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12090219-VOID CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CALIFORNIA OAK WAY&MAJESTIC OAK WAY CONTRACTOR:OVERLANDPT;r� IT NO: 12090219 CONTRACTING INC f OWNER'S NAME: PACIFIC GAS AND ELECTRIC CO 587 SIGMAN RD NE DATE ISSUED: 10/31/2012 OWNER'S PHONE: 4159735736 CONYERS,GA 30013 PHONE NO:(678)413-0333 ❑ LICENSED CONTRACTOR'S DECLARATION f r BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# ? J / & j //jj �. _ MECH RESIDENT COMMERCIAL Contractor r l�C/ j e �t�,31 l d 2— I hereby affirm that I am licensed under the pr 'sions of Chapter'9 JOB DESCRIPTION:SPRINT MODIFIC N TO EXI ING (commencing with Section 7000)of Division 3 of the Business&Professions TELECOMMUNICATION,, Code and that my license is in full force and effect. FACILITY:RELOCATING(2)(E)ANTENNAS,A ING(2) (N)ANTENNAS,AND(4)(N)RRU'S TO N)A NNA 1 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 ;' a Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Sq.Ft-floor Area: i Valuation:$45000 N„ APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is A Number:3421:4030.00 Occupancy Type: 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 .b'r indemnify and keep harmless the City of Cupertino against liabilities;judgments, y PE IT PIRES IF WORK IS NOT STARTED costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will com WI N 1 0 DAYS OF PERMIT ISSUANCE OR with all Dint source regulations per the Cupertino Municipal Code,Sec 180 DA ROM LAST CALLED INSPECTION. 9.18. Sign re r <� " Date Issued by: Date: / 31 ❑ OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's Lice a Law for one of RE-ROOFS: the following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is 1,as owner of the property,or my employees with wages as t r sole compensation, installed without first obtaining an inspection,I agree to remove all new materials for will do the work,and the structure is not intended or offere r sale(Sec.7044, inspection. Business&Professions Code) I,as owner of the property,am exclusively contracting w' licensed contractors to Signature of Applicant: Date: construct the project(Sec.7044,Business&Profession ode). I hereby affirm under penalty of perjury one of t following three ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER declarations: I have and will maintain a Certificate of Consent t self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE Compensation,as provided for by Section 3700 the Labor Code,for the performance of the work for which this permit' issued. I have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain Worker's Compensa n Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain Section 3700 of the Labor Code,for the per ance of the work for which this compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Safety Code,Section 25532(a)should I store or handle hazardous material. permit is issued. Additionally,should 1 use equipment or devices which emit hazardous air I certify that in the performance of the wo for which this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District I will not employ any person in any manner so to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Compensation laws of California. If,a r making this certificate of exemption,I Health&Safety Code,Sections 25505,25533,and 25534. 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. Ow r or au orized a e t: C 0 6�c � Date: 3 APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY 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 I hereby affirm that there is a construction lending agency for the performance of Aork's to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.) upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the Lender's Address granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION 9.18. 1 understand my plans shall be used as public records. Signature Date Licensed Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 (408)777-3228•�F//A��X(408)777-3333•build ingna cupertino.org CUPERTINO 0,(,t X I AKI 'r' m V 2, O� � J S � ❑NEW CONSTRUCTION ❑ ADDITION ALTERATION/TIVe REVISION/DEFE 'RED ORIGINAL PERMIT# PROJECT ADDRESS APN &JO OWNER NAME �Ei AA n,/yam ITYPHONE Q5,, 3(p E-MAIL a �• STREET ADDRESS C V a STATE,ZIP `J ,, I, IDS F C TACT NAME D �� p c PHONE :' E-MAIL ` mtd u r_6©r I F. l J ST ADD ESS '�Q� I,y CITY;STATE, ZIPf n FAX lansbMt ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTORCONTACTOR AGENT ElARCHITECT 11 ENGINE ER OP 11 ANT CONTRACTOR NAME ­� LICENSE NUMBER�� LICENSE TYPE BUS.LIr' 4. COMPANY NAME E-MAIN FAX 9 e` STREET ADDRESS C>'`SYI STATE,ZIP - PHO a I ARCHITECT/ENGINEER NRMEl nYi LICE NUMBER YU S.LIC# COMPANY NAME E-MAILFAX e 'A w om Ll STREET.ADDRES$ CITY,STATE,ZIP PHONE ie a, COIIC e IVd Salic A c -z75-41 o DESCRIPTION OF WORK Wheless fMdAedAA*1. Y iar0 2 �/�,IS11 panel ariMMS u���'h W nein Anel a�it�nas Duhtr�l �- Q{ un s l I V e Tau jibe N ankffll hili be m ! ai .tr� 2nd +f Wucbm,Y w (11'FeAstim ubirA uiTh new ea b i le-k u) +n S r (Me area. EXISTING USE PROPOSED USE CONSTR.T E #STORIES Uli _ USE TYPE OCC. SQ.FT. VALUATION($) EXISTG NEW FLOOR DEM4 TOTAL AREA AREA t`/Y) ip NET AREA (j�1 BATHROOM ,f KITCHEN OTHER REMODELAREA tJ) REMODEL AREA REMODEL AREA PORCH A DECK.AREA TOTAL K/PORCH AREA GARAGE AREA DETACH 6 Z Ix ❑ATTACH #DWELLING UNITS: IS A SECOND rr 'El YES SECOND STORY []YES BEING ADDI? 0 ADDITION? NeNO PRE-APPLICATION ES IF YES,PRO E COPY`OF IS THE BLDG AN E]YES RECEIV BY, TOTAL VALUATION: PLANNING APPL NO PANNING PRO LETTER EICHLER HOME? >tNo By my signature below,I certify to ch of the following: I am the property owner or authorized agent to act on the property owner's behalf, 1 have read this application and the information I e ph, rovided is correct. 