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15050135CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20803 STEVENS CREEK BLVD CONTRACTOR: ACTIVE SIGN CO PERMIT NO: 15050135 OWNER'S NAME: SA1CH WAY STATION LLC 1365 E TAYLOR ST DATE ISSUED: 05/26/2015 OWNER'S PHONE: 4084534700 SAN JOSE, CA 95133 PHONE NO: (408)297 -6640 ❑ LICENSED CONTRACTOR'S DECLARATI N JOB DESCRIPTION: RESIDENTIAL COMMERCIAL p u Z 2,Q�`( SAICH STATION WAY - INSTALL (N) MULTI - TENANT License Classy Lic. # ONUMENT SIGN ,1C �1T,t� �`rt 1U 4 � ' 2'4 Contractor l \ DateOG_M" l 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. I hereby affirm under penalty of perjury one of the following two declarations: 1 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 Sq. Ft Floor Area: Valuation: $4000 performance of the work for which this permit is issued. a e 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: 32632042.00 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 180 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 DAYS FROM 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 EjJlV��� L¢� Date: a� "l') granting of this permit. Additionally, the applicant understands and will comply 4 ') with all non -poin cc regulations per the Cupertino Municipal Code, Section 9.18. /� — 2 `\ RE- ROOFS: Signature All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, 1 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 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, 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). 1 have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I 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 th ertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, $r(Iions 2 05,255 3, and 2 34. Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Owner or authorized agent: Date 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 l 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 CUPERTINO SIGN PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (Q (408) 777 -3228 • FAX (408) 777 -3333 • building(kugertino.org V S e PROJECT ADDRESS� �7� r,(J , �� u 2 [c.� • J f 1✓ . t SNE T 'Z -32& ry 04 OWNER NAME 5A ) C-tk L44% 5 / t U PHONE 4os�- 4s3_ 01¢0 E77 STREET ADDRESS / Zf6sj J1�uCT 1u;3 /Ilia St��"f� l � CITY, STATE, ZIP 5«ti j- 1.5 -G-, C A �`� S tS k 7 L FAX CONTACT NAME L itisa0t'S Qul e PHONE�i�_ _Z�+'SS -3 E -MAIL I'URe Wca1 Le�,�, f-c' STREET ADDRESS ( ,` � V f= CITY, STATE, ZIP J --�� FIA 0�- 2� ❑ OWNER ❑ OWNER- BUILDER ❑ OWNER AGENT ❑ CONTRACTOR VCONTRACTTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME , r�`%( T g� N `[ 6 LICF,NSE NUMBER (ozz 6.21 LICENSE TYPE C/t '"'f BUS LIC # COMPANY NAME i�C"fl U 2 S(C.stiS E -MAIL tt-, I',,% 576ur 4),q U,,, e • n'� FAX SS _2_ _<j. STREET ADDRESS `.� G v! _ n : ,Txeer- cif /- / CITY, STATE, ZIP �, Lq _ , ;��, � 1q �'3� x "' PHONE , L �OF�TV ARCHITECT /ENGINEER NAME. LICENSE NUMBER BUS LIC # COMPANY NAME E -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK phi SAN &IF hio►`) ' L(,(„ i,;­ iil.s`:Te4­) 14 174E. —rWe A-Go� �► UD ss vk N SN i r Fk wA °� USE OF ❑ SFD or Duplex ❑ Multi- Family ILLUMINATED SIGN TYPE NO OF SIGN AREA VALUATION STRUCTURE Commercial (Y / /N) (CODE) SIGNS (SQ FT) TYPE I 1TR*"rf 3 4- ���-,��,� ��,,(S) if 4i - SIGN CODES (`(- B - BANNER SIGN M - MONUMENT (GROUND) SIGN BL - BLADE SIGN P - PROJECTING