Fee: IBSEISMICO $0.59 Select an Administrative Item
Blde Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $402.59 $0.00 TOTAL FEE: $402.59
Revised: 07101/2012
SIGN PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 2
10300 TORRE AVENUE •CUPERTINO,CA 95014-3255 r\3 J�
GUPERTINO (408)777-3228• FAX(408)777-3333 • building0cupertino.org v
PROJECT.ADDRESS 9-06-70 s Uens Cfe& Dod. " x0 rJ S al o 0 2�
OWNER HMIE rO r �� Ptl Nj E-SL41L /t rJ
O.1 b Qr.com
STREET.SDDRESS n c': STATE. 1 FAX
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CONTACT NMIE RA J\Qrd R-1 610 PHONE q31• r/L - (1 f�/I E-SLED.
STREETADDRESS ' n S Cm'.STA .LP l�U �Q JV� FAC B3 . /
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❑OWNER ❑ OPTTJt-BIIRDER ❑ OP'NER AGENT CONTRACTOR ❑CONTRACTORAGENT ❑ NtCTBJECT 0 ECGL\'EEit ❑ D=OPER ❑TENAN-T
CON. ACTORN.WE 3A
)Ffaf\�\ LICECSENUMHER.wb lllleT4 _ BDS.LKZ
COSIP.ANY NASHi Nof-4�WZIA SIRnS CEm.SI.AISTATE.2pilG . R+
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STREEADDRESS 120rue 4- oPHV51 -L169.8Zo
ACHITECIENGTNEERNMIE LICENSE NUSBER
BUS.LICv
COUP.M'Y N.WE 1V E-MAR. F.iC
STREET ADDRESS Cm'.STATE ZIP PHONE
DESCRIPTION OF WORE p
Jew s.zf- bu lCY( 1,1v
)e\ r I rh n �P (2kantlef tfPrj
USE OF ❑ S-U or Duplex ❑ Multi-Family ILUNUNATED SIGN ME NO.OF SIG]AR V.ALUATIOS
STRUCTURE: II- omnerClal D'IN7 (CODE) SIGNS (SO.FT.) (S)
SIGNTI'PE CODES: W 32 OpE/C)
B - BANNER SIG\ NJ - SIONUMENT(GROUND)SIGN
BL - BLADE SIGN P - PROJECTING SIGN
D - DE\ELOPSIENT m SIGN SP - SPECLAL EVENT BANNER
DI - DIRECTIONAL SIGN T - TESIPOItABY
E - ELECTRONIC R' - w.ALL SIGN
READERBOATID NT - WINDOW SIGN
RECEIVED BY: /' TOT, \'.V.t.DIOON:
By my signature below.I certify to each of the following: I am the property owner or amhorized agent to act on the property owner's behalf 1 mve read this
application and the information 1 have pmrided is correct. 1 have read the Description of Work and verify it is accum e. 1 agree to comply with all applicable local
ordinances and state laws relating to bm ng c traction. u ze represe ativcs of Cupertino to enter the above,-iiddcnti ied pro em'for inspection purposes.
Signature of ApplicanttAgene "_- K Date: y �Z3 [�
SUPPLEMENTAL INFORMATION REQUIRED orrice USE ONLY
_ �, PLEAS CHECK II'Pt: ��ROtiTTNG SLIP
Site Plan
IM et•xtiOnS T O\'EH-THE-COUNTER ur BLr t/'ILyISG PIA?MVIEW
n )ctails-including UL listing(s)applicable ❑ EYPREss L7 rLANNING PLAN IIEVIEw'
Structural Calculations(if applicable) ❑ STANDARD ❑ OTHER:
_tL'Copy of Plannin_e Approval Letter or Meeting with Planning prior to ❑ LARGE
submittal of Building Permit application. ❑ MAJOR
Signdpp_2011.doc revised 03/31/11
Certificate of Com liance (Sign Lighting) (Page l of 4) SLTC-1 C
Project Name: Q (N f . 'PS-� \�O Date: S .
'1, . 12-
Project Address: 1 d�
0670 Sfi-�eutns C(ze.k Blue C-lo
Location of Sign g Outdoor Signs ❑ Indoor Signs
Phase of Sign Construction New Signs ❑ Sign Alterations
Type of Lighting Control ❑ New Lighting Controls ❑ Replaced Li Mine Controls I*Not Imialline Liehtine Controls
This Certificate of Compliance includes the following components(check all that apply)
❑ Mandauny Measures(Lighting Controls) ❑ Maximum Allowed Lighting Power C Specific Lighting Sources
1. Certificate of Compliance Declaration Statement (this may be a Clo.Cos or ower eligible person)
I certify under penalty of perjury,under die laws of the State of California,the information provided on this form is true and
correct.
