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B-2016-1667CITY OF CUPERTINO BUILDING PERMIT BUILlllNGAllLKLSS: CONTRACTOR: PERMIT NO: B-2016-1667 21760 STEVENS CREEK BLVD CUPERTINO, CA 95014 (357 17 082) WALKER CELLULAR INC ROCKLIN, CA 95765 IOWNER'S NAME: PESTANA FAMILY PARTNERSHIP LP I IDATE ISSUED: 09121/2016 I I.OWNER'S PHONE: 408-996-8766 I I PHONE NO: (916) 259-2785 I 111 Lai wm 3 Jxvow a V t 1' 1 1� Class GENERAL BUILDING CONTRACTOR Lic. #954113 or WALKER CELLULAR INCDate 11/30/2016 hereby affirm that I am licensed under the provisions of Chapter 9 (commencing rith Section 7000) of Division 3 of the Business & Professions Code and that my cense is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: m. 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. 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, t plicant understands and will comply with all non -point source regul on per the Cupertino M tpal Code, Section 9.18. Signature Date 9/21/2016 hereby affirm that I am exempt from the Contractor's License Law for one of the PERMIT INFO: X_ BLDG —ELECT —PLUMB _ MECII _ RESIDENTIAL X COMMERCIAL JOB DESCRIPTION T -MOBILE - MODIFY (E) ROOF TOP MOUNTED CELL TOWER - REPLACE (E) CABINET, REPLACE 3 (E) ANTENNAE, INSTALL 3 RRU'S, AND REPLACE 6 (E) TMA'S Sq. Ft Floor Area: I Valuation: $20000.00 "N Number: Occupancy Type: 357 17 082 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Abby Ayende Date: 09/21/2016 two reasons: rum rows snau oe mspectea pnor to any rooting matMal Ming mstauea. a aroor IS I, as owner of the property, or my employees with wages as their sole installed without fust 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) 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: 9/21/2016 I hereby affirm under penalty of perjury one of the following three declarations: m. 1 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 9/21/2016 ALL ROOF "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. 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 I will maintain compliance with the C ertino Municipal Code, Chapter 9.12 and the Health & Safety Co ctions 25505, 25533, and 25534. 1 Owner or authorized agent: Date: 9/21/2016 CONSTRUCTION LENDING AGENCY hereby affirm that there is a construction tending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCH]TECT'S DECLARATION I understand my plans shall be used as public records. Licensed ICL)PERTINO I T i NRW C.l1NCTRTIf11 .l CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO,. CA 95014-3255 (408) 777-3228 •FAX (4108) 777-3333 •building cupertino.ora }_ of u I I AhT%TTTn1J '[ 1 AT menAmr—x. i— I-1 BldgApn_201 Ldoe revised 06121111 PROJECT ADDRESS i o -Z)*Cue-n-S (fve-'O- , APN # OWNERNAMEGSn OVA✓Y�iI �Iv� PHONE // 7� �+ 1 4 " p ,��Ci�r. E-MAIL STREET ADDRESS � / /`L f e t J V CITY. a ra ZIP �20!FAX] f !yes. C S �In v. PHONE CONTACT NAMEi-�- [ l ST E ADDRESS P� ITY, STA15E, ZIP rz srt�l� sC A q l PAX 13 OWNER 13 OWNER -BUILDER ❑ OWNERAOENT ❑ CONTRACTOR 13 CONTRACTOR AGENT ❑ ARCHITECT ® ENGINEER ❑ DEVELOPER D TENANT CONTRACTORNAME LICENSE NUMBER LICENSETYPE BUS. LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARC11 HITECTlENGINEER t!&MELICENSE L VoAes Y�� F NUMBER qq �--�+--� l� J BUS. LIC r1 COMPANX AME E-MAIL FAX STREET ADDRESSCITY, STATE, ZIP i -- c-' PHON 2TC DESCRIPTION OF WORK . ..Cil. I.��tJ(fe � � MIA T F—P-Frneec ol nZ Lace C(2- ., sfl _...�. r ob 1 e, c 'e-. t I C. i -ice.. EXISTING USE - - PROPOSED USE CONSTR, TYPE Ix STORIESUSE TYPE OCC. SQ.FT. VALUATION ($) EXIST NEW FLOOR DEMO TOTAL - - - - AREA AREA AREA NETAREA , BATHROOM KITCHEN ... OTHER _ REMODEL AREA REMODEL ARRA REMODELAREA PORCH AREA DECK AREA TOTAL DECKIPORCH AREA. GARAGE AREA: DETACH - - I ❑ ATTACH # DWELLING UNITS: ISA SECOND UNIT [:]YES SECOND STORY ❑ YES - - BRING ADDED? ❑ NO ADUr1YGN? [:]NO PRE -APPLICATION ❑ YES- IF YES, PROVIDE COPY OF IS THE BLDG AN [3 YES RECEIVED 13Y: .-.,TOTAL VALUATION: PLANNINO ADPL N l]NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO I V'(�IV. JD I Coo By nay signature below, I. certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I 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 buildin c nstruction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: PT^ Date: ` SUPPLEMENTAL INFORMATION REQUIRED PLAN CITECK TVPE ROUTING SLIP El OVER-THE-COUNTER ❑ BUILDING FLAN RE VIEW _ 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 ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project, ❑ LARGE ❑ FIRE DEPT — Copy ofPlanning Approval Letter or Meeting with Planning prior to ❑ MAJaR ❑ SANITARY SEWERDISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL IIEALTH BldgApn_201 Ldoe revised 06121111