12090031 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21251 STEVENS CREEK BLVD CONTRACTOR-TITI —M BE PERMIT NO: 12090031
ED
OWNER'S NAME: CITY OF CUPERTINO DATE ISSUED:07/15/2013
OWNER'S PHONE: 4087773269 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL El COMMERCIAL
,I Jff 3 T-MOBILE-MEMORIAL PARK(BEHIND THE BASEBALL
License Class 61 Lie.# -(
3 FIELD)-REPLACE 6 EXISTING ANTENNAS WITH 6 NEW
ContractorAt" ��//;�/_r L'h�/�i'f(iDate ANTENNAS
I hereby affirm that I am licensed under the provisions of hapter 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. Sq.Ft Floor Area: Valuation:$2500
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:32629006.00 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.I 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 DA 7M 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 17/r�/�
granting of this permit. Additionally,the applicant understands and will comply Issued by: Date: J
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signatur ate �� 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
I 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)
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 I
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 5505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this ,/�` 3
permit is issued. Owner or authorized age s Date:
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 ONSTRUCTION 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
7 o � � 1
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
4a 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255 5
(408) 777-3228• FAX (408)777-3333• building ncupertino.org '
CUPERTINO
❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROJECT ADDRESS APN# 3 C)h t
OWNERNAME Q PHONE L E�dQjJ.-I� J �J _�
A 154 �L- In . -.�+� r - V � L XLH_
STREET ADDRESSL& kCIT STATE J FAX
IN-o W06
AIM
CONTACT NAME -MAIL
Lld AWI+:
� V
STREET ADDRESS CITY,STATE,ZIP
11OWNER ElOWNER-BUILDERElOWNER AGENT 1-1CONTRACTOR CONTRACTOR AGENT 1:1ARCHITECT ElENGINEER 11 DEVELOPER ❑ TENAiJT'
CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION QF WO "T—Moble
- 1le (fek o-
EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES
USE TYPE OCC. SQ.FT. VALUATION(S)
EXISTG NEW FLOOR DEMO TOTAL
AREA AREA AREA NET AREA
BATHROOM KITCHEN OTHER
REMODEL AREA REMODEL AREA REMODEL AREA
PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: LJDETACH
❑ATTACH
#DWELLING UMTS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES
BEING ADDED? []NO ADDITION? ❑NO
PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RECEIVED BY: TOTAL VALUATION:
PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO
By my signature below,I 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 i 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 building strVion. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: Date: jo !tf/
SUPPLEMENT ORMATION REQTMED PLAN CHECKTYPE ROUTING SLIP, ;.
_New SFD or Multifamily dwellings: Apply for demolition permit for (� OVER TH>root7ly TER ❑ sU1LDrrvc PIAN REVIEW
existing building(s). Demolition permit is required prior to issuance of building
permit for new building. ❑ EXP ESS ❑ PLANNTINGPLAN REVIEW a
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure STANDARD ❑ PUBLICWORKS
form if any Hazardous Materials are being used as part of this project.
❑ -LARGE "_ ElFII2E DEPT
_Copy of Planning Approval Letter or Meeting with Planning prior to
submittal Of Building Permit application. ❑ AIAJOR ❑'SANITARY SEWER DISTRICT
❑ ENVIRONMENTAL HEALTH;a '
BldgApp_201 1.doc revised 06121111
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: DATE: REVIEWED BY:
APN: BP#: 'VALUATION: 1$2,500
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration /Addition / Repair
PRIMARY Commercial Building PENTAMATION 1GENCOM
USE: PERMIT TYPE:
WORK [Rfk lace 6 existing antennas with 6 new antennas
SCOPE
6?rc:;t /'Iur�Cl; rk Plzrnth. Pltart Cf!rck Fr`c,,. i'fan CY;:x��
P>rnril Fee: ;'k;rrzl;. I'errtit k�_. F1<°c. Prn�it f'a'ir
OIlia',llecf!. A"'11, (Ilher f'iura�b In.,��, !!?r.��.
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 prefimina information available and are only an estimate. Contact the Dept/or addn'l info,
FEE ITEMS (Fee Resolution 11-053 Eff 711/111 FEE QTY/FEE MISC ITEMS
Plan Check Fee: Hourly Only? 0 Yes 0 No $0.00-F-27 hours Plan Check,Hourly
Suppl.PC Fee: 0 Reg. Q OT 0,0 hrs $0.00 $266.00 ISTPLNCx
PME Plan Check: $0.00
Permit Fee: Hourly Only? 0 Yes Q No $0.00
Suppl. Insp. Fee-.0 Reg. Q OT 0.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
C.'oraslriection Tax:
Work Without Permit? 0 Yes No $0.00 E)
Advanced Planning Fee: $0.00
%i'(r;°Cl L)oc(rrarcrntulin,!1'`<,r��.9': A
Strong Motion Fee: IBSEISMICO $0.53 2.0 hrs Inspections
Bldy,Stds Commission Fee: IBCBSC $1.00 $266.00 ISTINSP Inspection,Hourly
* ' 9VT(► LS: $1.53 $532.00 TUTAL FRE.; $533.53
Revised: 07/01/2012
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
CU PE RTI N O Fax: 408-777-3333
CONTRACTOR 1 SUBCONTRACTOR LIST
JOB ADDRESS: PERMIT# C J
OWNER'S NAME: C- PHONE#
GENERAL CONTRACTOR: BUSINESS LICENSE#
ADDRESS: O e 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 SU CONTRACTORS HAVE OBTA ED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontract
ool
Signature Date
Please check applicable s ontractors and complete the following information:
V 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
June 05, 2014
City of Cupertino
Department of Building Inspection
10300 Torre Ave.
Cupertino, CA 95014
RE: Building Permit— Request for permit renewal
To Wliom It May Concerti:
T-Mobile was approved for Building Permit 4 1 209003 1 which has since
expired , which is for a site located at 21251 Stevens Creek Blvd. T-Mobile
requests that the expired permit be renewed.
T-Mobile's General Contractor for this project is NURev
and is authorized to pay outstanding fees for the renewal of the expired
permit.
T-Mobile appreciates your prompt assistance with this matter. If you have
any questions or need further informatiotl, please feel free to contact me at
(510) 684-4297.
Sincerely,
Victor Salas
Construction Project Manager
1
T-,Mobile USA.INC
Ofliee j925)521-5994
Fax:(925)521.5570
1855 Gateway Blvd,Suite 900
Concord,CA.94520
40
To: City of Cupertino
Building Division
10300 Torre Ave
Cupertino, CA 95014
From: Kevin Bowyer
115 Sansome St. #1400 B
San Francisco, CA 94104
RE: Building Permit Extension Request for Permit#: 12090229 (10730 N. Blaney Ave)
This letter serves as T-Mobile's written request to extend Building Permit Application #12090229 for
90 days.The application was to modify an existing wireless telecommunication facility at 10730
N. Blaney Ave by removing and replacing the (6) existing antennas with (6) new antennas.
When the building permit was originally submitted to the City of Cupertino, it was believed that
the new antennas would ship from the manufacturer by January 2013. There has been a delay
and the antennas will not likely be shipped from the manufacturer until April-May. For that
reason, T-Mobile request that the permit be extended for 90 days.
If you require any additional materials for this application, please do not hesitate to contact me
at (408) 219-5442 or kbowyer@modus-corp.com.
Sincerely,
Kevin Bowyer, Authorized Land Use Planning Agent for Sprint
Modus Corp
115 Sansome St. #1400
San Francisco, CA 94104
X408) 219-5442