B-2016-2515CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2016-2515
19499 STEVENS CREEK BLVD CUPERTINO, CA 95014 (316 20 112)
CITY SIGNS
MODESTO, CA 95351
OWNER'S NAME: MAIN STREET CUPERTINO AGGREGATOR LLC
DATE ISSUED: 08/15/2016
OWNER'S PHONE: 510-387-0546
PHONE NO: (209) 549-2412
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class C_45 Lic. #769900
Contractor CITY SIGNS Date 04/30/2017
X BLDG _ELECT _PLUMB
—
MECH RESIDENTIAL X COMMERCIAL
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.
JOB DESCRIPTION:
INSTALL (2) ILLUMINATED WALL SIGNS; (1) ILLUMINATED
I hereby affirm under penalty of perjury one of the following two declarations:
BLADE SIGN; (2) ILLUMINATED CANOPY SIGNS; (1) SET OF
1. I have and will maintain a certificate of consent to self -insure for Worker's
WINDOW VINYL; (1) ILLUMINATED INTERIOR WINDOW SIGN -
Compensation, as provided for by Section 3700 of the Labor Code, for the
TARGET EXPRESS
performance of the work for which this permit is issued.
REV #1 REDUCE SIZE OF "CVS" SIGN TO 15.83 S.F. - ISSUED
I have and will maintain Worker's Compensation Insurance, as provided for by
7/5/2017
Section 3700 of the Labor Code, for the performance of the work for which this
Sq. Ft Floor Area:
Valuation: $18000.00
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
APN Number:
Occupancy Type:
and state laws relating to building construction, and hereby authorize
31620 112
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
PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting of this permit.
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally, the applicant understands and will comply with all non -point
source regulation r the C pertino Muni pal Code, section s.18.
180 DAYS FROM LAST CALLED INSPECTION.
Signature _ Date 7/5/2017
Issued by: JASMINE ARCHBOLD
Date: 08/15/2016
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the
RE -ROOFS:
following two reasons:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
t. I, as owner of the property, or my employees with wages as their sole
installed without first obtaining an inspection, I agree to remove all new materials for
compensation, will do the work, and the structure is not intended or offered for
inspection.
sale (Sec.7044, Business & Professions Code)
2. I, as owner of the property, am exclusively contracting with licensed
Signature of Applicant:
contractors to construct the project (Sec.7044, Business & Professions Code).
Date: 7/5/2017
I hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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.
HAZARDOUS MATERIALS DISCLOSURE
z. I have and will maintain Worker's Compensation Insurance, as provided for by
I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code, for the performance of the work for which this
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
permit is issued.
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
s. I certify that in the performance of the work for which this permit is issued, I
Health & Safety Code, Section 25532(a) should I store or handle hazardous
shall not employ any person in any manner so as to become subject to the
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California. If, after making this certificate of
will maintain compliance with the Cuperti Municipal Code, Chapter 9.12 and
exemption, I become subject to the Worker's Compensation provisions of the
the Health & Safety Code, Se o s 255 25533, 534.
Labor Code, I must forthwith comply with such provisions or this permit shall
`
be deemed revoked.
Owner or authorized agent:
APPLICANT CERTIFICATION
Date: 7/5/2017
I certify that I have read this application and state that the above information is
CONSTRUCTION LENDING AGENCY
correct. I agree to comply with all city and county ordinances and state laws
I hereby affirm that there is a construction lending agency for the performance
relating to building construction, and hereby authorize representatives of this city
of work's for which this permit is issued (Sec. 3097, Civ C.)
to enter upon the above mentioned property for inspection purposes. (We) agree
Lender's Name
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments, costs, and expenses which may accrue against said City in
Lender's Address
consequence of the granting of this permit. Additionally, the applicant understands
and will comply with all non -point source regulations per the Cupertino Municipal
ARCHITECT",; DECLARATION
Code, Section 9.18.
1 understand my plans shall be used as public records.
Licensed
Signature Date 715/2017
Professional
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 i
UP�RTINU
(408) 777-3228 • FAX (408) 777-3333 • buildino(a)cupert! no.org
C,�,/
❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTER�.TION / TI L►1 REVISION / FERRED
ORIGINAL PERMIT'
PROTECT ADDRESS / ac- I l -- -----
OWNERNAME PHONE Lto�((�� 3 � E-MAIL
STREET ADDRESS J 1 C/L��( 0 CITY, STATE,, ZIIIPVV �l FAX
CONTACT NAME PHO\ E-D'iAIL
V �
STREET ADDRESS
CITY, STATE, ZIP
FAX
7
❑ Ow\a ❑ OWNER.BUaDER ❑ wkwERAGENT ❑ CONTRACTOR ❑ CONTRACTORAGEN'r ❑ ARCHITECT ❑ ENIGINEER ❑ DEVELOPER ❑ TENANT
CON7RACTORNAME
LICSENLT4BER I LICENSE TYPE
S. LIC
d
D
CMUAAT NAME
E-MAIL
FAX
STREET ADDRESS CITY, STATE., ZIP
PHONE
A .RCHITECTIENGLNEER NAIMENUT4BER
BUS. LIC #
---'-�LICE3SE
COMPANY NAME
EALAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP I
PHONE
DESCRIPTION OF WORK
EXISTING USE PROPOSED USE CONSTR.
TYPE t STORIES
USE
TYPE
OCC. I
SQ.FT.
