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BLD-2021-0177 C&D PCB 3Ž–˜™™ȏŘŖŗşǯ˜Œȱ›ŽŸ’œŽȱŖśȦŗȦŝŗş  ȱȱ ȱǛȱ ȱȱ  ȱ Ȭ  ȱȱ ȱȱ  ǰȱǰȱȱ ȱ ȱȱ ȱȱ  ȱȱ ȱȱ ȱ Ȭ  ȱȱ  ǰȱǰȱ ȱ  ȱ    ȱ ȱ   ȱ ȱ  ȱȱ  ȱȱȱȊȱ   ȱ    ȱŗŖřŖŖȱȱȱȊȱ ǰȱȱşśŖŗŚȬřŘśśȱ ǻŚŖŞǼ ŝŝŝȬřŘŘŞȱȊȱŝŝŝȬřřřřȱȊȱ‹ž’•’—ȓŒž™Ž›’—˜ǯ˜› ȱ    ȱȦ   Ȧ   Ȭ Ȧ Ȭ ǯǯȱ  ȱǻǞǼ ȱȱȱ ȱ  ȱ ȱȱȱ ȱȱȱ ȱȱ  ȱȱ  ȱȱ ȱȱ ȱ  ȱȬ ǯȱ ȱǛȱ  ȱǛȱȏȏȏȏȏȏȏȏȏȏȏȬȏȏȏȏȏȏȏȏȏȏȏ ȱ     ȱȱ  ȱȱ  ȱȱ ȱȱȱ  ˜ȱœ›žŒž›Š•ȱ˜›ȱ•˜˜›ȱœ•Š‹ȱœž™™˜›ȱœ‘Š••ȱ‹Žȱ‹ž’•ȱž—•Žœœȱ‘Žȱ™˜˜•ȱœ‘Ž••ȱ’œȱ›Ž–˜ŸŽȱ’—ȱ’œȱŽ—’›Ž¢ǯȱ ŠŒ”’••ȱ–žœȱ‹ŽȱŒŽ›’’Žȱ‹¢ȱŠȱ•’ŒŽ—œŽȱ Ž˜ŽŒ‘—’ŒŠ•ȱ˜›ȱ’Ÿ’•ȱ—’—ŽŽ›ȱ˜ȱŸŽ›’¢ȱ‹ŠŒ”’••ȱ–ŠŽ›’Š•œǰȱ œ˜’•ȱ¢™ŽȱŠ—ȱŒ˜–™ŠŒ’˜—ȱ™Ž›ŒŽ—ŠŽȱ˜ȱşŖƖȱ–Š¡’–ž–ȱŽ—œ’¢ȱ™›’˜›ȱ˜ȱ’—œ™ŽŒ’˜—ǯ ¢ȱ–¢ȱœ’—Šž›Žȱ‹Ž•˜ ȱ ȱŒŽ›’¢ȱ˜ȱŽŠŒ‘ȱ˜ȱ‘Žȱ˜••˜ ’—DZȱȱȱ ȱŠ–ȱ‘Žȱ™›˜™Ž›¢ȱ˜ —Ž›ȱ˜›ȱŠž‘˜›’£ŽȱŠŽ—ȱ˜ȱŠŒȱ˜—ȱ‘Žȱ™›˜™Ž›¢ȱ˜ —Ž›Ȃœȱ‹Ž‘Š•ǯȱȱ ȱ‘ŠŸŽȱ›ŽŠȱ ‘’œȱŠ™™•’ŒŠ’˜—ȱŠ—ȱ‘Žȱ’—˜›–Š’˜—ȱ ȱ‘ŠŸŽȱ™›˜Ÿ’Žȱ’œȱŒ˜››ŽŒǯȱȱ ȱ‘ŠŸŽȱ›ŽŠȱ‘ŽȱŽœŒ›’™’˜—ȱ˜ȱ˜›”ȱŠ—ȱŸŽ›’¢ȱ’ȱ’œȱŠŒŒž›ŠŽǯȱȱ ȱŠ›ŽŽȱ˜ȱŒ˜–™•¢ȱ ’‘ȱŠ••ȱ Š™™•’ŒŠ‹•Žȱ•˜ŒŠ•ȱ˜›’—Š—ŒŽœȱŠ—ȱœŠŽȱ•Š œȱ›Ž•Š’—ȱ˜ȱ‹ž’•’—ȱŒ˜—œ›žŒ’˜—ǯȱȱ ȱŠž‘˜›’£Žȱ›Ž™›ŽœŽ—Š’ŸŽœȱ˜ȱž™Ž›’—˜ȱ˜ȱŽ—Ž›ȱ‘ŽȱŠ‹˜ŸŽȬ’Ž—’’Žȱ ™›˜™Ž›¢ȱ˜›ȱ’—œ™ŽŒ’˜—ȱ™ž›™˜œŽœǯȱȱ ȱŠŒ”—˜ •ŽŽȱŠ—ȱŠž‘˜›’£ŽȱŠ••ȱ’—˜›–Š’˜—ȱŒ˜—Š’—Žȱ˜—ȱ‘’œȱŠ™™•’ŒŠ’˜—ȱ˜›–ȱ˜ȱ‹Žȱ–ŠŽȱŠŸŠ’•Š‹•Žȱ˜›ȱ™ž‹•’Œȱ›ŽŒ˜›ǯ ’—Šž›Žȱ˜ȱ™™•’ŒŠ—ȦŽ—DZȱȏȏȏȏȏȏȏȏȏȏȏȏȏȏȏȏȏȏȏȏȏȏȏȏȏȏȏȏȏȏȏȏȏȏȏȏȏȏȏȏȏȏȏȏȏȏȏȏȏȏȏȏȏȱȱ ŠŽDZȏȏȏȏȏȏȏȏȏȏȏȏȏȏȏȏȏȏȏȏȏȏȏȱ     ȱǞřŖǰŖŖŖ   ǛȱǛȱ  ȱ  DZ DZ Ȭ ȱȱ 10408 Sterling Boulevard 375-24-005 Janaka and Sherry Ranatunga (650) 743-5497 janaka_is@hotmail.com 10408 Sterling Boulevard Cupertino, CA 95014 GILBERT FERANDEZ GILBERT FERNANDEZ 954667 B Michelle Miner shelminer@aol.com 408-396-0984 DEMO EXISTING SINGLE STORY HOUSE WITH CARPORT AND BUILD A NEW TWO STORY HOUSE WITH ATTACHED GARAGE AND ATTACHED ADU 1 Michelle Miner Digitally signed by Michelle Miner Date: 2020.10.29 14:06:18 -07'00' 18488 Prospect Road #6 18488 Prospect Road #6 Saragoga, CA 95070 gilbert_fernandezjr@me.com 408-500-8511 1821 S BASCOM AVE CAMPBELL CA 95008 954667 1746 Total SF to be demoed 'HPR$SSBGRFUHYLVHG Demolition permits are required for all sites where a demolition of any building, structure, and/or pool is proposed. An application for a Demolition Permit may be submitted concurrently with a Building Permit. A Building Permit will not be issued until the Demolition Permit is approved. Plan check fees are due at the time of the application submittal. All items listed below are to be complete prior to the issuance of a Demolition Permit: Complete a Demolition Permit Application (D). (A Demo Permit application can be submitted concurrently with the Building Permit submittal.) One (1) scaled digital copy of a 'HPROLWLRQSite Plan on a USB thumb drive. (Refer to the Demolition SitePlan Requirements). 6KRZDOORQVLWHWUHHVDQGLQGLFDWHVSHFLHVDQGGLDPHWHUDWIHHWDERYHJUDGH6SHFLI\ZKHWKHU WUHHVZLOOEHUHPRYHGRUUHWDLQHGIllustrate the tree protectionmeasures that will remain in place during construction. Per City of Cupertino Municipal code14.18.200 and 14.18.210. 3ODQQLQJ'HSDUWPHQWSODQQLQJ#FXSHUWLQRRUJ 9HULI\LIWKHEXLOGLQJ V DQGRUVWUXFWXUH V DUHKLVWRULFDOODQGPDUN V 2EWDLQFOHDUDQFHIURPWKH 3ODQQLQJ'HSDUWPHQWSODQQLQJ#FXSHUWLQRRUJ 6KRZDOOVWUHHWWUHHVDGMDFHQWWRSURSHUW\,OOXVWUDWHWKHWUHHSURWHFWLRQPHDVXUHVWKDWZLOOUHPDLQ LQSODFHGXULQJFRQVWUXFWLRQ 1RWH1RVWUHHWWUHHVVKDOOEHUHPRYHGXQOHVVDSSURYHGE\WKH&LW\ $UERULVW 'HSDUWPHQWRI3XEOLF:RUNV Provide a Termination/Disconnect letter from the Utility Suppliers confirming that the gas and electrical services have been terminated at the main/street. Contact PG&E IMMEDIATELY @ 408-725-3325 to schedule a disconnect. Provide a letter of Certification from Bay Area Air Quality