SIGN D - DEVELOPMENT ID SIGN SP - SPECIAL EVENT BANNER Dl - DIRECTIONAL SIGN T - TEMPORARY // µ6 0 U V E - ELECTRONIC W - WALL SIGN READERBOARD WI - WINDOW SIGN (� TOTAL VALUATION By my signature below, l certify to each of the following: l am the property owner or orized agent to it 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 veriy,4t is accurate. I agree to comply with all applicable local ordinances and state laws relating to buildi constructi on. aut nze representatives of Cupertino tooder the above - identified property for inspection purposes. Signature of Applicant /Agent: Date: C_ ' ��` L��� SUPPLEM TAL INFORMATION REQUIRED OFFICE USE ONLY PLAN CHECK TYPE ROUTING SLIP Site Plan ❑ OVER - THE - COUNTER ❑ BUILDING PLAN REVIEW Elevations 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 03131111 FM-7- CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION baADDRESS: 20803 STEVENS CREEK BLVD DATE: 05121 /2015 REVIEWED BY: MELISSA APN: 326 32 042 BP #: 'VALUATION: $4,000 PERMIT TYPE: Building Permit 11 , V ` 11 PRIMARY n USE: Sig PENTAMATION PERMIT TYPE: 1 CEAP5 WORK SAICH STATION WAY - INSTALL N MULTI - TENANT MONUMENT SIGN SCOPE Suppl. Insp. Fee:Q Reg. Q OT SIGN TYPE FEE ID • • _ QTY SIGN FEE IESIGN Elec. Permit Fee: IEPERMIT Ground Sign 1SIGNGR /RF Other Elec. Insp. 0.0 $48.00 1 $359 Permit Fee: $359.00 Suppl. Insp. Fee:Q Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $48.00 PME Permit Fee: $48.00 El Work Without Permit? © Yes ID No $0.00 TOTALS: $0.00 Travel Documentation Fee: ITRAVDOC $359.00 Strong Motion Fee: IBSEISMICO NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc.). These fees are based on the nreliminary information available and are only an estimate. Contact the Dept for addn'1 info. FEE ITEMS (Fee Resolution 11 -053 E(L' 711/13) ' • • _ # Branch Circuits 1 $48.00 IESIGN Elec. Permit Fee: IEPERMIT h, °,, t; ` ) r,�, Other Elec. Insp. 0.0 $48.00 $0.00 NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc.). These fees are based on the nreliminary information available and are only an estimate. Contact the Dept for addn'1 info. FEE ITEMS (Fee Resolution 11 -053 E(L' 711/13) FEE QTY/FEE MISC ITEMS Suppl. PC Fee: (F) Reg. Q OT 0.0 L hrs $0.00 Permit Fee: $359.00 Suppl. Insp. Fee:Q Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $48.00 PME Permit Fee: $48.00 El Work Without Permit? © Yes ID No $0.00 Sign Master Plan: Q Yes e) No $0.00 Travel Documentation Fee: ITRAVDOC $48.00 Strong Motion Fee: IBSEISMICO $1.12 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $505.121 $0.001 TOTAL FEE: 1 $505.12 Revised: 05/07/2015 CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014 -3255 Telephone: 408 - 777 -3228 Fax: 408 - 777 -3333 JOB ADDRESS: e�3 PERMIT # � 3 OWNER'S NAME: j-, PHONE # % ' GENERAL CONTRACTOR: % yL*,r ,may �5 BUSINESS LICENSE # ADDRESS: 3 '?:r- �� Y�O z CITY /ZIPCODE: *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SU ONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. 2� I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner / Contractor Signature Date kk� QJ o . L� co :2 4J O U) U) E 0 E-11 F= v5 chi _I_ A Q? * y F= co C1, CI1y 7_u 15 > o rL r CP mg//, /M ./my Op CC) co cn- c CD M C, E :s ca m E 7 co cu 2D CD CD_ :::m = c" .2 E2 7c, = CD) CD (D CY> CD CD CD fm 1'-? 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