13070119 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10885 N WOLFE RD CONTRACTOR:SUCCESS GRAPHIC PERMIT NO:13070119
SIGNS
OWNER'S NAME: CUPERTINO VILLAGE,LP 1744 QUEENS CROSSING DR DATE ISSUED:07/18/2013
OWNER'S PHONE: 6507562162 SAN JOSE,CA 95132 PHONE NO:(408)667-1777
❑ LICENSED CONTRACTM DECARATI JOB DESCRIPTION: RESIDENTIAL 11S
COMMERCIAL
License Clasas Lic.# MA'S RESTAURANT-INSTALL(2)SET OF ILLUMINATED
-�--�� CHANNEL LETTER SIGN
Contractor 1 ; _ _ _ �1 Date
I hereby affirm that I am licensed under the provisions of apter 9
(commencing with Section 7000)of Division 3 of the Busin s&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:
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. Sq.Ft Floor Area: Valuation:$4500
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 APN Number:31605053.10885 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 00 DAYS OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned.property for inspection purposes. (We)agree to save 180 DAY F OM LAST CALLED INSPECTION.
indemnify and keep harmless the City of.Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the
Issued by: Date:
granting of this permit. Additionally,the applicant understands and will comply
with all non-point source re ns ppr the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature Date 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.
❑ OWNER-BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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 HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. 1 will
I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with the 't unicipal Code,Chapter 9. and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,SQ0ons 25505,25533,and 5534. j
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date: f /
permit is issued.
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 CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
APPLICANT CERTIFICATION Lender's Address
—
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 ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date
SIGN PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION `\
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 A�
GUPERTINO (408)777-3228•FAX(408)777-3333•building(aDcuperti qaM ^�
LL
PROJECT ADDRESS 1%j APN# J/�f
OWNE NAME ` �./ ` PHO �J -7 Sl`Y`. E-MAII G�
STREET ADDRESS
^ �`� I/ CITY,STATE, FAX
CONTACT NAME ` �j _l (!, PHONE 7MAIL
STREET ADDRESS CITY,STATE,ZIP FAX
❑OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME • . 1 N LICENSE NUMBER M ^ LICENSEE
BUS.LIC#
COMPANY NAME C..^ y„,5 Q dHIC- /J� E-MAIL �f p FAX
STREET ADDRESS �� �+Y\ r �75� CITY,STATE,ZIP PHONE�� q o-
OGfd
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# �/
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK
USE OF ❑ SFD or Duplex ❑ Multi-Family ILLUMINATED SIGN TYPE NO.OF SIGN AREA VALUATION
STRUCTURE: ❑ Commercial (Y/N) (CODE) SIGNS (SQ.Fr.) M
SIGN TYPE CODES: W � ¢ s-&-6
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
RECEI BY TAL UAT
By my signature below,I certify to each of the following: I am the property ownel(or3#orized agent to act on the property owner's behalf. I have ad this
application and the information I have provided is c. I h,ve read the Descriptio Work and verify it is accurate. I agree to comply wi all applicable local
ordinances and state laws relating to build' onstmction. I authonize,;Wresentativeslof Cupertino to enter the above-identified ro/p _fection purposes.
Signature of Applicant(Agent: Date:
SUPPLEMENTAL INFORMATION REQUIRED OF CE USE ONLY
Site Plan P HECK TYPE ROUTING SLIP
Elevations OVER-THE-COUNTER d:;BUILD 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 03131/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 10885 N Wolfe rd DATE: 07/18/720137] REVIEWED BY: Mendez
APN: BP#: *VALUATION: 1$4,500
%PERMIT TYPE: Building Permit PLAN CHECK TYPE:
PRIMARY PENTAMATION 1 CEAP5
USE: Sign PERMIT TYPE:
WORK Ma's Restaurant-install 2 set of illuminated channel letter sign
SCOPE
SIGN TYPE FEE ID QTY SIGN FEE
Wall Sign,Electric 1SIGNWELEC 2 $556
TOTALS: $556.00
,.