Management District, (BAAQMD - www.baaqmd.gov @ 415-749-4762) providing an ASB Number. The demolition of a pool will require a Cupertino Sewer District permit to drain the pool.Contact Frank Quach at fquach@markthomas.com Provide a letter of clearance of all vermin from a licensed pest control contractor. Complete a Construction and Demolition Recycling Diversion form. http://www.cupertino.org/home/showdocument?id=4078 Permittee shall install tree protection measures LIDSSOLFDEOH consistent with City StandardDetail 4(attached hereto), and contact the Public Works 'HSDUWPHQWDW 408-777-3,for inspection andapproval of the facilities. OBTAIN SIGN-OFF OF TREE PROTECTIONMEASURES PRIOR TOTHE DEMOLITION PERMIT ,668$1&( LIVE FIRE TRAINING DRILLS Municipal fire departments frequently use residential structures scheduled for demolition to provide realistic, yet controlled scenarios for training exercises. If you are interested in providing a Permitted Structure for a fire training exercise, please contact: Santa Clara County Fire Training Division @ 408-378-4010 PROCEDURE CHECKLIST FOR DEMOLITION PERMITS COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • building@cupertino.org  ’––’—˜˜•Ž–˜ŸŠ•ǯ Ž–˜™™ȏŘŖŗşǯ˜Œȱ›ŽŸ’œŽȱŖśȦŗȦŝŗşȱ PURPOSE The purpose of this guideline is to clarify the minimum requirements to allow for the removal of an existing swimming pool. A building permit is required for the removal of all swimming pools. PLAN REQUIREMENTS 1. Provide a completed construction permit application. 2. Provide an electronic copy of a completely dimensioned site plan showing all property lines, all existing structures, location of existing swimming pool and setback dimensions from the pool to the existing structures and property lines. Specify which of the options will be used below. - Drawing and document files shall be saved as .pdf files. Drawing sheet file names should be as follows: SHEET NUMBER ± SHEET TITLE. Save each drawing sheet as a single file. 3.Owner-Builder Disclosure Form (for property owners applying for their own building permit) 4. All existing gas and electrical lines will be verified to be properly terminated. OPTION A – POOL SHELL TO REMAIN 1. Drill a minimum of three (3) - 12´ diameWeU hRleV evenly spaced along the center line of the pool bottom. Call for initial inspection to verify size and spacing of required drain holes. 2.Backfill Whe UemaiQiQg SRRl Vhell ZiWh ô´ ma[imXm Vi]e cUXVhed URck fRU a miQimXm Rf 8´ deeS at the bottom of the pool. Gravel shall be packed into place. Clean fill may be added beyond the initial crushed rock backfill. 3. Line the top of gravel with a nonwoven geotextile filter fabric and wrap the fabric up the pool walls at least 1 foot. The filter fabric should be at least 6-ounce per square foot weight, such as Mirafi 160N, Amoco 4551, Contech 6-60NW, TNS R060, or other equivalent manufacturer's product. 4. Backfill with clean dirt. Backfill shall be moistened and tractor rolled or tamped with a wacker compacting plate into place. No fill dirt shall be stored on the street or public right-of-way without an encroachment permit issued by the Department of Public Works. 5. Call for final inspection after all the work is complete. 