13030171 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7335 BOLLINGER RD STE C CONTRACTOR:ALLEN SIGNS INC PERMIT NO: 13030171
OWNER'S NAME: SHEE SEET DING TRUSTEE&ET AL 1982 STONE AVE DATE ISSUED:04/02/2013
OWNER'S PHONE: 4083718770 SAN JOSE,CA 95125 PHONE NO:(408)280-6500
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIALE]
.0p 'r p,, INSTALL ILLUMINATED CHANNEL LETTER SIGN FOR
License Class Lic:# O Y'� a V
- � 2 AJITO
Contractor Date
I hereby affirm that a licensed under the provisions of Chapter 9
(commencing with Se on 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:$1800
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 APN Number:35923018.01 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that 1 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 R LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the
-4/
granting of this permit. Additionally,the applicant understands and will comply Issued by: Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
2 RE-ROOFS:
Signature Date 3 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.
❑ OWNE -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)
I,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. 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
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,Sections 255#5, 5533,au125534.
Section 3700 of the Labor Code,for the performance of the work for which this 3
permit is issued. Owner or authorized agent: Date:
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 Cuertino against liabilities,judgments, ARCHITECT'S DECLARATION
p
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
C��y �S�A
�v
SIGN PERMIT APPLICATION
Is COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTINO (408)777-3228•FAX(408)777-3333•building(Mcupertino.or4
PROJECT ADDRESSAPN# 3 5? i Z O 1
OWNERNAME
1 r ONE 37 V,?
E-MAIL
STREET ADDRESS/D �l x( ]Q� N CITY TIP' 1 ��� y FAX
CONTACT NAME PHONE�VO �O / �� E-MAIL
STREET ADDRESS CITY,STATE,ZIP FF
❑OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME S LICENSE NUMBER LICENSEE EL BUS.LIC# c�- /
COMPANY NAME E-MAIL FAX /
STREET ADDRESS CITY,STATE,ZIP (�� - PHONE sV ry b y
ARCHITECT/ENGINEER NAME LICENSE NUMBER `�/✓b w` BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK Nom`
USE OF ❑ SFD or Duplex ❑ Multi-Family ILLUMINATED SIGN TYPE NO.OF SIGN AREA VALUATION
STRUCTURE: Commercial (Y/N) (CODE) SIGNS (SQ.FT.) M
SIGN TYPE CODES: �-
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
READERBOARD WI - WINDOW SIGN /
RECEIVED BY: / TOT�tIry.4JtUQTION:
By my signature below,I certify to each of the following: I am the property owner or authorized agent to/acct on the property owner's behalf. I have read this
application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to buil i g nst actio . I authorize representatives of Cupertino to enter the above-identi ed property for inspection purposes.
Signature of Applicant/Agent: Date: l
SUPPLEMENTAL INFO ION REQUIRED OFFICE USE ONLY
_Site Plan PLAN CHECK TYPE ROUTING SLIP
Elevations ❑ OVER-THE-COUNTER 71-BUILDING PLAN REVIEW
Sign Details-including UL listing(s)applicable ❑ EXPRESS ly-PLANNING PLAN REVIEW
Structural Calculations(if applicable) STANDARD ❑ OTHER:
_Copy of Planning Approval Letter or Meeting with Planning prior to LARGE
submittal of Building Permit application.
❑ MAJOR
SignApp_2011.doc revised 03/31/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 7335 BOLLINGER RD UNIT C DATE: 03/29/2013 REVIEWED BY: MELISSA
APN: 316 05 051 BP#: /,3P-3bl7/ "VALUATION: $1,800
*PERMIT TYPE: Building Permit PLAN CHECK TYPE:
PRIMARY PENTAMATION 1 CEAP5
USE: Sign PERMIT TYPE: i
WOR* AJITO RESTAURANT INSTALL ILLUMINATED CHANNEL LETTER SIGN
SCOPE
SIGN TYPE FEE ID QTY SIGN FEE
Wall Sign,Electric 1SIGNWELEC 1 $266
TOTALS: $266.00
.ti1ech. Plan Check Plumb.Plan Check #Branch Circuits 1 $45.00
;Llaclr. Permit Fec:: Plurnlr.Permit f ee: IESIGN Elec.Permit Fee: IEPERMIT
Other Meeh.Insp. 01her Plumb Insp. Li
Other Elec.Insp. 0.0 $45.00
Hech-Insp. I,ee: Plumb. Insp.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,etc.). These fees are based on the prelimina information available and are only an estimate. Contact the Det fiv addn'l info.
