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15060073E CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22080 WALLACE DR CONTRACTOR: BAY AREA DESIGN & PERMIT NO: 15060073 CONSTRUCTION OWNER'S NAME: ZAMIR ITAMAR AND SHIRY P O BOX 2095 DATE ISSUED: 06/10/2015 OWNER'S PHONE: 6508611012 LOS GATOS, CA 95031 PHONE NO: (408) 209 -8942 ALICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL C� DEMO 1663 S.F. LIVING SPACE & GARAGE 441 S.F. License Class Lic. Contractor�I}YCa r a i - 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 the Sq. Ft Floor Area: Valuation: $10000 performance 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: 32603039.00 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 WITHIN 180 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 INSP .CCTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments costs, and expenses which may accrue against said City in consequent / 6 �6 granting of this permit. Additionally, the applicant understands and will comply Iss Date: with all non -point source regulations per the Cupertino Municipal Code, Section 9 18. RE- ROOFS: Signature .G�s Dat 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 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 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) 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. 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 , and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner agent: Date:�✓�JU�� 5 permit is issued. or authorized 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 CONSTRUCTION LENDING AGENCY 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, ARCHITECT'S DECLARATION 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 CUPERTINO COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 • buildinq(a-)cupertino.org rV #- l 3 - W5 -0 v i 3) �Y sa 1�-0660 �-3 PROJECT ADDRESS ` a C{ ^� iAJ eJ APN # -3 14o- 6 3 - ® -23- OWNERNAME ��- ®.v.�a✓ PHONE (050 - 8 0 — /olz E -MAIL 2t�w.;r S wei S s •( �,r�o•,•r.�✓ STREET ADDRESS -.2 Z 0 250 C111 VC e T) ' CITY, STATE, ZIP C K ® ^/A FAX CONTACT NAME, �°9n6'di/: f�+ ✓ZA.en ,YA PHONE pf 8 96d�l E -MAI L.i 1. f1 /� ✓'� STREET ADDRE iZ)0)( % CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER- BUILDER ❑ OWNER AGENT IVCONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME er7 f7o LICENSE NUMBER T LICENSE TYPE BUS. LIC # o. ,iv f-c c re 9 a 0 COMPANY NAME Co Ks4-yu,c E -MAIL, �} FAX 0 e>'317 7 6'7 -7 dw ��OQJ co- STREET ADDRESS CITY, STATE, ZIP b S A�6 S 6 Q PHONE DESCRIPTION OF WORK iR ` C�t�E�V/i -•9 ;i. YJV�• d, t7'� W 0 Lt ►rtee. �4A SSIDENTIAL # DWELLING OFFICE USE ONLY USE OCC:` TYPE S FT.' VALUATION _-. LOOR AREA ' J UNITS COMMERCIAL FLOOR AREA TYPE OF CONSTRUCTION Cove 1-r # STORIES ' w kC � w AQMD JOB NUMBER / -y RECEIVE TOTAL VALUATION: J#: /o o >0 By my signature below, I certify to each of the following: I am the property own rized age on the pe owner's behalf. I have read this application and the information I have provided is correct. I have read the gtion of Work rify it is ac rat agree to comply with all applicable local ordinances and state laws relating to building construction. I authorize, representatives of C rtino to enter a e- identified property for inspection purposes. Signature of ApplicanUAgent: Date: SUPPLEMENTAL INFORMATION REQUIRED PRIOR TO ISSUANCE OF DEMOLITION PERMIT OFFICEUSE ONLY PLAN CHECK TYPE- XProvide Job Number from Bay Area Air Quality Management District www.baaylnd.org @ 415- 749 -4762. ❑ EXPRESS _ rovide 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 eLc ❑ MAJOR _ rovl e 7ater 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. O 1G / 4-N _ Wanning Dept clearance to verify building is not con i Jergd an historical landmark. Allow 10 business days. SC iC� rte. i^ a'aev Provide letter of clearance of all vermin from a licensed pest control con factor. � v1rNN o� Applicant shall call the Public Works Department at 408 - 777 -3104 and schedule a "habitable dwelling" inspection. %rovide Debris Bin Recyclable Materials form. signed and DemoApp_2013.doc revised 02113113 I w` rev 71. CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION 19 ADDRESS: 22080 WALLACE DR DATE: 06/10/2015 REVIEWED BY: MELISSA Pltrn C6zetc.'Ic Fee: APN: 326 30 039 BP #: 15050013 *VALUATION: j$10,000 *PERMIT TYPE: Demolition Permit 1111 a v 0111"CK 7')'P/-,': PRIMARY USE: SFD or Duplex PtT rJ�Z v. %1 re rla.; El erg PENTAMATION PERMIT TYPE: 1 SFDWL -DE i WORK DEMO 1663 S.F. LIVING SPACE & GARAGE 441 S.F. SCOPE Suppl. Insp. Fee: Reg. Q OT FEE ID FLR AREA s.f. 1 DEMORES 2,104 NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School