6. NOTE: Backfill over the existing swimming pool shell may have differential settlement. Owner agrees to use the area for landscape purposes only and not for any structural or floor slab support. OPTION B – POOL SHELL TO BE REMOVED Pool backfill area can be used to support a building or structure if the pool shell is removed in its entirety and the backfill is certified by a licensed Geotechnical or Civil Engineer to verify backfill materials, soil type, percentage of compaction, etc. Compaction report is required for Final Inspection, and the compaction report must state that backfill area is suitable for a future structure. If a compaction report is not provided, the pool backfill area will allowed to be used for landscape purposes only and not for any structural or floor slab support. SWIMMING POOL REMOVAL REQUIREMENTS COMMUNITY DEVELOPMENT DEPARTMENT ‡ BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 7O55E A9EN8E ‡ C8PERTINO, CA 95014-3255 (408) 777-3228 ‡ building@cupertino.org 1SF TO BE DEMOED ‘Žȱ›Žšž’›Žȱœ’Žȱ™•Š—ȱœ‘Š••ȱŒ˜—œ’œȱ˜ȱŠ••ȱ‘ŽȱŽŠ’•œȱ˜ȱ‘Žȱ™›˜™˜œŽȱŽŸŽ•˜™–Ž—ȱœž‹–’Žȱ˜›ȱ›ŽŸ’Ž ǯȱ ••ȱ™•Š—œȱœ‘Š••ȱ‹ŽȱŠŒŒž›ŠŽ•¢ȱ›Š —ȱ˜—ȱŠȱœ‘ŽŽȱœ’£Žȱ—˜ȱ•Žœœȱ‘Š—ȱŞȱŗȦŘȄȱȱŗŗȄǯȱ••ȱ™›˜™˜œŠ•œȱŠ›Žȱ˜ȱŒ•ŽŠ›•¢ȱ ’••žœ›ŠŽDZ ŗǯ ›˜™Ž›¢ȱ•’—Žȱ•˜ŒŠ’˜—ǰȱ’–Ž—œ’˜—œǰȱœ›ŽŽǻœǼǰȱŠ••Ž¢ǰȱŠŽŒŽȱŽŠœŽ–Ž—œǰȱŠ—ȱ›’‘Ȭ˜Ȭ Š¢œǯ Řǯ ˜ȱœšžŠ›Žȱ˜˜ŠŽǯ řǯ ˜ŒŠ’˜—ȱ˜ȱž’•’’Žœǯ Śǯ ¡’œ’—ȱœ›žŒž›Žœȱ’—Œ•ž’—DZȱȱȱŠ›ŠŽœǰȱŒŠ›™˜›œǰȱœ‘ŽœǰȱŠ—ȱ™˜˜•œȦœ™Šœǯ śǯ —ȱœ’Žȱ›ŽŽœȱǭȱœ›ŽŽȱ›ŽŽœDZȱŽŽ›ȱ˜ȱǛřȱǭȱǛŚȱ˜ȱ‘Žȱ›˜ŒŽž›Žȱ‘ŽŒ”•’œȱ˜›ȱŽ–˜•’’˜—ȱŽ›–’œ Ŝǯ ›˜—ǰȱœ’ŽȱŠ—ȱ›ŽŠ›ȱ¢Š›ȱœŽ‹ŠŒ”ȱ’–Ž—œ’˜—œȱ›˜–ȱ™›˜™Ž›¢ȱ•’—Žȱ˜ȱŠ••ȱŽ¡’œ’—ȱœ›žŒž›Žœǯ ŝǯ ›žŒž›Žœǰȱ‹ž’•’—œǰȱŽŠž›ŽœǰȱŽŒǯȱ‘ŠȱŠ›Žȱ˜ȱ›Ž–Š’—ȱ’Ž—’¢ȱŠœȱȱ ǯȱȱ›žŒž›Žœǰ ‹ž’•’—œǰȱŽŠž›ŽœǰȱŽŒǯȱ‘ŠȱŠ›Žȱ˜ȱ‹ŽȱŽ–˜•’œ‘Žȱ’Ž—’¢ȱŠœȱȱȱȱ  ǯ Site Plan Example ŘŘȇ ȱŽ—ŒŽȱ    ȱ ȱȱȱ ȱ   ŗŖŝśȇȱ ŗŘŖȇȱ řȇ řȇ ŚŖȇȱ ǻ —’ŒŠŽȱ›ŽŽȱŠ–ŽǼȱ › ˜™Ž ›  ¢ȱ’ — Ž œ ȱ ŘŘȇ    ȱ ȱȱȱ   ȱ Ŝȇ ȱ ȱ ȱȱ   ȱŗśŖȇȱ Şȇ Şȇ ȱ ›’ŸŽ Š¢ȱ ŘŖȇ ȱ ȱȱ  ȱȱ ȱȱ DZ ȱ ȱ ȱ ȱ ȱ ȱ Ž–˜™™ȏŘŖŗşǯ˜Œȱ›ŽŸ’œŽȱŖśȦŗȦŝŗşȱ  ȱȱȱ   ȱȱȱȱ ȱȱȱ ȱ  ȱ ŚŖŖȇȱ Ž–˜•’’˜—ȱ’Žȱ•Š—ȱŽšž’›Ž–Ž—œȱ  ȱȱȱȊȱ    ȱ   ȱȱǰȱǯǯǰȱǯǯǯǰȱ    ȱ   ŗŖřŖŖȱȱȱȊȱ ǰȱȱşśŖŗŚȬřŘśś ǻŚŖŞǼ ŝŝŝȬřŘŘŞȱȊȱȱ‹ž’•’—ȓŒž™Ž›’—˜ǯ˜› TUHH PURWHFWLRQ AUHD VKDOO EH 6 WLPHV WKH DBH RI WKH WUHH LQ DOO GLUHFWLRQV IURP WKH IDFH RI WKH WUXQN. 4' - 0 " MDLQWDLQ H[LVWLQJ JUDGH ZLWK WKH WUHH SURWHFWLRQ IHQFH XQOHVV RWKHUZLVH DSSURYHG E\ WKH FLW\. 2" [ 6' VWHHO SRVWV RU DSSURYHG HTXDO GULYHQ LQWR WKH JURXQG. 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CLW\ RI CXSHUWLQR SWDQGDUG DHWDLO ASSURYHG B\BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBDDWHBBBBBBBB CLW\ EQJLQHHU 6-45/27/2020 ENVIRONMENTAL PROGRAMS DIVISION | 10300 TORRE AVENUE, CUPERTINO, CA 95014 408-777-3354 | ENVIRONMENTAL@CUPERTINO.ORG City of Cupertino Environmental Programs | C&D Recycling Plan | Page 1 of 2 CONSTRUCTION & DEMOL ITION (C&D) RECYCLIN G PLAN x Covered Projects must recycle or divert at least 65% of nonhazardous construction and demolition waste per the Cupertino Municipal Code and California Green Building Standards Code. x Permit applicants must submit this C&D Recycling Plan (Plan) before a permit will be issued. x Covered Projects must submit the C&D Recycling Report (Report) before final permit approval. A permit hold will be placed on the final inspection until you submit the Report and weight tickets. x Applicants for demolition projects (excluding interior demolitions) must complete and submit the PCB Screening Assessment Form available at cupertino.org/greendev. You must have this form approved before receiving a demolition permit. Is your project a Covered Project? Check the appropriate box that describes your project: Project Type Description Covered? Required Documents? …RESIDENTIAL Demolition, new home construction, additions, or alterations of existing residential buildings where the addition or ale›aionȱinc›eaœeœȱheȱbžildingȂœȱœšža›eȱfooageǯ Yes Plan and Report …NONRESIDENTIAL Demolition, interior tenant improvement preparation, newly