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B-2016-1716 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1716 CORNER OF FOOTHILL&280 CALTRANS RIGHT OF WAY(N 280 ONRAMP) NU REV COMMUNICATIONS ' INC LIVERMORE,CA 94550 OWNER'S NAME: (Caltrans) DATE ISSUED:08/23/2016 OWNER'S PHONE:(5110)286-5425 PHONE NO:(925)980-2799 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class S-7 Lic.#962583 Contractor NU REV COMMUNICATIONS,INC Date 06/30/2017 X BLDG _ELECT PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9(commencing MECH_RESIDENTIAL X COMMERCIAL with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. JOB DESCRIPTION: NORTHBOUND ON RAMP FOR 280 @ FOOTHILL REPLACE 3(E) I hereby affirm under penalty of perjury one of the following two declarations: ANTENNAE.6 TOTAL TMA's TO BE REPLACED WITH 3 STYLE 1. I have and willmaintain a certificate of consent to self-insure for Worker's TMS's AND 3 TWIN PCS TMA's-T-MOBILE 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. Sq.Ft Floor Area: Valuation:$15000.00 APPLICANT CERTMCATION 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 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. Additionally,the applicant understands and will comply with all non-point WITHIN 180 DAYS OF PERMIT ISSUANCE OR source regulations per th Cu ino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. { "Signature Date 08/23/2016 j Issued by:Kim Dunbar OWNER-BUILDER DECLARATION �J Date:08/23/2016 I hereby affirm that I ami 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 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:08/23/2016 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 ALL ROOF COVERINGS TO BE CLASS"A”OR BETTER 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 Bay Area Air Quality Management District I exemption,I become subject to the Worker's Compensation provisions of the will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and Labor Code,I must forthwith comply with such provisions or this permit shall the Health&Safety Code,Sections 255 , 5533,and 25534. be deemed revoked. a Owner or authorized agent: APPLICANT CERTIFICATION Date:08/23/2016 q I certify that I have read this application and state that the above information is CONSTRUCTION LENDINGAGE correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agenc or 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 08/23/2016 Licensed Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT+BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 _ CIJPER'1 INO (408)777-3226 FAX(448)777-3333•building@cuortino.€sra bw co sTRtCQ3 ALTF RATIO-N I TIlrI5iD3# DEFER ] ORG]NAI iEMT A01E AFN;1� I ► N / # 4a'NERNAME, 1 � � Pli6?v`E �� �f�/,.� � i•1,tAIL STREETlWD � � GL• 1 FAX / 4 CONTACT>vhti Kor ivtCx Aryi'Zvl I ?BOA4 (-119-)2'RZ-921+ £"tion. Kclrvizu@core,os.com STREETADDRE5s as5D (31rah 5 ye-ai-I #960 CITY,S9ATE,M �� � CA `12-821 FAS: O mgfim ©ourtR.stnLDast O oa reht;�-rrr [3 co]+�thcroR I3(;ONMAGtOR C1 ARCHITECT D E'.t]LS'IER O DEViLOPER ❑ AhT �t 11� 1 C _ ColgTRACT01ts ? iV�i `vY�iMtJlCsiT1 LICENSENUt+iEER rJJ J�^z LICENSETYPE �� 2 BUS.LIC CO 4PAh'Y NA.3ia E•DlA]l FAX rh U r(-_Zo ?1 way 1w, Govt. srn�t:FADD]tE ss C1r?,STA?ZZ3P PHONE CY ZS-4��>- i r . . C qr S S o_.... . . ARCI3l7ECT.6Nd]N1U NAME LICtENSE NUMBER Bt�S.i.]CK COMPANY NA.! Care ttcrrer�trv►ceSEWTLa m .Ay FAX ck STREET ADDRESS 335th aWy- .V) Streef, *a ga CITY.ttTkTz z1P tyre t� C& � g ( PHONE DESCAD71ON0�1101tx Replace -txiGhYl.c three cl-v) �,enrlaV -(br 'three neLo ctnI'tnnp�,; existlrtg fhiree fihwrl AWS TMAG With -f-1 me new StYlG 5CT1MA5 c1n_ tr i tin sib afC RC ince OCISfing VUL Unl� with n&0 DUS `I'1 Unit w fia7 IttKiSf11Z. Rb5 610 C4�11nCfi. .. IST1KtSLSE ARQFOSQUU5$ Coll, TYPE :S76RMS Ur111fi1eG` wireless facilt USE nPE occ, l e+:tsTa e'sta>;uwR bEa{aI roTAt _ .. ARrka ' ,StizA AR£A rsr AREA DThcR RBA{pppLAR&� REh{ODELAREA X MDDELAREA PQRGN'A AEGrME• . TOTALtsE4KPORCFtAFtFhI GSPAGAAUAI ATTACH ( 'ATTACH t{DIVELLtNGL'MijS' 15.ASLCOIDUNIT 1'£S SECQXDSTORY 1'£S•'"� i """ DEINGADDED? NO ADIAT10ti ONO WM-AP?LiCAT10V ❑vo W.).Xs.PROVIDE CO?Y OF IS 711E I;LDC A! I'LATIKING APPL N 0 W PLANINIKO APPROVAL LETTER EICHLER H0.10 T NO TOT.4I 1'. O;J 1 tJ4J O� By my signaturk