FEE ITEMS(Fee Resolution 11-053 E . 7/1/12) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Suppl.PC Fee: (E) Reg. Q OT 0.0 1 hrs $0.00
PIuinb.Al/fech./Elec
Permit Fee: $266.00
Suppl. Insp.Fee:Q Reg. ® OT 0.0 hrs .$0.00
PME Unit Fee: $45.00
PME Permit Fee: $45.00
Construction Tax:
AdministrativeT'ee:
Work Without Permit? 0 Yes No $0.00
Sign Master Plan: Q Yes 6) No $0.00
Travel Documentation Fee: ITRAVDOC $45:00 i
Strong Motion Fee: IBSEISMICO $0.50 Select an Administrative Item .
Bldg Stds Commission Fee: 1BCBSC $1.00
EM
$402.50 $0.00 < A $402.50
Revised: 01/01/2013
c
Certificate of Com fiance (Sign Li hdn ) (Page 1 of 4) SLTG-1C
Prc j}ect Name:
AJITO Date: 3=20-13
Project Address:
7335-C Bollinger Road
Location of Sign I?Outdoor Signs 0 Indoor Signs
Phase of Sign Construction M New Signs 0 Sign Alterations
Type of Lighting Control XI-New Lighting Controls 0 Replaced Lighting Controls 0 Not installing Lighting Controls
This Certificate of Compliance includes the following components(check all that apply)
E3 Mandatory Measures(Lighting:Controls) O Maximum Allowed Lighting Power 111 Specific Lighting Sources
1. Certificate of Compliance Declaration Statement(this maybe a Clo,C45 or other eligible 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.
N I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the lighting design.
N 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;calculations,plans and specifications submitted to the
enforcement agency for approval with.this building permit application.
Name: Kimberly Lin Signatare c
Company: Phone
Allen Signs,Inc 408-280-6500
Address: License number(may be contractor's lic#)
1982 Stone Ave C-45.834580
CityJState/Zip: Date
San Jose, CA 95125
2. Installation Certificate(to be signed by responsible person after installation)
Permit number Cbeeked by/Date
3,
cement A y Use nf-cat A Use
Installation.Declaration.statement
l I certify under penalty'of perjury,,under the laws of the State of California„the information provided:on this form is true and.
correct.
RI 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.
k� 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.
X I certify that the requirements detailed on this Certificate of Compliance have been met.
K 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 buildin&and made available to the enforcement agency for all applicable inspections. I understand
that a signed copy of this Installation Certificate is required to be included with the documentation the builder provides to the
building owner at occupancy.
Company Name:
Allen Signs, Inc
Responsible Person's Name: Responsibl Pe o Signa
Kimberly Lin
License number{may.be contractor's lie#) Date Signed: Position . tth Com aJn
834580 Project Man 3
2008 Nonresidential Compliance Forms October 2010
Certificate of Compliance (Sign Lighting) (Pagee 2 of 4 SLTG-IC
Project Name: AJITO Date: 3-20-13
3.Mandatory.Sign Lighting Controls
NOTES.-
1.
OTES.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 or the entire construction.
3a. Statements of Responsibility:Any person signing the Certificate of Compliance Declaration Statement on page 1 of
4 on this SLTG-1C 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,com lete parts 3a and 3b of this form 113 No,.com Tete part 3a of this form
2 There are no existing sign lighting controls and I will be installing compliant sign lighting controls
❑Yes R3 No
3 There are no existing sign lighting controls and someone else will be responsible to install compliant sign lighting controls
❑Yes ®No
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 ®No
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 RI No
3b. Mandatory Sign Lighting Controls
If the person signing the Certificate of Compliance Declaration Statement on page i of 4 of this"SLTG-1C is responsible for
complying with the sign lighting control requirements,thatperson shall answer all of the following uestions:
If there are construction documents,indicate where on the building plans the
mandatory measures sign lighting control note block can be located:
1 §133(a)l.All indoor sign lighting is controlled with an automatic time switch control that complies with the Y N NA
applicable requirements of§119. 0 0 91
§133(a)l 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. E] ❑ ❑
Exception to§133(a)2. Outdoor signs in tunnels or large covered areas that require illumination during. Y NA
daylight hours. ❑ KI
§133(a)3. All outdoor signs are controlled with a dimmer that provides the ability to automatically reduce Y N NA
.sign ower by a minimum of 165 percent durin ..ni httime hours. ❑ ❑ 1
Exception 1 to§133(a)3.Signs illuminated for less than one hour per day during daylight homy. Y NA
® ❑
3 Exception 2 to§133(a)3. Outdoor signs in tunnels or large covered areas that.regpire illumination.during Y NA.
daylight hours. 0 91
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. 0 0
§133(x)4. An Electronic Message Center(EMC)having a new connected lighting power load greater than Y N N/A
15 kW has a control installed capable of reducing the lighting power by a minimum of 30 percent when 0 0
4 receiving a demand response signal that is sent out by the local utility.
