B-2016-1948 VoidedCITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
197.00 VALLCO PKWY CUPERTINO, CA 95014 (316 20 108)
'S NAME: CUPERTINO PROPERTY DEVELOPMENT
OWNER'S PHONE:
LICENSED CONTRACTOR'S DECLARATION
License Class C-45 Lic. #678750
Contractor ILLUMINART SIGNS Date 10/31/2017
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.
I hereby affirm under penalty of perjury one of the following two declarations:
1. 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.
2. I have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the perfonnance of the work for which this
permit is issued.
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
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 accrue against said City in consequence of the granting of this permit.
Additionally, the applicant understands and will comply with all non -point
source regulations per the Cupertino Municipal Code, Section 9.18.
Signature Date 05/16/2016
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
L 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)
2. I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three declarations:
1. 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.
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.
3. I certify that in the performance of the work for which this permit is issued, I
shall not employ any person in any maturer so as to become subject to the
Worker's Compensation laws of California. If, after making this certificate of
exemption, I become subject to the Worker's Compensation provisions of the
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
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 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 accrue against said City in
consequence of the granting of this permit. Additionally, the applicant understands
and will comply with all non -point source regulations per the Cupertino Municipal
Code, Section 9.18.
Date 05/16/2016
CONTRACTOR: PERMIT NO: B-2016-1948
ILLUMINART SIGNS
YUBA CITY, CA 95993
DATE ISSUED: 05/16/2016
PHONE NO: (408) 386-1485
BUILDING PERMIT INFO:
X BLDG —ELECT —PLUMB
_ MECH _ RESIDENTIAL X COMMERCIAL
JOB DESCRIPTION:
INSTALL I (N) ILLUMINATED WALL SIGN - FRONT EXTERIOR (FIT
3 6)
Sq. Ft Floor Area: Valuation: $4792.00
APN Number: Occupancy Type:
31620 108
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: PAUL O'SULLIVAN
Date: 05/16/2016
RE -ROOFS:
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.
Signature of App]
Date: 05/16/2016
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, Sections 25505, 25533, and 25534.
Owner or authorized agent:
Date: 05/16/2016
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance
of work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed
Professional
CUPERTINO
SIGN PERMIT APPLICATION 1b_ dao
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildingO-cupertino.org
PRoJEcTADDREss 19700 Valico Pkwy, Suite100, Cupertino, CA 95M
7"N# 316-20-108-00
OWNERNAMEPHONE -- -- - — - - -
'/V `ti
+
E-MAIL
STREET ADDRESS CITY, STATE, ZIF /± jj� FAX
`rJ V � 1(jE-iMA
CONTACT NAME Jerry Schell
PHONE (408) 348-5909
lman1965@sbcglobal.net
STREET ADDRESS 351 Briar Ridge Drive
Com. STATE, zH' San Jose, CA 95123
FAX (408) 5834431
11OwNER 13OwNER-Buu.DER M OwNERAGENT ❑ CONTRACTOR ❑ CONTRACTORAGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTORNAME Don De Luze
LICENSE NUMBER 678750
LICENSE TYPE C-45
jjj���
Bus. LIC # 9LC53 rT
COMPANYNAME Illuminart Signs
E-MAIL illuminartsignco@att.net
FAX
STREET ADDRESS 2543 Somerset Way
CITY, STATE, zIP Yuba City, CA 95993
PHONE (408) 386-1485
ARCMTECT/ENGINEERNAME N/A
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK Provide and Install New FIT36 Sign per attached drawings
USE OF ❑ SFD or Duplex ❑ Multi -Family
STRUCTURE: ® Commercial
ILLUMINATED
(Y/N)
SIGN TYPE
(CODE)
NO. OF
SIGNS
SIGN AREA
(SQ. FT.)
VALUATION
($)
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
Y
W
1
20.6
$4,792.50
RECEIVED BY:R
p
/ ` k
(J ILIC.�I
TOTAL VALUATION:
$4,792.50
By my signature below, I certify to each of the following: I am the property owner or auth rized agent to.act 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 relatingto uilding co tion. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: Date: 4/21/2016
SUPPLEMENTAL INFORMATION REQUIRED
X Site Plan
X Elevations
X Sign Details - including UL listing(s) applicable
Structural Calculations (if applicable)
_ Copy ofPlanning Approval Letter or Meeting with Planning prior to
submittal of Building Permit application.
OFFICE USE ONLY
PLAN CHECK TYPE
ROUTING SL
❑ OVER-THE-COUNTER
❑ EXPRESS
❑ STANDARD
❑ LARGE
❑ MAJOR
e'er/
Iq BUILDING PL RE EW
/ PLANNING PL�
OTHER:
Sign,4pp 2011.doc revised 03/31111