12080330-EXPIREDCITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10655 MARY AVE
OWNER'S NAME: CUPERTINO LOC-N-STOR LLC
OWNER'S PHONE: 5309139577
❑ LICENSED CONTRACTOR'S DECLARATION
License Class /T Lic. # 73V-34-7
' `
`
Contractor ✓�✓� '' �� N �" bate 2- J Z
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.
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, judgment
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will coon
with all non -point source regulations per the Cupertino Municipal Code, Secti '
9.18.
Signature_ Date
❑ OWNER -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
construct 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, 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
CONTRACTOR: OVERLAND
CONTRACTING INC
587 SIGMAN RD NE
CONYERS, GA 30013
PERMIT NO: 12080330
DATE ISSUED: 09/21/2012
PHONE NO: (678) 413-0333
BUILDING PERMIT INFO: BLDG F- ELECT F- PLUMB
MECH r RESIDENTIAL r COMMERCIAL
JOB DESCRIPTION: INSTALL NEW ANTENNAS AT EXISTING LATTICE
TOWER
NEW CABINET
Sq. Ft Floor Area:
APN
Valuation: $45000
Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: Date:
RE -ROOFS:
All roofs shall be inspected prior to any roofing material berg installed. If a roof is
installed without first obtaining an^inspec gto emove all new materials for
inspection.
Signature of Ap (Ott*4:y %� Date:
ALL R' 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. 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 Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505, 25533, and 25534.
Date: z/ / 2 -
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of Hork's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's
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.org
❑ NEW CONSTRUCTION X ADDITION
V
❑ ALTERATION/ Ti ❑ REVISION / DEFERRED ORIGINAL PERMIT #
!:3
PROJECT ADDRESS 10 (D55 Aw/ Lj /�VSNUC ,-
/ tt ,Pi G'V G `PIHO
APv� �2/06-055
W
L -I -S INV _ \
OWNER NAME RVSS a LL 3 3 .C5 4,,v
E-MAILAI
�1
STREET ADDRESS'' -f 1 H qY 161 In P4. C �`/
1`
CITY, STATE, ZIP fy Ll' n I �A Q/ (, % 0
NV P l H /
FAX
CONTACT NAME
501 1: 8DVs NC, 0*% A 0 a (t
PHONE
530 - -115t
E-MAIL`71
all e odoi-
STR ET ADDRESS
S oM S�. V-.
CIT , STATE, ZIP
Q r u 5w o
FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT ❑ CONTRACTOR CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
-7
LICENSE NUMBER / ^ 3 � 36
LICENSE T/� F
BUS. LIC #
COMPANY NAME WSP Co►�-ACtIMr
i. + � V 1. ,vOLVOv
E-MAIL
FAX
STREET ADDRESS ����
T•
O V
CITY, ST`�ATE, ZIP �e CA
PHONE
Q
BUS. LIC #
ARCHITECT/ENGINEER NAME T ODAtimLMD
LICENSE NUMBER C -2
145(P
COMPANY NAME F7i
E-MAIL
FAX
STREET ADDRESS115 Sansg nt St- 141" r L.
CITY, STATE, ZIP6A n f�zhG ems, CA 111
PHONE
DESCRIPTION OF WORK /3� FJC1S17W� SQPrIM PArV,1. ANtEAlJARe t.W 4-E VM44 (3) NEW S
hMe4f NAS oN r -)c 1 mW P (r ol E lvvAeP' PepLA c.e (a) eke c"TINn p rrt wr c A i3: Nos
tIH tti) NMW V&V I Pgr" CAb/ r4I N GX I Tn n v eA s E P6&e^ %;L s7 W 00.7.
EXISTLNG USE PROPOSED USE
J/t
11 Q p A m�
CONSTR. TYPE
# STORIES
—
USE
TYPE
OCC.
SQ.FT.
VALUATION ($)
NEW FL(JR
DEMO
TOTAL
AREA
AREA `
AREA
AREA
AREA �.
NET AREA
BATHROOM
KITCHEN OTHER
REMODEL AREA ,,
REMODEL AREA _ REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECK�PORCH AREA
GARAGE AREA: DETACH
' ❑ ATTACH
# DWELLING UNITS:
IS A SECOND UNIT[]
BEING ADDED? WCO
SECOND STORY [:]YES
ADDITION?
