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B-2016-1397CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: Bi-2016-1397 10800 TORRE AVE CUPERTINO, CA 95014-3234 (369 31 033) QUALITY TELECOM CONSULTANTS INC LOOMIS, CA 95650 OWNER'S NAME: CUPERTINO CITY OF DATE ISSUED: 07/06/2016 OWNER'S PHONE: 408-777-3212 PHONE NO: (916) 315-0500 LICENSED CONTRACTOR'S DECLARRATION BUILDING PERMIT INFO: License Class WELDING Lic. #514K2 Contractor QUALITY TELECOM CONSULTANTS INC Date 11 /30/2018 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: VERIZON - INSTALL (I) FREE STANDING CELL TOWER I hereby affirm under penalty of perjury one of the following two declarations: (EUCALYPTUS STYLE) 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 REV #1 "8/8/16"- REVISE POWER DESIGN - ISSUED 2/9/2017 ® 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 Sq. Ft Floor Area: Valuation: $37000.00 permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above APN Number: Occupancy Type: information is correct. I agree to comply with all city and county ordinances 369 31033 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. (v1/e) 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 Cu rtino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature.";,-Date 2/9/2017 Issued by: Abby Avende ;E/CLARATION Date: 07/06/2016 OWNE -BITILDER 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: 2/9/2017 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 ofthe work for which this permit is issued. 2. I have and will maintain Worker's Compensation Insurance, as provided for by HAZARDOUS MATERIALS DISCLOSURE 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, SecItions 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the permit is issued. Health & Safety Code, Section 25532(a) should I store or handle hazardous s. I certify that in the performance of the work for which this permit is issued, I 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 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 `vim 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 this permit shall j be deemed revoked. ' Owner or authorized agent: a APPLICANT CERTIFICATION Date: 2/9/2017 ENDING AGENCv I certify that I have read this application and state that the above information is CONSTRUCTION I hereby affirm that there is construction lending agency for the performance correct. I agree to comply with all city and county ordinances and state laws of work's for which this permit is issued (Sec. 3097, Civ C.) relating to building construction, and hereby authorize representatives of this city Lender's Name to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Address judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands ARCHITECT'SDECLARATION and will comply with all non-point source regulations per the Cupertino Municipal I understand my plans shall be used as public records. Code, Section 9.18. Licensed Signature Date 2/9/2017 Professional +�-�UPERTINO I -[IXI-NF.W MN CTR T I('.TI0V CONSTRUCTION PERMI° SAPPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building@cupertino.orq ��-+ erg q (`I t� � � A nnTTIOW � 31 dT TRF dTTll1J J TS bL•t n[+Tn r �l hL'rL•nnni'+ -T PROJECT ADDRESS j0&0 0 q - OVNERNAt fL (C)/lPHONE ll �7AAi E -MA�IvL �/ �&I�' STREET ADDRESS - CITY, STATE, P FAx %A/(3 ij4 CONTACT f ' r a PHSfj CITY S STREETADDPE�q V. FAX j % la S.T + ❑ OWNER ❑ owNER-BUIL ER WNERAGL•NT ❑ CONTRACTOR ❑ CONTRACTCRAGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME ce LICENSENUMBER LICENSE TYPE BUS. LIC COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECTIENGINEERNAME Mr LICENSE BE BUS, LIC # COMPANYNAME tY%L'f a r� A� ! (�•�-_—__ 1 E-MAIi.,A �.tj f j� •���^^^ IArT � I�UV /y/J� ST'R}iETADDRfiSS r��11�3'7V`•+�zY/�L CITY, S/ � PHONfi �r f �• Y DESCWTION-OF-W-- C Al - - C1 t�V S P fLx U� EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES USE TYPE OCC, SQ.FT. VALUATION' (S) EXIST(] NEW FLOOR DEMO TOTAL AREA AREA AREA - NET AREA BATHROOM KITCHEN OTHER RETNODELAREA REMODELAREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA; 