15030002CITY OF CUPERTINO BUILDING PERMIT `
BUILDING ADDRESS: 10350 N WOLFE RD CONTRACTOR: OVERLAND PERMIT NO: 15030002
CONTRACTING INC
OWNER'S NAME: CUPERTINO PROPERTY DEVELOP LLC 587 SIGMAN RD NE DATE ISSUED: 12/10/2015
OWNER'S PHONE: 4087773081 CONYERS, GA 30013 PHONE NO: (678) 413-0333
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
op SPRINT-REMOVEIREPLACE (3) ANTENNAS; R/R (3)
License Classs_ Lic. # 3 $ 36�'T EQUIPMENT CABINETS WITH (2); INSTALL GPS
/ ANTENNA;
d Contractor ate 6� ADD (6) RRU UNITS AND (3) FILTERS; (N) VENTILATION
I hereby affirm that I am licensed uoil, 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
erfiormance of the work for which this permit is issued. Sq. Ft Floor Area: Valuation: $20000
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: 31620099.10350 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, VX,—z;1-1_
costs,and expenses which may accrue against said City in consequence of the���Date: ,%�granting of thisper ' . Additionally, the applicant understands and will comply Issued by: �T—/-- —
with all non-poin our a regulations r the Cu rtino Municipal Code, Section
4
9.18Whturew
�y RE -ROOFS:
r, Date 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.
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date:
the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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)
I, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct the project (Sec.7044, Business & Professions Code). I 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 the Cupertino Municipal de, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sectio s 5 5, 255 3, a id 2
Section 3700 of the Labor Code, for the performance of the work for which this
i• Owner or authorized a nt: Date:
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 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 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 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
CITY OF CUPERTINO
WE FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 10350 N Wolfe Road
DATE: 03/02/2015
REVIEWED BY: Sean
APN:
BP#:
°VALUATION: 1$20,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY
USE: Commercial Building
Civil / Religious activities
in BQ zone? Yes � No
PENTAMATION
PERMIT TYPE: 1 GENCOM
A
WORK
Remove/replace 3 antennas; R/R 3 equipment cabinets with 2 • install GPS antenna; add 6 RRU
SCOPE
units and .(3) filters; (N) ventilation screen. (Permit to replace expired permit 12040058)
'., k s:a
Mech. Plan Check
Plumh. Plan Check
Elec.. flan ('heck
tlec%. Permit.Fee:
Plrnnb. Permit Fee;
Elec. Permit Fe€:
Other Meek Insp.
Other Plumb Insp.Li
Other Elec. fnsp. Li
Meek Insp. Fee:
Plrnnb, Insp. Fee:
Elee. Insp. Free:
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc.l. These fees are based on the nreliminary information available and are only an estimate. Contact the Dent for addn I info.
FEE ITEMS (tree Resolution 11-053 E . 7%1113)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee: Hourly Only? 0 Yes Q) No
$0.00
hours Plan Check, Hourly
$286.00 ISTPLNCK
Suppl. PC Fee: Q Reg. Q OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee:Q Reg. Q OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tax: 1BCONSTAXC
$0.00
11tin7inhy1rative Fee:
G
Work Without Permit? 0 Yes No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential Q
Building or Structure
i
:Travel Documentation .Fees:
Strong Motion. Fee: 1BSEISMICO
$5.60
Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC
$1.00
SUBTOTALS
$6.60
$286.00
$292.60
Revised: 02/14/2015