z. .
b
Mech. Plan Check Plumb.Alan Check #Branch Circuits 1 $47.00
iLlech.Permil Fee: Plumb,Permit Fee: IESIGN Elec.Permit Fee: IEPERMIT
F"' Hech. In.SP. Other Plumb Insp. Other Elec.Insp. 0.0 $47.00
.Insp.Fee: Plumb. Insp.Fee: 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). Theseees are based on the relimina information available and are onlyan estimate- Contact the Det or addn'l info,
FEE ITEMS(Fee Resolution 11-053 E . 7/1/12) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Suppl.PC Fee:, Q Reg. ® OT 0.0 hrs $0.00
Plumb.i tech./Elec
Permit Fee: $556.00
Suppl. Insp.Feer Reg. 0OT0,0 hrs $0.00
PME Unit Fee: $47.00
PME Permit Fee: $47.00
Construction Tax.
Adan l nistrative.Fee:
Work Without Permit? 0 Yes (E) No $0.00
Sign Master Plan: 0 Yes (E) No $0.00
Travel Documentation Fee: ITRAVDOC $47.00
Strong Motion Fee: IBSEISMICO $0.95 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
$698.95 $0.00 = ' KNJ $698.95
Revised: 07/01/2013
STATE OF CALIFORNIA
CERTIFICATE OF COMPLIANCE, SIGN LIGHTING
CEC-SLTG-1C(Revised 10/10) CALIFORNIA ENERGY COMMISSION
Certificate of Compliance (Sign Lighting) (Page 1 of 4) SLTG-1C
Project Name: Date: 7/
L3
Project Address:
Location of Sign ❑Outdoor Signs ❑Indoor Signs
Phase of Sign Construction p ew Signs ❑Sign Alterations
Type ofLighting Control ❑New Lighting Controls ❑Replaced Li htin Controls ❑Not Installing Lighting Controls
This Certificate of Compliance includes the following components(check all that apply)
❑Mandatory Measures(Lighting Controls) ❑Maximum Allowed Lighting Power ❑ Specific Lighting Sources
1. Certificate of Compliance Declaration Statement(this may be a CIO,C45 or other eligible person)
• I certify under penalty of perjury,under the laws of the State of California,the information provided on this form is true and
correct.
• I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the lighting design.
• This Certificate of Compliance identifies the lighting features and performance specifications required for compliance with
Title 24,Parts 1 and 6 of the California Code of Regulations.
• The design features represented on this Certificate of Compliance are consistent with the information provided to document
this design on the other applicable compliance forms,worksheets,calculations,plans and specifications submitted to the
enforcement agency for approval with this building permit applicati
Name: Signature ,
Company: C t h Pho O �v 1
Address: '^� n LicenseOn �"ctor's*.
lic#)
Lwec 'C_
City/State/Zip: l .�� Date
$.
I ///gz/
2. Installation Certificate(to be signed by responsible person after installation)
Installation Declaration statement
• I certify under penalty of perjury,under the laws of the State of California,the information provided on this form is true'and
correct.
• I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction,or an authorized
representative of the person responsible for construction.
• I certify that the installed features,materials,components,or manufactured devices identified on this certificate conforms to all
applicable codes and regulations,and the installation is consistent with the plans and specifications approved by the
enforcement agency.
• I certify that the requirements detailed on this Certificate of Compliance have been met.
• I will ensure that a completed,signed copy of this Installation Certificate shall be posted,or made available with the building
permit(s)issued for the building,and made available to the enforcement agency for all applicable inspections. I understand .
that a signed copy of this Installation Certificate is required to be included with the documentation the builder provides to the
building owner at occupancy.
