B-2017-0833CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0833
10420 BUBB RD CUPERTINO, CA 95014-4150 (357 20 038) NU REV
COMMUNICATIONS
INC
LIVERMORE, CA 94550
OWNER'S NAME: HOME OF CHRIST CHURCH IN
OWNER'S PHONE: 408-506-7752
License Class _Q Lic. #962583
Contractor NU REV COMMUNICATIONS INC Date 06/30/2019
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:
t. 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
U' 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, the applicant understands and will comply with all non -point
source regulations per the Cupertino Municipal Code, Section 9.18.
Signature Date 6/28/2017
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
1. 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).
DATE ISSUED: 06/28/2017
PHONE NO: (925) 980-2799
BUILDING PERMIT INFO:
X BLDG —ELECT —PLUMB
_ MECH _ RESIDENTIAL X COMMERCIAL
JOB DESCRIPTION:
T -MOBILE - INSTALL 3 (N) ANTENNAS AND 3 (N) 3X6 HCS 20M
CABLES; REMOVE 3 (E) DIPLEXERS
Sq. Ft Floor Area: I Valuation: $25000.00
"N Number: Occupancy Type:
35720 038
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: Abby Avende
Date: 06/28/2017
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: 6/28/2017
I hereby affirm under penalty of perjury one of the following three declarations: ALL
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 6/28/2017
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, Sec Ons 25505, 25533, and 25534.
Owner or authorized agent: _
Date: 6/28/2017
CON TR i TIOAL NDING 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
SF04569A
CONSTRUCTION PERMIT APR 'ATION
Is COMMUNITY DEVELOPMENT DEPARTMENT • B. ING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-c
CUPERTINO (408) 777-3228 • FAX (408) 777-3333 • buiding n, �o,org
❑ NEW CONSTRUCTION 0 ADDITION ❑ ALTERATION/ Ti ❑ RriVISION / DEFERRED ORIGINAL PERMIT #
PROJECTADDRESS10420 Bubb Road, Cupertino, CA 95014
APNN 357-20-038
OWNERNAMEHomeof Christ Church of Cupertino
PHONE408-506-7752E-MAIL
STREET ADDRESS 10340 Bubb Road
CITY, STATE, ZIP Cupertino, CA 95014
FAX
CONTACT NAME Jimmy Le
PHONE 92.5-949-5909
S -MAIL LeJ@bv.com
STREETADDRESS 2999 Oak Rd., Suite 490
CITY, STATE, ZIP Walnut Creek, CA 94597
FAX
❑ OWNER ❑ OWNER -BUILDER El OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTORNAME TBD , JU I� ; / (�• p�C
[/
LICENSE NUMBER /�"
LICENSE TYPE
BUS. LIC #bO
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
C -"C e if rC C H ID/-
C ,r
ARC[ IITECTJENGINEERNAME Maged Henein
LICENSENUMBEtt 80188
BUS. LIC N
COMPANYNAMe Black & Veatch
E -MARL HeneinMwbv.com
FAX
STREET ADDRESS 2999 Oak Rd., Suite 490
CITY,STATE,ZIP Walnut Creek, CA 94597
PHONE
DESCRIPTION OF WORK Install (3) Proposed T -Mobile Antennas. Install (3) Proposed 3x6 HCS 20M Cables.
Remove (3) Existing Diplexers.
EXISTING USE
PROPOSED USE CONSTR.
TYPE
N STORIES
I
USE
'1'YI'E
OCC.
SQ.PT.
VALUATION (S)
EXISTG
NEW FLOOR
DEMO
TOTAL
AREA
AREA
AREA
NETAREA
BATHROOM KITCHEN
OTHER
REMODELAREA REMODEL AREA
REMODELAREA
PORCH AREA
DECK AREA
TOTAL DECK/PORCH AREA
GARAGE AREA: DETACI I
❑ ATTACH
I
0 DWELLING UNITS:IS
A SECOND UNIT [3 YES
SECOND STORY ❑YES
BEINCADDED? []NO
ADDITION? ❑NO
PRE -APPLICATION []YES IF YES, PROVIDE COPY OF
IS THE BLDG AN [I YES
RE IVB BY: --
TOTAL VALUATION:
PLANNfNGAPPLft []NO PLANNING APPROVAL LETTER
EICHLERHOME? [3 NO
$25,000
By try signature below, 1 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. 1 agree to comply with all applicable local
ordinances and state laws relating tp building cot truction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of ApplicantlAgent: Date:
SUPPLEMEN L INFOINIATION 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
�� +
4� PLANNING PLAN REVfEW
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 of Planning Approval Letter or Meeting with Planning prior to
❑ mmoa
❑ SANITARY SEWER DISTRICT
submittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH .
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