B-2016-1215CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2016-1215
10110 CALIFORNIA OAK WAY CUPERTINO, CA 95014 (342 12 030)
C B A SITE SERVICES
INC
OAKLEY, CA 94561
OWNER'S NAME: PACIFIC GAS AND ELECTRIC CO
DATE ISSUED: 06/23/2016
OWNER'S PHONE: 800-743-5000
PHONE NO: (925) 754-7633
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class ELECTRICAL Lic. #455726
Contractor C B A SITE SERVICES INC Date 04/30/2018
X BLDG _ELECT _PLUMB
MECH RESIDENTIAL X COMMERCIAL
I hereby affirm that I am licensed under the provisions of Chapter (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 (I) antenna, DC6 unit, DC12, Purcell cabinet, DUS411, XMU
I hereby affirm under penalty of perjury one of the following two dleclarations:
inside (N) Purcell cabinet, H1 -CAP retrofit, fiber/DC trunk.
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 Labo I Code, for the
performance of the work for which this permit is issued.
k�'
I have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance of the ork for which this
Sq. Ft Floor Area:
Valuation: $25000.00
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
342 12 030
3 42
A (Tenant Improvements)
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
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 nc n -point
source regulations per the Cupertino Municipal Code, Section 9.'8.
180 DAYS FROM LAST CALLED INSPECTION.
Signature Date236/ /2016
Issued by: Abby Ayende
Date: 06/23/2016
O ER -B LDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the
RF. -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 icenscd
Signature of Applicant:
contractors to construct the project (Sec.7044, Business & P ofessions Code).
Date: 6/23/2016
I hereby affirm under penalty of perjury one of the following three I eclarations:
for Worker's
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
1. I have and will maintain a Certificate of Consent to self -insure
Compensation, as provided for by Section 3700 of the Labo 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 ork for which tbis
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 p rmit is issued, I
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
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
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
exemption, I become subject to the Worker's Compensation rovisions of the
the Health & Safety Code, Sections 25505, 25533, and 25534.
Labor Code, I must forthwith comply with such provisions o r this permit shall
be deemed revoked.
Owner or authorized agent:
APPLICANT CERTIFICATION
Date: 6/23/201
I certify that I have read this application and state that the above 'information is
STR IO 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
regulations the Cup I rtino Municipal
ARCHITECT'S DECLARATION
and will comply with all non -point source per
Code, Section 9.18.
1 understand my plans shall be used as public records.
Licensed
Signature Date 6/23/2016
Professional
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
CllRI:f2TfN0 (408) 777-3228 • FAX (408 777-3333 • buildingOcupertino.ora 13
2-016
❑ NEW CONSTRUCTION El ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT
PROJECT ADDRESS 10110 California Oak Way
APN0 342-63-001
OWNERNAME PG&E
PHONE 800-743-5000
E-MAIL
STREET ADDRESS 245 Market Way
CITY, STATE, ZIP San Francisco
FAX
CONTACT NAMEon behalf of AT&T Mobility
PHONE 925-510-5081
EMAII 2pitskies@sbcglobal,net
STREETADDRESS 4780 Chabot Dr., Ste. 104
CITY, STATE, ZIP Pleasanton, CA 94588
FAX
❑ OWNER ❑ OWNER -BUILDER 11OWNER AGENT ❑ CDI
TRACTOR O CONTRACTOR AGENT IN ARCHITECT ❑ ENGFNB13R 111 DEVELOPER ❑ TBNANT
CONTRACTORNAME TBD
LICBNSENUMBER
LICENSETYPE
BUS. LTC 9
COMPANY NAME
B -MAIL
FAX
sTRBE'r ADDRESS
CITY, STATE, ZIP
PHONE
ARCHITECTIHNGINEERNAME Joshua YJ Kang
ICENSENUMBER C63216
BUS, LIC'4
COMPANYNAMB Byers Engineering CO.
E-MAIL
FAX
STRBETADDRESS 4780 Chabot Dr., Ste. 104
cITY,STATE,ztP Pleasanton, CA 94588
PHONE 925-785-7431
DESCRIPTION OF WORK
I
6 6 - t , CIA lA+/
Vl T
pus ._ 1
(/
S -Vl r1 C a bf tom.