Company Name:
Responsible Person's Name: Responsible Person's Signatur
c 1
License r(niay be contractor's lic#) Date Sig �: Position With Company:
2008 Nonresidential Compliance Forms October 2010
STATE OF CALIFORNIA
CERTIFICATE OF COMPLIANCE, SIGN LIGHTING
CEC-SLTG-1C(Revised 10/10) CALIFORNIA ENERGY COMMISSION
Certificate of Compliance (Sign Lighting) (Page 2 of 4 SLTG-IC
Project Name: Date:
3. Mandatory Sign Lighting Controls
NOTES:
1. The same responsible person may install both the sign lighting power and the sign lighting controls, or a different responsible
person may install the sign lighting controls than the responsible person installing the sign lighting power.
2. The Mandatory Measures(sign lighting controls)are required for compliance with the sign lighting Standards. If the person
responsible for installing the sign lighting power is not also responsible for the sign lighting controls, then the owner of the
sign,general contractor, or architect shall be responsible to have the sign lighting controls installed.
3. If more than one person has responsibility for compliance, each responsible person shall prepare and sign a Certificate of
Compliance and an Installation Certificate applicable to the portion of construction for which they are responsible;
alternatively, the person with chief responsibility for construction shall prepare and sign the Certificate of Compliance
Declaration Statement or the entire construction.
3a. Statements of Responsibility:Any person signing the Certificate of Compliance Declaration Statement on page 1 of
4 on this SLTG-1C shall complete Part 3a.Check Yes or No for all of the following statements:
1 I ve responsibility for installing the sign lighting controls
Yes,complete parts 3a and 3b of this form ❑No,complete part 3a of this form
2 There are no existing sign lighting controls and I will be installing compliant sign lighting controls
Jd Yes ❑No
3 Th re are no existing sign lighting controls and someone else will be responsible to install compliant sign lighting controls
Yes ❑No
There are existing sign lighting controls that do not comply with the applicable provision of§119 and§133 and I will be
4 installing compliant sign lighting controls
Yes ❑No
There are existing sign lighting controls that do not comply with the applicable provision of§119 and§133 and someone else
5 will be responsible to install compliant sign lighting controls
AM Yes ❑No
3b. Mandatory Sign Lighting Controls
If the person signing the Certificate of Compliance Declaration Statement on page 1 of 4 of this SLTG-1C is responsible for
-complyingwith the sign lighting control requirements,that person shall answer all of the following questions:
If there are construction documents,indicate where on the building plans the
in datory measures(sign lighting control note block can be located:
1 §133(a)l.All indoor sign lighting is controlled with an automatic time switch control that complies with the Y N N
applicable requirements of§119. ❑ ❑
§133(a)l and 2. All outdoor sign lighting is controlled with an automatic time switch control plus a photo Y NNA
2 control,or an outdoor astronomical time switch,that comply with the applicable requirements of§119. ❑ ❑
Exception to§133(a)2. Outdoor signs in tunnels or large covered areas that require illumination during Y NA
daylight hours.
§133(a)3. All outdoor signs are controlled with a dimmer that provides the ability to automatically reduce N NA,
sin power by a minimum of 65 percent during nighttime hours. ❑ M
Exception 1 to§133(a)3.Signs illuminated for less than one hour per day during daylight hours. y NA
❑ t.
3 Exception 2 to§133(a)3. Outdoor signs in tunnels or large covered areas that require illumination during Y NA
daylight hours. ❑
Exception 3 to§133(a)3.Only metal halide,high pressure sodium,cold cathode,or neon lamps used for Y Nl1
illuminating signs or parts of signs. ❑ q
§133(a)4. An Electronic Message Center(EMC)having a new connected lighting power load greater than Y NN/A
15 kW has a control installed capable of reducing the lighting power by a minimum of 30 percent when ❑ ❑
4 receiving a demand response signal that is sent out by the local utility.
