15100207CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 2 INFINITE LOOP
CONTRACTO"�- "� o at -�-
PERMIT NO: 15100207
\
D
OWNER'S NAME: APPLE COMPUTER INC
DATE ISSUED: 11/17/2015
OWNER'S PHONE: 4089961010
PHONE NO:
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL
� tO C--)
REMOVE AND REPLACE (3) ANTENNAS FOR (3) NEW LTE
License Class_ Lic. #
ANTENNAS ON AN EXISTING ROOFTOP WIRELESS
ff --
Contractor as Date ,- P
FACILITY.
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: $30000
perform ce of the work for which this permit is issued.
will maintain Worker's Compensation Insurance, as provided for by
00 of the Labor Code, for the performance of the work for which this
APN Number: 31602106.00
Occupancy Type:
e it is issued.
APPLICANT CERTIFICATION
I 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
WITIIIN 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 FROM LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, City in consequence of the
)
and expenses which may accrue against said
Issued by:�. Date: "
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
RE -ROOFS:
Signature ----.- Date.
All roofs shall be inspected prior to any roofing material being installed. If a roof is
for
installed without first obtaining an inspection, I agree to remove all new materials
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. 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(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 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 25505, 25533, and 25534. i
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent: --_ Date: t' t ,
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
CONSTRUCTION LENDING AGENCY
Compensation laws of California. If, after making this certificate of exemption, I
I
I hereby affirm that there is a construction lending agency for the performance of
become subject to the Worker's Compensation provisions of the Labor Code, must
work's for which this permit is issued (Sec. 3097, Civ C.)
forthwith comply with such provisions or this permit shall be deemed revoked.
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
CUPERTINO
CONsTRUcTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 - FAX (408) 777-3333 • building(cDcupertino.org 1_5M
_5l 090 7
❑ NEW CONSTRUCTION ❑ ADDITION M ALTERATION / TI ❑ REVISION /DEFERRED ORIGINAL PERMIT #
IMM
PROJECT ADDRESS
APN #
2 Infinite Loop, Cupertino CA
316-02-106
OWNER NAMEW)_
H(�j
E-MAIL
Apple Computer
10,1
(�-U'V 1 I U/ 0
TREET ADDRESS
CITY, STATE, ZIP
FAX
Infinite Loop
Cupertino, CA 95014
CONTACT NAME
PHONE
E-MAIL
Mackenzie Gutkin
925-786-1705
mackenzie@forzatelecom.com
STREET ADDRESS
CITY, STATE, ZIP
FAX
1330 North Broadway; Suite 202
Walnut Creek, CA 94596
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
LICENSE NUMBER
LICENSE TYPE
BUS. LIC #
TBD
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
Brian Winslow
C11535
COMPANY NAME
E-MAIL
FAX
Borges Architectural Group, Inc
Brian 9borgesarch.com
916-773-3037
STREET ADDRESS 1478 Stone Point Drive; Suite 350
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK
Swapping three existing antennas for three new LTE antennas on an existing rooftop wireless
facility. There will be no change in the height of the building or antennas.
EXISTING USE
PROPOSED USE CONSTR.
TYPE
# STORIES
USE
TYPE
OCC.
SQ.FT.
VALUATION ($)
EXISTG
NEW FLOOR
DEMO
TOTAL
AREA
AREA
AREA
NET AREA
BATHROOM
KITCHEN
OTHER
REMODELAREA
REMODELAREA
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECK/PORCH AREA
GARAGE AREA: DETACH
❑ATTACH
# DWELLING UNITS:
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 i'
RECEIVED Y:
TOT VALUATION:
PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER
EICHLER HOME? ❑ NO
/ "
000
By my signature below, I certify to o the following: I am the property owner or authorized agent to act on the property owner's behalf. have read this
application and the information I ave pr ided is correct. I hav "ad the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relati toyb=.on. I aut representatives of Cupertino to enter the abo e-identifie property for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INFORMATION REQUIREDPLAN
CHECK TYPE
ROUTING SLIP
OVER-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
BIdgApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
V -M -W FEE ESTIMATOR - BUILDING DIVISION
19
ADDRESS: 2 Infinite Loop
DATE: 10/26/2016
REVIEWED BY: Sean
,14ech. Permit Fee:
APN:
BP#:
*VALUATION: 1$30,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration /Addition/ Repair
PRIMARY
USE: Commercial Building
Civil / Religious activities
in BQ zone? 0 Yes 0No
PENTAMATION
PERMIT TYPE: TELECOMFA d
WORK
Remove and replace 3 antennas for 3 new LTE antennas on an existing rooftop wireless facility.