constructed buildings, and/or building alterations with a permit valuation of $100,000 or above. Yes Plan and Report …EXEMPT (not covered): The project does not meet the above criteria. It is not a ›eœidenialȱp›ojecȱhaȱinc›eaœeœȱheȱbžildingȂœȱœšža›eȱfooageȱORȱ is a nonresidential project with a permit valuation less than $100,000. Read, sign, and submit this page. Skip page two. No Page 1 of Plan Only All applicants must read and sign: o I understand I am responsible for complying with the requirements of the Cupertino Municipal Code which requires recycling of C&D waste materials in accordance with the municipal code and State law. o I understand City staff may visit the project site to ensure compliance. o I will instruct all site workers and subcontractors about sorting waste debris correctly on site. _________________________________ ________________________________________ ______________________ Print Name / Title Signature Date YOU MUST SUBMIT THIS PLAN TO RECEIVE THE BUILDING AND/OR DEMOLITION PERMIT APPLICATION. Project Name: ___________________________________ Permit #:________________________________________ Project Address: ____________________________________________________________________________________ Project Valuation (must match permit): $__řŖǰŖŖŖ__________ Project Sq. Ft.:____________________________________ Prepared By: ____________________________________ Phone: __________________________________________ Company Name: _________________________________ Email: __________________________________________ Company Address: __________________________________________________________________________________ Project Typ e: … New Construction … Demolition … Renovation/ Tenant Improvement Ž–˜™™ȏŘŖŗşǯ˜Œȱ›ŽŸ’œŽȱŖśȦŗŝȦŗş Ranatunga Residence 10408 Sterling Boulevard, Cupertino, CA 95014 1323 RICHARD HERNANDEZ 650-391-7425 GILBERT FERNANDEZ JR gilbert_fernandezjr@yahoo.com 1821 S BASCOM AVE #258 CAMPBELL CA 95008 Richard Hernandez / Project M 01/22/2021 Total of 1746 SF to be demoed ENVIRONMENTAL PROGRAMS DIVISION | 10300 TORRE AVENUE, CUPERTINO, CA 95014 408-777-3354 | ENVIRONMENTAL@CUPERTINO.ORG City of Cupertino Environmental Programs | C&D Recycling Plan | Page 2 of 2 CONSTRUCTION & DEMOL ITION (C&D) RECYCLIN G PLAN SELF HAUL: Put an X for any materials you will be discarding from your project. This is the Plan. Changes may be made with the final Report. Can it be salvaged for reuse? Plan to take photos of salvaged materials to estimate cubic yards/tons. MATERIAL DESTINATION FACILITY (or SALVAGE) MATERIAL DESTINATION FACILITY (or SALVAGE) Mixed C&D Debris Drywall (unpainted) Asphalt/ Concrete/ Brick/ Masonry/ Tile Landscape Debris Cabinets/ Doors/ Fixtures/ Windows Metals Carpet/ Carpet Padding / Foam Roofing Materials Cardboard Wood / Lumber Ceiling Tile (acoustic) Other Material (list): Excavated soil Trash 1. An approved C&D Recycling facility means a mixed recovery facility that has achieved third party verification consistent with facility-average recycling rates as recognized by the US Green Building Council. Presently, the Rec¢clingȱCe›ificaionȱInœižeȂœ Certification of Real Rates (CORR) protocol meets these requirements (recyclingcertification.org). For staff use: Date PD/Accela Staff Hold Released – C&D Recycling Plan Received Hold Placed – Need C&D Recycling Report with Weight Tickets Hold Released – C&D Recycling Report Received and Approved For covered projects only, please check the box(es) below to describe your disposal plan: †I will use Recology debris box(es). o