1 have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relatin o uilding construction. 1 au o ' representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEM TAL IN RMATION REQUI D PLAN CHECK TYPE ROUTING SLIP' New SFD or Multifa ly dwellings: Apply for demolition permit for ❑ OVER-THE-COUNTER BUILDING PIAN REVIEW existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ 'EXPRESS PLANNING 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. LARGE ❑ TIRE DEPT, Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. 11 MAJOR El SA1tiITARY&EwERDISTRtCT ❑ ENVIRONMENTAL HEALTH BldgApp_2011.doe revised 06121111 � C2�'L14 CM( OF CUPERTINO 61 FEE ESTIMATOR-BUILDING DIVISION rA DDRESS: DATE: 09/26/2012 REVIEWED BY: Sean PN: �'� /9 036 BP#: `VALUATION: 1$45,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: ,,' Alteration /Addition/ Repair PRIMARY Commercial Building PENTAMATION TELECOMFAC USE: PERMIT TYPE: WORK S rint Wirless modification: Replace 2 existing angF% ntennas with new on existing H-frames SCOPE replace (3) existing cabinets with (2) new cabinets within lease area. 17 x` e .1 i- 7. Li NOTE.This estimate does not i lude fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). These fees are b ed on the prelimina information available and are only an estimate. Contact the Dept-for addn'l info. FEE ITEMS Fee Resolut' n 11-053 E . 711!11 FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 Select a Misc Bldg/Structure Suppl. PC Fee: E) g. OOT 0.0 hrs $0.00 or Element of a Building PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee' Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Work Without Permit? Yes E) No $0.00 Advanced Planning Fee: $0.00 0 # Antenna-Telecom Facility F / ,: $1,065.00 IANTCELFRE Cellular,Free-Standing �A Strong Motion Fee: IBSEISMICO $9.45 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $2.00 SUBTOTALS: $11.451$1,065.001 TOTAL FEE: 1 $1,076.45 Revised: 07/01/2012 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: , PERMIT# w� OWNER'S NAME: HONE# S 30— b 74- 1 S 1 7 GENERAL CONTRA TOR: r BUSINESS LICENSE# 3S 3 CP ADDRESS 61&-7 f CITY/ZIPCODE: *Our municipal code requires all businesses working 'n the to have a City of Cupertin 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 subcontractor Signature Date Please check applicable subcontractors and complete the following-information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing X, V Flooring/Carpeting Linoleum/Wood ' Glass /Glazing t Heating Insulation Landscaping f Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date PLAN REVIEW SUBMITTAL CHECKLIST COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL CIJPERTINO 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 (408)777-3228• FAX(408)777-3333•build ina(kupertino.org *PERMIT TYPE: Building Permit FOOD ESTABLISHMENT? 0 Y E)N *USE: Commercial Building PUBLIC SWIMMING POOL? O Y 0 N *PLAN CHECK TYPE: Addition / Repair HILLSIDE/UNFAV. SOIL? 4 Y E)N *ROUTING TYPE: Express OWNER;-/BUILDER? Q Y (F)N FENGIN1G PROPOSED? ©Y E)N Plans/Docurnents Required: 5 Sets of Plans Z Sets of SupporAtrig Documents APPLICATION SUBMITTAL INFORMAT40N Required Provided Scope of Work specified on cover sheet ❑x Specify the following Governing Codes on cover stet: • 2010 Calif. Building Code (based on 2009 Inteafiational Building Code) • 2010 Calif. Residential Code (based on 200!,international Resid. Code) 2010 Calif. Plumbing Code (based on 2000niform Plumbing Code) • 2010 Calif. Mechanical Code (based on 09 Uniform Mechanical Code) D W • 2010 Calif. Electrical Code (based on x,009 National Electrical Code) W • 2010 Calif. Energy Code �� Cn • 2010 Calif. Green Building Standar 8 Code W • Cupertino Municipal Code 0 Name and Address of property ow t-r ❑x L) Provide a Drawing Index that list ''aII pages part of the official drawing set Q Project Data Form information ncluding assessor's parcel number, use of building, etc. tnk to Residential Form link to Commercial Form Deferred Submittal Items (if. pplicable) ❑ Special Inspection /Struc ral Observation Items (if applicable) ❑x ❑ Q, Alternate Materials and Vethods granted for project (if applicable) ❑x ❑ Fully dimensioned site tan with a minimum scale of 1/8"=1' or 1:20 to include North arrow, type/andimension