WvtrirL etc )_ These fees are ha.ced nn dze nrelinzinary infnrnzatinn availahle and are anly an estimate Cnntart the Dent for addn'l info. FEE ITEMS (Fee Resolution 11 -053 Eff.' 711113) FEE QTY /FEE MISC ITEMS Pltrn C6zetc.'Ic Fee: A suppl. PC Fee T-1 PtT rJ�Z v. %1 re rla.; El erg Permit Fee: $574.00 Suppl. Insp. Fee: Reg. Q OT p p hrs $0.00 Plzfrrrl3.;'rllecl t.; Elee Phfnib. %A-Ieeh.:,`E1 lee Permit Fee: Construction Tax: Administrative Fee: bl,()rk TKithoutPernrit? ,4,1vancecl Planning Fees: 4 Trowel Documentation Fees: Strong Motion Fee: IBSEISMICR $1.30 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 ' t� � `SUBTOTAh� $576.30 $0.00 $576.30 Revised: 05/07/2015 I CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 22080 WALLACE DR CONTRACTOR:�T� �/E /3iQ1?N�S I PERMIT NO: 15060073 I OWNER'S NAME: ZAMIR ITAMAR AND SHIRY DATE ISSUED: 06/10/2015 OWNER'S PHONE: 6508611012 // /ECG t/FJZS� 5✓_ Chi PHONE NO: , 797 7e fl ❑ LICENSED CONTRACTOR'S DECLARATION License Class_ Lic. # 9Ci3 7 1-9 -7 5—,,2 t3 u Contractor G 3A�N ,,. Date L 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 the K lrfiormance of the work for which this permit is issued. ave 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 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 perty for inspection purposes. (We) agree to save indemnify and keep h less he Citv of Cupertino against liabilities, judgments, costs, and expenses ich ma against said City in consequence of the granting of this pe it. Ad di ' a , the applicant understands and will comply with all non -point s urce r a s per the Cupertino Municipal Code, Section 9.18. Signature Date 7A�sd ❑ 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) I, 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: 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 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, 1 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 1 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 JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL ❑ DEMO 1663 S.F. LIVING SPACE & GARAGE 441 S.F. Sq. Ft Floor Area: I Valuation: $10000 APN Number: 32603039.00 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: 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 Applicant: 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. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(x) should I store or handle hazardous material. Additionally, shouACupe ' ment or devices which emit hazardous air contaminants as defined ea ' Quality Management District I will maintain compliance win unicipal Code, Chapter 9.12 and the He alth & Safety Code, S 3, and 25534. Owner or authorized agent: Date: 7 9 J 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 ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CUPERTINO DEMOLITION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 • building0cupertino.ong C PROJECT ADDRESS APN # OWNER NAME PHONE -7 E -MAIL STREET ADDRESS CITY, STATE, ZIP FAX CONTACT NAME PHONE E -MAIL STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER - BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NA. LICE E NUMBER - LICENSE TYPE BUS. LIC # V AlLr•► S COMPA AME E-MAIL AaL . C•�i FAX STREET DRES n CITY, T TE, ZIP �J �. P/ Cn /V'� gyp o� PHONE 787-701/ L o"Or. T e.oeiYJl'�. DESCRIPTION OF WORK RESIDENTIAL # DWELLING OFFICE USE ONLY USE OCC. TYPE S . Fr. VALUATION FLOOR AREA UNITS COMMERCIAL FLOOR AREA TYPE OF CONSTRUCTION # STORIES AQMD JOB NUMBER RECEIVED BY: TOTAL V ALUATION: J #: By my signature below, l certify to each of the foWc.rre. the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided i e read the De scription of Work and verity it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building horize representatives of Cupertino to enter the above- identi ed groperty for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED PRIOR TO ISSUANCE OF DEMOLITION PERMIT OFFICE USE ONLY PLAN CHECK TYPE Provide Job Number from Bay Area Air Quality Management District www.baaymd.org @ 415- 749 -4762. ❑ EXPRESS Provide three copies of a site plan showing protection for any trees 10" in diameter or more at 3' above grade. Provide letter from PG &E (408- 725 -3325) stating all gas and electric has been disconnected. ❑ STANDARD ❑ LARGE 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. ❑ MAJOR Planning Dept clearance to verify building is not considered an historical landmark. Allow 10 business days. Provide 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. Commercial Buildings Only: Provide Fire Dept clearance for fire suppression / alarm system review. DemoApp_201 Ldoe revised 03116111 'rrr CUPERTINO DEMOLITION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 • buildinga@cupgrtino.org I( !3P Ill r Sac0 0 1 3 I] 1�-066o �-3 PROJECT ADDRESS �n 0 1. \ G11A�{ APN ti O OWNER NAME �' �(�V�+LO.