Exception to§133(x)4.EMC required by a_health or life safely:stalue,ordinance,or regulation,including Y NA
but not limited to exit signs and traffic signs. 0ZI
Field Inspector Notes:
2008 Nonresidential Compliance Forms October 2010
Certificate of Com Hance Sign Lighting) (Page 3 of 4 SLTG-1C
Project Name: AJITO Date:
3-20-13
4.Maximum Allowed Lighting rower 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 Secific li titin sources method of com fiance
A B -C D E I F G H I J
A Allowed Watts Design Complies?
w Watts Y/N
ua o
U a o ``^ �W w a`` CVf
d 3 x
Field
.2
as '� 2.
� Inspector
w ° 11 Check that
F W Q Lj Sign
0 Complies
Description ✓
Internally Illuminated Letter Sign ❑ ❑
❑ ❑
❑ ❑
» n
13 ❑
❑ ❑
A Symbol or code used on the pcans 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 ISOJEC 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 insquare 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`B"in column E.
G Multiply the square footage in column D times the allowed Lighting Power Density PD=watts in column F.
H Show the total installed watts in the sign,as determined according to the applicable provisions of§130 d ore .
I Enter Y if the number in column H is less than orequal 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 Farms October 2010
a
Certificate of Com fiance (Sign Lighting) (Page 4 of 4 SLTG-1C
Project Name: AJITO Date.12-21-12
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 ower method of compliance)
A B C D E
OPTIONAL Field
ENERGY Specific light source used for
Symbol -.VERIFIED compliance Inspector
or Description label Shall include only lighting Check that..
Code '.-(sec instructions technologies listed below Sign
below) List all that apply Complies
f �
Internally Illuminated Letter Sign (] 8 0
0 0
0 0
O 0 .
0 0.
A Symbol or code used on the plans when plans are require and other documents.
B A narrative description of the sign,or location of sign on the buildin •and the location of sign on construction documents
E 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,Part 6 Standards,using the Specific Lighting SourceMethod 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 ISOJEC 17020.For signs with such an ENERGY VERIFIED label,
column`D'is 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.
Specific Light Source Compliance Method. The sign(s)identified above use only the following lighting technologies:
List all applicable numbers i through 10 that apply in column D above for each row.
1 High pressure sodium lamps
2 Pulse start or ceramic metal halide lamps served by a ballast with >_88%efficient
3 Pulse start metal halide lamps that are<_320 watts,are not 250 watt or 175 watt lamps,and are served by a ballast
with>80%efficient
4 Neon or cold cathode lamps with transformer or power supply efficient >_ 7.5%with rated output current<50 mA
5 Neon or cold cathode lamps with transformer or ower supply efficient >_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.tom liance,lamps with a CRI<80 may be used)
7 Light emitting diodes(LEDs)with a power supply with> 80%efficient
Single voltage LED external power supplies designed to convert 120 volt AC input into lower voltage DC or AC
8 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 24IE26
10 Electronic ballasts with a fundamental output frequency>20 kHz
E This page doubles as a field inspection checklist.
Field Inspector Notts:
2008 Nonresidential Compliance Forms October 2010
..
s
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: 408-777-3228
C U P E RT I N O Fax: 408-777-3333
CONTRACTOR/SUBCONTRACTOR LIST
JOB ADDRESS: ' Rld PERMIT# L
OWNER'S NAME: PHONE# 10,
GENERAL CONTRACTOR: " In BUSINESS.LICENSE#
ADDRESS: jqRz -e CITY/ZIPCODE:
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR.AND ALL SUBCON' RACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE. RAZ
I am not using any subcontractors: ��
S gnature Date
Please check applicable subcontractors and comp ete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE#
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring/Carpeting
Linoleum/Wood
Glass/Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting/Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date
R
AJT*O WELDING SIGN ELEVATION: 7335-C BOLL INGER ROAD CITY OF CUPERTINO
ARM N Property r
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a s e6® e s e 1 KRRi&ROfAT1RZE,IHANKYOUI
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BULb@lf3 Et.EYA'IIOFt:
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�tup9�+�do�.rr)uoLlo'�ns
All degas&art works belong to Allen Signs,Inc. Any duplication is prohibited.COPY RIGHT 2012
7E�408/aZRPb'Soa Ira.
.� rswsa»,rn.wswrTomGrq
i
03/28/2007 17:33 'FAX 4085171100 MIKE 'PAN 006
96 — 63 = 05 Policy Number: 18090 — 34 — 17
Binder The insu ante has been applied for and is bo or 60 days from the Effective Date pending issuance of a policy to the
Named Insured'i
.The quoted premium is subject to veriftcatio and ch a (increase or decrease),when necessary,by the company.
