B-2017-1324CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-1324
10650 S DE ANZA BLVD CUPERTINO, CA 950144450 (369 37 027) WEST COAST SIGN
AND INSTALLATION
CONCORD, CA 94520
OWNER'S NAME: BYER PROPERTIES LP I I DATE ISSUED: 08/10/2017 1
OWNER'S PHONE: 415-626-2937
LICENSED CONTRACTOR'S DECLARATION
PHONE NO: (925) 689-0737
BUILDING PERMIT INFO:
License Class ELECTRICAL SIGNS Lic. #871353
Contractor WEST COAST SIGN AND INSTALLATION Date 01/31/2018 X BLDG —ELECT —PLUMB
I hereby affirm that Lam licensedunder 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:
SHERWIN-WILLIAMS PAINTS - INSTALL (2) ILLUMINATED WALL
I hereby affirm under penalty of perjury one of the following two declarations: SIGNS
m. I have and will maintain a certificate of consent to self -insure for Worker's
11 / • 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 Worke'r'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: $10200.00
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 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
may accrue against said City in consequence of the granting of this permit.
Additionally, the applicant, nderstands and will comply with all non -point
source regulations per t Cupertino Municipal Code, Section 9.18.
Signatures._ 17
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following.two reasons:
1. 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)
2. I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three declarations:
m. 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.
2. 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
permit is issued.
3. 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 become subject to the Worker's Compensation provisions of the
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
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 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 ex uses which may accrue against said City in
consequence of thegra ng of this permit. Additionally, the applicant understands
and will comply with aon-point source regulations per the Cupertino Municipal
Code, Section 9.18.
Date 08/10/2017
APN Number: Occupancy Type:
369 37 027 1 A (Tenant Improvements)
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
by: SEAN HATCH
RE -ROOFS:
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.
Signature of Applicant:
Date: 08/10/2017
TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino unicipal Code, Chapter 9.12 and
the Health & Safety Code, Sectio 25505, 25533, and 25534.
Owner or authorized agent:
Date: 08/10/2017
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance
of work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed
Professional
SIGN PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228.• FAX (408) 777-3333 • buildin cu ettino.or
PROJECT ADDRESS
APN
OWNER NAME A0. PHONE E-MAIL
STREET ADDRESS CITY, STATE, ZIP c,k� jle, FAX
CONTACT NAMEA4/I
e�
���
PHONE'
E-MAIL
__
STREET ADDRESS % /
CITY, STATE, ZIP
FAX —
❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME c
lti D� L lei q
LICENSE NUMBER
5�3
LICENSE TYPE
S Z
COMPANY NAME
E-MAIL
STREET ADDRESS / CITY, STATE, ZIP/
A7 Ce�iS�2�Z1`
PHONE
ARCHITECT/ENGINEER NAME LICENSE NUMBER i
BUS: LIC #
COMPANY NAME
E-MAIL —
FAX —�—�
STREET ADDRESS
CITY, STATE,
PHONE,
it
DESCRIPTION OF WORT{•,
USE OF ❑ SFD or Duplex ❑ MUlti-Family
STRUCTURE: ❑ Commercial
ILLUMINATED
(Y/N)
SIGN TYPE
(CODE)
NO.OF
SIGNS
SIGN AREA
(SQ.Fr.)>_
VALUATION
(S)
SIGN "TYPE CODES:
_- y
- Z/
B - BANNER SIGN M - MONUMENT (GROUND) SIGN
BL - BLADE SIGN P - PROJECTING SIGN
77
3
'
I
D - DEVELOPMENT ID SIGN SP - SPECIAL EVENT BANNER
DI - DIRECTIONAL_ SIGN T - TEMPORARY
E - ELECTRONIC WALL SIGN
READERBOARD /`y1_2 WINDOW SIGN
RE C D BY
T T VALUATION:
By my signature below, I certify to each of the llowing: I am the property owner or authorized agent to act on the property owner' behalf. I hav read this
application and the information I have provi 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 build• ons Ietion. j!BLhuL4 representatives of Cupertino to enter the above -identified property for inspection purposes.
i
Signature ofApplicant/A e*. Date: I
SUPPLEMEN INFORMATION REQUIRED
OFFICE USE ONLY
PLAN CHECK TYPE
ROUTING SLIP
Site Plan s)
Elevations
❑ OVER-THE-COUNTER
�l;
❑ 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 03/31111
r