Contact Recology: (408) 725-4020 to order debris boxes. o Provide Recology your project building or demolition permit number(s) and ask Recology to track and compile weight tickets for heȱ™›ojecȂœȱdž›aion. The applicant is responsible for submitting the weight tickets with the Report at the end of the project. †I will haul debris myself and track my own weight tickets. o Mixed C&D materials may only be removed from the project site by Recology per the Exclusive Franchise Agreement with the City of Cupertino OR b¢ȱheȱ™›ojecȂœȱlicenœedȱconœ›žcionȱand demolition contractor as part of a total service offered by that contractor. An employee of the contractor must perform removal, using equipment (including but not limited to debris boxes and roll-off trucks) which are owned by the contractor. o Mixed C&D materials must be delivered to an approved recycling facility1. Weight tickets for all loads must name the address or city the material came from, inbound and outbound weights, and material type (e.g. mixed C&D, metal, concrete, garbage/MSW). o Submit the Report and weight tickets of all waste material removed from the project site. You must submit this to get your final building inspection. Ž–˜™™ȏŘŖŗşǯ˜Œȱ›ŽŸ’œŽȱŖśȦŗŝȦŗş Guadalupe Guadalupe Guadalupe ENVIRONMENTAL PROGRAMS DIVISION | 10300 TORRE AVENUE, CUPERTINO, CA 95014 408-777-3354 | ENVIRONMENTAL@CUPERTINO.ORG City of Cupertino Environmental Programs | C&D Debris Recycling Report | Page 1 of 2 CONSTRUCTION & DEMOL ITION (C&D) RECYCLIN G REPORT FOR COVERED PROJECTS, YOU MUST SUBMIT THIS REPORT PRIOR TO OBTAINING FINAL INSPECTION/OCCUPANCY Project Name: Permit #: Project Address: Prepared By: Email: Phone: x To receive a final building inspection and close the demolition or building permit, submit this C&D Recycling Report with all weight tickets or proof of salvage for all material salvaged, recycled, disposed, or removed from the project site. x Calculate the overall diversion rate for the project. Complete the table below or provide the same information in an Excel spreadsheet. If using Recology debris boxes, please enter the information below and attach the Recology reports. For self-hauled materials, get diversion rates for each weight ticket from the approved recycling facilities. You are responsible for getting the recycling rate by material type from each facility. Enter weight ticket information here. Space for additional tickets on back of page. Facility Name Material Type Total Tons (A) Facility Diversion % Rate for this Material (Contact the facility for this rate or look online) (B) Tons Recycled A x B = (C) Tons Disposed A - C = (D) Tons Salvaged or Reused (if needed, use the worksheet on the back to convert from cubic yards) Totals: A C E ________________________________ ___________________________________________ ____________________________ Print Name / Title Signature Date Project Diversion Calculation: (add in totals from other side if used) Total Tons Recycled + Salvaged = C E y Total Project Tons A ƽȱProject Diversion Rate % Ž–˜™™ȏŘŖŗşǯ˜Œȱ›ŽŸ’œŽȱŖśȦŗŝȦŗş Ranatunga Residence 10408 Sterling Boulevard, Cupertino, CA 95014 0 0 0 0 0 ENVIRONMENTAL PROGRAMS DIVISION | 10300 TORRE AVENUE, CUPERTINO, CA 95014 408-777-3354 | ENVIRONMENTAL@CUPERTINO.ORG City of Cupertino Environmental Programs | C&D Debris Recycling Report | Page 2 of 2 CONSTRUCTION & DEMOL ITION (C&D) RECYCLIN G REPORT Enter additional weight ticket information here if needed: Facility Name Material Type Total Tons (A) Facility Diversion % Rate for this Material (Contact