B-2016-1610 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1610
23600 VIA ESPLENDOR CUPERTINO,CA 95014-6516(342 54 016) COMMUNICATION
COMPONENT
SYSTEMS INC
SOUTH
HACKENSACK,NJ
07606
OWNER'S NAME: ROMAN CATHOLIC BISHOP OF SAN JOSE,THE DATE ISSUED:09/21/2016
OWNER'S PHONE:408-983-0100 PHONE NO:(201)927-6846
LICENCED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C. -7 Lic.#972367
Contractor COMMUNICATION COMPONENT SYSTEMS INCDate 94/30/2018 X BLDG _ELECT _PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing MECH RESIDENTIAL 2X COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
REMOVE AND REPLACE(6)PANEL ANTENNAS WITH
I hereby affirm under penalty of perjury one of the following two declarations: ASSOCIATED EQUIPMENT ON(E)MONO EUCALYPTUS.
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. Sq.Ft Floor Area: Valuation:$25000.00
APPLICANT CERTIFICATION
certify that]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 342 54 016 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
Additional[ ,the applicant understands and will comply with all non-point
sour a r' egulaatie s per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature ,CP- Date 9-21-2016 Issued by:Kim Dunbar
CL,
Date:09/21/2016
0 RB ER DECLARAT
I hereby affirm that I am 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:9-21-2016
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 of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
z. 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
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 will 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&Splety-Godg,Sections 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall Owner \\
be deemed revoked. ner or authorized'.agent: �.
APPLICANT CERTIFICATION Date:9-21-2016
I certify that I have read this application and state that the above information is CONSTRUCTIPN19NMTP AGENCY
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for 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 Lenders 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.
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE.•CUPERTINO,CA 85014-3255
CUPERTINO (408)777-3228•FAX(408)777-3333•building0ounertina ora '16T� 1V
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❑NEW CONSTRUCTION ❑ADDITION ALTERATION/TI ❑ REVISION 1 DEFERRED ORIGINAL PERMIT#
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DESCRIPTION(JE WORK .. �/A L:��c'`a 1_ ='T
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EXISTING USE PROPOSED USE - - CONSTR.TYPE - #STORIES - - -USE TYPE OCC. SQ.FT. VALUATION($}
EXISTG- NEW FLOOR DEMO TOTAL - -
AREA AREA AREA NBTARRA
nATHROOM KITCHEN. OTHER - -REMODEL AREA RBMODELARBA RIMODEL AREA
PORCH AREA DECK AREA TOTAL DECK/PORCH AREA - GARAGE AREA:- DETACH - - - - - -
ATTACH
K DWBLLINO UNrrs: I.ASECONn UNIT DYES SECONDSTORY AYES -
REIN.ADDRO?' QNO ADDITION? ❑NO
PRE-APPLICATION ❑YES IFyr'S,PROVIDE COPY OP IS THE.BLDG AN ❑YES .RELIVSD BY'- TO'J•A; VAf1{UATION:
PLANNINGAPPL* '❑NO PLANNING APPROVAL LETTBR CICRLF.RITOME? ❑NO , 144 21.0c)
-
By my signature below,I certify to ea¢ I followZ11
pro y owner orauthorized agent act a the property owner's behalf. I have read this
application and the information I have pr ded is coa Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to b nstruI presentatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: Date: 3 " 2—
-
SUPPLEME 1'AL,INFO lON i2EQ U1RED PLAN CHECK TYPE ROUTING SLIP
Now SID or Multifamily dwellings: pply for demolition permit for ❑ OVER-THP
existing PinN:lzEvrE►v
existing building(s). Demolition permit is required prior to issuance of building
permit for new building. CI EXPRESS &TIPLANNTNG.PLAN REVIEW
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 11 STANDARD 0 PU LICWORKS
form if any Hazardous Materials are being used as part of this project. p LARGE Cl FIREDEPT
_Copy of Planning Approval Letter or Meeting with Planning priorto ElMAJOR 0 SANITARY SEWER DISTRICT
submittal of Building Permit application.
.0 ENVIRONMENTAL HEALTH
RldgApp 20l Ldoe revised 06121111