15090118I CITY OF CUPERTINO BUILDING PERMIT I
BUILDING ADDRESS: 1 INFINITE LOOP I CONSTRUCTION, CONTRACTOR: ELNECCTRIC TECH I PERMIT NO: 15090118
I OWNER'S NAME: APPLE COMPUTER INC 1110 SECOND AVE S STE A2 I DATE ISSUED: 10/09/2015 I
OWNER'S PHONE: 2013125076 ' PACHECO, CA 94553 PHONE NO: (925) 849-5324
04 LICENSED CONTRACTOR'S DECLARATION
License Class - ` Li,. # N I '� 9
Contractor Date i U t
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:
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.
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.
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 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 tb
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 t �P _z, , —Date <'J f �8 ! l �
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
9. 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)
2. I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
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
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.
3. 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, I
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. 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.
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
AT&T - ON (E) CELL TOWER, SWAP OUT ANTENNAS,
INSTALL RRU'S, SURGE SUPPRESSORS, INSTALL (N) RACK
UNIT IN EQUIPMENT ROOM
Sq. Ft Floor Area: I Valuation: $15000
APN Number: 31602105.00 I Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM M LAST CALLED -INSPECTION.
- _- p S_
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
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 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 will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505, 25533, and 25534.
Owner uthoriz ag fit:
- Date:
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional_
a
1
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT ^ BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 building(a)cupertino.org
❑ NEW CONSTRUCTION ❑ ADDITION 0 ALTERATION! TI ❑ REVISION / DEFERRF.D ORIGNMAI. PFRMTT ii
PROJECT ADDRESS APN # "�� ,
1 Infinite Loop, Cupertino,
CA
OWNER NAME Apple, Inc PHONE E-MAILrcolledge@apple.com
201-312-5076
STREET ADDRESS 1 Infinite Loop,
CITY, STATE, ZIP
FAX
Cupertino, CA 95014
CONTACT NAME
Austin Ching - on behalf of AT&T Mobility
PHONE 808-282-3006
I
E-MAIL austin.ching@ericsson.com
1
STREET ADDRESS 6140 Stoneridge Mall Rd., 3rd Floor
CITY, STATE, ZIP Pleasanton, CA 94588
FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER IN TENANT
CONTRACTOR NAME
Andrew Badger
LICENSE NUMBER
CSLB#897792
LICENSE TYPE
C10, B
BUS, LIC
COMPANY NAME
Electric Tech Construction Inc.
E-MAIL
andrewb@etch-inc.net
FAX
STREET ADDRESS
1910 Mart Ct., Ste. 130
, CITYSTATE, ZIP
Concord, CA 94520
PHONE
925-490-9244
ARCHITECTIENGINEER NAME Jeffery L. Rome
LICENSE NUMBER C-020876
BUS. LTC #
COMPANY NAME
Jeffery Rome &Associates
E-MAIL
robinn@jrainc.net
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
949-760-3929
DESCRIPTION OF WORK
swapping 3 antennas; installing 3 RRU-12 and 3 RRU-A2s behind antennas; installing 3 DC -6 surge suppressors
install 1 DUS-41 rack unit inside new 23" rack in equipment room; install 1 DC -12 surge suppressor inside new rack in equipment
room
EXISTING USE
wireless facility
PROPOSED USE - CONSTR.
same
TYPE
V-8
#STORIES
4
USE
TYPE
OCC.
-
SQ.FT:
VALUATION ($)
EXISTG
NEW FLOORDEMO
n/a
TOTAL
AREA
AREA
AREA n/a
AREA
NET
BATHROOM KITCHENN'
OTHER -
REMODEL AREA n/a REMODEL AREA n a
REMODEL AREA n/a
PORCH AREA
DECK AREA TOTAL DECKIPORCH AREA
GARAGE AREA: ❑DETACH -
n/a
n/a n/a
I
n/a ❑ ATTACH
I
# DWELLING UNITS:
IS A SECOND UNIT []YES
SECOND STORY []YES
Ila
BEING ADDED? ®NO
ADDITION? ®NO
PRE -APPLICATION []YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑ YES
VED BY:
TOTAL VALUATION:
PLANNINGAPPL# ❑NO PLANNING APPROVAL LETTER
EICHLER HOME? [3 NO
_- ,y
$15,000..00.
By my signature below, I certify to each of the following: I am the property owner or authorizild agent to act on the property owner's behalf. I have read this
application and the information I have is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
provided
ordinances and state laws relating to buildin4 construction. I authorize representatives of Cupertino to enter the above-identifiedpro erty for inspection purposes.
Signature of ApplicanUAgem: _ Date:
SUPPLEMENTAL INFORMATION REQUIRED
PLAN CHECK TYPE
ROUTING SLIP
VER 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 DisclosureSTANDARD
❑ PUBLIC WORKS
fotTn if any Hazardous Materials are being used as part of this project.
C] LARGE
❑ FIRE DEPT
Copy of Planning Approval Letter or Meeting with Planning prior to
0 MAJOR
❑ SANITARY SEWER DISTRICT
submittal of Building Permit application.
-
❑ ENVHtONMENTALHEALTH
BidgApp 201 Ldoc revised 06/21/11
CITY OF CUPERTINO lan) I
FEE FSTIMATO-111 - RITTI DING DIVTqlnN
ADDRESS: 1 Infinite Loop
1A
-
DATE: 09/17/2015
7
REVIEWED BY: PAUL
APN: 316 02105
AA,611. Pe'rivii Fee:
BP#:
*VALUATION: 1$15,000
*PERMIT TYPE: Building Permit
Plumh Permit Fee":
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY Commercial Building
USE.
0.0
Civil / Religious activities
in BQ zone? 0 Yes 0 No
PENTAMATION TELECOMFA
PERMIT TYPE:
WORK
AT&T - On (E) Cell Tower,
Swap out Antennas, Install RRU's, Surge Suppressors, Install (N) rack unit
SCOPE
in Equipment Room
Af;;(:,-h. Plart
Check
Phunb.
('heci,
AA,611. Pe'rivii Fee:
$0.00
Plumh Permit Fee":
Other Hcch, Irts.o.
Othei, PlUnib frup.
--Wech In p. Fee: I Plumb, Insp. Fee:
NOTE. This estimate does not includefees due to other Depan
I1."Iec. Irsf.".let
(i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District eta). These fees are based on the nrelimina information available and are only an estimate. Contact the Dent for addn't into.
FEE ITEMS (Fee Resolution 11-053 Elf.' L11I131
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
Select a Misc, Bldg/Structure
or Element of a Building
A
Suppl. PC Fee: (E) Reg. T
0 0—
0.0
hrs
$0.00
PNIE Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee.(F) Reg. 0 OT"00
hrs
$0.00
PME Unit Fee:
$0.00
PW Permit Fee:
$0.00
Construction Tax: IBCONSTAXC
$0.00
Administrative Fee:
T-
0
0
Work Without Permit? 0 Yes (j) No
$0.00
Advanced Planning -Fee,
$0.00
4
$1,145.001T]AANTCELATT
Antenna - Telecom Facility
I Cellular, Attached to Bldg
(F)
0
Travel Doc umenlalion Fees:
Strong Motion Fee: IBSEISMICO
$4.20
Select an Administrative Item
1 i.
Bldy Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:.
$5.20
$1,145.00
$1,150.201,�t
r.,evi5eu: utlul-11-ulu