13090205 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21000 STEVENS CREEK BLVD CONTRACTOR::FBB 4^BE r" """"'^ PERMIT NO: 13090205
OWNER'S NAME: FIRSTRO INVESTMENTS LLC —6/6111O/V'E DATE ISSUED:09/26/2013
OWNER'S PHONE: 8319176844 ILI� P ONE NO:,F31-jfg5
❑ LICENSED CONTRACTOR'S DECLARATIONr— V
C BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class ( Lic.# f y 3 K )Sy j W
MECH RESIDENTIAL COMMERCIAL
Contractor L Date
I hereby affirm at I am ensed under the provisions of Chapter 9 JOB DESCRIPTION:ILLUMINATED CHANNEL LETTERS SIGN,ELECTRICAL,
(commencing with Section 7000)of Division 3 of the Business&Professions BUILDING EXTERIOR
Code and that my license is in full force and effect.
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 Sq.Ft Floor Area: Valuation:$2000
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued.
APN Number:35907005.00 Occupancy Type:
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 PERMIT EXPIRES IF WORK IS NOT STARTED
upon the above mentioned property for inspection purposes. (We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs,and expenses which may accrue against said City in consequence of the 180 D YS FROM�ST CALLED INSPECTION.
granting of this permit. Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section 2
9.18. Issued by. / i� J Date:
Signature_ Date
❑ OWNER-BUILDER DECLARATION RE-ROOFS:
All roofs shall be inspected prior to any roofing material being installed.If a roof is
I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for
the following two reasons: inspection.
1,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, Signature of Applicant: Date:
Business&Professions Code)
1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I hereby affirm under penalty of perjury one of the following three
declarations: HAZARDOUS MATERIALS DISCLOSURE
I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the
Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material.
Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air
permit is issued. 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
I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534.
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 Own o thori ed agent:
become subject to the Worker's Compensation provisions of the Labor Code,I must Date: 4
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's
I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.)
correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records.
9.18.
Licensed Professional
Signature Date
SIGN PERMIT APPLICATION
12 COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION
10300 TORRE AVENUE-CUPERTINO, CA 95014-3255
CUPERTINO (408)777-3228-FAX(408)777-3333-buildinqCoD-cupertino.org
PROJECT ADDRESS APN9
:.�-► S�v'��� `I"ICCCSSUrSUCCC ` C.�
OWNERNAME ��q e/ [ / gq�
C -A a`•'1 �� PH01 7 MAII S V 3U �10twi
STREET ADDRESS ✓ /J%ry,STATE ZIP r tSUrl s FAx
J a
CONTACT NAME To KI
PA R kI PHONE 7 g 1�{r3_jg� E MAII p,I�®-I�_ SI �/)�� cc,,,q
STREET ADDRESS C 1 6 ti-�wlv oit $1 cry crrr,STATE, JZrnI/gccvl CA 159 _ 1 V F"�3 I�5''3�f—74°o e°1
❑OWNER ❑ OWNER-BUILDER ❑ OWNERAGENr CONTRACTOR ❑coNTRACToRAGENT ❑ ARCHITECT ❑ENGINEE2 ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME To \` p N LICENSE NUMBER 136 3 LICENSE TYPE BUS.LIC#
COMPANY NAME 5 l�V �ry�K E-MAIL O o Si h d Y " Ccs FAX
STREET ADDRESS 11 6 (J�`A o f V
CITY,STATE,Ckl U l J C'�- 3 9 5"� PHGN .93 SW 3 c%
ARCHITECT/ENGDUMR NAME I J�-rY ov CL LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK
CA s
6' -FV77-t 0 Q1, - IF--L-U-C- - r.1
USE OF ❑ SFD or Duplex ❑ Multi-Family ILLUMINATED SIGN TYPE NO.OF SIGN AREA VALUATION
STRUCTURE: Commercial (Y/N) (CODE) SIGNS (SQ.FT.) (S)
SIGN TYPE CODES: E 2 —2-10QQ% �
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
RECEIVED BY: TOTALZO
UpTIQN��
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 co n. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: Date: O / d �Z
SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY
Site Plan PLAN CHECK TYPE ROUTING SLIP
ti Elevations OVER-THE-COUNTER BUILDING PLAN REVIEW
Sign Details-including UL listing(s)applicable ❑ EXPRESS PLANNING PLAN REVIEW
Structural Calculations(if applicable) ❑ STANDARD ❑ OTHER:
_Copy of Planning Approval Letter or Meeting with Planning prior to ❑ LARGE
submittal of Building Permit application.
❑ MAJOR
SignApp 2011.doc revised 03/31/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 21000 Stevens Creek Blvd DATE: 09/26/2013 REVIEWED BY: larrys
APN: BP#: f�(� C�oc � VALUATION: 1$2,000
xPERMIT TYPE: Building Permit PL4 iV CIIF_'`'fC TYPE:
PRIMARY g PENTAMATION 10EAP
USE: Sign PERMIT TYPE: A
WORK sin electrical building exterior
SCOPE
SIGN TYPE FEE ID QTY SIGN FEE
Wall Sign,Electric 1SIGNWELEC 1 $278
TOTALS: $278.00
i f c4. Plan Check Phuirb. Plcm Check #Branch Circuits 1 $47.00
L1eeh. Permit Fec Plumb. Pcrrzit Fee: IESIGN Elec.Permit Fee: IEPERMIT
C)tizct illecl�_I;zsp. Othc�r Plumb hasp_ Other Elec.Insp. 0.0 $47.00
1lecfz. Irzsh_Fee: Piumh. lnsp.Tee: Elec.Insp.Fee:
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). Thesefees are based on the prelimina information available and are only an estimate- Contact the De t or addn'1 info.
FEE ITEMS (Fee Resolution 11-053 Eff.' 711/13) FEE QTY/FEE MISC ITEMS
Plan
Suppl.PC Fee: ) Reg. 0 OT 0.0 hrs $0.00
P'i`er
Permit Fee: $278.00
Suppl. Insp.Fee:Q Reg. 0 OT0 0 hrs $0.00
PME Unit Fee: $47.00
PME Permit Fee: $47.00
C071Sr I/C!ian ..,7X
r"d;P2li1I.4II"C1if -Fee:
Work Without Permit? 0 Yes ID No $0.00
Sign Master Plan: Yes ) No $0.00
Travel Documentation Fee: ITRAVDOC $47.00
Strong Motion Fee: 1BSEISMIC0 $0.50 Select an Administrative Item
BldgStds Commission Fee-
SUBTOTALS:
$1.00
SUBTOTALS: $420.501 $0.00 TOTAL FEE: $420.50
Revised: 08/01/2013 �
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