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15060058I CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 22635 SAN JUAN RD 1 CONTRACTOR; I PERMIT NO: 15060058 OWNER'S NAME: SUMINA VERMA 11D�BOX mfr I DATE ISSUED: 06/08/2015 I OWNER'S PHONE: 4083862713 1 Pf F_1-1:qL1IVT4gn i / A `1LJ,_`_^ 1 PHONE NO: I d LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL F] COMMERCIAL F] Q DEMO (E) 1700 SQFT HOUSE License ClassLic. #,,,,,��'��ia e 6p� p Contractor _RF -D ROA O Coo aV llA;- I hereby affirm that 1 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 or 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. 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. APPLICANT CERTIFICATION 1 certify that I have read this application and state that the above information is correct. 1 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. Signatureye4z �Date D ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1, 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 must 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. Sip -nature Date Sq. Ft Floor Area: I Valuation: $20000 APN Number: 34217019.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180,DAYS FROM LAST CALLED INSPECTION. Issued by: ritid1­05C&La''�'� Date: 6 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 Applicant:_ rvate: ALL ROOF CbVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE 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(x) should 1 store or handle hazardous material. Additionally, should 1 use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and25534 Owner or authorized agent: / 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 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22635 SAN JUAN RD CONTRACTOR: ALPS CONSTRUCTION & PERMIT NO: 15060058 REMODELING OWNER'S NAME: SUMINA VERMA 1011 S DE ANZA BLVD DATE ISSUED: 06/08/2015 OWNER'S PHONE: 4083862713 SAN JOSE, CA 95129 PHONE NO: (408) 898-6474 LICENSED CONTRACTOR'S DECLARATION T�l© JOB DESCRIPTION: RESIDENTIAL COMMERCIAL DEMO (E) 1700 S.F. SFD License Class_Lie. N Contractor A Date r -- I hereby affirm that I am licensed under the o isions o Chap er 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: 1 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: $20000 erformance of the work for which this permit is issued. 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 APN Number: 34217019.00 Occupancy Type: permit 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 WIT SOF T 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 AYS F INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments,— , costs, and expenses which may accrue against said City in consequence of granting of this permit. Additionally, the applicant understands and will com Date: with all non -point sou e r ulations per the Cupertino Municipal Code, Seed 9.18. RE -ROOFS: Signature a 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. ElOWNE - ILDER 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 1, 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. 1 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 1 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 1 performance of the work for which this permit is issued. will maintain compliance with the Cuper ino Municipal Code, Chapter 9.12 and 1 have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 2,65X5,25533, and 25534. Section 3700 of the Gabor Code, for the performance of the work for which this Q� Owner or authorized agent: ate: 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 CONST UCTIO LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, I must I hereby affirm that there is a onstruc 'on 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 (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 per the Cupertino Municipal