15120185CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: 15120185
10900 N BLANEY AVE (316 03 045)
ELECTRIC TECH
CONSTRUCTION INC
CONCORD, CA 94520
OWNER'S NAME: PACIFIC GAS AND ELECTRIC CO
DATE ISSUED: 05/13/2016
OWNER'S PHONE: 916-396-1470
PHONE NO: (925) 849-5324
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class C-10. B Lic. #897792
Contractor ELECTRIC TECH CONSTRUCTION INC Date 10/31/2017
_ BLDG _ ELECT _ PLUMB
MECI3 RESIDENTIAL 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:
MODIFICATION OF (E) AT&T MOBILITY WIRELESS
I hereby affirm under penalty of perjury one of the following two declarations:
FACILITY ON (E) PG&E TOWER
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.
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: $15000.00
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 03 045
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 applicant understands and will comply with all non-point
source regulations per the Cupertino Municipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Signature �i��7 l— Date 5/13/2016
Issued by: Abby Avende O - [til _
OWNER-BUILDER DECLARATION
1' � "'"
Date: 05/13/2016 `�""�
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
t. 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 inteded or offered for
inspection.
sale (Sec.7044, Business & Professions Code)
i. I, as owner of the property, am exclusively contracting with ceased
Signature of Applicant:
contractors to construct the project (Sec.7044, Business & Professions Code).
Date: 5/13/2016
I 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
s. 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. 1 will
permit is issued.
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
s. I certify that in the performance of the work for which this permit is issued, I
Health & Safety Code, Section 25532(x) 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 Cupertino Municipal Code, Chapter 9.12 and
exemption, I become subject to the Worker's Compensation provisions of the
the Health & Safety Code, Sections 25505, 25533, and 25534.
Labor Code, I must forthwith comply with such provisions or ibis permit shall
be deemed revoked.
Owner or authorized agent::
APPLICANT CERTIFICATION
Date: 5/13/2016
I certify that I have read this application and state that the above information is
CONSTRUCTION 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.
Signature Date 5/13/2016
Licensed
Professional
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION I� �/�'\�CJ�-�
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 1 ,�(^-'J
ts
CUPERTINO
(408) 777-3228 • FAX (408) 777-3333 • buildinoAcugertino.org ❑R /
NW CONS ,.._,
TRUCTION ❑ ADDITION I ALTERATION / TI ❑ REVISION /DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS
APN #
10900 North Blaney Ave
316-03-045
OWNER NAME
PHONE
E-MAIL
Pacffic Gas and Electric
916-396-1470
chadchristie@omniserveinc.com
STREET ADDRESS
CITY, STATE, ZIP
FAX
77 Beale St.
San Francisco, CA 94105
CONTACT NAME
Chad Christie
PHONE
916-396-1470
EMAIL
chadchristie@omniserveinc.com
STREET ADDRESS
CITY, STATE, ZIP
FAX
949 Antiquity Drive
Fairfield, CA 94534
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER 10 TENANT
CONTRACTOR NAME G ac 1)0r4 i
LICE E UMBER
LICENSE TYPE
BUS. LIC #
TBD p r7 i
77 2
G/O
3Z 10b
COMPANY NAME
E-MAIL
STREET ADDRESS
CITY, STATE, ZIP
,-OAC✓,- J- >
PHONE
o , 1
,zSBC/9-�3z
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
Byers Engineering
COMPANY NAME
E-MAIL
FAX
Byers Engineering
STREET ADDRESS
CITY, STATE, ZIP
PHONE
4780 Chabot Drive
Pleasanton, CA 94588
DESCRIPTION OF WORK
Modification of existing AT&T Mobility wireless communication facility on an existing PG&E tower. Detailed scope of work
is included in the project description on the front page of the Construction Drawings enclosed with this application.
EXISTING USE
PROPOSED USE CONSTR.
TYPE
# STORIES
USE
TYPE
OCC.
