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11090205CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10730 N BLANEY AVE CONTRACTOR: CAPITAL TOWER AND PERMIT NO: 11090205 COMMUNICATIONS OWNER'S NAME: CUPERTINO MINI WAREHOUSE PARTN 13330 AMBERLY RD DATE ISSUED: 09/29/2011 OWNER'S PHONE: 4082572900 WAVERLY, NE 68462 PHONE NO: (404) 786-3333 ❑ LICENSED CONTRACTOR'S DECLARATION F \ 'A ' ' BUILDING PERMIT INFO: BLDG ELECT PLUMB ` .. License Class # r Cyr MECH RESIDENTIAL COMMERCIAL Contractor �� ate g'�� ° I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: T-MOBILE CELL TOWER - REMOVE AND REPLACE AN (commencing with Section 7000) of Division 3 of the Business & Professions EXISTING BTS CABINET WITH A NEW BTS CABINET FOR Code and that my license is in full force and effect. T-MOBILE WEST CORPORATION 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 Sq. Ft Floor Area: Valuation: $5000 Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APN Number: 31643009.00 Occupancy Type: APPLICANT CERTIFICATION 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 PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this per it Additionally, the applicant understands and will comply 180 DAYS FRO AST CALLED INSPECTION. with all non-po' s regulations per the Cupertino Municipal Code, Section 9.18. a .l g c1j, Zc�, �r Signature Date Issued by: Date: ❑ OWNER -BUILDER DECLARATION RE -ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed. If a roof is the following two reasons: installed without first obtaining an inspection, I agree to remove all new materials for I, as owner of the property, or my employees with wages as their sole compensation, inspection. will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) Signature of Applicant: Date: I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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 HAZARDOUS MATERIALS DISCLOSURE Compensation, as provided for by Section 3700 of the Labor Code, for the I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain I have and will maintain Worker's Compensation Insurance, as provided for by compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Section 3700 of the Labor Code, for the performance of the work for which this Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air permit is issued. contami nts as defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued, I shall maintai pliance with the Cupertino Municipal Code, Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health & S f Code, Sections 25505, 25533, and 25534. Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must Ow e r orized agent: Date: forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of NNork's correct. I agree to comply with all city and county ordinances and state laws relating for which this permit is issued (Sec. 3097, Civ C.) to building construction, and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, Lender's Address costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply ARCHITECT'S DECLARATION with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. I understand my plans shall be used as public records. Signature Date Licensed Professional CUPERTINO I I-1 wTn nnXTQDTTnTTnNT CONSTRUCTION PERMIT APPLICATION ( (c),"/ 1 COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX ((408) 777-3333 . bLJ.1 t€i—Iqmc per ino_c �-g, 1-1 A nTITn TTA1 T I 1 AT TFu ATfC)NT / TT 1 I RFVTCTnN[ / TIFFFRRFII ORTCHNAT. PERMIT # OAP PROJECT ADDRESS ( ®11p C> r ^ t�y A' I � V APN # h OWNERNAME ��51_ `"llyil PHO t i ° \2� 1 -io 6 O fJ 1 STREET ADDRESS A CITY STA [ ®-� FAX CONTACT NAME •� „ „L � G•`�•' PHONE E-MAIL STREET ADDRESS ` G t -r-E �0I� l `J CITY, STATE, ZIP /7 1) C3 / 2 �® �©IL�V `"-1 h � Lr—) FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER d'rMA CONTRACTOR NAME / n (� `�� J �� `_ J -` j' LICENSE NUMBER �j�LoJ�� \ LICENSE TYPO 1 /� BUS. LIC fi L COMPANY NAME E-MAIL FAX STREET ADDRESS '� CITY, STATE, ZIp �� �r' 7XJONE r� Q. ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES :OFFICE USE ONLY OCC. TYPE DESCRIPTION SO -FT. VALUATION EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODELAREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKNORCH AREA GARAGE AREA: ❑ DETACH ❑ ATTACH # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES BEINGADDED? ❑ NO ADDITION? ❑ NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF PLANNER'S NAME: RECEIVED BY: TOTAL VALUATION: PLANNING APPL# ❑ NO PLANNING APPROVAL LETTER By my signature below, I certify to each of o owing: I a he er or authorized agent to act on the property owner's behalf. I have read this application and the information I hav pro3'ded is ect. I ave rer . tion of Work and verify it is accurate. I agree to comply with all applicable local Qth ordinances and state laws relating buildi g c ru tion. authortive�of upertino to enter the above-identifi d prope for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP AVER -THE -COUNTER ❑ BUILDING PLAN REVIEW New SFD or Multifamily dwellings: Apply for demolition permit for 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 ❑ FIRE DEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH 1r!12® BldgApp_2011.doc revised 03116111 CITY OF CUPERTINO - FEE ESTIMATOR - BUILDING DIVISION imADDRESS: , 10730 n. blaney ave DATE: 09/29/2011 REVIEWED BY: larrys APN: BP#: "VALUATION: 1$5,000 rPERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY USE: Commercial Building PENTAMATION PERMIT TYPE: 10EAP WORK change out electrical cabinet like for like SCOPE APPLIANCE / EQUIP TYPE FEE ID QTY UNITS BP FEES Apparatus 1BREMMISC 1 # $130 TOTALS: $130.00 Elec. Plan Check 0.0 1 his $0.00 -?f:;:'�. Elec. Permit Fee: 1EPERMIT �rrlte�r .;t.Fc�z it. ira_s�r, 3iF're�: 'rrr,r; Iu n. Other Elec. Insp. 0.0 hrs $44.00 NOTE. This estimate does not include fees due to other Depts (i.e. Public Works, Sanitary Sewer District, School District, etc.). Thoco foo.c aro ha.cod nn the nre/iminary infnrnlatinn availahle and are only an estimate. Contact the Dent for addn'i info. FEE ITEMS (Fee Resohition 11-053 & 7,1U1IJ FEE QTY/FEE MISC ITEMS ,'i�rFrf31, r� l'Nc, PME Plan Check: $0.00 PME Unit Fee: $130.00 PME Permit Fee: $44.00 Ta T-F Administrative Fee: IADMIN $41.00 Work Without Permit? Q Yes Q No $0.00 t A Travel Documentation Fee: ITRAVDOC $44.00 Stron€, Motion Fee: IBSEISMICO $1.05 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $261,05 $0.00 TOTAL FEE: $261.05 Revised: 09/02/2011