Code, Section Licensed Professional 9.18. Signature Date DEMOLITION PERMIT APPLICATION mmshh COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building@cupertino.org -a #- tloa G ,22 ( 5—o 600S-�S PROJECT ADDRESS 3_5 5q A Jmxv1 j APN k 7 ,4 Z ( O 02 OWNER NAME K Y o s PHON Q `'7 /• r r - MAIL STREET ADDRESS a _ ^ CITY, STATE, ZIP FAX CONTACT NAME J.L � I y�/I /� I,� , ' � (� � B / EMAIL STREET ADDRESS1 I C �AA ZA ( / CITY, STATE, ZIP na � E,5� FAX - O Wo ❑ OWNTER ❑ OV,TIER-BUILDER) ❑. OV,T'ER AGENT CONTRACTOR ❑ CONTRACTOR AGcT'T ❑ ARCHITECT ❑ ENGINEER . ❑ DEVELOPER ❑ TENANT CONTRACTOR ' L' )5 w' 1 S4y N C LICENSE NUMBER l 01 L LICENSE TYPE BUS. LIC n COMPANY NS�hL Ce1yfl s/QtSV (Volo 0 - ceM STREET ADDRE S � E 1,4, CITYSTATE, ZIP 5 P N� o DESCRIPTION OF WORK U - RESIDENTIAI Y DWELLINGel AJFFIGE L1SE OIrI X a FLOORAREA UNITSz 5 ��' ;' F„� r USE � uRr t 1"•� n � u�k''is' S FT w VALtY [ON COMMERCIAL '7 j t.. r 5 y1 21 :t hr'^7 d 1 +� 9V`lY'✓ f !N (Yt '� t A✓,k S�Y.F, ✓ y A h P��l ✓ f,Y bR�6�R x✓ L�fi Vi XI /.. !ti �'^ `� d T{r 4"),N Y�1 4 ]" 4 li(i�, Y fir. ¢ FLOOR AREA a �� 3..`., -; , ew,. �_� ., . TYPE OF CONSTRUCTION STORIES kl b AQMD JOB NUMBER N3.2 7 RCEIVEDBY Yq T ALvALUATTON: 1 #:q By my signature below, I certify to. each of the following: I am the property owner or authorized agent to act oa the property owner's behalf. I have read this application and the information I have prov' ed is correct. I have read the Description of )Alork and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating tAdyd# construction. I authorize representatives of Cupertino to enter the above-identi ed prope-y for inspection purposes. Signature of Applicant/Agent: f Date: d SUPPLEMENTAL INFORMATI QUIRED PRIOR TO ISSUANCE OF DEMOLITION PERMIT ofldUs] ONL Provide Job Number from Bay AreaIr Quality Management District wunv.baaomd.or-1 @ 415-749-4762. i PLAN CIiECKTYPE ❑ ;°ExPREss Provide three copies (Residential) or six copies (Commerical) of a site plan showing protection for any trees 10' in diameter or more at 3' above grade. ❑;STANDARD , Provide letter from PG&E (408-725-3325) stating all gas and electric has been disconnected. LARGE Provide a letter of inspection, tests, and abatement of any Hazardous Materials. Letter to be initiated by person(s) ]1IAJOR; certified in asbestos, mercury and/or hazardous material examination. PPanning Dept clearance to verify building is not considered an historical landmark. Allow 10 business days. rovide letter of clearance of all vermin from a licensed pest control contractor. Applicant shall call the Public Works Department at 408-777-3104 and schedule a "habitable dwelling” inspection _ Provide signed Debris Bin and Recyclable Materials form. 5 con DemoApp_2013.doc revised 02113113 I I CITY OF CUPERTINO D FEE ESTIMATOR - BUILDING DIVISION iADDRESS: 22635 SAN JUAN RD DATE: 06/08/2015 REVIEWED BY: MELISSA APN: 342 17 019 BP#: 13080122 *VALUATION: 1$20,000 ADDRESS: FEE QTY/FEE MISC ITEMS TYPE: Demolition Permit PRIMARY SFD or Duplex USE: PENTAMATION lSFDWL-DEM PERMIT TYPE: WORK E) 1700 S.F. SFD SCOPE Permit Fee: FEE ID FLR AREA A 1DEMORES 1,700 I L NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public s, Fire, Sanitary Sewer District, School District.ete.). These fees are based on the Preliminary, information available and are onlv an estimate- Contact the Dept for addn'l info. FEE ITEMS (Fee Resolulion 11-053 E 711,113) FEE QTY/FEE MISC ITEMS Permit Fee: $574.00 Suppl. Insp. Fee.E) Reg. 0 OT 0.0 hrs $0.00 Phiadj 7/,!ch, ['/cc Pcrma 1"(!f. Strong Motion Fee. IBSEISMICR $2.60 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SVRTOTALSi $577.60 $0.00 TOTAL'YEE. $577.60 Revised: 05/07/2015 Construction and Demolition Recycling Diversion Requirements and Instructions Covered projects, or all construction, demolition