B-2016-1581CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2016-1581
20325 STEVENS CREEK BLVD CUPERTINO, CA 95014-2225 (316 26 090)
NU REV
COMMUNICATIONS
INC
LIVERMORE, CA 94550
OWNER'S NAME: W D V PROPERTIES
DATE ISSUED: 04/28/2016
OWNER'S PHONE: 707-364-1075
PHONE NO: (925) 980-2799
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class C-1 Lic. #962583
Contractor NU REV COMMUNICATIONS INC Date 06/30/2019
X BLDG —ELECT —PLUMB
MECH RESIDENTIAL X COMMERCIAL
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.
JOB DESCRIPTION:
INSTALL (3) NEW ANTENNAS; (3) NEW RRUS; UPGRADE MAIN
I hereby affirm under penalty of perjury one of the following two declarations:
BREAKER AND CABINET BREAKER.
1. I have and will maintain a certificate of consent to self -insure for Worker's
REV #I - REMOVE MAIN BREAKER UPGRADE FROM SCOPE OF
Compensation, as provided for by Section 3700 of the Labor Code, for the
WORK - ISSUED 7/5/2017
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
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
APN Number:
Occupancy Type:
and state laws relating to building construction, and hereby authorize
316 26 090
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.
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally, the applica understands and will comply with all non -point
source regulation e C ertino Municipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 7/5(2017
Issued by: Abby Ayende
OWNER -BUILDER rEC71Lt, RATION
Date: 04/28/2016
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
L 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: 7/5/2017
I hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
L 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
Worker's Compensation laws of California. If, after making this certificate of
air contaminants as defined by the Ba ,Area Air Quality Management District I
will maintain compliance with t ertino Municipal Code, Chapter 9.12 and
exemption, I become subject to the Worker's Compensation provisions of the
the Health & Safety o e Secd n 5505, 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: 7/5/2017
I certify that I have read this application and state that the above information is
CON DiUCTION LENDING AGENCY
correct. I agree to comply with all city and county ordinances and state laws
I hereby affirm that there is at4struction 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 DECLARATION
Code, Section 9.18.
1 understand my plans shall be used as public records.
Licensed
Signature Date 7/5/2017
Professional
CONSTRUCTION PERMIT APPLICATION
12 COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(a)cupertin
CUPERTINO
❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI REVISI )/ DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESSZ0521 V' nn Vt' I 1 /' W CK
OWNERNAME„}
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❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT -CGNTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANI
CONT CTOR NAME „ I I r /
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LICENSE NUMBER Cl' C i�
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LICENSE TYPE
BUS. LIC #
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E-MAIL
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
ARCHITECT/ENGINERN eE C�
LICENSE NUMBER A {�
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BUS. LIC #
COMPANY N f CI 1 O - N / ^ I�� `� �G
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FAX
STREET ADDR
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CITY STATE, ZIPPHONE
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DESCRIPTION OF WORK 1
EXISTING USE
PROPOSED USECONSTR
TYPE
#STORIES
USE
TYPE
OCC.
SQ.FT.
VALUATION (S)
EXISTG
NEW FLOOR
DEMO
TOTAL
AREA
AREA
AREA
NETAREA
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODEL AREA
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECKTORCH AREA
GARAGE AREA:LJ DETACH
❑ ATTACH
I
# DWELLING UNITS:
IS A SECOND UNIT ❑ YES
SECOND STORY ❑ YES
BEING ADDED? ❑ NO
ADDITION? ONO
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑ YES
RYAEIVED BY:
TOTAL VALUATION:
PLANNING APPL # ❑ NO PLANNING APPROVAL LEITER
EICHLER HOME? ❑ NO
I
By my signature below, I certify to each of the following: I am the property owner or authorized agent tb act on &e property owner's behalf. I have read this
application and the information I have p;V i I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
gnec,.
ordinances and state laws relating to buil g co I authorize representatives of Cupertino to enter the above-iden 'fled perty for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTALION REQUIRED
PLAN CHECK TYPE
ROUTING SLIP
❑ OVER-THE-COUNTER
❑ BUILDING PLAN REVIEW
_ New SFD or Multifamily dwellin s. Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
permit for new building.
❑ EXPRESS
❑ PLANNING PLAN REVIEW
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
❑ STANDARD
1-1PUBLICPUBLIC WOR
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.doc revised 06/21/11
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2016-1581
20325 STEVENS CREEK BLVD CUPERTINO, CA 95014-2225 (316 26 090)
NU REV
COMMUNICATIONS
INC
LIVERMORE, CA 94550
OWNER'S NAME: WDV PROPERTIES
DATE ISSUED: 04/28/2016
OWNER'S PHONE: 510-914-1357
PHONE NO: (925) 980-2799
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class LOW VOLTAGE SYSTEMS Lic. #962583
Contractor NU REV COMMUNICATIONS INC Date 06/30/2017
X BLDG _ELECT _PLUMB
MECH RESIDENTIAL X COMMERCIAL
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.