PRE -APPLICATION ES IF YES, PROVIDE COPY OF
PLANNING APPL # ❑ O PLANNING APPROVAL LETTER
IS THE BLDG AN El YES
EICHLER HOME? O
RECEIVED BY:
TQTAL VALUATION:
By my 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 relatin to ilding c c ii.uthorize r s tatives of Cupertino to enter the above-ientifie property for inspection purposes.
Signature of Applicant/Agent: Date: ?i so
SUPPLEMEN AL INF YAATION REQUIRED y
PLAN CHECK TYPE
ROUTING SLIP
_ New SFD or Multifamily dwellings: Apply for demolition permit for
El OVER-THE-COUNTER
,,.--
E BOILDING PLAN REVIEW
existing building(s). Demolition permit is required prior to issuance of building
for building.
ET
ErPE,;,,,NG
permit new
EXPRESS
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.
El LARGE
, E
FIS' tRE WEPT
Copy of Planning Approval Letter or Meeting with Planning prior to
❑
MAJOR
El SANITARY sEYYER DISTRICT
submittal of Building Permit application. EMAIL,
❑ EN-VIRON:NIENTAL HEALTH
BldgApp_2011.doe revised 06/21/11
,��,���,,������,,�� CITY OF CUPERTINO
%w--- �l FEE ESTIMATOR - BUILDING DIVISION
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
nictrict etc-) Thaw foot aro ha.cod on the nreliminary information available and are onlv an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff 7/1/11)
DRESS: 10655 mary ave.
DATE: 08/31/2012
REVIEWED BY: bobs.
lfech_ Permit Fee
P:
BP#: � �(� � �
`VALUATION: $45,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY
USE: Commercial Building
Plumb. Insp. Fee:
PENTAMATION
PERMIT TYPE: 1GENC0
WORK
install new antennas at existing lattice tower, new cabinet:.
SCOPE
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
nictrict etc-) Thaw foot aro ha.cod on the nreliminary information available and are onlv an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff 7/1/11)
Ifech. Plan Check
Plumb. Plan C*cA
Elec. Plan Checi
lfech_ Permit Fee
Plttmh. Per =,r ,�_
Elec. Permit fee:
Other Mech. Insp.
Other Plumb Insp -Li
Other Elee. Insp.
:F
;tlech hnp. Fco
Plumb. Insp. Fee:
"hoc_ Insp. fee:
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
nictrict etc-) Thaw foot aro ha.cod on the nreliminary information available and are onlv an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff 7/1/11)
FEE
QTYIFEE
MISC ITEMS
Plan Check Fee: Hourly Only? Yes Q No
$0.00
® hours Plan Check, Hourly
$532.00 1STPLNCK
Suppl. PC Fee: (j) Reg. () OT
0.0 1
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee: Hourly Only? Q Yes Q No
$0.00
Suppl. Insp. Fee:Q Reg. Q OT
0.0
1 hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Consowetion Tax:
Administrative Fee:
1
G)
Work Without Permit? 0 Yes (D No
$0.00
Advanced Planning_Fee:
$0.00
= hours Inspections
$266.00 ISTINSP Inspection, Hourly
1'ravel Documentation Fees:
Strong Motion Fee: 1BSEISMICo
$9.45
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$2.00
SUBTOTALS:
$11.45
$798.00
TOTAL FEE:
F
$809.45
Revised: 07/01/2012
CUPERTINO
CONTRACTOR / SUBCONTRACTOR LIST
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
Fax: 408-777-3333
JOB ADDRESS: 1065"S /44, -t .
PERMIT # 12 0:56) 3 3 O
OWNER'S NAME: AL45se-11 4/,',,,5k%
PHONE# !<-3v-9/3-ys 27
GENERAL CONTRACTOR: O,.ti Gr,eJ y�/gCfM
BUSINESS LICENSE # 3 34ly5—
ADDRESS: S'g 7 4 h XJ, /V/:—::
CITY/ZIPCODE: e-' ,, X e ---s �;A 700 13
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:G�`"
Signature Date
Please check applicable subcontractors and complete the following information:
V
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring / Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner / Contractor Signature Date