below,I certify to each Df the follotiving: l am iac property o«zter ar authflrized a nt to a propc�'owDsr's behalf. I have read this appliaz Toa andihe infomtation i have provided is eorrw. I have read the Description of 141113,and 1 e accurate, I agree to eompEy with ell mppllceble local ordinnuces and sure laws relating t building nstsvetio7 I authorize mpreseatztit•es o{C I slit-[1.1111,the above•Sdtnti ped propery for iuspeetiouptupasss. SignsturlofApplicant/Agent:- _ r 7r" Date. '"�'���r + SUP}?L>rA3ENTAi»INFQ fAIC')i`REQUIRED PI A _I... ROUTl1G.SL7P, New SFE or Multifamily d-wellings: Apply for dcmolltion pertn[t far # � O�ER THE COULTER Q ,Bt!tLDS1ti PLA4 Tt£\'I>F existing huildig(s). Demolition permit is required prior to issuance of birtlding permit for nein°building. .•© R1PRE55 ,, D'3�L A.\\LAG PL4'v R8ti IEVt Gomm ,pial Bldgs: C rovidc a completed Hazardous Matet•ials Disclosure PLIILtCItoRi.S fc'rm ii any Hzzrdaas lhiaierials are Using used as Dart�-f this project '.� LARGE ` � F1R$DEP1' r Copy of Planning Approval Letter or Meeting with I'l2nning prier to 7L4JOR © 1SANITA:RYSEWERDISTIU submittal of Ouildin:s Ferniit application, c1 S �i ENCtkb\,13E+7ALLt£ALTEt <•. Et1dg,4pp.201(,doe revised 06131111 M CUPERTINO El NEW coNsTR1 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 - build)naiacuoertino.org L.� W�((✓ 1 � El ADDITION ❑ALTELBTIONITI ❑ REVISION (DEFERRED 0R1C;WAL.PERMITN ��Cl ADDREss°rf 'a �� cti�/ Y `:5 NIA eL� oWTTER RAMS l I PHONE (lt U/ ry / STREETADDRES 1 / �, 1 STA/ FAX eQ CONTACT RAMS VCOrt V1G1 Arvrzt.A I PHONE (jI+):2-q Z- g21`h' I"wL Karvau@COre.us. corn fi` ' STREETADDRESs 335D Pirah Jtremi , #960 CITY, STATE, ZIP ❑,�.� CA FAX 1 ❑ Ov'r m ❑ OWNTOI•BUmmot ❑ ovvNT.RAGENT ❑ CONTRACTOR 0 CONTMCTOR F) ❑ ARCHITECT 13 ENOD<EER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME - �. LICENSETNhiEER I LICENSETYPE I BUS. LICK COMPANY NAME E•MAiL FAX STREET ADDRESS ___.. CITY. STATE, VP - - - PHONE ARCHITECTIENOMIllt NAME LICENSE NUMB ER BCS. LICK COMPANYNASIE CMP- DL vekC n-r- -t Scrv'l(a EMAIL 4Ar at-in9(y@(ore us'tay� FAX 17REETADDREII 5350 6)rCh S1Yeef, a,50 , CITY. STATE,ZIP Px C/t PHONE DESCRIPTIONOF WORK Replace 'P.xlshrlry thrYe CLY)renrjag -fbc thyein YIe Lo CIn I'Cnnasre Place existing three tiow AW9 TMAG With three neW Stiyic 3C-FMA5 on e>zl hn site ole Re lace f Yisfing OUL UYtlt with new DUS 'ti WiY vilin Ul'sf ri RbG 610A cAbIr ct. EYISTING L'SE PROPOSED USE utilliie6 wlreles5 facility COtiETR TYPE :STORKS I USE I I TYPE I OCC, - i SQ.FT. I VA.LU.ATION(S) E\ISTO NEW FLDOR DEMO TOTAL AREA I AREA AREA N'ETAREA I_ BATHROOM _ KITCHEN i OTHER REMODEL.AREA REMODELAREA I REAIODELAREA I POACH AREA DECKMEA-TO'l.AL DE(K'PORCH ARFdGAP-AGE.iRF.A1 DETACH ❑ATTACH k DWELLING IDitTS- IS A SECOND UNIT _YES SECOND STORY U)'ES BEING ADDED? NO ADOITIONe ONo PRS-APPLiCAT161.4 ❑1'ES WWS. PROVIDE COPY OF is ME HLnO AR • z TOT.A11'.ALC.ATION ALU PLAITING AT ONO PLANNING APPROVAL LETTER I EICHLER fl0AtE7 NO '= _ I o0 By my Signature below, I certify to each of the following: 1 am ue property owner OP authodacd a nt to a prope.•ry owner's bahalf. I have road this application and the information I have provided is correct. 1 have read the Description of Work and re '" accurate. I agree to comply widen all applicable local ordinances and stzrc laws relzung t building flstmctioo. I authorize rep: esentadves of Cupenhru to enter the above-identi fed propertyfor inspection purposes. S)gnarureofApp)icant/ARenr. ,( - Date: SUPPLEMENTALI\FOn-IATIONREQUIRED FLANCHECNTSPE •(.' +ROUTINGSLIP,:•_. � " OCER THE COV\TERQ DwLDi1c'ru� REvr£t¢. New SFD or Multifamily dteellings:.Apply for demolition pemut far ting building(s). Demolition, is required prior to issuance of bu0dina exis for bmlding. 0' Q,TRESE 0PLR.\�LNC permit over' PL4ti kEC1EH'. t : - c Commercial Bldgs: Provide a completed Hazardous Materials Disclosure U sra\DAIw r ', r � C NXLIC IN OARS fca•in if any Hazrrdaus Materials are being used as parr, cf this project. El LARGE ❑ FIREDEP'f Copy of Planning Approval Letter or Meeting With P12nning prior to D I,LSJOR Cl EA.\)RARYSE4IERDISTRICT subminallofBuildingpermit application. S ®j-ERt2A0\pr EA7AL llEALTlt -- Bldo;pp 2011.docrevised06121111