SQ.FT.
VALUATION ($)
EXISTG
NEW FLOOR
DEMO
TOTAL
AREA
AREA
AREA
NET AREA
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODEL AREA
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECK/PORCH AREA
GARAGE AREA: U DETACH
I
ATTACH
# DWELLING UNITS:
ISA SECOND UNIT []YES
SECOND STORY ❑ YES
BEING ADDED? ONO
ADDITION? []NO
PRE -APPLICATION ❑YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑ YES
RECEIVED BY:
T9JAL VALUATION:
PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER
EICHLER HOME? ❑ NO14
` . Cfl
I OO
By my signature below, I certify to each of the ing: 1 aI h rope owner or authorized agent to act on the property owner's behalf. I have ad this
application and the information d is a have ead th escription of Work and verify it is accurate. I agree to comply with all applicable local
�ha
ordinances and state laws reltinin s ti n. I authonz Ir en upeLtino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: Date: 12-7-15
SUPPLEMENTAL INFORMATION REQUIRED
PLAN CHECK TYPE
ROUTING SLIP
New SFD or Multifamily dwellings: Apply for demolition permit for
❑ OVER-THE-COUNTER
❑ BUILDING PLAN REVIEW
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
❑ 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
❑
❑ DISTRICT
submittal of Building Permit application.
MAJOR
SANITARY SEWER
❑ ENVIRONMENTAL HEALTH
CITY OF CUPERTINO 151xi 5-mz-
IV M-1
FEE ESTIMATOR - BUILDING DIVISION
NOTE. This estimate does not include fees due to other Departments (i. e. Planning, Public Works, Fire, Sanitary Sewer District, School
District_ etc►. These fees are hated an the nrelindnarb information available and are onlv an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 E,(f. 711113)
ADDRESS: 10900 N Blaney Ave
DATE: 12/22/2015
REVIEWED BY: ARNOLD
MISC ITEMS
APN: 316 03 045
BP#:
*VALUATION:
1$15,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY
USE: Commercial Building
t-ee:
PENTAMATION
PERMIT TYPE: 1 GENCO
WORK
Modification of E AT&T Mobility Wireless Facility on E PG&E tower
SCOPE
NOTE. This estimate does not include fees due to other Departments (i. e. Planning, Public Works, Fire, Sanitary Sewer District, School
District_ etc►. These fees are hated an the nrelindnarb information available and are onlv an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 E,(f. 711113)
Alech. Plan t ":a>
QTY/FEE
haer'. i't�arr f,:fter;
MISC ITEMS
j5
L)t}2e't" �tdc ', i
1 hours Plan Check, Hourly
$143.00 1STPLNCK
other k7eC` %ll,ct).
11erh. 1r..r.�. I CC.'
0.0
t-ee:
NOTE. This estimate does not include fees due to other Departments (i. e. Planning, Public Works, Fire, Sanitary Sewer District, School
District_ etc►. These fees are hated an the nrelindnarb information available and are onlv an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 E,(f. 711113)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee: Hourly Only? 0 Yes (F) No
$0.00
1 hours Plan Check, Hourly
$143.00 1STPLNCK
Suppl. PC Fee: (E) Reg. Q OT
0.0
1 firs
$0.00
PME Plan Check:
$0.00
Permit Fee: Hourly Only? 0 Yes 0 No
$0.00
Suppl. Insp. Feer Reg. OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
(:.'r.nsiruction Mx:
Administrative
O
G)
Work Without Permit? Yes (E) No
$0.00
Advanced Planning Fee:
$0.00
hours Inspections
$286.00 ISTLNSP Inspection, Ilourl�
0
0
7ira��i i rtc;fs:,c'#1t�Irr�r:--
Strong Motion Fee: 1BSEISMICO
$4.20
Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC
$1.00
SUBTOTALS:
$5.20
$429.00
TOTAL FEE:
$434.20
Revise: e"
Ll1101