08090026 (2) CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10351 S TANTAU AVE CONTRAC'MR:TBD-TO BE PERMIT No:08090026
DETERMINED
OWNER'S NAME: MINDY NGUYEN DATE ISSUED:05/18/2009
OWNERS PHONE: 7023707755 PI ION NO:
❑ LICENSED CONIRACI'OR'S DECLARATION
131111,DIN'G I'EKdll'1"INFO: BI,DC r' ELECT r' rLtDtlt r
License Class Lic.q n F7 r
x1EC11 HESIUEVI'1,\I, COMMEHCI,\I,
Contractor Due
1 hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION: IIOUS17 DEMO 1,179'
(commencing with Section 7000)of Division 3 of(hBusiness usiness&Professions SCANNI:D
Code and that my license is in full force and effect.
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. Sq.Ft Fluor Area: Valuation:510000
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 \PN Number.37508017.00 Occu ane "I'
permit is issued. p y )pe:
APPLICANT CERTI FIC TION
I ccnify that l have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.l agree to comply with all city and county ordinances and state Imes relating WITHIN 18U 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,and expenses which may accrue against said Cit'in consequence of the
granting of this permit. Additionally,the applicant understands and will comply Issued by: Date:
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
installed without first obtaining an inspection,I agree to remove all new materials for
inspection.
❑ OWNER-BUILDER DECLARATION
hereby affirm That 1 am exempt from the Contractor's License I,aw for one of Signature of Applicant: Date:
the fallowing two reasons: ALL ROOF CO\'P;RINGS'I'O BF,CLASS \"OR RE'I'1'EIt
I,as owner of the propcny,or my employees hrith 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 IIA%ARDOUS MATEIRIALS DISCLOSURE
construct the project(See.7044,Business K Professions Code). 1 have read the hazardous materials requirements under Chapter 6.95 of the
California Ilealth&Safety Code,Sections 25505.25533.and 25534. 1 will
1 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(x)should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should 1 use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air conlammants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit i5 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.
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Owner or authorized agent: Date.
I ccnify 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 dhe Worker's
Compensation laws of Cnlifomia. If,after making this certificate of exenhption.I CONSTRUCHON LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby afTmn that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be devoted revoked w'ork'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 stale 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 properly for inspection purposes.(We)agree to save
indemnify and keep harmless the City of Cupenino against liabilities,judgments, ARCI IITECI"S DECLARA'T'ION
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-paint source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date
CITY OF CUPERTINO
4'(-L�- DEMO
fCUPERTINO` PERMIT APPLICATION FORM
" cab oacP
APN#3 7 5- 0 F/O 17
Date: g a � Q t
Buildine Address: _
I Ga SI s. -7_An/T -C1 C UPC 4e T IAJO
Mailing Address (if different from building address):
X67 TG,llt (� QST A-S V /3
Owner's Name: Phone:
1,1)t4Dy NC10Yt N) -70 a70 - -17ss
Contractor: Phone
Fax:
Contractor License #:
Cupertino Business License #:
Contact: CJ AR TO-N Phone: 51cJ-"01 —3 q(J 3
Fax:
Residential ® Sq Footage: Commercial ❑ Sq Footage
Job Description:
Tia St � _ S31--;Xr
Valuation: f or poo
i
Project Size: Express ❑ Standard ❑ Large N Major ❑
Please complete relevant portions of the Green Building Checklist & attach it to the application
or if applicable, include on the plan set & the sheet index.
Quantity Fee ID Fee Description Fee Group Permit Type
IDEMORES Demo-Residential B ISFDWL-DEM
IDEMOPRES Pool Demo Residential B 1SFPOOL-DEM
1BSEISMICRE Seismic Residential B
Revised 6/16/08
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Ame'riSci!Job#: 909051182; -Page"2ibf.2�
C1len4'Name:, Environmental'Rernedlation'iech'.. J
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Client,No_ ! HG& , Cabe: No. Asb"estos Present _ Total;/e Asbestos
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Loaa_tlon: 'Stucco/.Exterior Siding (by CCVESj
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I)y The black mastic on floor throughout the interior residence, plus
the exterior window putty was found to contain asbestos . These materials
must be removed from the structure prior to renovation or demolition activity.
The handling, work practices, and disposal of asbestos is regulated and
restricted by certain governmental agencies such as Cal-OSHA, BAAQMD, EPA, and
DISC. All work must be performed by a licensed asbestos abatement contractor.
Please give this report to the licensed asbestos abatement contractor of your
choice. The chosen contractor shall remove the asbestos from the residence
prior to renovation or demolition as required by BAAQMD.
,ReportingAotes: �t ��r
NAD eno'Jasbestos de ectad Dete_c6on Limd<1.6 Re mn Date Analyietl 5(8/2009. ir. -
n y
I - ° po g..Limits:CVES-jt . 400,Pt Ct y 0 25%SZ1000 P1 Cwt 0 1/° NA not'analyzetl__IJWPS
=p"t /ppsrtwe stop NVA='No Vslble Asbestos PLM(polar,zed.light m,croscopy)Bulk Asbestos Anaiyss'b7 EPA 6001M4 82-020 per 40 q
CFR;763(NVLAP Lab#200346-0°,CP.ELAP lati N23�2) Note:'PLM,snot corisatenlly reliable In detectlng asbestos in floor, and Simi ar,NOB
�matedals. TEM s$urrenUy the only methotl that can be used'to'determine it tAti material can be considered or treated as nonasbeslos-containing In
Newar
Yk_State(also see EPA Advisory for 0cdrthe 38
FR 59}146, 970 B%1/94) NISTAcc
, reditat,on requirements mandate that I is repoitmuustnotbe-
j reproduced except m full w h e" 'al of the'.abora }y uC P M report relates ONLYito the items tested.
tRevlewedlDy r " >/
SOS
P=C ONTRM
May 5, 2009
To Whom It May Concern:
The property at 1041 antau Ave, Cupertino, California, 95014, was
inspected today for any infestation of rodents. No active infestation was
found.
