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10020009CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19754 STEVENS CREEK BLVD I CONTRACTOR: TBD - TO BE DETERMINED I PERMIT NO: 10020009 OWNER'S NAME: BRAD KIM OWNER'S PHONE: 4083415185 ❑ LICEN/rSEED CONTRACTOR'S /DECLARATION License Class — `t1 Lic. 4 O 0 I Contractor - 5 Date I hereby affirm that I am licens d 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. DATE ISSUED: 02/01/2010 PHONE NO: G PERMIT INFO: BLDG r ELECT r PLUMB r MECH r RESIDENTIAL r COMMERCIAL JOB DESCRIPTION: INSTALLING ILLUMINATED CHANNEL LETTER SIGN;LEE'S SIGNS PD FOR BSL 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. 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 Sq. Ft Floor Area: 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 p r the Cupertino Municipal Code, Section 9.18. Signature Date ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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 construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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. 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. 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 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 egulations per the Cupertino Municipal Code, Section 9.18. 7 , v Signature APN Number: 36906009.02 Valuation: $2700 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: ^ s _- – 7 Date,L--/ / O 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 Applicant: Date: 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 aufhorii d ggent: Date:/ ""I 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 adl-- CITY OF CUPEkTINO CITY OF CUPERTINO SIGN PERMIT APPLICATION FORM APN # Date: Building Address: !97 AeV�5 Creek l � ��voi. Cu in© CA `�� C Mailing Address (if different from building address): Owner's Name: Phone #: vvi Contractor: Phone #: Fax #: Contractor License #: Cupertino Business License #: Contact: JLA5-i Phone #: Fax #: �1 Building Permit Info: I C N) e4t, 5?A Building Bldg Elect Monument ❑ Mounted on ❑ Residential .. Commercial l----, Job Description: Valuation (cost of project): 2-,70o , 0 0 Project Size: Express ©-`Standard ❑ Large ❑ Major ❑ Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the G�--- application or if applicable, include in plan set & the sheet index. Revised 01 /07/09 ..fix CITY OF CUPEKrINO CITY OF CUPERTINO SIGN FEE SCHEDULE .. - Quantity Fee ID Fee Description Fee Group Permit Type 1 SIGNDIRECT Directional B 1 SIGN/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 1ESIGN 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 IELCPLNCK Plan Check Fee E EPERMITFEE Electric Permit Fee E / IBCBSC Cal Bldg Standards Commision Fee B ALL PERMIT TYPES / BSEISMICOM Seismic Commercial B SEISMICRE Seismic Residential B RAVDOC Travel & Documentation B P-BUSLIC Business License B CITY OF CUPEI�TINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333, Building Department JOB ADDRESS: [6t ��� �v�s `� '"DQE, Creek W • PERMIT # Ua 2060 � OWNER'S NAME: rVa 1c1,m Cabinets & Millwork PHONE # GENERAL CONTRACTOR: c ( Cement Finishing FAX # I am not using any subcontractors: 2 --4 — ( o Signature Date Please check applicable subcontractors and complete the following information: Owner/ Contractor Signature Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical 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