Exception to§133(a)4.EMC required by a health or life safety statue,ordinance,or regulation,including Y NA
but not limited to exit signs and traffic signs. ❑
Field Inspector Notes:
2008 Nonresidential Compliance Forms October 2010
STATE OF CALIFORNIA
CERTIFICATE OF COMPLIANCE, SIGN LIGHTING
CEC-SLTG-1C(Revised 10/10) CALIFORNIA ENERGY COMMISSION
Certificate of Compliance (Sign Lighting) Pa e 3 of 4 SLTG-IC
Project Name: Date:
4.Maximum Allowed LiehtinE Power Method of Compliance
Certificate of Compliance and Field Inspection Energy Checklist
Complete this part if there are signs using the maximum allowed lighting power method of compliance.(Complete part 5
of this Certificate of Compliance if there are signs using the S ecific lighting sources method of com liance
A B C D E I F G H I _
Allowed Watts Design Complies?
w Watts Y/N
4,
C7
o CJ q N O �� ..N VI
U
O ul n z0. C� M by y
N
O
z a
�.
h
Description,
8"
SLI
0
0 _'i-ml
o _ -
A Symbol or code used on the plans whenplans are required)and other documents.
B A narrative description ofthe sign,or location of sign on the building;and the location of sign on construction documents.
OPTIONAL-Check this box only if this sign has a permanent,pre-printed,factory-installed,ENERGY VERIFIED label,confirming that
the sign complies with the Section 148 of the California 2008 Title 24,Part 6 Standards,using the Maximum Allowed Lighting Power
method of compliance. The only labels that will be recognized for this purpose are ENERGY VERIFIED Certification Marks authorized
C by Underwriters Laboratories(UL)or other Product Certification Body accredited to ISO/IEC Guide 65 by the American National
Standards Institute in accordance with ISO/IEC 17011.Surveillance by the Accredited Certification Body shall be an ongoing annual
inspection program carried out by a Type A Inspection body in accordance with ISO/IEC 17020.For signs with such an ENERGY
VERIFIED label,columns`D'through`I'are not required to be filled out.Note:Using an ENERGY VERIFIED label is an optional
method to validate compliance.An ENERGY VERIFIED label is not needed for compliance.
D The sign area insquare feet.
E List"I"if the sign is internally illuminated. List`B"if the sign is externally illuminated.
F Allowed watts per square foot. Enter 12 if the sign is listed as"I"in column E.Enter 2.3 if sign is listed as`B"in column E.
G Multiply the square footage in column D times the allowed Lighting Power Density PD=watts in column F.
H Show the total installed watts in sign,as determined according to the applicable provisions of§130 d ore .
I Enter Y if the number in column H is less than orequal to the number in column G. Otherwise,the sign does not comply.
J This page doubles as a field inspection checklist.
Field Inspector Notes:
2008 Nonresidential Compliance Farms October 2010
STATE OF CALIFORNIA
CERTIFICATE OF COMPLIANCE, SIGN LIGHTING
CEC-SLTG-1C(Revised 10/10) CALIFORNIA ENERGY COMMISSION
Certificate of Compliance (Sign Lighting) (Page 4 of 4 SLTG-1C
Project Name: Date:
5. Specific Lighting Source Method of Compliance
Certificate of Compliance and Field Inspection Energy Checklist
Complete this part if there are signs using the Specific lighting source method of compliance. (Complete part 4 of this
Certificate of Compliance if there are signs using the maximum allowed lighting ower method of compliance)
A B C D
OPTIONAL -
ENERGY Specific light source used for _
Symbol VERIFIED compliance
or Description label Shall include only lighting
Code (see instructions technologies listed below
below) List all that apply
❑ C1 .
❑
A Symbol or code used on the plans when plans are required)and other documents.