_
cxt
'+A,6-er
BXISTING•USB
PROPOSED USE CONSTR.TYIE
8S RIES
PG&E EIec.Tower
Wireless Telecom
USE
TYPE
OCC.
SQ.F'I'.
VALUATION ($)
EXISTG
NEW FLOOR
DEMO
TOTAL
AREA
AREA
AREA
ETAREA
BATHROOM KITCHEN
OTHER
REMODELAREA REMODBLARRA
RHMODH
AREA
PORCH AREA
DECK ARBA
TOTAL DECK/PORCIf Ali aA
G
B ARRA; ❑ DErrACH
I
I
O ATTACH
6 DWELLING UNITS;
IS A SECOND UNIT 0 YES
SRCONq
STORY J] 'ns
BEING ADDED? ONO
ADDITI
i N? ONO
PRH -APPLICATION ❑YES IF YES, PROVIDE COPY OF
IS THE
OLDG AN OYES
' RECE] VE Y:..
TOTAL VALUATION;
PLANNINGAPPL# ONO PLANNING APPROVAL LETTER
EICHLERROME?
ONO'.
$25,000
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act onhe p perry owner's behalf. I have read this
application and the information I have provided is correct. I have road the Description of Work and verify it is acbu c. I agree to comply with all applicable local
ordinances and state laws relati to build' g c nstruction. I autholze r presentatives of Cupertino to enter the above -identified property for inspection purposes.
Signature Applicant/Agent: ' Date:
of I• �
SUPPLEMENTAL INFORMATION REQUiZED
. „PLAN,CHEC&TYPE .-
'.-. ..",.. ROUTING SLI P.'•,.
❑ OVER -THF -.COUNTER
1'LANREVn3W ..'.
Now SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
.BIIII7)iNG ...`•.
..
permit for new building,
❑ EXPRE§S ' '
❑ PLANNING PLA N' REVIEW: .
_ Commercial Bldgs: Provide a completed Hazardous Milterials Disclosure
❑ '.STAiMAzin .
❑PuDyic woitJr§ '• .
Porin if any Hazardous Materials are being used as part of this project..:
Q
�nIE TJEPT
_ Copy of Planning Approval Letter or Meeting with Plan) Ing prior t0
~:
❑
El: YSEN
submittal of Building Permit application.
MAJOR
SANITARY EI1 DIS Tf CT
'
EI' ENVI[iON ENTAL IIEALTB,. • ' .. •.
BldgApp_2011.doc revised 06/21/11
Rai Pacific Gas and Telecommunications us Mall:
Pa
Business Development Pacific Gas and Electric Company
Electric Company.., 246 Market Street
Mall Code N10D
San Francisco, CA 94105-1702
WE DELIVER ENERGY,' Fax: 415-973-3884
Letter of Authorization
Wireless Provider: AT&T
Location: 10110 California Oak
APN: N/A
SBE: 135-43-038C Parcel 1
Pacific Gas and Electric Comnpar
above, and pursuant to the term,,
Antenna Attachments entered in
PCS, LLC (LICENSEE) dated Fe
the Wireless Provider, its agents,
• Access the PG&E Land
Fee Property
ay, Cupertino, CA
(PG&E), as the owner of the property referenced
and conditions of Master License Agreement for
o by and between PG&E and New Cingular Wireless
)ruary 17, 2005 (Wireless Provider), hereby authorizes
contractors to:
above, following advanced notice to PG&E.
• Conduct necessary activities such as site design visits, radio frequency tests subject to PG&E's
prior review and approval.
• Apply for and obtain all land use approvals and permits, to order building permit plans and
architectural/engineering drawings which are appropriate for the installation, construction, and
continued operation of a wireless communications site (including antennas and all ancillary
equipment and structures).
