15040237CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: 15040237
10380 PERIMETER RD CUPERTINO CA 95014 (316 20 092)
S B C C INC
CAMPBELL, CA 95008
OWNER'S NAME: (CUPERTINO PROPERTY DEVELOP LLC)
DATE ISSUED: 11/03/2015
OWNER'S PHONE: (408) 777-3081
PHONE NO: (408) 379-5500
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class JJ Lic. #336974
Contractor S B C C INC Date 03/31/2018
— BLDG —ELECT —PLUMB
MECH RESIDENTIAL COMMERCIAL
[ 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.
JOB DESCRIPTION:
SPRINT - RELOCATE (E) EQUIPMENT & ANTENNA(S)
I hereby affirm under penalty of perjury one of the following two declarations:
1. I have and will maintain a certificate of consent to self -insure for Worker's
"PERMIT EXT'D TO 11/5/16
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
Sq. Ft Floor Area:
Valuation: $10000.00
permit is issued.
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
APN Number:
Occupancy Type:
and state laws relating to building construction, and hereby authorize
316 20 092
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
PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting of this permit.
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally, the applicant understands and will comply with all non -point
source regulations per the Cupertino Municipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Signature ( .fig.. Date 10/11/2016
Issued by: 1-e�acv e S S�'� N 0.✓N e S
�,
Date:
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the
RE -ROOFS:
following two reasons:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
t. 1, as owner of the property, or my employees with wages as their sole
installed without first obtaining an inspection, I agree to remove all new materials for
compensation, will do the work, and the structure is not intended or offered for
inspection.
sale (Sec.7044, Business & Professions Code)
2. I, as owner of the property, am exclusively contracting with licensed
Signature of Applicant:
contractors to construct the project (Sec.7044, Business & Professions Code).
Date: 10/11/2016
I hereby affirm under penalty of perjury one of the following three declarations:ALL
ROOF COVERINGS TO BE CLASS "A" OR BETTER
1. 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.
HAZARDOUS MATERIALS DISCLOSURE
2. 1 have and will maintain Worker's Compensation Insurance, as provided for by
I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code, for the performance of the work for which this
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
permit is issued.
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
3. I certify that in the performance of the work for which this permit is issued, I
Health & Safety Code, Section 25532(a) should I store or handle hazardous
shall not employ any person in any manner so as to become subject to the
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California. If, after making this certificate of
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
exemption, I become subject to the Worker's Compensation provisions of the
the Health & Safety Code, Sections 25515,25533, and 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
Owner or authorized agent.
APPLICANT CERTIFICATION
Date: 10/11/2016
1 certify that I have read this application and state that the above information is
CONSTRUCTION LENDING AGENCY
correct. I agree to comply with all city and county ordinances and state laws
I hereby affirm that there is a construction lending agency for the performance
relating to building construction, and hereby authorize representatives of this city
of work's for which this permit is issued (Sec. 3097, Civ C.)
to enter upon the above mentioned property for inspection purposes. (We) agree
Lender's Name
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments, costs, and expenses which may accrue against said City in
Lender's Address
consequence of the granting of this permit. Additionally, the applicant understands
and will comply with all non -point source regulations per the Cupertino Municipal
ARCHITECT'S DECLARATION i
Code, Section 9.18.
1 understand my plans shall be used as public records.
Signature Date 10/11/2016
Licensed
Professional
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10380 PERIMETER RD
CONTRACTOR: CUPERTINO PROPERTY
PERMIT NO: 15040237
DEVELOP LLC
OWNER'S NAME: CUPERTINO PROPERTY DEVELOP LLC
19620 STEVENS CREEK BLVD
DATE ISSUED: 11/03/2015
OWNER'S PHONE: 4083431088
CUPERTINO, CA 95014
PHONE NO:
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL ® COMMERCIAL
License Class Lic. #
SPRINT - RELOCATE (E) EQUIPMENT & ANTENNA(S)
Contractor Date
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 andwill 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: $10000
performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation hisurance, as provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APN Number: 31620092.00
Occupancy Type:
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
PERMIT EXPIRES TF WORK IS NOT STARTED
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 toJ
WITHIN 180 DAYS VIIT ISSUANCE OR
upon the above mentioned property for inspection purposes. (We) agree to
1ODAY ALLED INSPECTI N.
indemnify and keep harmless the City of Cupertino against liabilities, judg
costs, and expenses which may accrue against said City in consequence of t
granting of this permit. Additionally, the applicant understands and will co
Date;
with all non -point source regulations per the Cupertino Municipal Code,
9.18.
Signature Date
RE -ROOFS:
All roofs shall b nspected 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 SETTER
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,
usiness & 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(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, 255 3, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Date:
Owner or authorized agent: l l
permit is issued.11
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
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 �er the Cupertino Municipal Code, Section
Licensed Professional
9.18./ p ( t
'G"V � l S
Signature / Date
l
CITY OF CUPERTINO
FEE FSTIMATnR — RTTTT .-n1XV D1V1C1t11V
1AADDRESS: 10380 PERIMETER RD
DATE: 04/30/2015
REVIEWED BY: MELISSA
APN: —31620092
BP#:
*VALUATION: $10,000 —�
--PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building
USE: 9
Select a Mise Bldg/Structure
or Element of a Building
PENTAMATION
PERMIT TYPE: TELECOMFA �
WORK
RELOCATE E SPRINT EQUIPMENT & ANTENNA(S)
SCOPE
$0.00
;1.fech. Plcarr Check Phrrs;h. Plan Check 1-1c�c. Plan Check
Meeh. Pet•naid Fee: Plumb. Per-iriil Fee: I>iec. Permit Fee:
oilrer tech. Imp.E3--L- Oflier Plivnh True. Oilier is ec. Insp.
i4ech. 111.v). Fee: Play O. hisp. Fez: L lec. I vp4 Fee:
NOTE. This estimate does not include fees due to other Departments 0.a Planning, Public Works, Fire, Sanitary Sewer District, School
nictrirt air 1 Th— faac nra h—d nn iha nroliwainnru infnrcrantinn mrnilnhlo and nro nnhr nn owdmatarn"mot tho Dant far addn'f in n..
FEE ITEMS (Fee Resolution 11-053 Eff. 711113)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
Select a Mise Bldg/Structure
or Element of a Building
Suppl. PC Fee: Reg. 0 OT
0.0
I hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee: Reg. 0 OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tax:
Achninistrati e Fee
Work Without Permit? 0 Yes (F) No
$0.00
Advanced Planning Fee.
$0.00
�� #
$1,145.00
Antenna - Telecom Facility
JANTCELF;; Cellular, Free -Standing
A
TrOvel Dootanenioli ,ii Fl?es;
Strong Motion Fee: IBSEISMICO
$2.80
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
STJT(�TAIyS:=
$3.801$1,145.00[TONAL
FE
$1,148.80
Kevised: u4muzu,io