the facility for this rate or look online) (B) Tons Recycled A x B = (C) Tons Disposed A - C = (D) Tons Salvaged or Reused (if needed, use the worksheet on the back to convert from cubic yards) Totals: A C E Cubic Yards to Tons Conversion Worksheet Material Type Cubic Yards Conversion Factor from Cubic Yards to Tons (per CalRecycle) Tons (Cubic Yards x Conversion Factor) Asphalt 0.59 Cabinets/ Doors/ Fixtures/ Windows 0.25 Concrete 1.0 Other Inerts (brick, rock, stone) 0.62 Cardboard 0.05 Carpet 0.3 Dirt/Clean Fill 0.18 Gypsum Dry Wall 0.23 Job office paper, glass & plastic bottles, cans (collect separately) 0.1 Metals 0.49 Landscape/Clearing 0.18 Roofing (specify type) 0.59 Untreated Wood (Pallets, lumber) 0.14 Treated Wood (painted, stained, pressure- treated) 0.14 For staff use: Date PD/Accela Staff Hold Released – C&D Waste Diversion Report (WRP) with weight tickets received Hold Placed (if full demo) - place hold on address to require Plan & Report on building Ž–˜™™ȏŘŖŗşǯ˜Œȱ›ŽŸ’œŽȱŖśȦŗŝȦŗş 0 0 0 SF TO BE DEMOED 88 ENVIRONMENTAL PROGRAMS DIVISION | 10300 TORRE AVENUE, CUPERTINO, CA 95014 408-777-3354 | ENVIRONMENTAL@CUPERTINO.ORG City of Cupertino Environmental Programs | Approved C&D Recycling Facilities | Page 1 of 1 A PPROVED C&D RECYCLING FACLITIES FOR MATERIALS FROM CUPERTINO Self-hauled mixed C&D materials must be delivered to an approved C&D recycling facility that has achieved third party verification consistent with facility-average recycling rates as recognized by the US Green Building Council (USGBC). The Recycling Certification Institute (RCI) program meets the USGBC approved facilities criteria. All RCI facilities are listed on the RCI website: https://www.recyclingcertification.org Approved mixed C&D facilities near Cupertino are included in the table below. Inert materials (metal, concrete, asphalt, dirt) and single-source separated materials may be taken to other recycling facilities, but must be identified on the C&D Plan and Report. RCI Certified Facilities for Mixed C&D Materials Facility Name Address Phone Number Website Davis Street Transfer Station 2615 Davis St, San Leandro (510) 912-1238 davisstreet.wm.com Zanker Recycling 675 Los Esteros Road, San Jose (408) 263-2384 zankerrecycling.com Inert Material Recovery Facilities** Facility Name Address Phone Number Notes Stevens Creek Quarry 12100 Stevens Canyon Rd Cupertino (408)253-2512 Accepts clean concrete, asphalt, AC grindings. Granite Rock 100 Graniterock Way San Jose (408)574-3000 Accepts mixed or separated concrete and asphalt. Call for more information. Reed & Graham, Inc. 690 Sunol Street San Jose (408)287-1400 Accepts asphalt grindings, asphalt with Petromat (contact for prior approval), broken asphalt from roads or parking lots, base rock, and broken cement sidewalks (contact for prior approval). SRDC 11740 Berryessa Road San Jose (408)392-9175 Accepts mixed or separated asphalt, bricks, concrete, dirt, porcelain, and rock. Schnitzer Steel 11665 Berryessa Road San Jose (408)452-0777 Accepts ferrous and non-ferrous metals. ECS Refining 705 Reed Street San Jose (408)988-4386 Accepts ferrous metal, non-ferrous metal, batteries, fluorescent tubes, ballasts, and electronic waste. Sims Metal 1800 Monterey Road San Jose (408)494-4200 Accepts ferrous metals, non-ferrous metals (aluminum, copper, brass, stainless and alloys), insulated wire, and electronic waste. Ž–˜™™ȏŘŖŗşǯ˜Œȱ›ŽŸ’œŽȱŖśȦŗŝȦŗş 16SF TO BE DEMOEDSF TO BE DEMOEDSF TO BE DEMOED ENVIRONMENTAL PROGRAMS DIVISION | 10300 TORRE AVENUE, CUPERTINO, CA 95014 408-777-3354 | ENVIRONMENTAL@CUPERTINO.ORG City of Cupertino Environmental Programs | FAQs: C&D Recycling | Page 1 of 2 FAQS: CONSTRUCTION & DEMOLITION (C&D) RECYCLING Frequently Asked Questions 1. Why do I need to recycle materials from my construction project?