JOB DESCRIPTION:
INSTALL (3) NEW ANTENNAS; (3) NEW RRUS; UPGRADE MAIN
I hereby affirm under penalty of perjury one of the following two declarations:
BREAKER AND CABINET BREAKER.
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.
�zhave and will maintain Worker's Compensation Insurance, as provided for by
ection 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
I certify that I have read this application and state that the above
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
3 16
316 26 090
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.
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally, the a licant understands and will comply with all non-point
source regula ' s p r the ertio Municipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
oil re Date 4/28/2016
Issued by: Abby A ende nr
UqUk-L
Date: 04/28/2016 LA-�
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the
RE-ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
following two reasons:
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 of Applicant:
contractors to construct the project (Sec.7044, Business & Professions Code).
Date: 4/28/2016
I hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
t. 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 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 no Munici 1 Code, Chapter 9.12 and
exemption, I become subject to the Worker's Compensation provisions of the
the Health & Safety C e, Sec ons 25505/25 33, and 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
er or authorized agent:
Ile
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
ONSTRUC N 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 DECLARATION
Code, Section 9.18.
1 understand my plans shall be used as public records.
Licensed
Signature Date 4/28/2016
professional
CUPERTINO
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buil dincl(d-cupertino.org
❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED
�3�2o1b•-- rs?3(
ORIGINAL PERMIT #
PROJECT ADDRESS ljQ f /7J�
APN# aj�/_ - t�� ,- rq(::?C)
OWNER NAME Flu , h � D p
U (�{(�
PHONE
E-MAIL
STREETADDRESS 110 � V` L(
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CITY, STATE, ZIP%„�.,, �A4�f�'n /��`�� FAX
(�(J`�j lJa iE- %
CONTACT NAME
HONE
IL�(J
s�cfeev�
STREET ADDRES5.�7j /0�
CITY, STATE P}
FAX
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L102=- r-lcn !V=d
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E3 OWNER 11 OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR`f ❑• CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER TENANT
CONTRACTOR NAME
LICENSE NUMBER
LICENSE TYPE
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PIdONE
A ITECT/ENGINEER NAME -OC
LICENSE NUMBER
BUS. LIC #
COMPANY NAME�; 7 Qk--)E--MAIL
FAX
STREET ADDRESS u
CITY, STATE, Z1P-jwLky n c ^ 11�6-n
PHONE V
DESCRIPTION OF WORK
c
EXISTING USE
PROPOSED USE CONSTh.'fYPE
fA STORIES
USE
TYPE
OCC.
SQ.FT.
VALUATION (S)
E;X1STO
AREA
NEW FLOOR
AREA
UP=
AREA
TOTAL
NET AREA
co
0, o
!1l/ V
BATHROOM KITCHEN
OTHER
REMODELAREA REMODELAREA
REMODEL AREA
PORCH AREA
DECK AREA TOTAL DRCK/PORCH ARRA
GARAGE ARRA: FIDrTACII
❑ ATTACH
it DWELLING UNITS:
IS ASECOND UNIT YES
SECOND STORY []YES
BEING ADDED? ❑ NO
ADDITION? ❑ NO
PRE -APPLICATION An YES IF YES, PROVIDE COPY OF
PLANNING APPL # I] NO PLANNING APPROVAL LE77ER
IS THE BLDG AN ❑ YES
rICHINK HOiMF? ❑ NO
BY: ,.
'TOTAL VALUATION:
By my signature below, I certify to each of the following: I ani the property owner or authori d ent 'tact on the property owner's behalf. I lr a read this
application and the information I have provided is correct. I have read the Description of' Vork and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to gildi onstruc ion. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
%
Signature of Applicant/Agent: / ' '' Date: nx tLL(e
SUPPLEMENTAL INFORMATION REQUIRED
PLAN CHECK TYPE
ROUTING, SLIP
El OVER -TRF
❑ BUILDING PLAN REVIEW
_ New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
permit for new building.
❑ ExPRESs
❑ PLANNING PLAN REVIEW
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
El STANDARD
❑ PUBLIC WORICS
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
El MAJOR
SANITARY SEWER DISTIuc.r
submittal of Building Pennit application,
❑ ENVIRONBIF.NTAL HEALTH
BldgApp_201 Ldoc P•evised 06/21/11
CvY•i