SCOPE
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 lite Preliminary information available and are only an estimate. Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Ff. 711113)
Alech, Plenc Check
PhLmb. Plan Check
1?lec. Plan Check
,14ech. Permit Fee:
Plume. Permit Fen.:
Elec. Permit Fee:
Other 111ech. Insp.ET-L-
Other Plumb Insp.ED--L--
Other Elec. Insp.
E17-
Afech, lisp. Fee:
Plumb. Insp. Fee:
h7ec. hIsp. Fee.
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 lite Preliminary information available and are only an estimate. Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Ff. 711113)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
Select a Misc Bldg/Structure
or Element of a Building
i
Suppl. PC Fee: Q Reg. 0 OT0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Feer Reg. 0 OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tax: IBCONSTAXC
$0.00
Aelininistrative Fee:
0
E)
Work Without Permit? 0 Yes (F) No
$0.00
Advanced Planning Fee:
$0.00
#
$1,145.00
Antenna - Telecom Facility
IANTCELATT Cellular, Attached to Bldg
G
0
Travel.Documentulioft.Fees:
Strong Motion Fee: IBSEISMICO
$8.40
Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC
$2.00
SUBTOTALS:
$10.401$1,145.00
TOTAL FEE:
$1,155.40
Revised: 10/01/2015
CUPERTINO
PLAN REVIEW SUBMITTAL CHECKLIST
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildingacupertino.org
*PERMIT TYPE: Building Permit
*USE: Commercial Building
*PLAN CHECK TYPE: Tenant Improvement
*ROUTING TYPE:
FOOD ESTABLISHMENT? . O Y ON
PUBLIC SWIMMING POOL? 0 Y r®; N
OWNER / BUILDER?
FENCING PROPOSED?
Plans/Documents Required: Sets of Plans
Sats of Sunnnr ina Dnruments
QY (DN
OY (j)
APPLICATION SUBMITTAL INFORMATION
Required .
Provided
Scope of Work specified on cover sheet
❑x
❑
Specify the following Governing Codes on cover sheet:
• 2013 Calif. Building Code (based on 2012 International Building Code)
• 2013 Calif. Residential Code (based on 2012 International Resid. Code)
• 2013 Calif. Plumbing Code (based on 2012 Uniform Plumbing Code)
• 2013 Calif. Mechanical Code (based on 2012 Uniform Mechanical Code)
❑D
❑
W
• 2013 Calif. Electrical Code (based on 2011 National Electrical Code)
_
• 2013 Calif. Energy Code
co
2013 Calif. Green Building Standards Code
L
w
Cupertino Municipal Code
0
Name and Address of property owner
❑x
❑
V
Provide a Drawing Index that lists all pages part of the official drawing set
❑x
❑
Project Data Form information (including assessor's parcel number, use of
❑x
❑
building, etc.) (link to Residential Form) (link to Commercial Form)
Deferred Submittal Items (if applicable)
®
❑
Special Inspection / Structural Observation Items (if applicable)
❑x
❑
Alternate Materials and Methods granted for project (if applicable)
❑x
❑
Fully dimensioned site plan with a minimum scale of 1/8"=1' or 1:20 to include
North arrow, type and dimension of existing overhead utility lines and
easements, perimeter outline and dimensions of existing and proposed
❑x
❑
building and/or structures, property line and setback dimensions, existing tree
sped s & trunk diameter measured 4' above natural grade).