�Mike Stadmiller, Field Representative
V Mc( t
408-866-6609
RECEIVED
MAY 14 2009
BY:
2432 DeneA Ddve, Son Jose, CA 95130-2104, (408) 866-6609
and.P.ieCtl'iC.faciliues.bave.be-n.Cel7noved.and/n r,abandoned,3.i::
City of Cupertino
Public Works Department
10300 Torre Ave.
Cupertino CA 95014
(408)777-3354
Debris Bins
Debris from a project in Cupertino can be collected and disposed of in either:
1. a Los Altos Garbage Co. bin (call 725-4020 to order), OR
2. a bin owned by the project's general contractor or demolition contractor, and hauled by a vehicle
owned and registered to that contractor (contractor should be prepared to prove ownership), OR
3. a private truck with a bed, but no bin
The Los Altos Garbage Company is the only debris bin service provider
franchised to do business in Cupertino.
Bins from other leasing companies may not be used in Cupertino.
Please check all that apply:
❑ I will use a Los Altos Garbage Company.bin
I will use a bin and truck owned by the general contractor or the demolition contractor.
❑ I will use a private truck, and not drop a bin.
Recyclable Materials .
Recyclable materials may be collected in private debris bins or containers leased
from ANY company, as long as the materials are both:
1. separated by type of material into separate containers, AND
2. are not contaminated by garbage.
Separated recyclable materials are materials that are separated into individual containers, each
containing just one type of recyclable material. Typical examples of recyclable materials
include: metal, wood, concrete, steel-reinforced concrete, asphalt, tree trimmings, white goods,
toilets (hardware'removed), rocks and clean fill dirt. Separated recyclables must ultimately be
recycled or otherwise reused, and not disposed of in a landfill.
Contractor should be prepared to provide the name and phone number of any recycling companies being
used on the project. A list of loran recycling companies can be found at: www.recyclestuff.org.
A . ................................................
Signature: Date: 5-18 09 _
Name (printed): �'H(Jhl G D.
Title: _'fiOME C� YJIIIF.I?
Phone: UI-5 — 63 3 — 18 883
Project address: 1035/ S° T-gN I'AL) -/i-1/C 0_0 Ilek NoG GA 950
This form to remain in the project's building permit file for the dutadon of the pmj=L
Revised 1103
CITY OF • Building Department
10300 Torre Avenue
Cupertino, CA 95014
Phone (408)777-3228
Fax (408) 777-3333
CUPERTINO
PROCEDURE FOR DEMOLITION PERMITS
The demolition application should be applied for before or at the same time as the new
construction permit application (these are separate permit applications & fees). Plan check
fees are due at the time of application/plan submittal. The new construction permit will not
be issued until the demolition permit is issued.
BEFORE DEMOLITION PERMITS CAN BE ISSUED,THE FOLLOWING STEPS MUST BE COMPLETED:
SIGN TURIVDATI::
1. A demolition/plot plan will be required showing any trees 10 inches in diameter at 3 feet
above grade on the subject property, and what means will be taken to protect same. Three
copies of this plan are required for review by the Planning Department. These need to be
submitted at the time of permit application, to the Building Department.
2. P.C.& E. must be contacted AS EARLY AS POSSIBLE prior to demolition to schedule the
abandonment. Contact P.C.& E. at (408) 725-3325. A letter from P.C.& E. shall be provided
to the City, stating that all gas and electric has been disconnected. (This step can be time
ons ming, so it is important to begin the process immediately)
f-o ➢I Provide a current preliminary title report,which shows ownership of property, open deeds
of trust,any liens, taxes, and a legal description. All taxes must be current and paid in full.
t �[S(i/l 7 I II I• Any hens(This excludes mortgages) must be taken care of. This report is to be issued within
(30)days prior to issuance of the demolition permit. Allow 5 working days for review.
V
4. Fill out e Demolitio Request Fo m( with the names and addresses(correspondence address)
0� of any lending institutions,banks, lease holders, partnerships, lines of equity, or any other
II Ing persons having entitlement to the property. We will send the form(s) advising interested
I p" parties that there is a request for demolition, and they have 15 business days to respond to
our office if they object to the demolition.
kaS 5. Provide a letter of inspection, tests,and abatement of any Hazardous Materials. Letter to be
initiated by person(s)certified in asbestos, mercury and/or hazardous material examination.
6. Check to see if the building is considered an historical landmark. Obtain clearance from the
—�f�f'��� Community Development Planning Department. Allow 10 working days.
S/L/ 7. Provide a letter of clearance of all vermin from a licensed pest control contractor.
8. Important: Prior to the issuance of the demolition permit, the applicant must call the Public
Works Department at (408)777-3104 and arrange a "habitable dwelling" inspection.
—G 9. Debris bin and Recycling sheet: read,sign and date. The sheet will remain in the project's
/ building permit file for the duration of the project.
�10. Prior to issuance of the demolition permit, the Fire Department must review the plans for
fire Suppression/alarm systems that shall remain in service or be modified diving demolition
or that shall be replaced with the new construction.
Revised 9/03/08