1 am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the lighting design.
This Cenificate of Compliance identifies the lighting features and performance specifications required for compliance with
Title 24, Parts I 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,calculations,plans and specifications submitted to the
enforcement agency for approval with this building permit application.
Name: Signature
\ P\o�ct
Company Phone
we\ 1 ns 331. 46 . ?2 ws
Address:2 0 _ y License number(matv�be contractor's He#)
City/State/Z`tJp: C Z C S O(0Q Date
2. Installation Certificate(to be signed by responsible person after installation) S
Permit number Chocked bv/Dmc
(Enu..t Agy Um (Enfinecmrnt Ag.Use)
Installation Declaration statement
I certify under penalty of perjury,under the laws of the State of California.the information provided on this form is we 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 responsiblefor 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 cenifv that die requirements detailed on this Certificate of Compliance have been met.
I will ensure that a completed,signed copy or 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. 1 understand
that a signed copy of this Installation Certif tate is required to be included with the documentation the builder provides to the
building owner at occupancy.
Company Name:
/jdri-I 4 S( oS
Responsible Person's Signature:
Responsible Person's Name:
License number((may be contractor's he=) Date Signed: Position With Company:
7
l Ol/0 `3S
2008 Nonresidential Compliance Forms October 2010
Certificate of Com liance (Sign Lighting) (Pace 2 of 4) SLTG-JC
Project Name: C-44
Werc7+ `�O Dam: p
1� 12-
3.
Z3. 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 cotrols than the responsible person installing the sign lighting power.
2. The,Wri ndaroty 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. 1f Pnore 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 consnvction for which them are responsible;
alternatively, the person with chief responsibilin,for consnvction shall prepare and sign the Certifrcare of Compliance
Declaration Statement for the entire construction.
3a. Statements of 12esponsibilit.N': Any person signing the Certificate of Compliance Declaration Statement on page 1 of
4 on this SLTG-I C shall complete part 3a.Check Yes or No for all of the following statements:
I I have responsibility for installing the sign lighting controls
❑ Yes.complete parts 3a and 3b of this form 15rNo,coo tete 2ari 3a of this form
I There are no existing sign lighting controls and I will be installing compliant sign lighting controls
❑ Yes 62No
3 There are no existing sign lighting controls and someone else will be responsible to install compliant sign lighting controls
I=Yes 6rNo
There are existing sign lighting controls that do not comply with the applicable provision of§119 and §133 and I will be
4 installing compliant sign lighting controls
❑ Yes ERNo
There are existing sign lighting controls that do not comply with the applicable provision of§119 and§133 and someone else
5 will be responsible to install compliant sign lighting controls
❑ Yes 19 No
3b. Mandaton, Sign Lighting Controls
If the person signing the Certificate of Compliance Declaration Statement on page 1 of 4 of this SLTG-IC is responsible for
coo (vine with the sign lighting control requirements,that person shall answer all of the followingquestions:
If there are construction documents,indicate where on the building plans the
mandatory measures(sign lighting control)note block can be located:
N
1 §133(a)1:All indoor sign lighting is controlled with an automatic time switch control that complies with the 1' NA
a licable re uirements of§119. ❑ ❑ I ❑
§133(a)l and 2. All Outdoor sign lighting is controlled with an automatic time switch control plus a photo Y N NA
control,or an outdoor astronomical time switch,that comply with the applicable requirements of§119. ❑ ❑ ❑
Exception to §133(a)2. Outdoor signs in tunnels or large covered areas that require illumination during Y NA
daylight hours. ❑ El§l33(a)3. All outdoor sips are controlled with a dimmer that provides the ability to automatically reduce Y N NA
sin power by a minimum of 65 percent durin nighttime hours. ❑ ❑ ❑
Exception 1 to§133(x)3.Signs illuminated for less than one hour per day daring daylight hours. } NA
3 Exception 2 to§133(x)3. Outdoor signs in tunnels or large covered areas that require illumination during Y NA
daylight hours. ❑ ❑
Exception 3 to§133(x)3.Only metal halide,high pressure sodium,cold cathode,or neon lamps used for Y NA
illuminating signs or parts of signs. ❑ ❑
§133(x)4. An Electronic Message Center(EMC)having a new connected lighting power load greater than N N/A
15 kXV has a control installed capable of reducing the lighting power by a minimum of 30 percent when ❑ ❑ ❑
4 receiving a demand response sinal that is sent out by the local utility.
