The URL can be used to link to this page

15090117A CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 5 RESULTS WAY CONTRACTOR: ;�i r W 4-,] i✓ PERMIT NO: 15090117 OWNER'S NAME: BVK PERIMETER SQUARE RETAIL LLC ET DATE ISSUED: 11/18/2015 OWNER'S PHONE: 6503731613 PHONE NO: LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL AT&T - ON (E) CELL TOWER, SWAP OUT ANTENNAS, License Class_ Lic. # INSTALL RRU'S, SURGE SUPPRESSORS, NEW FIBER CONDUITS Contractor �1r�J�/L tSt�1 (/Tse _ Date � 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 Sq. Ft Floor Area: Valuation: $15000 performance of the work for which this permit is issued. 1 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: 35720042.5 Occupancy Type. permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is EXPIRES IF IS NOT STARTED correct. I agree to comply with all city and county ordinances and state taws relating ITHIN 180 ERMIT 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 sa 18 M ALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, ju nts, costs, and expenses which may accrue against said City in consequen granting of this permit. Additionally, the applicant understands and will comply sued by: Date: with all non-po' source regulations per the Cupertino Municipal Code, Section 9.18. 1 Signature Date 1 RE -ROOFS: All roofs shat a 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 Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of 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 I 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 I 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 I performance of the work for which this permit is issued. will maintain compliance with the upertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: Date: 1 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 CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, I must I 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, ARCHITECT'S DECLARATION 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 CUPERTINO CONSTRUCTION PERMIT APPLICATION 150q () I COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 - buildincIO)cupertino.org F-1 NFW CONSTRI ICTION n ADDITION I x I ALTERATION/ Ti FI REVISION / DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS 5 Result Way DUP1, Cupertino, CA 95014 APN# 357-18-035 OWNER NAME ECI Two Results, LLC PHONE 650-373-1613 E-MAIL -x - STREET ADDRESS 1301 Shoreway Road, Suite 250 CITY, STATE, ZIP Belmont, CA 94002 7 CONTACT NAME Austin Ching - on behalf of AT&T Mobility PHONE 808-282-3006 E-MAIL austin.ching@ericsson.com g@ STREET ADDRESS 6140 Stoneridge Mall Rd., 3rd Floor CITY, STATE, ZIP Pleasanton, CA 94588 FAx ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER IN TENANT CONTRACTOR NAME tbd LICENSE NUMBER LICENSE TYPE BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEER NAME Sohail Shah LICENSE NUMBER C60216 BUS. LIC # COMPANY NAME PDC Corporation E-MAIL paulo@pdccorp.net cco net FAX STREET ADDRESS 1062 Concannon Blvd. CITY, STATE, ZIP Livermore, CA 94550 PHONE 925-606-5868 DESCRIPTION OF WORK swapping 3 antennas; installing 3 RRU-12, 3 RRU-A2s, and 3 DC -6 suid sure suppressors behind antennas; install 1 new Purcell Cabinet stacked on top of existing Purcell; remove 1 DUL41 and add 2 new DUS41 inside new purcell; add 2 new 3" fiber/DC conduits; 1 new H -frame installed behind existing RBA 72 with 3 new DC -6 surge suppressors. EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES wireless facility same USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG AREA 940.5 NEW FLOOR AREA n/a DEMO AREA n/a TOTAL NET AREA 940.5 BATHROOM KITCHEN OTHER REMODEL AREA n/a REMODEL AREA n/a REMODEL AREA n/a PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH n/a n/a I n/a n/a ❑ ATTACH # DWELLING UNITS: IS A SECOND UNIT []YES SECOND STORY ❑YES n/a BEING ADDED? ®NO ADDITION? ®NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YESEI D BY: TAL VALUATION: PLANNING APPL # []NO PLANNING APPROVAL LETTER EICHLER HOME? ® NO QI S,000.00 .p By my signature below, I certify to each of the following: I am the property owner or authorize 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 buildi construction. I authorize representatives of Cupertino to enter the above- d ntified p perty for inspection purposes. �� 7 Signature of Applicant/Agent: •�� Date: / SUPPLEMENTAL INFORMATION REQCMD PLAN CHECK TYPE ROUTING SLIP ❑ New SFD or Multifamily dwellings: Apply for demolition permit for _ existing building(s). Demolition permit is required prior to issuance of building VER -THE -COUNTER BUILDING PLAN REVIEW permit for new building. ❑5, EXPRESS ❑ PLANNING PLAN REVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure CY 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 ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO )D 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 District, eta). These fees are based on the prelimina information available and are only an estimate^ Contact the Dept or addn'l info. FEE ITEMS (Fee Resolution 11-053 Efl. 711,,'13) DDRESS: 5 Results Way DATE: 09/17/2015 REVIEWED BY: PAUL W PN: 357 18 035 BP#: `VALUATION: $15,000 PE: Building Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY USE: Commercial Building Civil / Religious activities in BQ zone? 0 Yes E) No PENTAMATION PERMIT TYPE: TELECOMFA WORK AT&T - On E Cell Tower Swap out Antennas Install RRU's Sure Suppressors, New Fiber Conduits SCOPE $0.00 NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, eta). These fees are based on the prelimina information available and are only an estimate^ Contact the Dept or addn'l info. FEE ITEMS (Fee Resolution 11-053 Efl. 711,,'13) FEE Phinib. Plan Check _ Plumb. 1, $0.00 Ocher Plumb Insp. ED 1, h, III .,vr t lee: 0.0 NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, eta). These fees are based on the prelimina information available and are only an estimate^ Contact the Dept or addn'l info. FEE ITEMS (Fee Resolution 11-053 Efl. 711,,'13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: (F) Reg. () OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee.e Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: IBCONSTAXC $0.00 1.Trlarrrrttrrrzila 1'>r.:" Work Without Permit? 0 Yes (F) No $0.00 Advanced Planning Fee: $0.00 0 # $1,145.00 Antenna - Telecom Facility IANTCELATT Cellular, Attached to Bldg 0 Travel Strong Motion Fee: IBSEISMICO $4.20 Select an Administrative Item BldgStds Commission Fee: IBCBSC $1.00 SUBTOTALS: $5.201$1,145.00 TOTAL FEE: $1,150.20 Revised: 07/02/2015