This Letter of Authorization is subject to the following conditions:
• The Wireless Provider shall be sol�ly responsible for satisfying all conditions of approval that
may be contained in a conditional use permit issued by the responsible jurisdiction on behalf of
"owner," "applicant" and/or "development permit holder" as referenced in the conditional use
permit for as long as the same may exist (without regard to the term of the Master License
Agreement). Prior to the issuance of any conditional use permit, all conditions of approval,
associated with permit must be reviewed and approved by PG&E's Land Department.
• As the applicant, the Wireless ProSider shall be solely responsible for the payment of all agency
fees including, but not limited to application fees, costs of agency review and permitting fees.
• Before entering the PG&E Land, the Wireless Provider, shall ftrrnish PG&E's Land Department with
satisfactory evidence that the Wireess Provider has procured the insurance policies and coverages set forth
in the Master License Agreement.
• The Wireless Provider shall pr
the PG&E Land by contacting
o The Wireless Provider, its agents
the PG&E Facilities and Land.
• The Wireless Provider's activities
terms and conditions set forth the T
Date: /!� r l� l�'�vt�l�'L� a;. X,
Ralph Medina
Manager, Land Management
Pacific Gas and Electric Company
124 -hour advanced notice to PG&E's Land Department prior to entry on
Toy at (415) 973-0622.
contractors shall not interfere with or impair PG&E's use of
this Letter of Authorization are subject to all of the
License Agreement.
Site #: ATT-CNU2037 LTE 3C
Site Name: Ranch
S
^v°4 _ CustoEngineering
u ,m ` SOLUTIONS
November 25, 2015
AT&T Mobility
c/o Ronald Keller
Byers Engineering - California
4780 Chabot Dr., Suite 104
Pleasanton, CA 94588
Reference: Structural Analysis of PG&E 1
kV Transmission Line, AT&T
APN: 342-63-001; SBE 135.4
Dear Mr. Keller:
Cofijornia.
Custom Engineering Solutions
2603 Camino Ramon, Suite 200
San Ramon, CA 94583
Headquarters.
Custom Engineering Solutions
1060 Windward Ridge Pkwy, Suite 150
Alpharetta, GA 30005
:r No. 40752557 (181114); Lawrence -Monte Vista, Newark -Britton, 115
No, ATT-CNU2037 located 10110 California Oak Way, Cupertino, CA;
2C-1
PG&E and its' engineering consultants, h ve in accordance with the California Public Utility Commission's (CPUC)
general orders, performed a structural ana ysis on the above referenced lattice steel tower and have determined that
the tower meets or exceeds CPUC and P�&E strength requirements for your proposed antenna installation. For the
reasons stated below, structural calculations need not be provided to Santa Clara County.
The following Information should clarify
on transmission towers. PG&E is a pul
electric transmission towers and poles
PG&E is responsible to the CPUC to en
its towers. Local jurisdictions are "preer
utility to submit to their permitting proce
In order to comply with CPUC regulation
mounting PCS or cellular antennas to a
consultants must thoroughly review the stl
the structural engineer's responsibility to
mounting arrangements are suitable. In m
(both wind and weight) are so insignific
calculations nor modifications to the tower
or mounting arrangement are required
installation, PG&E inspects the workmans
with PG&E design requirements.
Sincerely,
dr
Stephan Tremblay
Civil Engineer, P.E,
Custom Engineering Solutions Inc, for PG
v PG&E interacts with local permitting agencies when installing antennas
utility, therefore, the design and construction of utility structures such as
e under the jurisdiction of the CPUC rather than under local jurisdictions.
the use of sound engineering principles in the design and construction of
T by State Law under the Public Utilities Code and cannot require a public
i when doing work on utility structures,
> and standards PG&E has established the following procedures; before
iy transmission tower, PG&E's structural engineers and its engineering
ictural Integrity of the tower and the proposed mounting arrangement. It is
determine whether modifications to the tower are required and that the
ist cases, the additional loading due to the antennas and associated cable
int compared to the strength of the tower that neither actual structural
.re necessary. In some cases, however, structural modifications to the tower
nd must be done before any antenna may be attached. Following the
lip of the mounting to ensure that the installation was made in accordance
r,