and renovation projects that are 3,000 square feet or more are required to complete a Waste Management Plan for the City of Cupertino demonstrating that 60% of the material generated is recycled, in compliance with ordinance CMC 16.72.050. At the conclusion of the project a Construction Recycling Report must be filed with the Public Works DepartmentlEnviromnental Division showing the tons recycled and disposed by material type. Use tonnage information from weight tags provided by facilities to quantify total estimated waste and percentages for materials. Weight Tags of all material recycled and disposed must be submitted with the final report in order to receive a Final Building Inspection. bin service provider franchised to do business in Cupertino. Debris from a project 3,000 square feet or more in Cupertino can be collected and disposed by using: Plellse check all that apply: JrI am not using a Recology debris bin, however, the project is less than 3,000 s.f., e.g. buildings, patios, sidewalks, driveways. ❑ 1 will use a Recology debris bin. By Agreement with the City, Recology will prepare my required Waste Management Plan & Recycling Report. Contact Recology: (408) 725-4020. ❑ I am not using a Recology debris bin. I will provide the following submittals to the City's Public Works Department, showing that I have recycled at least 60% of all construction demolition material: Ask for the Construction & Demolition Recycling Packet from the Building Department and complete the following: ✓ Submit a Construction and Demolition Waste Managentent Plan with your building permit application. No fee.for this plan. Forms are available at the Building/Public If�orks counter and online at www.ctrpertino.org/environmental. Report the tonnage recycled and disposed by material type. Recycling facilities must be selected from. the City's approved list of Recycling Resources. ✓ Submit a Construction Recycling Report form. The report is required before the Building Departnmt will schedule a final inspection. The report form is available at the Building/Public Works Counterp7W online n,ivw.cupertino.or,a/enviromnental. Signature: Name: (printed) Title: Phone: Project Addres Date: This form to remain in the project's building permit file for the duration of the project. Revised 317112 P City of Cupertino 1 ' / Public works Department i Environmental Programs Division 10300 Torre Ave Cupertino, CA 95014 CUPERrINO GREEN Program (408) 777-3354 Construction and Demolition Recycling Diversion Requirements and Instructions Covered projects, or all construction, demolition and renovation projects that are 3,000 square feet or more are required to complete a Waste Management Plan for the City of Cupertino demonstrating that 60% of the material generated is recycled, in compliance with ordinance CMC 16.72.050. At the conclusion of the project a Construction Recycling Report must be filed with the Public Works DepartmentlEnviromnental Division showing the tons recycled and disposed by material type. Use tonnage information from weight tags provided by facilities to quantify total estimated waste and percentages for materials. Weight Tags of all material recycled and disposed must be submitted with the final report in order to receive a Final Building Inspection. bin service provider franchised to do business in Cupertino. Debris from a project 3,000 square feet or more in Cupertino can be collected and disposed by using: Plellse check all that apply: JrI am not using a Recology debris bin, however, the project is less than 3,000 s.f., e.g. buildings, patios, sidewalks, driveways. ❑ 1 will use a Recology debris bin. By Agreement with the City, Recology will prepare my required Waste Management Plan & Recycling Report. Contact Recology: (408) 725-4020. ❑ I am not using a Recology