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14070144J CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10218 IMPERIAL AVE I C NQ 'T ACTOORkT" -"^ mac` I PERMIT NO: 14070144 � OWNER'S NAME: ECI TWO RESULTS LLC I .m,"„,— � 11P 1111 — / _ I DATE ISSUED: 11 /19/2014 1 OWNER'S PHONE: 4082898310 1 , J PHONE NO: LICENSED CONTRACTOR'S DECLARATION License Class�.._!t Lic. g RD Contractor {i �� f jiJ q C e Date 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: 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. 1 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. APPLICANT CERTIFICATION I certify that 1 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. Signature / Date ❑ OV1'N'ER- BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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) I, as owner of the property, am exclusively contracting with licensed contractors to constrict the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: 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 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, l 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. 1 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. l 8. Signature Date JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL E] ADD 1 (N) PANEL PER SECTOR, 3 TOTAL, ON (E) TELECOM FACILITY Sq. Ft Floor Area: I Valuation: $35000 APN Number: 35718035.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN S OF PERMIT ISSUANCE OR S . OM LAST CALLED INSPECTION. 180 DAY Issued by:..µ Date: �✓ ���� 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: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE have read the hazardous materials requirements wider 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 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. Owner or authorized agent: /__' Date: l — r f —f CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this pen-nit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Add ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 • building okupertino.orq ❑ NEW CONSTRUCTION ❑ ADDITION ® ALTERATION / TI ❑ REVISION / DEFERRED PROJECT ADDRESS 10218 Imperial Ave, Cupertino CA 95014 APNN 357 18 035 OWNER NAME EMBARCADERO CAPITAL PARTNERS INVESTOR TWO, LP PHONE 408 289 8310 7E-L1ILpeter] @ecp- Ilc.com STREETADDRESS 1301 SHOREWAY ROAD, STE. 250 CITY, STATE, zip Belmont, CA 94002 FAX N/A CONTACT NAME Gabriella Barr PHONE 650 387 7016 E -MAIL gbarr @flnhc.com STREETADDRESs 2525 Stanwell Drive CITY, STATE, ZIP Concord, CA, 94520 FAX N/A ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ EX Agent OWNER OWNER- BUILDER OWNER AGENT CONTRACTOR CONTRACTOR AGENT ARCHITECT ENGINEER DEVELOPER TENANT CONTRACTORNAME LICENSE NUMBER LICENSE TYPE BUS. LICN COMPANY NAME E -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEER NAME DANIEL FREDRICKSON LICENSE NUMBER S4384 (Engineer) BUS. LIC N COMPANY NAME CAMP & ASSOC. (architects) -MAIL (arch. ) erlc.camp @campassoc.com FAX N/A STREETADDRESS 19401 40`h Ave., W, Ste 304 CITY, STATE, zip Lynnwood, CA 98036 PHONE 425 740 6392 DESCRIPTION OF WORK Add 1 new panel antenna per sector, 3 total, install 1 new DU within existing cabinet, Install 1 new RRU per sector, 3 total. EXISTING USE PROPOSED USE CONSTR. TYPE N STORIES USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL Exist. Cell Site $35,000 AREA AREA N/A AREA NET AREA N/A N/A BATHROOM KITCHEN OTHER REMODEL AREA N/A REMODEL AREA N/A REMODEL AREA N /A❑ PORCH FNA DECK DECK/PORCH GARAGE DETACH ATTACH El 1:1 N DWELLING UNITS: SE COND UNTT S SECOND STORY S FIS NG ADDED? X ADDITION? N /A°°°; ° PRE - APPLICATION CUES IF YES, PROVIDE COPY OF IS THE BLDG AN []YES -°^° VALUATION' PLANNING APPLN NO PLANNING APPROVAL LETTER EICHLER HOME? NO f/v By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on a proper�_�TOTAL ave read this application and the information 1 have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to buildinak-olfs—tNction. I authorize representatives of Cupertino to enter the above - identified property for inspection purposes. Signature of Applicant/Agent Date: 7/31/14 SUPPLEMEN -'AL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP © OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW _New SFD or Multifamily dwellings: Apply for demolition permit for 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 ❑ PuBLIcwoRKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE FIRE DEPT X Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. © ENVIRONMENTAL HEALTH CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School niclrirl otr ) Thoco foec aro hacod an tho nroliminary infarmatian availahlo and aro nnh an Pwimato_ Cnntart the nont fnr oddn'l info_ FEE ITEMS (Fee Resolulion 11 -053 Eff..' 71V13) ADDRESS: 10218 IMPERIAL AVE DATE: 07/31/2014 REVIEWED BY: MELISSA APN: 35718 035 BP #: 'VALUATION: 1$35,000 *PERMIT TYPE: Building Permit LAN CHECK TYPE: Alteration / Addition / Repair PRIMARY USE: Commercial Building PENTAMATION PERMIT TYPE: TELECOMFA WORK ADD 1 IV PANEL PER SECTOR 3 TOTAL ON E TELECOM FACILITY SCOPE PME Plan Check: NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School niclrirl otr ) Thoco foec aro hacod an tho nroliminary infarmatian availahlo and aro nnh an Pwimato_ Cnntart the nont fnr oddn'l info_ FEE ITEMS (Fee Resolulion 11 -053 Eff..' 71V13) FEE QTY /FEE MISC ITEMS Plan Check Fee: $0.00 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: (F) Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Work Without Permit? ® Yes No $0.00 Advanced Planning Fee: $0.00 # $1,145.00 Antenna - Telecom Facility 1ANTCELFRE Cellular, Free- Standing ) ©A Strong Motion Fee: IBSE1Sj1k11CO $9.80 Select an Administrative Item Bldg Stds Commission Fee: 18C16SC $2.00 SUBTOTALS: $11.801$1,145.001 TOTAL IEEE, 1 $1,156.80 Revised: 0711012014