B-2017-1919 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1919
19409 STEVENS CREEK BLVD STE 100 CUPERTINO,CA 95014(316 20 112) SIGN SERVICES .
ANGELS CAMP,CA
95222
•
OWNER'S NAME: MAIN STREET CUPERTINO DATE ISSUED: 11/07/2017
OWNER'S PHONE:408-777-3080 PHONE NO:(650)938-4151
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C45 Lig.#717919 •
Contractor SIGN SERVICES Date 01/31/2018 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 NEW EXTERIOR ILLUMINATED SIGN
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. Sq.Ft Floor Area: Valuation:$4100.00
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 20 112
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 regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signa �,. _1�_,�_...a•-. ."....7 Date 11-07-2017 Issued by:Kim Dunbar
Date: 11/07/2017
OWNER-BUILDER DECLARATION„
I hereby affirm that I ant exempt from the Contractor's License Law for one of the RE-ROOFS:
following two reasons: I. ; All roofs shall be inspected prior to any roofihg material being installed.If a roof is
• 1. 'I,as owner ofthe'property,,or my employees with wages as their sole installed without first obtaining an inspection,,1 agree to remove all new materials for
'compensation,*ill do the work,and the stricture is not intended or offered for inspection.
sale(Sec.7044,Business&Professions Code)
2. I,a's owner of die property,atmexclusively contracting with licensed Signature of Applicant:
contractors'to coInstruct the project(Sec.7044,Business&Professions Code). Date: 11-07-2017
I hereby affirm under penalty,of perjury one of the following three declarations: „ „
1. I have and will'inaintain a Certificate of Consent to self-insure for Worker's ALL ROOF COVERINGS TO BE CLASS A OR BETTER
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 Workerompensation 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
3. 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 Cupertino Municipal Code,Chapter 9.12 and
. exemption,1 liecome subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 25505,25533,and 2 534.
Labor Code,I must forthwith comply with such provisions or this permit shall 1: ./
be deemed revoked: Owner or authorized agent:
,i APPLICANT CERTIFICATION Date:11-07-2017 1,
I certify that I have read this,applicon and state that the above information is CONS `$.. CTION LENDING DING 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 issuied(Sec.3097,Civ C.)
to enter upon the above',mentioned property for inspection purposes. (We)agree Lender's Name
to save indemnify and kdep harmless the City of Cupertino against liabilities, 1
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'S DECLARATION
Code,Section 9.18. I understand my plans shall be usedas public records.
Licensed
Signature . ' . Date 11-07-2017 Professional
// SIGN PERMIT APPLICATION
VCOMMUNITY DEVELOPIVENT DEPARTMENT•BUILDING DIVISION
e.,,,,, 10300 TORRE AVENUE•CUPER f1NO,CA 95014-3255
C U P E RT 1 N O (08)777- aux228•FAX(408)777-3333•buildincl Jr)ertino.orq
5 --zo i -q- - I / 9
FREUECTADDRESS
ICI Li09 S-Vetere S Cree-1C ZIVc1 4I01AP14
# 3/( - /SCJ - / / 2—
owNExNAnE l4 v' SA-fP_k CU'ec tvcr� �(t0EMAIL
% 8) 177-30(30
STREET AIXRFSS CITY,STATE ZIP FAX
14 A tel. S4•evewS Cr eck A1vd >. r&v�o .(4 GIS-01 Li
CONTACT NAME PHONE kl�ati in Q u 1 (Looe') .x-9 8-Li 1c3 i ye!cysts)Lt.5s Ya>^od•cosi
SIREET ADDRESS CITY,STATE,ZIP FAX
1266,Alwcc, Ci' ccac.� SoSe i C/' 4S-11--1--
❑OWNER 0 OWNER-EMBER BER 0 amERRAGENT 0 coN rRACIut ffiaoNIRAcro tAGFNr 0 .ARCEIlTECr' 0 ardIsIEER 0 DEVELAPER. 0 TFrrANr
C NIRACICRNANE LIGN'EE 1AvI3ER LICENSE= B[S.UC# '
C ` Oe .
r -Poo leo -117q I Ct citw o3 zs
ccaVANYNAME BM,1L FAX
tc%t� Se,C\ft CP
EINEM.ADDRESS QTY,STATE ZIP PFKNE
LtQ)C1 Roe.k orge Lco? AV is Caw Cf- 46Z-2-7 Cg69.,)ek3?)-ti 151
NAME LICII.SENUM3ER ' BUS.LIC# ' '
00IVPANYNANE BM R, ' FAX
S1KNh1 ADDRESS CITY,STATE,ZIP FUME :
> IIONOF VAC "
.a-IAS1--till . 1�-'\. 111101mtvtakeri , baklc IC- 14" ck4,.I te44f 4-6 Xvovv-V ' ecce .
USE OF [if SED or Duplex ;0 Multi-Family ul UMNATZD SIGNTYPE Nn CF sIGNARFA vALuATIaq
SIRLTCIURE 0 C.amrn ial (YIN) ((XtE) SIGNS (9Q FI:) (s)
SIGIVTYIEQI S: 'Y (A) 1 -7 6•'81 syr ;i 3s-c0
B -BANNSI SIGN M -,MCNUMENI'(GROLIND)SIGN N �� b00
BL -FAIR SIGN P -,PRL]1BCI1IUSIGN
D - DEVELCPNENTIDSIGN SP SI OALEVFSIPBANNFR i:
DI - IBRECIIONAL SIGN T -TEMPORARY
E - E[EC IR IIC W -WALL SIGN ,
READERBOARD 1M -,SIGN ' ;
RECEIVED: TOTALVALUATION
,/,.?
"hit_ ,
i By mysignature below,Icertify toeachOfthefollowing Iamthe property owneror.. ' .:•.:.agent to act on the ptopetty owner'a behalf I1m'emad this
application and the intimation have proVided is coned. I havereadthe DsaiptiorlofWmicand verify it is accurate. I agree to oo ply with all applicable 1ocB1
ordinances and state laws relating to building oonsauctioa Itatives ofOrpatiro to arta the above-identified property for inspection purposes.
I attasofApplianrt/Agzrrt: '_% � ' I D 1I t / :
Sig
SUPT wrAL.)Ab ORMA1IONRDQUIRED omcltis
RV max
Site Plan rrANra>ECK ; , ROIAiIlVGSUP
_Elevations 0 OVER0'BunDrOPLANREVIEW
_SignDetaiis-including II,listing(s)applicable 0 0 PLeriNIVGPiANREVIEW
_
Structural Calculations(if applicable) 0 sr,u nnLm 0 OTHER: '
_Copy ofPlanning Approval Letter or Matting with Maiming prior to 0 'LARGE
submittal ofBuilding Permit application. ❑
MAJOR
\,:seis‘a. t 201 Lam revised 03/31/11
a
o,c, .-. lr,--
I 5944,000 Paf ffthorize Khanh Bui to act as my agent to apply for,sign,and file the
documents required to obtain a building,permit for the project at listed address.I declare that I am the
named Licensed Contractor holder.
ao Hot Pot -y fir7/77/,
19409 Stevens Creek Blvd t� •
Cupertino,CA 95014