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11070023CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: N FOOTHILL & 280 CONTRACTOR: CAPITAL TOWER AND PERMIT NO: 11070023 COMMUNICATIONS OWNER'S NAME: CALTRANS 13330 AMBERLY RD DATE ISSUED: 08/02/2011 OWNER'S PHONE: 5102864444 WAVE RLY, NE 68462 PHONE NO: (404) 786-3333 ❑ /, LIC>ENSEppD CONTRACTOR'S DECLARATION put Cs` tj Lie. ��! License Class # Contractor ."2i`, Date 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: 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. 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. 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 understands and will comply with all non -poi source regulations per the Cqpe mo Municipal Code, Section 9.18. Signature ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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 (See.7044, Business & Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (See.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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. 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. 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 expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Date BUILDING PERMIT INFO: BLDG 'r ELECT h PLUMB r MECH RESIDENTIAL Y_ COMMERCIAL r JOB DESCRIPTION: REMOVE AND REPLACE EXISTING EQUIPMENT CABINET INSIDE OF LEASE AREA Sq. Ft Floor Area: Valuation: $4000 APN Number: 32601.CALTRAN I Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by;/./ v Date:, 2: C_ 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: ALL ROOF COVERINGS 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 CupertinoSunicipal Code, Chapter 9.12 and the Health &�afety Code, Se ons�3105>2533, and 25534. ' " CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of Nwrk's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed CONSTRUCTION PERMIT-APPLICATI COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION f 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 I (408) 777-3228 ^ FAX (408) 777-3333 • bL jldh I IK r perifr't 01-,(J 0 1, cm l— k A) ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION /TI ❑ REVISION/ DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS Cc> /� Of— 'A APL # `� V 10 t4 -r- �7� PHONE 510 . OWNER NAME CAL- �2��1`i� E-MAILMAw\"Az > asT�rN,z STREET ADDRESS AVE- CITY, STATE, ZIP 0.4I� �-6 FAX Poi CONTACT NAME ONE - G/ GE -M IL y-0 cl '-�m STREET ADDRESS CITY, STATE, ZIP c" 2F(+ ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME /^� LICENSE NUMBER (� a TLICE;N E TYPE BUS. LIC # I A (sl7 11o3 ot C''% COMPANY NAME CAP) -FAL- ID F E-MAIL c►�,� ,IVa,-+c)c e: ®.� FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK � 1✓Itil, o�i,� �� E�2� ! ��l�li I `�'i 1 Y� �j ��"� t.,t � �Y�1 �l��i n� n EXISTING USE PROPOSED USE CONSTR. YPE # STORIES OFFICE USE ONLY OCC. TYPE DESCRIPTION S .FT. VALUATION EXISTG NEW FLOOR DEMO TOTAL - AREA AREA AREA NET AREA Z BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: ❑ DETACH ❑ ATTACH # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY YES BEING ADDED? ❑ NO ADDITION? ❑ NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF PLANNER'S NAME: RECEIVED BY: TOT VALUATION: bio PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER z-6, 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 ha e i d is c escription of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relatin o b ild' g ons ructi X;;�,.ntatives of Cupertino to enter t11e above-ide tified property for inspection purposes. � . 7 1 Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP New SFD or Multifamily dwellings: Apply for demolition permit for2--OVER-THE-COUNTER ET existing building(s). Demolition permit is required prior to issuance of building ' BUILDING PLAN REVIEW permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FIRE DEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp_2011.doe revised 03/16/11 .6700 - LL CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION LOADDRESS: n.e. corner of 1:280 @ Foothill blv DATE: 07/05/2011 REVIEWED BY: bobs. N, APN: BP#: *VALUATION: $4,000 rPERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY Commercial BuildingPENTAMATION USE: 1 GENCOM PERMIT TYPE: WORK remove and replace existing cell site equipment cabinet. SCOPE nrnIV--. 74. h l . ihanrvli.... *.nry iafnrvaniimt nvailnhly Oiitl aro.. niily aii e.4tliiiote. Contaet tale Dept for f ddn '/ info. vsu. usw� ��... .. .......... .... ..... .............. ... �. FEE ITEMS (Fee Resohition 09-05I &, 7%1110) ......._---- --------- FEE ----- QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes iil ., $0.00 I I hours $260.00 Plan Check, Hourly ISTPLNCK F: 0.0 1 nrnIV--. 74. h l . ihanrvli.... *.nry iafnrvaniimt nvailnhly Oiitl aro.. niily aii e.4tliiiote. Contaet tale Dept for f ddn '/ info. vsu. usw� ��... .. .......... .... ..... .............. ... �. FEE ITEMS (Fee Resohition 09-05I &, 7%1110) ......._---- --------- FEE ----- QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes s) No $0.00 I I hours $260.00 Plan Check, Hourly ISTPLNCK Suppl. PC Fee: 0 Reg. 0 OT 0.0 1 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Feer Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Acoustical Fee: 0 Yes 0 No $0.00 0 0 Work Without Permit? 0 Yes G) No $0.00 Planning Fee. $0.00 Select a Non -Residential 0 Building or Structure 0 I �r r .7i'el 3 ,t1ii EtT'it t C)F?. f 1 Strong Motion Fee: 1BSEISnrrcO $0.84 2.0 hrs $260.00 Inspections ISTINSP Standard Inspections Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $1.84 $520.00 TOTAL FEE: 1 $521.84 Revised: 07/01/2011 nn IT e m e'R May 25, 2011 Department of Transportation Headquarters Accounting Office Cashier PO Box 168019 Sacramento, CA 95816-3819 Re: Acknowledgment and Consent Letter for Equipment Update Site Number: SF04956 Site Address: T -Mobile Communications Site Lease located @ 1-280 & Foothill Expressway, Cupertino, CA; SLA NO: 04-SCL-280-9012-01 Dear Mr. Yee, T -Mobile West Corporation ("T -Mobile") will be updating its equipment at the above -referenced Property. This update will include the removal and replacement of one cabinet with a newer model of similar size and dimension. Pursuant to its lease at the Property, T -Mobile requests your consent to proceed with the equipment update within the existing lease area. To confirm your consent to the proposed update, please sign.and date the following acknowledgement on the two enclosed originals. Return one original in the enclosed return envelope. You can also return the acknowledgement by sending fax copies to the following number: 510-881-1059 or by email to: L.Bilialon@Comcast.net If you have any questions, please contact Lorrie Billalon at 510-825-8889. We appreciate your cooperation with this request. Sincerely, All Ryan Elias -Berg 3G/4G Deployment Project Manager T -Mobile USA Acknowledged, Accepted, and Agreed: Lessor: Name: Title: &m Oje_ g''U Date: Acknowledgement and Consent - Equipment Update l' a,