B-2016-3174 Expired CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-3174
19700 VALLCO PKWY CUPERTINO,CA 95014(316 20 108)119700 VALLCO PKWY S J P SIGNS INC
STE 150 CUPERTINO,CA 95014(316 20 108) SUNNYVALE,CA
95131
OWNER'S NAME: CUPERTINO PROP DEVELOPMENT DATE ISSUED:11/28/2016
OWNER'S PHONE:858-748-2800 PHONE NO:(408)971-6643
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-45 Lig.#945852
Contractor S J P SIGNS INC Date 04/30/2018 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 ONE(1)ILLUMINATED WALL SIGN(KEBAB SHOP)
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 performance of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$3000.00
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 316 20 108
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 regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature / i4Leh'z.i__. Date 11/28/2016 Issued by:MELISSA NAMES
Date:11/28/2016
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
i. 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:11/28/2016
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
2. 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
maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
permit is issued.
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
material. Additionally,should I use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California. If,atter making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent:
APaLICANT CERTIFICATION I hereby affirm that there T a CTIOENDING AGENCY
Date:11/28/2016
I certify that I have.read this application and state that the above information is CONSTRUCTION L
correct.I agree to comply with all city and county ordinances and state lawsiconstruction 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 ARCHITECT'S DECLARATION
and will comply with all non-point source regulations per the Cupertino Municipal
Code,Section 9.18. I understand my plans shall be used as public records.
Licensed
Signature Date 11/28/2016 Professional
SIGN PERMIT APPLICATION
• COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISIONS
a.rs� 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333•buildinq(a,cupertino.orq -
CUPERTINO
PROJECT ADDRESS / !, E e'
j jAPN# 314
/ L` y �J 6 `/
OWNER NAME )7 Y®®`cy - � PHONE -2'
E. `L '*/"� e. :..5/dc "66
STREET ADDRESS®,' ( o :)*-r awl/ r 6/ CITY, STATE,ZIP A ' y FAX
/Il /
CONTACT NAME. PHONE 6 II 4 — o7 E-MAIL
STREET ADDRESS - CITY,STATE,ZIP /. J FAX
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT Pi<TRACTOR 0 CONTRACTOR AGENT ❑ ARCHITECT 0 ENGINEER 0 DEVELOPER 0 TENANT
CONTRACTOR NAME LICENSE NUMBER .� LICENSE TYPE BUS.LIC#�j
/�Inf-47- S,` C / - �s 7 7 �
COMPANY NAM E-MAIL FAX
.
,, / wyJ7/'f`zZc.(-eyeSTREET ADDRESS ) S �L0q t. v CITY,STATE,ZIP ‘,70 r1 y4� PHONE (?7,,L6,143
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
r
DESCRIPTION OF WORK 9 7 SIA
USE OF I] SFD or Duplex ❑ Multi-Family ILLUMINATED SIGN TYPE NO.OF SIGN AREA VALUATION
STRUCTURE: ❑ Commercial (Y/N) (CODE) SIGNS (SQ.FT.) ($)a�
SIGN TYPE CODES: I / . , CI ,�j�
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
RECE `:£- TOJJ�TN:
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 building construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: , . 'I Date: 17/1 Ye
SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY
_Site Plan PLAN CHECK TYPE ROUTING SLIP
_Elevations ❑ OVER-THE-COUNTER 0 BUILDING PLAN REVIEW
Sign Details-including UL listing(s)applicable 0 EXPRESS 0 PLANNING PLAN REVIEW
Structural Calculations(if applicable) 0 STANDARD 0 OTHER:
Copy of Planning Approval Letter or Meeting with Planning prior to 0 LARGE
submittal of Building Permit application.
❑ MAJOR
SignApp_2011.doc revised 03/31/11