Exception to§133(a)4.En'IC required by a health or life safety statue,ordinance,or regulation,including T NA
but not limited to exit signs and traffic signs. ❑ ❑
Field Inspector Notes:
2008 Nonresidential Compliance Forms October 2010
Certificate of Compliance (Sian Lighting) (Page 3 of 4) SLTC-IC
Project Name: �S+ �� `JO Dau:
4. Maximum Allowed Liehtine PoNver Method of Compliance
Certificate of Compliance and Field Inspection Energy Checklist
Complete this pan 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 li hting sources method of com liance)
Q C U E F G H 1 J
Allowed Watts Design Complies?
Watts Y/N
z
c
U J V L
L U
V c O v t]r c VI
T 1>
� Nr�' Field
Inspector
Y = ° u it c u IT
= Check that
rn _ < " < U Sign
. L
Complies
Description
❑ ❑
❑ ❑
❑ ❑
A Svmbol or code used on the plans(when plans are required)and other documents.
B A narrative description of the sign,or location of sim 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,conftmting that
the sign complies with the Section 148 of the California 2008 Title 24,Pan 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'Fare not required to be filled out.Note:Using an ENERGY VERIFIED label is an optional
method to validate compliance.An ENERGY VERIFIED label is nes 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 extemally illuminated.
F Allowed watts per square foot. Enter 12 if the sign is listed as"I"in column E.Enter 2.3 if sin 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 I1 is less than orequal to the number in column G. Otherwise,the sign does not comply.
J This page doubles as a field ins cetion checklist.
Field Inspector Notes:
2008 Nonresidential Compliance Forms October 2010
Certificate of Compliance (Sign Lighting) (Page 4 of 4) SLTG-1C
Project N Z/'0-
W-0 O G Date:
5. Specific Lighting Source Method of Compliance
Certificate of Compliance and Field Inspection Energy Checklist
Complete this part if there are signs using the Specific lighting source method of compliance. (Complete part 4 of this
Certificate of Compliance if there are signs using the maximum allowed lighting power method of compliance)
A B C D E
OPTIONAL Field
ENERGY Specific light source used for Inspector
Symbol VERIFIED compliance
or Description label Shall include only lighting Check that
Code (see instructions technologies listed below Sign
bem�w) List all that apply Complies
I/
c>L llJor� �o Ohannel A r ° --7 °
❑ ❑
❑ ❑
❑ ❑
❑ ❑
A Svmbol 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 buildine:and the location of sign on construction documents
C OPTIONAL-Check this box only if this sign has a permanent,pre-printed,factory-installed ENERGY VERIFIED label,confirming that
this sign complies with the Section 148 of the California 2008 Title 24,Pan 6 Standards,using the Specific Lighting Source Method of
Compliance. The only labels that will be recognized for this purpose are ENERGY VERIFIED Certification Marks authorized 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.
column*D' is not required to be filled out. Note:Using an ENERGY VERIFIED labelis an optional method to validate compliance.An
ENERGY VERIFIED label is not needed for compliance.
Specific Light Source Compliance Method. The sign(s)identified above use only the followingfighting technologies:
List all applicable numbers(I through 10)that appiv in column D above for each row.
I High pressure sodium lamps
2 Pulse start or ceramic metal halide lamps served by a ballast with >88%efficiency
3 Pulse start metal halide lamps that are 5 320 watts,are not 250 wart or 175 watt lamps,and are served by a ballast
with>80%efficienev
4 Neon or cold cathode lams with transformer or power supply efficiency>_ 75%with rated output current<50 mA
5 Neon or cold cathode lams with transformer or ower supply efficiency. 68%with rated output current>50 mA
D Fluorescent lamps with a minimum color rendering index (CRI)of 80
6 (Note: when using electronic ballasts for compliance,lamps with a CRI<80 ma •be used)
7 Light emitting diodes(LEDs)with a power supply with>_ 80%efficient
Single voltage LIED external power supplies designed to convert 120 volt AC input into lower voltage DC or AC
S output,having a nameplate output power less than or equal to 250 watts,and certified to the Energy Commission as
complying with the applicable requirements of the Appliance Efficiency Regulations Title 20
9 Compact fluorescent lamps that do not contain a medium screw base sockets(E24/E26)
10 Electronic ballasts with a fundamental output fire uenc•>_20 kHz
E This pace doubles as a field inspection checklist.
Field Inspector Notes:
2008 Nonresidential Compliance Forms October 2010
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