12030078 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10831 N WOLFE RD CONTRACTOR:A D&C DESIGN PERMIT NO: 12030078
OWNER'S NAME: CUPERTINO VILLAGE,LP 2060 WARM SPRINGS CT API'4 DATE ISSUED:03/16/2012
OWNER'S PHONE: 9259638541 FREMONT.CA 94539 .PHONE NO:(510)625-9566
❑ LICENSED CONTRACTOR'S DECLARATION 3OB DESCRIPTION: RMDENTIALU CONIhIERCIAL
License Class Lic.a CHEF YANG BBQ- INSTALL WALL SIGN
Contractor Date
hereby affirm that 1 am licensed under lite pi ovisiuns of Chapter9
(commencing with Section 7000)of Division 3 of(lie Business&Professions
Code and that my license is in full force and effect.
1 herehy afirin under penalty of perjury one of the following two declarations:
I have and will maintain a certificate of consem to self-insure for Worker's
Compensation,as provided for by Section 3700 of die Labor Code,for the
performance of the work for whicluhis permit is issued. Sq.Ff Floor Area: Valuation:$1000
I have and will nmiomin Worker's Compensation Insurance,as provided for by
Section 3700 of die Labor Code,for Ane performance of(he wort:for which(his
AI'N Number:31605052.10831 Occupancy Type:
pennil is issued.
APPLICANT CERTIFICATION
I unify dim I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.I agree to eontplymilh all city and count'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 properly for inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities.judgmems,
costs,and expenseswhichA maty nccme against said City in consequence of to
granting of this permit. Additionally,theapplicant understands mel will carpo. Issued by:
with all non-point source regulations per the Cupertino Municipal Code,Section /�—�, l
9.18.
RF.-ROOFS:
Signmure Date All roofs shall be inspected prior to any roofing material being installed.Ira roof is
installed without firs[obtaining an inspection,I agree to remove all new materials for
inspection.
❑ OWNER-BUILDER DECLARATION
1 hereby nfirm that I am exempt from the Contrncuhr's License Law for our of Signature of Applicant: Date:
tine following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
L 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 properly,not exclusively contracting with licensed contractors it, HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sce.7044,Business&Professions Code). I have read the hazardous materials requirements under Chaplet 6.95 of the
California Itealth&Safety Cale.Sections 25505.25533.and 25534. 1 will
herebyaffirmUnder penaltyof pPl'jUr)'One(if the following Three maintain Compliance with the Cupertino Municipal Code.Clmpter9.12 and file
declarations: Health&Safety Code,Section 25532(a)should 1 store or handle hazardous
1 have and will maintain a Cenificale Of Consent to sel6insure for Worker's material. Additionally,should 1 use equipment sir devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defamed by the Bay Area Air Quality Management District
performance of tine work for whichthis 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 (lie Health&Safety Code,Sections 25505,25533,and 25534.
Section 3700 of the Labor Code,for die performance of the work for which this l� �p/��� ` i
permit is issued Owner or authorized agent: ��VvYgJWr�.///� Dnte:�.�(�
1 certify that in the performance of the work for which this permit is issued,I shall
not employ any person inany manner so as to become subject to the Worker's
Compensation laws of California. If,after making this certificate ofexemlOiOn,I CONSTRUCTION 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 lite performance of
forthwith comply with such provisions or this pennil shall be deemed revoked w'ork'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 if"application and state tint the above information is
correct I agree to comply withall city all county ordinances and state Imus relating
to building construction•mid hereby authorize representatives of(his city to enter
upon the above mentioned property tie inspection purposes.(We)agree to save
indemnify and keep harmless the Cit•of Cupertino against liabilities,judgniens, ARCHITECT:S DECLARATION
costs,and expenses which Only acerae against said City in consequence of de I understand my plans shall be used as public records.
grating of this permit.Additionally,the illiberal understands and will comply
with all non-point source regulations per the Cupenino Municipal Code,Section Licensed Professional
9.18.
Signmure Date
CITY OF CUPERTINO
6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 31605052 . 10831
DATE ISSUED. . . . . . . : 03/16/2012
RECEIPT # . . . . . . . . . : BS000016296
REFERENCE ID # . . . : 12030078
SITE ADDRESS . . . . . : 10831 N WOLFE RD
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : CUPERTINO VILLAGE, LP
ADDRESS . . . . . . . . . . : 3333 NEW HYDE PARK RD
CITY/STATE/ZIP . . . : NEW HYDE PARK, NY 11042
RECEIVED FROM . . . . : MINGKUI YANG
CONTRACTOR . . . . . . . : CHAI YUNZHOU LIC # 31644
COMPANY . . . . . . . . . . : A D & C DESIGN
ADDRESS . . . . . . . . . . : 2060 WARM SPRINGS CT APT 4
CITY/STATE/ZIP . . . : FREMONT, CA 94539
TELEPHONE . . . . . . . . : (510) 625-9566
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 1, 000 .00 1.00 0 .00 1 .00 0 . 00
1BSEISMICO VALUATION 1, 000 . 00 0 . 50 0 .00 0 .50 0 . 00
1EPERMITFE FLAT RATE 1 . 00 44 . 00 0 . 00 44 .00 0 . 00
1ESIGN UNITS 1 . 00 44 . 00 0 .00 44 .00 0 .00
1SIGNWELEC EACH 1 .00 260.00 0 .00 260 .00 0 .00
1TRAVDOC FLAT RATE 1 . 00 44 . 00 0 .00 44 .00 0 .00
---------- --------- ---------- ----------
TOTAL PERMIT 393 . 50 0.00 393 .50 0 .00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 393 .50 VISA
---------------
.TOTAL RECEIPT 393 .50
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
101 FOUNDATION 103 UFER
104 REBAR 105 ANCHOR BOLTS
304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 10831 N.Wolfe Rd. DATE: 03/1612012 REVIEWED BY: jsg
APN: BP#: "VALUATION: $1,000
•PERMITTVPE: Building Permit PLdNCHECKnPE.
