12040010CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10655 MARY AVE
CONTRACTOR: OVERLAND
PERMIT NO: 12040010
CONTRACTING INC
OWNER'S NAME: CUPERTINO LOC-N-STOR LLC
587 SIGMAN RD NE
DATE ISSUED: 04/12/2012
OWNER'S PHONE: 5309139577
CONYERS, GA 30013
PHONE NO: (678) 413-0333
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL E]
SPRINT WIRELESS MODIFICATION THREE(3)EXISTING
License Class_ _ Lic. # 7 � U�3��%
PANEL ANTENNAS HOTSWAPPED WITH THREE(3)NEW
�-
ContractorDate ?— /
PANEL
.�_/
ANTENNAS ON AN EXISTING PG&E TOWER
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:
1 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: $45000
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
APN Number: 32606050.00
Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that l 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
WITHIN 180 DAYS OF PERMIT 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 DAYS F D INSP CTION.
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 compl
Date:
with all non -point source regulations per the Cupertino Municipal Code, Sc
'
9.18.
Signature L Date 2 —//L
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.
❑ 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
1, 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)
1, 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. I 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(x) 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 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
5 , 25533, and 25534.
the Health & Safety Code, Sections 257
Section 3700 of the Labor Code, for the performance of the work for which this
l
Owner or authorized agent: Date:
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
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
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10655 MARY AVE
OWNER'S NAME: CUPERTMO LOC-N-STOR LLC
OWNER'S PHONE: 5309139577
1Z LICENSED CONTRACTOR'S DECLARATION
License Class Lie. N 7302i,4`7
Contractor ate ZZZo/ Z
I hereby affirm that I am licensed un er 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 die work for which this
permit is issued. �-}�
APPLICANT CERTIFICATION JZ_
1 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 regul tions per the Cupertino Municipal Code, Section
9.18.
L
Signature Date lZ 211
1
Z
❑ 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, l must
forthwith comply with such provisions or this permit shall be deemed revoked.
APPLICANT CERTIFICATION
[ 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 egulations per the Cupertino Municipal Code, Section
9.18.
Signa Date
CONTRACTOR: D I PERMIT NO: 12040010
DATE ISSUED: 04/12/2012
PHONE
BUILDING PERMIT INFO: BLDG F ELECT F_ PLUMB F
MECH r RESIDENTIAL F_ COMMERCIAL r—
JOB DESCRIPTION: SPRINT WIRELESS MODIFICATION THREE(3)EXISTING
PANEL ANTENNAS HOTSWAPPED WITH THREE(3)NEW PANEL
ANTENNAS ON AN EXISTING PG&E TOWER
Sq. Ft Floor Area: I Valuation: $45000
APN Number: 32606050.00 1 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 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:
ALL ROOF 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. 1 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.
Owne or,authorize agent:
Date: '7 --
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of %ork'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
CITY OF CUPERTINO
FM -7 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). Thesejees are based on the preliminary information available and are only an estimate. Contact the Dept for addn7 info.
FEE ITEMS (Fee Resolution 11-053F,f. 7/7/11)
ADDRESS: 10655 mary ave
QTY/FEE
DATE: 04/02/2012
REVIEWED BY: larry s
Plan Check Fee:
APN:
BP#:
$0.00
"VALUATION: 1$45,000
PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY Commercial Building
USE:PERMIT
0.0
hrs
PENTAMATION TELECOMFAC
TYPE:
WORK
sprint wireless modification 3 existinq panel
antennas hotswapped with 3 new panel antennas on an
SCOPE
existing pg&e tower 3 equipment cabinets existing replacee with 2 new equipment cabinets within p
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, eta). Thesejees are based on the preliminary information available and are only an estimate. Contact the Dept for addn7 info.
FEE ITEMS (Fee Resolution 11-053F,f. 7/7/11)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
Lj
Select a Misc Bldg/Structure
or Element of a Building
Suppl. PC Fee: Q Reg. Q OT
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, eta). Thesejees are based on the preliminary information available and are only an estimate. Contact the Dept for addn7 info.
FEE ITEMS (Fee Resolution 11-053F,f. 7/7/11)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
Select a Misc Bldg/Structure
or Element of a Building
Suppl. PC Fee: Q Reg. Q OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee -0 Reg. Q OT
0 0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
0
Work Without Permit? 0 Yes (j) No
$0.00
Advanced Planning Fee:
$0.00
F 3 J#
$3,132.00
Antenna - Telecom Facility
1ANTCELAT Cellular, Attached to Bldg
E)
0
Strong Motion Fee:
/BSE/SM/CO
$9.45
Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC
$2.00
SUBTOTALS:
$11.45
$3,132.00J
TOTAL FEE:
$3,143.45
Revised: 1/19/2012
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 10655 Mary lane
FEE
DATE: 0112812015
REVIEWED BY: Sean
APN:
BP#:J1.17-6oel d
2 1 hours Plan Check, Hourly
$286.00 ISTPLNCK
'VALUATION: Iso
PERMIT TYPE: Building Permit
hrs
PLAN CHECK TYPE:
Alteration / Addition / Repair
PRIMARY Commercial Building
USE:
Permit Fee:
PENTAMATION 1GENCOM
PERMIT TYPE:
WORK
Renew Permit and provide updated plans to 2013 codes.
hrs
SCOPE
PME Unit Fee:
$0.00
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.). These fees are based on the preliminary information available and are only an estimate. Contact the Deptfor addn'l info.
FEE ITEMS Fee Resolution 11-053 Q 7,'1%13)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee: Hourly Only? 0 Yes Q) No
$0.001
2 1 hours Plan Check, Hourly
$286.00 ISTPLNCK
Suppl. PC Fee: Q Reg. 0 OT
1 0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee -.(F) Reg. Q OTT0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
0
Work Without Permit? 0 Yes (E) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential Q
Building or Structure 0
i
Strom Motion Fee:
$0.00
Select an Administrative Item
1
Bldg_Stds Commission Fee.:
$0.001
SUBTOTALS:
$0.00
$286.00 TOTAL FEE:
$286.00
Revised: 01/06/2015