_______________ Cupertino Municipal Code and California Green Building Standards Code require projects that meet certain specifications (Covered Projects) to recycle or divert from landfill at least 65% of nonhazardous C&D waste. 2.How do I know if my project is a Covered Project?_______________________________ RESIDENTIAL: Demolition, new home construction, or additions or alterations of existing residential buildings where the addition or alteration increasesȱtheȱbžildingȂsȱsqžareȱfootage. NONRESIDENTIAL: Demolition, interior tenant improvement preparation, newly constructed buildings, and/or building alterations with a permit valuation of $100,000 or above. 3. What is the process?__________________________________________________________ x Step 1: Complete the C&D Recycling Plan (Plan) and submit it with the permit application. Your permit will not be issued without an approved Plan. x Step 2: Environmental Programs Division staff will: o Review and approve the Plan and authorize the permit to be issued. o For Covered Projects, staff will place a hold on the permit final inspection to ensure submittal of the C&D Recycling Report (Report) at the end of the project. x Step 3: Contact Recology for a debris box and provide the associated permit number to track with your project. x Step 4: Upon collection of each debris box by Recology, request a copy of the receipt and weight ticket(s) from delivery to the C&D recycling facility. x Step 5: At the end of the your project, complete the C&D Recycling Report, attach copies of all debris box weight tickets from the project (or a weight ticket report provided by Recology) and submit directly to the Environmental Programs Division. Upon review of the report, supporting documents, and verification of the diversion, staff will release the hold on the permit and final inspection may be scheduled. 4. Is Recology the only company I can obtain a debris box from?___________________ Yes, Recology (408-725-4020) is the only debris box provider franchised to service Cupertino unless a debris box is provided by the contractor working on the site as part of total service (see question #5). Ž–˜™™ȏŘŖŗşǯ˜Œȱ›ŽŸ’œŽȱŖśȦŗŝȦŗş ENVIRONMENTAL PROGRAMS DIVISION | 10300 TORRE AVENUE, CUPERTINO, CA 95014 408-777-3354 | ENVIRONMENTAL@CUPERTINO.ORG City of Cupertino Environmental Programs | FAQs: C&D Recycling | Page 2 of 2 FAQS: CONSTRUCTION & DEMOLITION (C&D) RECYCLING 5.Can I self-haul my mixed construction and demolition waste?_____________________ Yes, but only under the following circumstances: x Mixed C&D materials may only be removed from the ™›ojecȱœieȱb¢ȱheȱ™›ojecȂœȱlicenœed construction and demolition contractor as part of a total service offered by that contractor. Removal must be performed by an employee of the contractor, using equipment (including but not limited to debris boxes and roll-off trucks) which are owned by the contractor. x Removal of single source separated materials (metal, wood, concrete) that are sold or donated to any other person or organization which have a value equal to or more than the cost of collection. 6.Where can I take self-hauled mixed construction and demolition materials?