B-2017-03046
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-20.17-0304
10619 S DE ANZA BLVD CUPERTINO, CA 950144431 (359 18 044)
YADA SIGNS
HAYWARD, CA 94545
OWNER'S NAME: TRAM XUONG PHUC TRUSTEE & ET AL
DATE ISSUED: 02/23/2017
OWNER'S PHONE: 408-518-9277
PHONE NO: (510) 756-1728
LICENSED CONIRACTOR'S CONTRACTOR'SDECLARATION
BUILDING PERMIT INFO:
License Class C-45 Lie. #958377
Contractor YADA SIGNS Date 03/31/2017
XBLDG _ELECT _PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
— MECH — RESIDENTIAL X COMMERCIAL
with Section 7000) of Division 3 of the Business & Professions Code and that my
license is in full force and effect.
JOB DESCRIPTION:
HECHAA - INSTALL 2 ILLUMINATED WALL SIGNS
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.
�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: $3500.00
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above
APN Number:
Occupancy Type:
information is correct. I agree to comply with all city and county ordinances
and state laws relating to building construction, and hereby authorize
359 18 044
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.
Additionally, the applicant understands and will comply with all non -point
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
source regulations per the ertino Municipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
_
Signatu Date 2/23/2017
Issued by: Abby Ayende
Date: 02/23/2017
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the
RF -ROOFS:
following two reasons:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
1. I, as owner of the property, or my employees with wages as their sole
installed without first obtaining an inspection, I agree to remove all new materials for
compensation; will do the work, and the structure is not intended or offered for
inspection.
sale (Sec.7044, Business & Professions Code)
2. I, as owner of the property, am exclusively contracting with licensed
Signature ofApplicant:
contractors to construct the project (Sec.7044, Business & Professions Code).
Date: 2/2- 3/2017
I hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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.
HAZARDOUS MATERIALS DISCLOSURE
2. I have and will maintain Worker's Compensation 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 dermed 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, I become subject to the Worker's Compensation provisions of the
the Health & Safety Code, Sections 25505, 25533, and 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
/�
be deemed revoked.
Diner or authorized agen
nj
t
APPLICANT CERTIFICATION
bate: 2/23/2017
I certify that I have read this application and state that the above information is
CONSTRUCTION LENDING 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 issued (Sec. 3097, Civ C.)
to enter upon the above mentioned property for inspection purposes. (We) agree
Lender's Name
to save indemnify and keep harmless the City of Cupertino against liabilities,
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 DF LARATION
Code, Section 9.18.
1 understand my plans shall be used as public records.
Licensed
Signature Date/2 23/2
Professional—
SIGN PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(a)-cupertino.org
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CONTRACTOR NAME
LICENSE NUMBER
LICENSE TYPE
BUS. LIC #
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STREET ADDRESS
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PHONE
DESCRIPTION OF WORK �(L
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USE OF �❑/SFD or Duplex [:]Multi -Family
STRUCTURE: Commercial
(_ij
ILLUMINATED
(Y / N)
SIGN TYPE
(CODE)
NO. OF
SIGNS
SIGN AREA
"(SQ. FT.)
VALUATION
M
SIGN TYPE CODES:
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
'
43,
A
RECEIVED BY:a + _
TOT�I. V�A_,.�'ION:
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 construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature ofApplicant/Age Date:
SUPPLEMENTAL INFORMATION REQUIRED
Site Plan
_Elevations
Sign Details - including. UL listing(s) applicable
Structural Calculations (if applicable)'
_ Copy of Planning Approval Letter or Meeting with Planning prior to
submittal of Building Permit application.
OFFICE USE ONLY
PLAN CHECK TYPE
ROUTING SLIP
❑ OVER-THE-COUNTER
❑ EXPRESS
❑ STANDARD
❑ LARGE
❑ ]VLAJOR
❑ BUILDING PLAN REVIEW CQCq�
❑ PLANNING PLAN REVIEW
❑ OTHER:
SignApp_2011.doc revised 03131111