of existing overhead utility lines and easements, perimutline and dimensions of existing and proposed x❑building and/or stres, property line and setback dimensions, existing tree Cn s ecies &trunk dir measured 4' above natural grade). z Floor Plans (exis ' g and proposed) J Elevations (NoV, South, East and West )with Section View referenced ❑x z Section Views Longitudinal and Transverse) ❑x ❑ O Electrical plans stamped and signed by licensed professional ❑x F- Plumbing Plans stamped and signed by licensed professional ❑x ❑ON Mechanical Plans stamped and signed by licensed professional ❑x ❑W z Grading and Drainage Plans ❑x ❑ Excavation and Shoring Plans ❑ ❑ Foundation Plan with cross-referenced structural details ❑x ❑ Floor and Roof Framing Plans with cross-referenced structural details ❑x ❑ Gas and Plumbing Isometric Drawings (for one-two family dwellings and ❑ ❑ accessory buildings) Plan CheckSubmittalChecklist 2011.doc revised 03122111 Window alignment and privacy protection requirements for second stories or ❑ z0 new second story windows or letter of waiver. One 8 1/2 x 11 copy of the site plan, with privacy protection planting shown a (tree location, tree canopy, tree species, dimensioned planting distance) O Affidavit from a certified arborist/landscape architect. (Affidavit should have a >` z copy of the privacy plantingIan attached). Landscape Water-Efficiency Checklist (click for entire landscape ordinance) Q = Fence Approval Form (click for entire fence ordinance" ❑ ❑ p Incorporate the City of Cupertino Best Management Practices (BMP) shee#into ❑x all Ian sets. Completed and Signed Plan Review Submittal Checklist Q zCompleted and Signed Construction Permit Application Form Q W Structural Calculations stamped and signed by licensed professional Q v Geotechnical Soils Investigation report stamped and signed by licensed ❑ ❑ O professional 2 copies) o Title 24 Energy Certificate of Compliance forms incorporated into all plan sets. O Depending on the scope of the project, Installation Certificates may be D ❑��, z required prior the final sign off for project. O Manufacturer's Specifications ❑ ❑ a Owner-Builder Disclosure Form (for property ownersiapplying for their own ❑ ❑ building permit) Hazardous Materials Questionnaire Form ❑x o Building Department 408-777-3228 ® ❑ Planning Department el , 408-777-3308 ® ❑ Public Works Department— New SFD, add' ion/remodel with 25% increase in floor area, hillside construction, grading and drainage permits, retaining wall © ❑ permits, swimming pools new/demo 408-777-3354 w Santa Clara County Fire Department ,° 408-378-4010 ® ❑ zz County Health Department 408-918-3400 ❑ ❑ Q Cupertino Sanitary Sewer District 408-253-7071 ® ❑ W Other: �'' ❑ ❑ U Other: ❑ ❑ If an existing residence is pro�Osed to be demolished as part of the U construction of a new residetbe, a DEMOLITION PERMIT APPLICATION co shall be applied for at the sq'me time the construction permit application for the ❑ ❑ new residence is applied fear. ;J' 1 understand this may not a complete list of required items due to the variations for each project and additional co a related information may be required. I understand that an incomplete plan check ubmittal may result in delays in the plan review process. Applicant Name (Prin : rm U CA1� MbAU( �Ar, . Applicant Signature: Applicant's Phone: 5:30- Applicant's Email. ZW U1 I CA A MAUS- UM Date: LU IR It, Plan CheckSuhmittalChecklist 2011.doc revised 03/31111 HAZARDOUS MATERIALS CHECKLIST COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL CUPERTINO 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255ri (408)777-3228• FAX(408)777-3333•building Wcupertino.org PURPOSE To minimize possible delays that would result for the Fire Department plan review please complete the following checklist to determine if an additional level of Hazardous Materials plan Vreview will be required. MARK `YES' IF THE PROPOSED SCOPE OF WORK INCLUDE ANY OF�THE FOLLOWING? PLEASE MARK YOUR ANSWER WITH AN `X' IN THE YES OR IVA BOX ON THE SIDE YES NO BELOW. 1. Use, dispensing, mixing or storage of flammable or combu91ible liquids or gases, hazardous materials, etc. R: 2. Battery back-up rooms or racks. ." 3. Propane tanks. 4. Gasoline stations with underground tanks. 5. Installation or replacement above ground qr underground storage of liquid petroleum products, liquefied petroleum gases, compressed natural gas, explosives or other regulated hazardous materials. 6. Gas rooms for dentist, doctors or vgerinarians. 7. Generators with back-up diesel ofother fuels. 8. Large refrigeration systems. 9. Fuel cell systems. x 10. Commercial pool systems. 11. Chemical Storage aas. x 12. Flammable liquid torage. 13. Compressed CAes. 14. Dry cleaner x 15. Print Sho . x 16. Auto R air and Auto Body Shops. >c 17. Research and Development. x For any additional information regarding this checklist, please contact Hazardous Materials Specialist, Santa Clara County Fire Department, at(408)378-4010. HasMat 2011.doc revised 03/07/11