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B-2016-1379CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-1379 10101 N DE ANZA BLVD CUPERTINO, CA 95014 (326 34 071) COMMUNICATION COMPONENT SYSTEMS INC SOUTH HACKENSACY,NJ 07606 OWNER'S NAME: WATERDRAGON 289 LLC DATE ISSUED: 05/05/2016 OWNER'S PHONE: 4t)S,! "1 -L —�' j s- PHONE NO: (201) 927-6846 LICENSED CONTRACTOR'S DECLARATION License Class C-7 Lic. #972367 Contractor COMMUNICATION COMPONENT SYSTEMS INC Date 04/30/2018 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: 1. I have and will maintain a certificate of consent to self -insure for Worker's Compensation, as provided for by SispeTtisissued tion 3700 of the Labor Code, for the performance of the work for which Ihave and willmaintain Worker's Cmpeion 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 -point source regulations per the Cupertino Municipal Code, Section 9.18. Date 515/2016 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: 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. 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. 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. BUILDING PERMIT INFO: BLDG —ELECT —PLUMB MECH _ RESIDENTIAL X COMMERCIAL JOB DESCRIPTION: AT&T - MODIFY (E) ROOF TOP CELL SITE Sq. Ft Floor Area: Valuation: $10000.00 APN Number: Occupancy Type: 326 34 071 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: AbbyAvende Date: 05/05/2016 aW% JwJ4 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: 5/5/2016 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 Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. Oor authorized agent: Datere: 1515/2016 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. is CUPERTINO F1 N-PW(_;nWRTRTJM10N MENEM. CONSTRUCTION PERMIT 'APPLICATION N-195 aniff COMMUNITY -DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300'TORREAVENUE -CUPERTINO., CA 95014-3255 .(408) 777-3228 - FAX .(40.8) 777-3833 -- WildlagMagpertino.orcl M AMIT70tj 'q ALTFRATION111 T1 R�v*,u-nNj-nr--r.r,_RRT?ii -DRURNAL PERMIT -9 I'ROJECT ADIMMISS 1.0101: North De Anza Blvd. .326-34-0'41 QW.NI-KNAMr 141"" 40.8-572 8457 JIFE-mebeLeca. a s0cushwake.corn . STRECT ADD RM to. 40. NIN, STATE, M' San Jose, CA 951, -FAX CONTACTNAME Rebecca Walls (Agent) GUShman 4 pTIONr, I R -MAIL akefield 57 R,-ebecraWls0_dtz_com STREL'I'MYRESS 10 Almaden Blvd., Ste 535. CITY, STATE, ZtP Ban Jose, CA 95113 VAX IM N CTci NT OMM 11 OWNFR;RUILDER. OWNER -AGENT CONIT! C.TOR 11 CO MA RA06 . IR ARCHMICt El MIJOINPPA El DPVHLWVJt IXTEffANT CONMACTORNAME :L1.CT-K'81:NUMBFR F, -xnN'MrrVPH BUS. LFC'f TQQ COMPANY NAME FAX sl'kPET ADDRESS CITy'sT'KrB'Z1P PHONE XkClATECTMOINHIM NAME, _Joshua YJ Kang UUNGEEM C6321NUMB 6 aux. LIC a OOMPAM.'MME.13vers Engineering Co, on behalf E-MAIL FAX of Wobilijy Yong-Joonq Kang <yj.kqngCZD. ers.corn> STRUWADDRESS47.80 -Chabot Dr., Ste 104 c"y- "'ATL-"'? Pleasanton, GA. 94588 PHONE 925-785 7431 DESCAPT-ION OF WORK Modification of an existing AT&T Mobility rooftop cell site. -SEE ATTACHED EXISTING Us]] -PROPOSED LSH CONSTR. TYPI! Y.STORIES ' Office Bldg. [ same LISF, TYPE OM SQ.FT. VAIMATION (S) rxISTG NVWI-IOOR DEMO TOTAL AREA ARFj IWA NETARYA BATHROOM '111324 Yaw OTHER REMODEL AREA -mo-itcuAKKK REMODUL AREA RUMMEL AREA NCY AREA TIYIAl.PrCICII.",IRCIIAllr,,A GARA(MAR13k, D11TACI-I I ATTACH I it DWELLUqG umm. 1SASECONOUNrl! -1:1111ES SreaNDSTORY YES I RETWADD)EP? ©NO AMMON? ONO R.R&APPUCATION E3YES 1FYHqj%Q%q=COP1OF IS TH E BLDC AN 01 YES VALLIATION: PLANMIGAPPLfr' []NO PLANNING APPROVALLP17FR FICIILMRONIV? 1140 0 Bym.ysigmiurebLIci,kv,re-crti.fytoeach 6filio foll.o%vir.ig: 1 a the property .oi%-noi'or-litithorited age n9ref ropeiti,oNmiei'.si>eilalrlbayer�eadiliiq I ip -ion and theinformation I have provided is correct I have read the. Description Of Work: _., in �-Cccumtc, I agree to cornply with all.applicablp local na. t r _plicaf y y .ordinances and. State 1ftW&xCJH1jW to building construction. I audiori.ze representatives of(Atperfino to ekibove,identified-)roperlyi'ori ectf()r)Puq)oS0.% z. d�, .. dr Ijq6,b) I-/- Y., Ayevz &,5-r_ef- Sipaturg ofApplicantlAge Dato: SUPPLEMENTAL INIFORMAX)ON REQUIREDK T-imx' -.:.96i Mlio srut. �nutr:>lisivr�_t?ifiniArmtow New SED or Multifamily dwellings: Apply for demolition permivrorVii; existing l)uildfng(s]. Demolition peilnit is regttired.,prior to issuance of building permit for now building. 1vIN0'%A?MWrK%V - Commercial Bldgs: Provide a completed 1jazardous Materials Disclosure - Q .*tAffQAR0 ,T To— rm -if any Hamdous AdateriaLs Euv being used as part of thisprqject. .0 Copy -of Planning Approval Letter orMeefingwith. Plarinbig: prior to n—ibinittal of Building Permit application. 131,IgApp__2011. clot revised 06121111 PROJECT DESCRIPTION 1.INSTALL (N) RRH'S BEHIND'POSITON-1. 2.RE-ARRANGE. THE (E) LOCATION OF THE LTE RRUS SO THAT ANTENNA.JUMPERS GOING TO ANTENNA POSI.TION-1 IS SHORTER. 3.RE-USE THE (E) (2) DUS41 AND ADD .3RD DUS41 IN (.E) 19" RACK. 4.VERIFY ALL THE RETS & INSTALL/CONFIGURE ACCORDINGLY. S. UPGRADE THE SIAD TO CISCO ASR 901.. 6.PAINT ALL (N) EQUIPMENT TO MATCH BACKGROUND PAINT SCHEME/COLOR. 7.INSTALL RF SIGNAGE/BARRIERS AS REQUIRED.