B A narrative description of the sin or location of sign on the buildin •and the location of sign on construction documents
C OPTIONAL-Check this box only if this sign has a permanent,pre-printed,factory-installed ENERGY VERIFIED label,confirming that
this sign complies with the Section 148 of the California 2008 Title 24,Part 6 Standards,using the Specific Lighting Source Method of
Compliance. The only labels that will be recognized for this purpose are ENERGY VERIFIED Certification Marks authorized by
Underwriters Laboratories(UL)or other Product Certification Body accredited to ISO/IEC Guide 65 by the American National Standards
Institute in accordance with ISO/IEC 17011.Surveillance by the Accredited Certification Body shall be an ongoing annual inspection
program carried out by a Type A Inspection body in accordance with ISO/IEC 17020.For signs with such an ENERGY VERIFIED label,
column`D'is not required to be filled out.Note:Using an ENERGY VERIFIED label is an optional method to validate compliance.An
ENERGY VERIFIED label is not needed for compliance.
Specific Light Source Compliance Method. The sign(s)identified above use only the following lighting technologies:
List all applicable numbers 1 through 10 that apply in column D above for each row.
I High pressure sodium lamps
2 Pulse start or ceramic metal halide lamps served by a ballast with >_88%efficiency
3 Pulse start metal halide lamps that are<_320 watts,are not 250 watt or 175 watt lamps,and are served by a ballast
with>80%efficiency
4 Neon or cold cathode lamps with transformer or power supply efficiency>_ 75%with rated output current<50 mA
5 1 Neon or cold cathode lamps with transformer or power supply efficiency>_68%with rated output >current 50 mA
DFluorescent lamps with a minimum color rendering index(CRI)of 80
6 (Note:when using electronic ballasts for compliance,lamps with a CRI<80 may be used
7 Light emitting diodes(LEDs)with a power supply with>_ 80%efficiency
Single voltage LED external power supplies designed to convert 120 volt AC input into lower voltage DC or AC
8 output,having.a nameplate output power less than or equal to 250 watts,and certified to the Energy Commission as
complying with the applicable requirements of the Appliance Efficiency Regulations Title 20
9 Compact fluorescent lamps that do not contain a medium screw base sockets 24/E26
10 1 Electronic ballasts with a fundamental output frequency>_20 kHz
E This page doubles as a field inspection checklist.
Field Inspector Notes:
2008 Nonresidential Compliance Forms October 2010.
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CUPERTINO
IrP�lllding Departrnent
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62013 I•
REVIEWC, FrR CODE
.. COMPLIANCE
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77
,���� I
'ions MUST be kept at the
it is unlawful to make any
go, same,or to deviate
!`rom the Building Official.
0 0 0 0�� 9ga necifications SHALL NOT
n ,,.proval of the violation
U;Ly Ordinance or State Law.
D TAIL= FACE LIT CHANNEL LETTER DETAIL DRAWIN
Restra r
AF'Ma�PS
(i) R9CUIT
721T' 1c366JL ell
ing
0Plywood Back12VOLT/20
Stucco Fascia
5"Auminium Return(.040)411 'r
AlAVIALR ! Malls1u )ant
#10 x 3 1/2"Drive screws
minimum threee(3)per letter
or as required per field conditions PrimaryC 0
r
w/sleeves for stand-of T' Electrical Source.
I� 323" Rubber brushing —4supplies by othe
Acrylic Face Class 2 Low Voltage
1 I I LED —?•'` Wiring
( e ` ��( 1 I Note:No conduit or flex
J, 7 `� ••'a/) ' j �'fij' ►`/ ��a>''S� il`le � ►�a�ulr) r�n� ►� 118"
required per class 21ow
l ) l Trim Cap 3/4"� voltage wiring guideline
1/4"Drain Hole Power Supply
(120-277 VAC) d „
Disconnected Switches
Sign Type: (1 Ipternally illuminated LED individual Channel Letters Sign.
Letter Face: Thick acrylic face color as shown -th
y Letter Returns: 5"White with.040 Aluminum °
+� Trim Cap: 3/4"gold
Project Location Approval
1744 Queens Crossing Drive-San Jose-CA 95132
T. (408) 667-1777 E-mail:swu1966@gmail.com I 10885 N Wolfe Rd I !,
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10885 NWolfe Rd
T (408)667-1777 E-mail:swu1966@gmail.com f