VALUATION (S)
EXISTG
NEW FLOOR
DEMO
TOTAL
AREA
AREA
AREA
NET AREA
BATHROOM
KITCHEN
OTHER
R.EN40DELAREA
M40DELAREA
RB40DELAREA
PORCH AREA
DECK AREA
TOTAL DECK'PORCH AREA
GARAGE AREA: EIDETACH
❑ ATTACH
F D"i'ELLING UNITS:
IS A SECOND LNIT ❑ YES
SECOND STORY ❑ YES
_
BEING ADDED? []NO
ADDITION? ❑ NO
I
PRF -APPLICATION ❑ YES IF YES, PROVIDE COPY OF
1S THE BLDG A\ ❑ YES
TOTAL VALUATION:
PL,ANNINGAPPL# F1 NO PLALKNINGAPPROVAL LETTER
EICHLERHOME? E] NO
I
-
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information I have prod Corre . I have read the Description of R%ork and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to b ' g c s ze representatives of Cupertino to enter the above -Ade tI ed property for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INFO ION REQUIRED
1
PLAN crcr ri FE r�, ..�c n
New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition pen -nit is required prior to issuance of bulldmQ
x
permit for new building.
I v
Commercial Bldss: Provide a completed Hazardous Materials Disclosure
fonn if any Hazardous Materials are being used as part of this project.
-
-�-
_ Copy of Planning Approval Letter or Meeting with Planning prior to
submittal of Building Permit application.
-
Ll EN\:IRO\ EALT 'k
B1dg pp_2011.doC J-evised 06121111
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-2515
19499 STEVENS CREEK BLVD CUPERTINO, CA 95014 (316 20 112) CITY SIGNS
MODESTO, CA 95351
OWNER'S NAME: MAIN STREET CUPERTINO AGGREGATOR LLC DATE ISSUED: 08/15/2016
OWNER'S PHONE: 408-777 3081 PHONE NO: (209) 549-2412
LICENSED CONTRACTOR'S DECLARATION I BUILDING PERMIT INFO:
License Class C5 Lic, #769900
Contractor CITY SIGNS Date 04/30/2017
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.
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.
APPLICANT C R IFI ATION
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 de, Section 9.18.
Signature _ Date 08/15/2016
ER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the
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:
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.
s. 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 regulations per the Cupertino Municipal
Code, Section 9.18.
Signatu
Date 08/15/2016
X BLDG —ELECT —PLUMB
MECH RESIDENTIAL X COMMERCIAL
JOB DESCRIPTION:
INSTALL (2) ILLUMINATED WALL SIGNS; (1) ILLUMINATED
BLADE SIGN; (2) ILLUMINATED CANOPY SIGNS; (1) SET OF
WINDOW VINYL; (1) ILLUMINATED INTERIOR WINDOW SIGN -
TARGET EXPRESS
Sq. Ft Floor Area: I Valuation: $18000.00
APN Number:j Occupancy Type:
316 20 112
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: 08/15/2016
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 Applicant:
Date: 08/15/2016
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. 1 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 Cod�rl'o-n-s)225,505, 25533, and 25
Owner or authorized agent:
Date: 08/15/2016
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. $097, Civ C.)
Lender's Name
Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed
SIGN PERMIT APPLICATION M116 - 9515
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 ® FAX (408) 777-3333
91
PROJECT ADDRESS
APN #
OWNER NAME /VONE
) I
E-MAIL�P!
STREET ADDRESS
. )Vvp
CITY, STAT FAX
;ag�
-
CONTACT NAME PHONE E-MAIL
'
STREET ADDRESS CITY, STAT �P FAX
OWNER 13 OWNER -BUILDER 13 OWNER.AGENT 13 CONTRACTOR CONTRACTOR AGENT ARCHITECT ❑ ENGINEER DEVELOPER 13 TENANT
CONTRACTOR NAME _FFNSF
NUMBER
,71 ,f3pvoQ&9%-
LICENSE TYPE
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
do�-
ARCHITECT/ENGINEER ArME
LICENSE.NUMBER
BUS, LIC
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK
N it
USE OF L J SFD or Duplex Multi -Family
ILLUMINATEDI
SIGN TYPE
No, OF
SIGN AREA
VALUATION
STRUCTURE: Commercial
(YIN)
(CODE)
SIGNS
(SQ. FT.)
SIGN TYPE CODES:
2-
B - BANNER SIGN M - MONUMENT (GROUND) SI
Y
/7-
BL - BLADE SIGN P - PROJECTING SIGN
Y
-7,
D - DEVELOPMENT ID SIGN SP - SPECIAL EVENT BANNER
DI - DIRECTIONAL SIGN T - TEMPORARY
JA
Yboo
E - ELECTRONIC W - WALL SIGN
READERBOARD WI - WINDOW SIGN
L
RECEIVED BY:
I TOTAL VALUATION: W
a
'avo
By my signature below, I certify to each of the following: I am the property owner or authorized 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 relating to I in .62truiion. 1!iWe representatives of Cupertino to enter the above -identified property for inspection purposes.
w#
Signature of Applicant(Agent: Date:
SUPPLEMENTAL INFORMATION REQUIRED
OFFICE USE ONLY
PLAN CHECK TYPE
ROUTING SLIP
Site Plan
El OVER-THE-COUNTER
El BUILDING PLAN REVIEW
Elevations
— Sign Details - including UL listing(s) applicable
11 EXPRESS
El PLANNING PLAN REVIEW
— Structural Calculations (if applicable)
0 STANDARD
D OTHER:
— Copy of PlanningApproval Letter or Meeting with Planning prior to
El LARGE
submittal of Building Permit application.
1_0 'MOR
Sign4pp_2011.cloc revised 03/31/11
r -r