Races quoted reflect the rates in'effect!as of a date of t application which was entered into the insurer's computer records and
which is memorialit d, in part, in this M orandum o Automobile Instiranme—California ("Memorandum"). Rates are subject to
revision: The insurer reserves the right accept,reje ,or modify the application,the Memorandum and/or quotes/rates/premium
afterinvestigation, r view of the apph ation,and,rev' w of all other underwriting informatio
The undersigned represents and w rrants that he/s a has applied for the','insurance co age(s) a set forth above, pursuant to an
application entered nto'the insu is computer r', ords,and hereby confirms that a/she suppi' d the information so entered and
warrants and rdpres nts!that ai uch informatio is true and correct.The un signed repr ents and warrants that r concealed has read
the Memorandum f lhsur cc and underst 'ds that if the insurer 1 s that,the un 'rsigned misrepresented or concealed
any material info anon quested in this emorandum of Insur e,a loss of cov age for all insureds under the polity
could result, and t le pol' could be rest ded.Loss of coverage d rescission oft a policy may result even if a claim is
alreadypending oi has een reported.
Note:Failure to pr vi any requested i ormation within th time required,or dat developed from that information, may result in
the cancellation or i n'renewal of your policy.
Acknowledgment have received a' py of the Notic of Information!Practic ,which advises me:of my rights concerning the
information prat c s of the membe companies'an exchanges of the Farmer nsurance Group of Companies.
FOR YOUR P O ECTION,C IFORNIA W REQUIRES`THE F LLOWING,TO APPEAR ON THIS FORM:ANY
PERSON O OWINGf Y RESENT A'FALSE OR FRAUD NT CLAIM FOR PAYMENT OF LOSS, OR
KNOWIN Y P ENTS F E OR SLEADING INFO RMA ON TO AN INSURANCE C FOR THE
PURPOS F DITRAUDIN OR MPTING TO DEFRA .AN INSURANCE COMP ,O PROVIDES FALSE
INFO TION ONCE NG TERIAL FACT ON, A)!PLICATIONFOR IN RANC OR HELPS ANY
OTHER ERSO COMMI SU ' ACTS,MAY BE GUILTY FINSURANCE F ,AND BE SUBJECT TO
SUBSTANTIAL C ML AND MINAL PENALTIES,PU ANT TO THE LA OF THE S° ATE IN WHICH THESE
ACTS OCCUR.
p nrs Signature Date Time
I
,i
31-5105 9.06 MCA Please keep a copy foryoar policy records
3 FINAL
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: 408-777-3228
C U P E RT 1 N O Fax: 408-777-3333
CONTRACTOR/SUBCONTRACTOR LIST
JOB ADDRESS: P PERMIT#
OWNER'S NAME: PHONE#
GENERAL CONTRACTOR: oL/l 6i'm ke BUSINESS.LICENSE#
ADDRESS: CITY/ZIPCODE:
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR.AND ALL SUBCON RACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors: 3
S gnature Date
Please check applicable subcontractors and.comp ete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE#
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring/Carpeting
Linoleum/Wood
Glass/Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting/Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date
AJITO BUILDING SIGN ELEVATION: 7335-C BOLLINGER ROAD CITY OF CUPERTINO
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28'-0"SCORE FRONTAGE �� s
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NEW 51GN � J �J e L
6"
5'. SHEET METAL RACEWAY
RACEWAY BOX TO BE
FAINTED SAME COLOR -
1/4"LAG SCREW INTO
A5 BACK WALL AJITO BUILDING WOOD MEMBER
A�JI.�T�O�
TOP&BOTTOM 0 4'-0"O.C.
_ 1.5"x1.5"METAL BRACKET
5"THICK INDIVIDUAL CHANNEL LETTEK5,INTERNALLY ILLUMINATED
3/4"WHITE COLOR TRIM-CAP,RETURN FAINTED WHITE COLOR. �1"�' I' 015CONNECT SWITCH
LETTER WILL BE RED COLOR
#10x1"SCREW MIN.3 PER LETTER
5CALE:1/4"=1'-0" DATE:MAR-19-2013
1/4"xt"BOLT&NUT
BUILDING ELEVATION: ice-BUILDING BACKGROUND
TRANSFORMER
CHANNEL LETTER
AJITO INSTALLATION DETAIL
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All designs v art woriks belong to Allen Signs,
any duplication is probibiled.COPYRIGHT 2010
All designs &art works belong to Allen Signs, Inc. Any duplication is prohibited. COPY RIGHT 2012 E-mailaddress.allensigns@)�vaboo.coi,e-e
Tel.•4081280-6500 Fax:408/280-6700
• 1982 Stone Ave.San Jose,Ca.95125 State Lic.#834580