0 DETACH ❑ ATTACH I P DWELLING UNITS: ISASECONDUNIT ❑YES SECONDSTORY ❑YES ::]JIMIG ADDED? ❑ NO ADDITION7 []No PRL• -APPLICATION ❑YES IF YES, PROVIDE COPY OF IS THE BLDG AN ©YES '=xa-_ TOTAL VALUATION• PLAININUAPPL#❑ NO PLANNING APPROVAL LETTER EICHLERHOME7 NO ❑ "- .:: `-� '-'=-�==5 -` ;'_•>::: -:=. _::_tM.. By -my signature below, I certify to each ofthe following: I am the property owner- or authorized agent A act on tie property owner's behalf, l have read this ,application and the information I have provided is cornett. I have read t cription of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to build' g construction. i au representatives of Cu pe ino to enter the above-ideenti ed property for inspection purposes. Signature of Applicant/Agent: Date: f PPLE E SU M NTAI IIS ATIflN R E QUI - _ = _ - _::: ftAh CIIECKTIPE-_: `� �_i - INN. - - �� =� � `='f�'I20TJTITG..SLIP'�:�.::.?�'=' - - -- - - - `. - -- _ - -- - — - - - - Net� SPD or u r] dice I s.f de Iolit a erntit for Multifamily Il'nApply- or n I exlstlntrbuildm� s . Demolition permit is required prior to issuance of buildirT b b( p 4 P g _...,:.:...:.:.. --_-- pennitfor now building. _';..�_��_'_��f�`=_.,.._•__,''`___:.-_�:,.:_..;: ;�;::.LA _ ,.%_,_hhINGPLAN.RT:\SEI}:.-:_-;.;<;:.-. O Bld s PrDisclosure Commercial Ovide a completed Hazardous Materials s ta.r;;`'. SIATtbARD:_• ::= ...:... .... .:._,,: , :; LTC-t�'6IUis,:=` ``_' _;°.^-._ _. Ton—i•Materialsn i if any Hazardous ar a bernb used as Balt of this pr o�ect. -:_•:.;,=l=i:-:-•::.-_:�:-_:::.;r._.>. .<. :_._.; ci. LARGh....:.;_. ` ='FIRE'D.EPI:::-;:;_;c_-::__':.;_•:-:::.,. -- Copy of Planning Approval Letter or Meeting with Planning prior to wlvLliOR submittal of Building Persalt application. - --- -I _-- - - ------ - r--__ "il---- ----- --- -- _ - i�'t IRdh'I1�11TAitHH"!� B1dg,4pp 011.rloc revised 06121111 F,% CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-1397 10800 TORRE AVE CUPERTINO, CA 95014-3234 (369 31 033) QUALITY TELECOM CONSULTANTS INC LOOMIS, CA 95650 OWNER'S NAME: CUPERTINO CITY OF DATE ISSUED: 07/06/2016 OWNER'S PHONE: PHONE NO: (916) 315-0500 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class WELDING Lic. # 18 4859 Contractor QUALITY TELECOM CONSULTANTS INC Date 11/30/2016 X BLDG —ELECT —PLUMB MECH 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: VERIZON - INSTALL (N) FREE STANDING CEI L TOWER I hereby affirm under penalty of perjury one of the following two declarations: (EUCALYPTUS STYLE) 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 j ` 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: $378000.00 permit is issued. APPLICANT CERTIFICATION 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 369 Number: Occupancy Type: and state laws relating to building construction, and hereby authorize 369 31 033 A{Tenant Improvements) 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 Date 7 Issued by: AbbyA en Date: 07/06/2016 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 r move 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: 7/5/20 16 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER i. 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 ATER Al DISCLOSURE 2. 1 have and will maintain Worker's Compensation Insurance, as provided for by I have read the hazardous materials requirements wider 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 maintain compliance with the Cupertino Municipal C de, Chapter 9.12 and the permit is issued. Health & Safety Code, Section 25532(a) should I store or handle hazardous 3. I certify that in the performance of the work for which this permit is issued, I material. Additionally, should i use equipment or de ceS which emit hazardous shall not employ any person in any manner so as to become subject to the air contaminants as -defined by the Bay Area Air Qua ty Management District I Worker's Compensation laws of California. If, after making this certificate of will maintain compliance with the Cupertino Municip A Code, Chapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety Cod Sectio s 255q5, 2 533, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall - be deemed revoked.Owner or authorized agent: Date: 77/512016 APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is CONS TRCTION LENDING I hereby affirm that there is a construction lending agency ENCY for the performance correct. I agree to comply with all city and county ordinances and state laws of work's for which this permit is issued (Sec. 3097,' Div C.) relating to building construction, and hereby authorize representatives of this city 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, Lender's Address judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands ARC ITECTIS DECLARATION and will comply with all non -point source regulations per the Cupertino Municipal I understand my plans shall be used as public recur s. Code, Section 9,18. Licensed Signature Date 7/5/2016 professional CONSTRUCTION PtRMIT APPLICA"40MB COMMUNITYTDEVELOPM NT C?EPAFRTMF I_pi3€J1lDING DTVI ION 101300 TORRE AVENUE • CUPERTI O, CA 95014-3255 UPERTIP40 (08) 777-3228 }SAX { t38} 777-3333 • to 11 IIt cu(aer[inA c– G — ?— a E_Nl W CONSTRUCTION ❑ ADDITIC)N ❑ AL'I'E.RATiown ❑ REVISION/DEFERRED ORIGINAL PER1v rr# PROJECTAD13RESS 10800 Torre Averill# APNH 369-31-033 OWNER NAME City of Cupertino PtiONF EMAIL STREET ADDRESS 10800 Torre Avenue CITY, STATE 71P : Cupertino, CA 95014 rAX CONTACT NARIE Charles Lindsay PHONE (5 63 217-1804 EMAIL clindsay@completewireless.net STREETADDRESS 2009 V Street: C1TY.5rATS, ZIP Sacramento, CA 95818 FAX 13 OWNEtt 0 OWNER•DWI.DER 0 OXVNER A06h"1' n CoafmcToR d CONTRACTOR AWNT 13 ARCHITECT ❑ ENGINEER Il DEVELOPER M TENANT C'ONTRACTOR NAME TAA - I.ICFNS£NI.IhIBER. t.ICENSETYPE BUS LIC9 - COMPANYNANIE F -MAIL FAX - STREETADORBSS CITY STATE, ZIP PHONE ARCHITECT-'&WINELRNAME Manuel S. Tsiblas LICENSE NUMBER C-20081 BUS. LICR COMPANYNARI6 NST Architects PW,1AIL manel.@mstarchite.ct.r.com FAX STRRRTADDRUS 157.0 River. ParA prive CITY,STATE,TIP Sacramento, Ch 95815 rlIONF (316)5097945 DESCRIPTION OF WORK 743 sq. ft., out door equipment cabinets, cable ice bridge, under ground power and utilities, standby generator, antennas and r soaciaved. equipment mounter on a new Mono -eucalyptUS. EXISIrINO USE - - PROPOSED USE CYINSI'R TVPF N STORIES - Wireless Facilit V- USE TYPE OCC SQ'rT VALUATIONS) FXISTO NEW FLOOR Dr -Wo TOTAL. AREA AREA. AREA ° NET AREA . BATHROOM - KITCtIIiN: OTHER RLMOWLAREA RENIODELAREA R£hrODELAREA PORCHAREA DECKAREA TOTALDLCKIPORCI€ARCA 0 RAGEAREA. DCFACII - - - ATTACH NDWELLINGUNITS ISASFCONDUNrr YES SECOND STORY U YES - REING ABDEW RNO ADDITION! [ANO. PR&APPLICATION AYES IF YES, PROVIDE COPY OF IS THE SLUGAN EjYB' -,'WC .:.. PLANNINGAP14.4 []NO PLANNING APPROVALLE.rrE'S F'rCH1' En1IO%JFY ® -... - ... .... . By Iny signature below, I certiry to each of the.fallowing. I am the property owner or autharized agent to on the o +ner'S bellatf I have roti tlits application and the information t have provided is correct. I have read the Description of Wark and verify it is acauratc- I agree to comply with all applicable local ordinances and state laws relating ttr ts�^ u1ld?;rg eNtcstrnctiim. lives ol'Cupertina to enter the above-idanti ed.pra sty for Inspection purposes. a 9 $ignatareofApplicanUAga Date. � SUPPLEMENTAL INFORMATION REQUIRED ... -:.,, FLAN CNBCIc'f'YPE.; SL ❑............ H&6L3Uh'rER .❑ IIYGPLh'YIIEViEW .��Ne%vSFDOrMultifurnilydf vellings: Apply for demolition permit for existing building(s). Demolition permit IS required prior to issuance of building permit for new building, l�. EXPRESS I� ,YLAIVIIIN6 FLAN tEYIESY (fltnrrlerciui Bldgs: Provide a completed IIazElydoas vl,terials Disclosure �.'SrAPitfARD ® PusLtcIYORAS Farm if any Hazardous Materials Bre being used as part of this project, ` °❑ 0 LAItc�.`: Fin lit Pr: copy of Planning Approval Letter or Meeting with Planning prior to ❑ i1AJOR. :: -❑ SA'jtTAItYSRleERl7tsrixcr submittal of Building Permit application, . °_ .. c© .)NYrRCI?lhlEa�i'fAL i3EAL7'H_ 131dlgt4ppz.._201 Ldbe revised 06-21: 1 /