The URL can be used to link to this page

12070057 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10101 N DE ANZA BLVD CONTRACTOR:OVERLAND PERMIT NO: 12070057 CONTRACTING INC OWNER'S NAME: WATERDRAGON 289 LLC 587 SIGMAN RD NE DATE ISSUED:01/11/2013 OWNER'S PHONE: 4153984196 CONYERS,GA 30013 PHONE NO:(678)413-0333 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL Ll COMMERCIAL License Class A Lic.# AT&T MODIFICATION OF(E)UNMANNED /� u�,�, 0//11//3 / TELECOMMUNICATIONS FACILITY-REMOVE AND Contractor D er Cvr 11I 1 REPLACE 3 1 hereby affirm that 1 am licensed under the prdisions of 4hapier 9 ANTENNAS WITH RELATED EQUIPMENT,PAINT (commencing with Section 7000)of Division 3 of the Business&Professions EXISTING 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. Sq.Ft Floor Area: Valuation:$20000 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 APN Number:32634071.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION 1 certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.1 agree to comply with all city and county ordinances and state laws relating WIT 80 DAYS OF PERMTT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DA OM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the ZU granting of this permit. Additionally,the applicant understands and will comply Issued by: Date: with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signature Dat 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. ❑ OWNER-BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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 HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. 1 will hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should 1 use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District 1 performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 255 5,25533,and 25534. / Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date: Of permit is issued. 1 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 CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,I must 1 hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address 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 ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date C� 0-7 37 ji �073 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE •CUPERTINO, CA 950143255 CUPERTINO (408) 777-3228• FAX(408)777-333na 3 • building "cupertino.org co5 ❑NEW CONSTRUCTION ❑ ADDITION ALTERATION/T1 ❑ REVISION 1 DEFERRED 0RIG AL PERNUT# PROJECTADDRESS }� APN$ 3 U _W b 3 Z �` , -9A�l OWNER NAME '�` ' cat GGAPHONEIcJ t1�C}� E-MAJL FAX 0 ACT N LJ fZJ � P o S-36 A) 142,4 S ADORES © CITY,ST.4 ZIP r"A �j ❑ OWNER ❑ OWNER.BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER 7LICENSE TYPE BUS.LIC N COMPANY NAME E-MAII_ FAX . STREET ADDRESS CITY,STATE,IIP PHONE ARC'HITECT/ITf LICENSE NUMB ER/p%^-7 BUS.LIC# McANY NAME E-MAIL FAX BTREETTI Cie as A40 g C_v� �,S J W C 9q 5)S Q P °�� -- Q DESCRD GN OF WORK `t l A 7 — 1 )p!aA/ I rye /G� �, �t��/ey • 9 A .ev 1 �j L / r Ap7 4, VDw A OJ D Q3R&(-9-!;, KPA A NTN EXISTING E PROPOSED USE CONSTR. PE k STORIES USE TYPE OCC. SQ-FT. VALUATION(S) EGSTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL.AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DEClUPORCH AREA GARAGE AR&L DETACH ATTACH If DWELLING UNITS: ISA SECOND UNIT ❑YES SECOND STORY ❑YES BErnG ADDED? ❑ro ADDITION? ❑No PRE-APPLICATION ❑YTS IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RE=,-ED A(• TOTAL VALUATION: PLANNING APPL A ❑No PLANNING APPROVAL LETTER EICHLER aoME° ❑NO 01-/N/ dU 'nO '` Sy my signature below,I certify to each of the following: 1 a grope owner or authorized agent to act on the pr-operty owner's behalf. I ve read this application and the information I have prgvided is c We e cription of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to 1 " coon. ras pertino to enter the�a7bove-identified property for for inspection purposes. Signature ofApplicant/Agenr Date: /�� -�L SUPPLE.NvfENTAL UIFORMATION REQUIRED PLAN CIMCK TYPE ROU=G SLIP New SFD or Multifamily dwellings: Apply for demolition permit for ❑ OVER-TBE-COUNTER Bmz.)nvGPLALI REVIEW existing building(s). Demolition permit is required pr.or to issuance of building permit for new building. 111 FLANN[NGPLANREVIEW _Commercial BLdgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORTSS form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ ME DEPT _Copy of Planning Approval Letter or Meeting with Planning prior to ❑ VAToR Cl SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIItONMENTAS.HEALTH 31dg,4pp_201 Ldoc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION W'PERMIT DDRESS: 10101 North De Anza Blvd DATE: 07/09/2012 REVIEWED BY: Sean PN: 326-34-017 BP#: *VALUATION: $20,000 PE: Building Permit PLAN CHECK TYPE: Alteration / Repair PENTAMATION TELECOMFAC USE: PERMIT TYPE: PRIMARY SFD or Duplex WORK Modification of E unmanned telecommunication Facility- Remove and replace 3 antennas with SCOPE related equipment, paint existing and new antennas to match building facade. Ilan C h.'c hlec:h. Perarit l r=" Plumb. Permit ree: Penn: e'r;blech. Insrr. El--L- 011ier Plumb InsP Other Flet. Insp Ll h.InsP. FCC: Phtruh. hrs).Fera Elec. Insp. J,ce: NOTE: This estimate does not include fees due to other Departments(Le.Planning,Public Works, Fire,Sanitary Sewer District,School District,etc.). These ees are based on the prelimina information available and are only an estimate. Contact the Dept/or addn 7 info. FEE ITEMS (Fee Resolution 11-053 Ef 7/1/11) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 Select a Misc Bldg/Structure Suppl. PC Fee: (j) Reg. Q OT 0,0 hrs $0.00 or Element of a Building PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee.S Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Constmction Tax: eIdlnimstr ativee I'C.'(': Work Without Permit? ® Yes No $0.00 Advanced Planning Fee: $0.00 0 # Antenna-Telecom Facility Q Travel Documentation Fees. $1,065.00 IANTCELATT Cellular,Attached to Bldg StronV,Motion Fee: IBSEISMICR $2.00 Select an Administrative Item Bldg; Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $3.00 $1,065.00 TOTAL FEE: $1,068.00 Revised: 07/01/2012 E 7.17 St- ©7-3 7 Building Department City Of Cupertino 10300 Torre Avenue / Cupertino,CA 95014-3255 Telephone: 408-777-3228 C U P E RTI N O j Fax: 408-777-3333 CONTRACTOR / SUBCONTRACTOR LIST JOB ADDRESS: /0&1 —LD PERMIT# 1 ' � OWNER'S NAME:Rx1 G.U,d-NtAkj lvl BA-M BA-MPHONE# GENERAL CONTRACTOR: BUSINESS LICENSE# ADDRESS: CITY/ZIPCODE: *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: Signature Date Please check applicable subcontractors and complete the following information: ✓ 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