B-2016-1296CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2016-1296
21251 STEVENS CREEK BLVD CUPERTINO, CA 95014-5713 (326 29 006)
TERRALINK
COMMUNICATION
5145 GOLDEN
FOOTHILL PWKY
OWNER'S NAME: CUPERTINO CITY OF
DATE ISSUED: 04/18/2016 `
OWNER'S PHONE: 408-777-3228
PHONE NO: 916-337-7355
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class Lie. #
Contractor TERRALINK COMMUNICATION Date
X BLDG _ 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:
T-MOBILE - ADD 3 (1) ANTENNAS, 3 RRU'S & SWAP 3 TMA'S
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.
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
Sq. Ft Floor Area:
Valuation: $20000.00
permit is issued.
APPLICANT CERTIFICATION
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
APN Number:
Occupancy Type:
and state laws relating to building construction, and hereby authorize
326 29 006
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 s . 1 inconsequence of the granting of this permit.
Additionally, the ap � :can nderstands and will comply with all non-point
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
source regulns per a Cupertino Municipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Signature - Date 04/18/2016
Issued by: MELI SA NAMES
Date: 04/18/2016
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the
RE-ROOFS:
following two reasons:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
:. 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)
z. I, as owner ofthe property, am exclusively contracting with licensed
Signature of Applicant:
contractors to construct the project (Sec.7044, Business & Professions Code).
Date: 04/18/2016
1 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
a. I certify that in the performance of the work for which this permit is issued, I
Health & Safety Code, Section 25532(a) should I stare 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 defined 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 CugeXthio-ATU;ntcipal Code, Chapter 9.12 and
exemption, I become subject to the Worker's Compensation provisions of the
the Health & Safety C,qde, ections 05, 25533, and 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall'
be deemed revoked./
Owner or authorized agent:
APPLICANT CERTIFICATION
Date: 04/18/2016 ci
I certify that I have read this application and state that the above information is
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance
correct. I agree to comply with all city and county ordinances and state laws
of work's for which this permit is issued (Sec. 3097, Civ C.)
relating to building construction, and hereby authorize representatives of this city
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 DECLARATION
Code, Section 9.18.
i understand my plans shall be used as public records.
Licensed
Signature Date 04/18/2016
professional
SL
CONSTRUCTION PERMIT APPLICATION
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Bic:' Mpp_ 011. eoc revised 06121111
I
CITY OF CUPERTINO
FFE F.STTMATnR — RTTTT.DTNC TITVTCTnN
11alADDRESS:
21251 STEVENS CREEK BLVD DATE: 02/0212016
REVIEWED BY: MELISSA
MISC ITEMS
APN: 326 29 006
BP#: B-2016-1296
*VALUATION: 1$20,000
*PERMIT TYPE: Building Permit
PLANCHECKTYPE: Tenant Improvement
PRIMARY Commercial Building
USE: g
$0.00
PENTAMATION
PERMIT TYPE: TELECOMFAC
WORK
T BILE - ADD 3 N ANTENNAS, 3 RRU'S & SWAP 3 TMA'S
SCOPE
$0.00
I�1eclr. 1'lcu; Pivi rb, A art Ghec* 1 -kc, I'km Check
Ivle ir. P rmit Tee: ? lwnb . Pei vi t Fsr 1 `h-xc 1'a r trd!
C7;1 e r .3v. £ir..Fa1573• C zfwr I'Iaanh 7l1,5p. I I I €trite; ;;1t:c. hap
NOTE: T his estimate does not
Plarat : Imp, Feet, Elee. I..sv. �«
e to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
niviri!'1_ of.- _ )_ Thoco foot — 1--1 oar fr n xnlir,.:..nx., :s.%,. nfint.., ni1nP.Po —.4 — nr.l,, ..r. nof: m. nfn !'`n:,t....F 4— n,,..t P— 11 ]..f:.
FEE ITEMS (Fee Resolutiolr 11-053 E f 711113)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
Select a Misc Bldg/Structure
or Element of a Building
Suppl. PC Fee: 0 Reg. 0 OT
0, 0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee -G) Reg. Q OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
("Onsfrur"tio ?
Adinin,Cstrative fee.,
0
Work Without Permit? Yes (E) No
$0.00
Advanced Planmizia Fee:
$0.00
1 # Antenna - Telecom Facility
$1,145.00 I.ANTCELRU Cellular, Free -Standing 0
rx�el.thrczrnt'rrrt€tdon X Tc.s°:
Strong Motion Fee: IPSEISMICO
$5.60
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
�M_�.-::_:
..... ...... ..............-
_.:;
_..... �.._...�....._._._ ... _ . ._..__:vSu ��`T�%s
$s 60
� a.� as • ��--�Ta�.�L
$1,151.601
Revised: 01/0112016
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CROWN Memorial Park Site # 825940 looking Northwest from Alves Drive
CASTLE — 21267 Stevens Creek Blvd. View #2
1119116 .,San Jose, CA Applied Im4in4llon 510914-0500
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CROWN Memorial Park Site # 825940 Looking North .from Anton Way
�+ CASTLE
21267 Stevens Creek Blvd. View #f
1/19116 San Jose, CA Applied bnac inat on 510 814-0500