debris bin. I will provide the following submittals to the City's Public Works Department, showing that I have recycled at least 60% of all construction demolition material: Ask for the Construction & Demolition Recycling Packet from the Building Department and complete the following: ✓ Submit a Construction and Demolition Waste Managentent Plan with your building permit application. No fee.for this plan. Forms are available at the Building/Public If�orks counter and online at www.ctrpertino.org/environmental. Report the tonnage recycled and disposed by material type. Recycling facilities must be selected from. the City's approved list of Recycling Resources. ✓ Submit a Construction Recycling Report form. The report is required before the Building Departnmt will schedule a final inspection. The report form is available at the Building/Public Works Counterp7W online n,ivw.cupertino.or,a/enviromnental. Signature: Name: (printed) Title: Phone: Project Addres Date: This form to remain in the project's building permit file for the duration of the project. Revised 317112 P 4 SI a0" I IW TYP, POST EL EVATION NOTES: I. THE DEVELOPER SHALL INSTALL THE " TREE PROTECTION° DEVICES PRIOR TO THE START OF GRADING OR CLEARING WORK. 2. THE CITY RESERVES THE RIGHT TO ISSUE A "STOP WORK" NOTICE IF THE "TREE PROTECTION" DEVICES ARE NOT INSTALLED OR IF THE DEVICES ARE NOT MAINTAINED PROPERLY. 3, SEE THE PROJECT GRADING PLAN FOR SPECIFIC TREES THAT REQUIRE PROTECTION. ALL SPECIMEN TREES REQUIRE PROTECTION UNLESS OTHERWISE NOTED. 4. NO EXCAVATIONS WITHIN THE "TREE PROTECTION AREA" ARE ALLOWED UNLESS UNDER THE SUPERVISION OF A REGISTERED TREE SERVICE COMPANY. 5. ANY FILLING WITHIN THE "TREE PROTECTION AREA" SHALL BE DONE IN ACCORDANCE WITH A DETAILED IMPROVEMENT PLAN APPROVED BY THE CITY. G. NO TRIMMING, CUTTING,OR PRUNING OF DESIGNATED TREES CAN OCCUR WITHOUT A REGISTERED TREE SERVICE COMPANY. 7. CONSULT ORDINANCE 778 OF THE CITY OF CUPERTINO FOR PERMIT REQUIREMENTS AND EXCEPTIONS, B. TEMPORARY CHAIN LINK FENCING IS AN ACCEPTABLE SUBSTITUTE TO THE WOOD CONSTRUCTIOAI. 4 TREE PROTECTION STANDARDS vF,APPROVED BY Ell -lrls. 506 q%%35 (5 CJAND. C( § I S Is t-0 :�oY, (A n, c9ae�5 51,Nplal Gu PE27i ,\jbPC,A W50+ MEN t�k '::�O >AatuA U- 0( /0y �Gb �ohD �'oNs7Rve � lonf --J-u 1,7 -� 9 o + C a ki pe- COl,,AAC_t.i I w IZ4 1.0A, yoaA I -JA az POAD s : P, 0, gax �'it , Y" �ontact 11k I�1 tGK K LE/N ion .et Plow CW 34 d 0 Corm P1�re <<� 3- 431- 06 lel Cbr,l�ct ��� 9�-398pdb39 �onfsiCt= fir( hick®�pOdCOYS-Cby✓f in/C b i! W W, �hcl4 C bn S C 0 I w IZ4 1.0A, yoaA I -JA az All's Construction 1011 S. De Anza Blvd San Jose, CA 95129 Regulation 11, Rule 2 Acknowledgement of Notification and Payment of Fees 5/27/2015 Job No: 4N327 Invoice No: 3PN50 The Bay Area Air Quality Management District (BAAQMD) acknowledges receipt of your payment and your Asbestos Removal or Demolition Plan described as: Demolition Site address 22635 San Juan Rd Cupertino, CA 95014 Start Date May 26, 2015 Completion Date June 9, 2015 Removal amounts of friable ACM 0 linear feet 0 square feet 0 cubic feet Should it become necessary to revise this plan, please do so in the spaces provided below and immediately copy the District by fax or by mail. REGULATION 11-2 REVISION BAAQMD J# 4N327 REVISION # START DATE COMPLETION DATE NOTE: This form is not intended as a verification of either the completeness of your original notification or of its compliance with BAAQMD Regulation 11-2. Ifyou have any questions about this acknowledgment, please call our office at (415) 749-4762. 2 3 4 5 NOTE: This form is not intended as a verification of either the completeness of your original notification or of its compliance with BAAQMD Regulation 11-2. Ifyou have any questions about this acknowledgment, please call our office at (415) 749-4762.