11040085 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19960 STEVENS CREEK BLVD CONTRACTOR:PARAMOUNT SIGN PERMIT NO: 11040085
CONTRACTORS
OWNER'S NAME: ERIC HOFFMAN ENTERPRISES 2701 ROAD I DATE ISSUED:04/12/2011
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OWNER'S PHONE: 4082933500 REDWOOD VALLEY,CA 95470 PHONE NO:(707)485-7555
❑ LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class U Ric.# r r r
ME CH RESIDENTIAL COMMERCIAL
Contractor - Pmts Hate
I hereby affirm thatfoY7C
nsed under the provisions of C apter 9 JOB DESCRIPTION:FIRST TECH CREDIT UNTION(FORMERLY ADDISON
(commencing with Sec00)ofDivision 3 of the Business&Professions AVENUE)-INSTALL MONUMENT SIGN ILLUMINATING CHNNEL
Code and that my license is in full force and effect. LETTERS SIGNS
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 j
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: Valuation:$20000
permit is issued.
APPLICANT CERTIFICATION APN Number:36905008.00 Occupancy Type:
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 PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point sour ul tions per the Cupertino Municipal Code,Section
9.18. s _
�� Issued bye r Date:
Signature Date 1�
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❑ OWNER-BUILDER DECLARATION
RE-ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is
the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for
I,as owner of the property,or my employees with wages as their sole compensation, inspection.
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code) Signature of Applicant: Date:
I,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
[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 I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(x)should I store or handle hazardous material.
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
I certif<j that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's Healt .&Safety e, ections 25505,25533,and 25534.
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 r r 9 izeng t: 1
forthwith comply with such provisions or this permit shall be deemed revoked. }�(� ate:
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's
correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.)
to building construction,and hereby authorize representatives of this city to enter Lender's Name
upon the above mentioned property for inspection purposes.(We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
costs,and expenses which may accrue against said City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. I understand my plans shall be used as public records.
Signature Date Licensed Professional
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WADDRESS:
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
19960 stvns crk blvd. DATE: 04/12/2011 REVIEWED BY: bobs.
N: BP#: "VALUATION: $20,000
PE: Building Permit I'?: ('i t' It'(:`I l7 'i,
PRIMARY PENTAMATION 1 CEAPS
USE: Sign PERMIT TYPE:
WORK install monument sign and illuminating channel letter signs
SCOPE
SIGN TYPE FEE ID QTY SIGN FEE
Wall Sign,Electric 1SIGNWELEC 1 $253
Ground Sign 1SIGNGR/RF 1 $317
TOTALS: 1 $570.00
#Branch Circuits 1 $42.00
1ESIGN Elec.Permit Fee: IEPERMIT
Other Elea Insp. 0.0 $42.00
NOTE. Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addh 7 info.
FEE ITEMS (Fee Resohition 09-051 E'. 7/1/1(1) FEE QTY/FEE MISC ITEMS
Suppl.PC Fee: E) Reg. 0 OT 0.0 Ins $0.00
Permit Fee: $570.00
Suppl.Insp.Feer Reg. 0 OT 0.0 hrs $0.00
PME Unit Fee: $42.00
PME Permit Fee: $42.00
„(t7Z�Zt klt,'�7sT71
Tax
Sign Master Plan: Q Yes E) No $0.00
Work Without Permit? 0 Yes 0 No $0.00
Travel Documentation Fee: ITRA VD0C $42.00
Strong Motion Fee: IBSEISMICO $4.20 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
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SUBTOTALS: $701.20 $0.00 TOTAL FEET $701.20
Revised: 01/15/2011
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