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12110143CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10050 S DE ANZA BLVD CONTRACTING CONTRACTOR: OVERLAND PERMIT NO: 12110143 OWNER'S NAME: CH CUPERTINO OWNER LLC 587 SIGMAN RD NE I DATE ISSUED: 11/30/2012 OWVR'S PHONE: 4082538900 1 CONYERS, GA 30013 1 PHONE NO: (678) 413-0333 LICENSED CONTRACTOR'S DECLARATION License Class r -t Lic. # _7 3 8'311 7/ Contractor 0J.—V-t/�� 'A/ Date r1(3� I Z - 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 performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provide by Section 3700 of the Labor Code, for the performance of the work f.�de h permit is issued. I certify that I have read this a lication State that ove information correct. I agree to comply wit all city an county ordinance d state laws laid to building construction, and reby auth ize representatives f this city to enter upon the above mentioned pr, ertyfor in ection purposes. e) agree to save indemnify and keep harmless a City of ertino against ' I dies, judgments, costs, and expenses which ma accrue again d Ci ' onsequence of the granting of thi it. Addi Wally, the applicant understands and will comply with all non -point a reg tions perpe e Cupertino Municipal Code, Section 9.18. Signature '� Date ❑ 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) 1, 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, I mi forthwith comply with such provisions or this permit shall be deemed revoked. 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 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 regulations per the Cupertino Municipal Code, Section 9.18. Date BUILDING PERMIT INFO: BLDG F ELECT r PLUMB f— MECII r— RESIDENTIAL r— COMMERCIAL r - JOB DESCRIPTION: SPRINT: REPLACE 3 ANTENNA IN SAME LOCATION 0RqRk*1L(A % Sq.-P%Lloor Area: n Valuation: $5000 APN Numbei%36901065.00 A Occupancy Type: P'E'RMIT 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 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. Date CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Add ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CUPERTINO zu v 1q 3 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT a BUILDING DIVISION 10300 TORRE AVENUE ^ CUPERTINO, CA 95014-3255 ' 1 1, B (408) 777-3228 ^ F r_1 NEW CONSTRUCTfON I I ADDITION FAX (408) 777-3333 o buildin cu ertino.Gr AI.TF.RATION/-n I I RF.VI9I0N/DEFRRR1RD nRIr.TNAT. FRMIT PROJECT ADDRESS, D APN # (i7' O OO C,` e -AM _ I 1 OWNERNAMEG LLC. PHOO — t_ `r J X11 E-MAIL STREET ADD SS _ C STA ZIP k—tnctnct« �4Za i FAX ar :cl , t CONTACT NAME 11 PHONE - / E-t� / /e_/7S6,1 J, d t 1 ' tSi r� C) - 1 ��- d -t /' 1•S /e/1 O �✓ a t /. C o� STREET ADDRESS C TE, ZVIC 10 FAX s SC C U - tSr dtil i (� C ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR Pal CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NY 1 6D LICENSE NUMBER T LICENSE TYPE BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECr/ENGINEER NME Romer LICENSE NUMBER C--61067, BUS. LIC # u tct COMPANY NAME E-MAIL FAX 7 o e_ S ales Q� r at_ STREET ADD SS SCIn 11174 Sui z � C L PHONEE / 9 Yc _%�,G-"3 SC riAkn I.cJ Cr iT (O (4 V L DESCRIPTION OF WORK 02 r Aa J Ze-AultJ A i C nQ 1 '00/n ' c i1n1c _/r Q A'(Ac/ EX6TING USE PROPOSED USE CONST& TYPE JU # STORIES USE TYPE OCC. SQ,IT. VALUATION ($) EXISTG 4JEW FLOOR' MO TAL AREA A NET AREA BATHROOM -WCHEN OTHER REMODEL AREA EL AREA REMODEL AREA PORCH AREA DECK AREA TO RCH AREA GARAGE AREA: DETACH 1 10 ATTACH # DWELLING UNITS: IS A SECOND UNIT []YES SECOND STORY ❑ YES BEING ADDED? []NO ADDITION? []NO PRE -APPLICATION []YES IF YES, PROVIDE COPY OF PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER IS THE BLDG AN ❑ YES EICHLER HOME? []NO RECEIVED BY: f TOTAL VALUATION: C E () By my signature below, I certify to each of the following: 1 am the property owner or authorized agent to act on the property owner's behalf I have read this application and the information 1 have pr vided is 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 b Ing constructio 1 autho ' repr sentatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: / Z I� SUPPLEMENTAL INFORMATION REQU[RED PLAN 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. ❑ EX ss ❑ PLANNING PLAN REVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ARD ❑ PUBLIC WORM _ 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 ❑ SArffTARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp_2011.doc revised 06/21/11 S :D&40rCZ'4k----- TY OF CUPERTINO ESTIMATOR - BUILDING DIVISION ADDRESS: 10050Y. V1 d DATE: 08/28/2012 REVIEWED BY: APN: BP#: "VALUATION: 1$5,000 *PERMIT TYPE: Building Permit PLAN CAECKTYPE: Alteration / Addition / Repair PRIMARY Commercial Building PENTAMATION 1GENCOM USE: PERMIT TYPE: WORK Sprint: 3 antenna SCOPE rT _1 NOTE. This estimate does not include fees due to other Departments (Le. Planning, Public Works, Tire, Sanitary Sewer District, School District, e1a). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 E . 711/11) FEE QTY/FEE MISC ITEMS FA No $0.00 1 hours Plan Check, Hourly $133.00 ISTPLNCK Supp/. PC Fee: Reg. ®OT 0.0 hrs $0.00 NOTE. This estimate does not include fees due to other Departments (Le. Planning, Public Works, Tire, Sanitary Sewer District, School District, e1a). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 E . 711/11) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? ® Yes (F) No $0.00 1 hours Plan Check, Hourly $133.00 ISTPLNCK Supp/. PC Fee: Reg. ®OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: Hourly Only? ()Yes () No $0.00 Suppl. Insp. Feer Reg. ® OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 7 '1'( !1'; t F Work Without Permit? ® Yes No $0.00 Advanced Planning Fee: $0.00 hours Inspections $266.00 ISTINSP Inspection, Hourly G 01 F I;c,(.i ;-'Ic r;l,'.!%,),I "':'_'.h': Strong Motion Fee: 1BSEISMICO $1.05 Select an Administrative Item 1 BldgLStds Commission Fee: IBCBSC $1.001 SUBTOTALS: $2.05 $399.00 TOTAL FEE: $401.05 Revised: 07/01/2012