z
Floor Plans (existing and proposed)
❑x
❑
aElevations
(North, South, East and West ) with Section View referenced
El
El
Z
Section Views (Longitudinal and Transverse)
❑
❑
0Electrical
plans stamped and signed by licensed professional
❑x
❑
Plumbing Plans stamped and signed by licensed professional
❑x
❑
Mechanical Plans stamped and signed by licensed professional
❑x
❑
z
Grading and Drainage Plans
❑
❑
VExcavation
and Shoring Plans
❑
❑
Foundation Plan with cross-referenced structural details
❑
❑
Floor and Roof Framing Plans with cross-referenced structural details
❑
❑
Gas and Plumbing Isometric Drawings (for one-two family dwellings and
13
El
buildings)
PlanCheckSubmitialChecklist 2015.doc revised 06/05/15
I understand this may not be a complete list of required items due to the variations for each
project and additional code related information may be required. I understand that an
incomplete plan check submittal may result in delays in the plan review process.
Applicant Name (Print): Anwut Gwiyu
Applicant Signature: Cl-)��
Applicant's Phone:
Applicant's Email.-
Date:
mail:Date: l v
P1anCheckSzthmittalChecklist 2015.doc revised 06/05/15
Window alignment and privacy protection requirements for second stories or
❑
❑
new second story windows or letter of waiver.
00
p:
One 8 1/2 x 11 copy of the site plan, with privacy protection planting shown
(tree location, tree canopy, tree species, dimensioned planting distance)
❑
❑
O
Affidavit from a certified arborist/landscape architect. (Affidavit should have a
Z
copyof the privacy plantingIan attached).
W
Landscape Water -Efficiency Checklist (click for entire landscape ordinance)
❑X
❑
=
Fence Approval Form (click for entire fence ordinance)
❑
❑
O
Incorporate the City of Cupertino Best Management Practices (BMP) sheet into
0
❑
all plan sets.
Cn
Completed and Signed Plan Review Submittal Checklist
0
❑
Completed and Signed Construction Permit Application Form
0
❑
W
Structural Calculations stamped and signed by licensed professional
0
❑
M
V
Geotechnical Soils Investigation report stamped and signed by licensed
❑
❑
p
professional 2 copies)
Title 24 Energy Certificate of Compliance forms incorporated into all plan sets.
O
Z
Depending on the scope of the project, Installation Certficates may be required
0
❑
P:
prior to final sign -off for project.
W
O
Manufacturer's Specifications
❑
❑
a
Owner -Builder Disclosure Form (for property owners applying for their own
❑
M
buildingermit)❑
Hazardous Materials Questionnaire Form
❑x
❑
Building Department 408-777-3228
®
ClLU
Planning Department 408-777-3308
®
❑
Public Works Department — New SFD, addition/remodel with 25% increase in
O
floor area, hillside construction, grading and drainage permits, retaining wall
®
❑
W
permits, swimming pools (new/demo) 408-777-3354
Cn W
Public Works Department, Environmental Programs — Waste Trios, Trash
❑
❑
0
Enclosure w/ roof, Inlet Protection. 408-777-3354
Q�
Santa Clara County Fire Department 408-378-4010
®
❑
Q
County Health Department 408-918-3400
❑
❑
Cupertino Sanitary Sewer District 408-253-7071
®
❑
U
Other:
If an existing residence is proposed to be demolished as part of the
0
construction of a new residence, a DEMOLITION PERMIT APPLICATION
Cn
shall be applied for at the same time the construction permit application for the
❑
❑
new residence is applied for.
I understand this may not be a complete list of required items due to the variations for each
project and additional code related information may be required. I understand that an
incomplete plan check submittal may result in delays in the plan review process.
Applicant Name (Print): Anwut Gwiyu
Applicant Signature: Cl-)��
Applicant's Phone:
Applicant's Email.-
Date:
mail:Date: l v
P1anCheckSzthmittalChecklist 2015.doc revised 06/05/15