______ Mixed construction and demolition materials may only be taken to an approved C&D recycling facility. An approved C&D Recycling facility means a mixed recovery facility that has achieved third party verification consistent with facility-average recycling rates as recognized by the US Green Building Council. Presently, the Rec¢clingȱCe›ificaionȱInœižeȂœ Certification of Real Rates (CORR) protocol meets these requirements. (See recyclingcertification.org for nearby facilities). Source separated inert material may be taken to other material recovery facilities. 7.Can I obtain diversion credit for salvaging materials?______________________________ Yes, the first priority for demolition is to remove recoverable materials such as solid wood floorboards and lumber, brick, appliances, windows, doors, and decorative hardware. There is a conversion to weight for these items to assist completing the Report. Best Management Practices The following are key strategies to implement on your project to ensure that materials generated during demolition and construction can be recycled and/or repurposed: x Separate recyclable materials and keep them dry and free from contamination. x Identify opportunities to source separate material generated from the project. For example, consolidate clean lumber, metal, sheetrock, cardboard from the mixed debris. Single source separated materials carry a greater potential for recycling and recovery when taken to a recycling facility. x Label debris boxes or storage containment areas by material type. For example, clean wood, sheetrock, metal, concrete, and garbage. x Your project will generate some material that is not recyclable. To avoid contaminating materials that can be recycled or repurposed, place a container, either a Recology debris box or smaller container (small single family residential jobs) specifically for garbage such as rigid plastics, film plastics, empty adhesive containers, and worker food packaging. x Tarp all debris boxes and contained material storage piles during wet weather. 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See Notices to Applicants section in the Applicant Instructions and at the end of this form. &RPSOHWHDOODSSOLFDEOHSDUWVRIWKH3&%V6FUHHQLQJ$VVHVVPHQW)RUPDQGVXEPLWZLWK\RXU GHPROLWLRQSHUPLWDSSOLFDWLRQ $OO$SSOLFDQWVPXVWFRPSOHWH3DUWDQG3DUW Part 1. Owner/Consultant and project information Owner Information 1DPH $GGUHVV &LW\6WDWH=LS &RQWDFW $JHQW  3KRQH(PDLO Consultant Information )LUP1DPH $GGUHVV &LW\6WDWH=LS &RQWDFW3HUVRQ 3KRQH(PDLO Project Location $GGUHVV &LW\6WDWH&$=LS $31 V  <HDU%XLOGLQJZDV%XLOW7\SHRI&RQVWUXFWLRQ (VWLPDWHG'HPROLWLRQ'DWH JANAKA & SHERRY RANATUNGA 10408 STERLING BLVD CUPERTINO CA 95014 RICHARD HERNANDEZ 650-391-7425 RICHARD.HERNANDEZPM@GMAIL.COM GILBERT FERNANDEZ JR 1821 S BASCOM #258 CAMPBELL CA 95008 GILBERT FERNANDEZ JR 408-500-8511 gilbert_fernandezjr@me.com 10408 STERLING BLVD CUPERTINO 94586 375-24-005 1954 APPROX: 02/01/2021 Wood Frame SF TO BE DEMOED  Part 2. Is building subject to the PCBs screening requirement based on type, use, and age of the building? 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Report concentrations of PCBs in priority building materials 2SWLRQ Applicants conducted representative sampling and analysis of the priority building materials per the Protocol for Evaluating Priority PCBs-Containing Materials before Building Demolition (2018) (Attachment C). 2SWLRQ Applicants possess existing sample results that are that are consistent with the Protocol for Evaluating Priority PCBs-Containing Materials before Building Demolition (2018) (Attachment C). 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