PRIMARY PENTAMATION
USE: Sign PERMITTYPE: 10EAP5
WORK installation of wall sign
SCOPE
SIGN TYPE FEE ID QTY SIGN FEE
Wall Sign, Electric 1SIGNWELEC 1 $260
TOTALS: $260.00
:Yeah Plan Citc.k Plumb.Plan Cherk #Branch Circuits 1 $44.00
Mrmh. Permit Fee Plump.Pemil Feer IESIGN Elec.Permit Fee: IEPERABT
other dixh.1+41>. Li I Other Plumb harp. Other Elee. Insp. 0.0 $44.00
dii,h Iny Tce Plualb.Imp.Fee: Cleo./nip. Pee:
NOTE: This eitinude does not include jeer due to other Departments(i.e. Planning,Public Works. Fire,Saidutly Seu•er District.School
District,etc.). These ees are based on the trelininam in ornution available and are onlr an estimate. Comact the Den or addn7 info.
FEE ITEMS (Fae Resolution 11-053 EA 7/1/111 FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Suppl. PC Fee: Q Reg. Q OT O O hrs $0.00
P1umb./A2'ech.:Glec.
Pennit Fee: $260.00
Suppl. Insp. Feet@ Reg. O OT 0.0 1 hrs $0.00
PME Unit Fee: $44.00
PME Permit Fee: $44.00
Cottrinrrlion Tac:
Administrolive Fee.-
Work
ie:Wok Without Permit? O Yes (2) No $0.00
Sign Master Plan: O Yes (2) No $0.00
Travel Documentation Fee: ITRA I DOC $44.00
Strong Motion Fee: IBSE1S,11/CO $0.50 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $1.00
SUBTOTALS: $393.50 $0.001 TOTAL FEE: $393.50
Revised: 1/19/2012
SIGN PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO, CA 95014-3255
CUPERTINO (408)777-3228 • FAX(408)777-3333•buildinD(a)cupertino.orG
/ G30C1
PROJECT ADDRESS 10131 1J W C Q 4-n 0 AFN 9 311 05 D o�
OWNER NAND: K -t"'LYryU VII u l PHONE RLS- E-MAIL
463 8 a N C,
STREET ADDRESS CITY STATE,ZP FAX
33 a h ton B {F2 .�.. C ri`Ts
CONTACT NAME Ya N PHONE ^2S -i�]Y• I E-MAIL
STREET ADDRESS7 CTTY,STAT$ ZIP FAX
��,,// J32 shit 70 `'2 cl S'
xOWNER ❑ OWNER-BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑EtmIMIER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS,LIC9
COMPANY NAME I E-MAIL - FAX
CL t Q>LG t\.PJit 6z('i.SL•6 ` vl�- (, Cc,STREET ADDRESS 1 y/-u-. CITY.STATE,ZIP ' PHONE
ARCHITEC 1ENGINEER NAME LICENSE NUMBER BUS.LIC 0
COMPANY NAME E-MAIL FAX
STREET ADDRESS /�ITY,STATE,ZIP PHONE
DESCRIPTION OF WORK J rlS;Il-CAI I&)-(o M 0G w CxV cS'
1
USE OF ❑ SFD or Duplex ❑ Multi-Family ILLUMINATED SIGN TYPE NO.OF SIGN AREA VALUATION
STRUCTURE: ❑ Commercial (YIN) (CODE) SIGNS (SQ.FT.) 1 (S)
SIGN TYPE CODES: Y vv i (6 •S". L I Qt1O
B - BANNER SIGN M - MONUMENT(GROUNDI SIGN
BL - BLADE SIGN P - PROJECTING SIGN
D - DEVELOPMENT m SIGN SP - SPECIAL EVENT BANNER
DI - DBECIIONALSION T - TEMPORARY
E - ELECTRONIC W - WALL SIGN
RFADERBOARD WI - WINDOW SIGN
"rliEE flVE�Y '�� IMPOSE—
* G" TOTAL VALUATION:
'-� m � "%{
By my signature below,1 certify to each of the following: 1 am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information[have provided is correct. I have read the Description of Work and vc.ify it is accurate. 1 agree to comply with all applicable]oral
ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature ofApplicanOAgenC Date: I
SUPPLEMENTAL INFORMATION REQUIRED
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Site Plan
RO
*D E.CPRESS"' A❑kBUlEO.ryGPEAN REV[tW
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Sip Details-including UL listing(s)applicable a
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Structural Calculations(if applicable) �• ARD i 'Q PLAyN'L G$�PUNREY
IEW
,Rces�
Copy of Planning Approval Letter or Meeting with Planning prior to Ms7 - t �'
AI❑_ 1 4'e• _
submittal of Building Permit application. _ '
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OFFICE COIF DATE 316
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