✓ 2P Vr. j i PHONE �� S I '•- � O I Z E -MAt. {M / .5 S • C STREET ADDRESS n O �O , _ t C'I1 a C e ' (' I/V CITY. STATE, 7_IP /' O ` FAX CONTACT NAME r "✓zC, PHONE K 2- E -MAI es 1 , . STREETADDRE O� „ 09 CITY, STATE, ZIP J FAX --7t-7 ❑ OWNER ❑ OWNER- BUILDER ❑ OWNER AGENT IXCONTRACTOR ❑ CONTRACTOR AGENT ❑ .ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME { LICENSE NUMBER LICENSE TYPE BUS. LIC # A w� COMPANY NAME --r v-eo. T C 5 1,i• 7- 7e'i i STREET ADDRESS ^ O �� o 1/� CITY, STATE. ZIP �O� 0.�� S L 5631 ` �C PHONE qd(a _to ol_� DESCRIPTION OF WORK ,mc e. C%,Ce_t ?SIDENTIAL # DWELLING OFFICE USE ONLY USE 0 C TYPE S . FT. VALUATION OOR AREA UNITS COMMERCIAL FLOOR AREA TYPE OF CONSTRUCTION KC # STORIES AQMD JOB NUMBER / RECEIVE TOTAL VALUATION. J #: -7 �O S /O 0&0 By my signature below, I certify to each of the following: I am the property own rized age on the pe owner's behalf. I have read this application and the information 1 have provided is correct. l have read the DeNTription of Work rlfy it is a at agree to comply with all applicable local ordinances and state laws relating to building construction. I authorize representatives of C rtino to enter e- identified property for inspection purposes. Signature of Applicant /Agent: Date: r / ) t S SUPPLEMENTAL INFORMATION REQUIRED PRIOR TO ISSUANCE OF DEMOLITION PERMIT OFFICE USE ONLY PLAN CHECK TYPE Provide Job Number from Bay Area Air Quality Management District wtvw.baagrnd.org n 415- 749 -4762. EXPRESS fi rovide 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 roX rovl e a ter of inspection, tests, and abatement of any Hazardous Materials. Letter to be initiated by person(s) MAJOR certified _in ysbestos, mercury and /or hazardous material examination. OW1� anning Dept clearance to verify building is not con idqrpdan historical landmark. Allow 10 business days. Cj1/}1,*-j fir. Sac S Provide letter of clearance of all vermin from a licensed pest control contractor. owij oY-- "habitable Applicant shall call the Public Works Department at 408 - 777 -3104 and schedule a dwelling' inspection. -Ti- Syske_— " Nrovide Debris Bin Recyclable Materials form. signed and DemoApp_2013.doc revised 02113113 )w� 2. M CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22080 WALLACE DR CONTRACTOR: BAY AREA DESIGN & PERMIT NO: 15060073 CONSTRUCTION OWNER'S NAME: ZAMIR ITAMAR AND SHIRY P O BOX 2095 DATE ISSUED: 06/10/2015 OWNER'S PHONE: 6508611012 LOS GATOS, CA 95031 PHONE NO: (408) 209 -8 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL t DEMO 1663 S.F. LIVING SPACE & GARAGE 44 F. License Class Lic. #/1 q2—'410 S `` C•`S� /� I S Contractor & Ayec� ysS qW l -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 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: $10000 performance 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: 326030 .00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is T EXPIR ES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating N 180 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 Y INSPECTION. 4PE indemnify and keep harmless the City of Cupertino against liabilities, judgments costs, and expenses which may accrue against said City in consequent 4 granting of this permit. Additionally, the applicant understands and will comply Iss Date: with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. / /c RE- ROOFS: Signature //� C/� 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 Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law or 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 ompensation, will do the work, and the structure is not intended or offered for sal Sec.7044, Business & Professions Code) 1, as owner of the property, am exclusively contracting with lice sed 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 foil ing 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 se' I have and will maintain a Certificate of Consent to sel nsure for Worker's material. Additionally, should I use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of abor 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 is ed. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation nsurance, as provided for by the Health & Safety Code, Sections 25505, 255 , and 25534. Section 3700 of the Labor Code, for the perfo cc of the work for which this ,//O/" Owner or authorized agent: Date: 6 / /v�! permit is issued. certify that in the performance of the wor or which this permit is issued, I shall not employ any person in any manner so to become subject to the Worker's Compensation laws of California. If, a r making this certificate of exemption, I CONSTRUCTION LENDING AGENCY become subject to the Worker's Comp nsation 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 provisio s or this permit shall be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name APPLI ANT CERTIFICATION Lender's Address I certify that I have read this a lication and state that the above information is correct. I agree to comply wit all city and county ordinances and state laws relating to building construction, andjhereby 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 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 Department /Environmental 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. Recology is the only debris 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: Please check all that apply: ❑ 1 am not using a Recology debris bin, however, the project is less than 3,000 s.£, e.g. buildings, patios, sidewalks, driveways. ❑ 1 will use a Recology debris bin. By Agreement with the City, Recology wilt prepare my required Waste Management Plan & Recycling Report. Contact Recology: (408) 725 -4020. L i am not r>Sing a Recology debris bin. 1 wilt 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: ✓ ,Suhtnit a Construction and Demolition Waste Alanagement Plan with your building permit application. A'o, fee for this plan. Fornis are available at the Building,11"ublic [Yorks counter and online at YClAr1N', G7( p(' I" trl '1O,or� %CT'7�NdT "on7rte71fa1'. Report the tonnage recycled and disposed, bi, material 4y)e. Recycfing,ficilities nrus be selected from the City's approved list of Recycling Resources. ✓ Submit Constructi r Recycl' eportforrn. The rejwrt is required bgfore the Building Department vt,ill scI e tde Iion. The reportf brrn is available at the Building /Public Works Counter an n lz•r 7erti c')rgrf iI viroinnel itrrl. Signature: - _ Date: �.. /� ts- . Name: (printed) Phone: y.Q� -_Zaei - 159Y.._L Project Address: 22oQ,o_�,.(�ac This form to remain in the project's building permit file for the duration of the project. N%011 Revised 317112 1 City of Cupertino Public works Department Environmental Programs Division 1 0300 Torre Ave Cupertino, CA 95014 CUPERTINO GR4'FN Pr:r rxrr (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 Department /Environmental 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. Recology is the only debris 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: Please check all that apply: ❑ 1 am not using a Recology debris bin, however, the project is less than 3,000 s.£, e.g. buildings, patios, sidewalks, driveways. ❑ 1 will use a Recology debris bin. By Agreement with the City, Recology wilt prepare my required Waste Management Plan & Recycling Report. Contact Recology: (408) 725 -4020. L i am not r>Sing a Recology debris bin. 1 wilt 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: ✓ ,Suhtnit a Construction and Demolition Waste Alanagement Plan with your building permit application. A'o, fee for this plan. Fornis are available at the Building,11"ublic [Yorks counter and online at YClAr1N', G7( p(' I" trl '1O,or� %CT'7�NdT "on7rte71fa1'. Report the tonnage recycled and disposed, bi, material 4y)e. Recycfing,ficilities nrus be selected from the City's approved list of Recycling Resources. ✓ Submit Constructi r Recycl' eportforrn. The rejwrt is required bgfore the Building Department vt,ill scI e tde Iion. The reportf brrn is available at the Building /Public Works Counter an n lz•r 7erti c')rgrf iI viroinnel itrrl. Signature: - _ Date: �.. /� ts- . Name: (printed) Phone: y.Q� -_Zaei - 159Y.._L Project Address: 22oQ,o_�,.(�ac This form to remain in the project's building permit file for the duration of the project. N%011 Revised 317112 1 Bay Area Design & Construction P.O. Box 2095 Los Gatos, CA 95031 Regulation 11, Rule 2 Acknowledgement of Notification and Payment of Fees 4/23/2015 Job No: 4M765 Invoice No: 3PC00 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 Start Date Completion Date 22080 Wallace Ct Cupertino, CA 95014 April 27, 2015 May 4, 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# 4M765 REVISION # START DATE COMPLETION DATE I 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. If you have any questions about this acknowledgment, please call our office at (415) 749 -4762. M i "s; DATE: �j21 � (! CITY OF CUPERTINO 10300 TORRE AVE CUPERTINO CA 95014 10900 No. Blaney Avenue Cupertino, CA 95014 SUBJECT: REMOVAL OF GAS SERVICES (CUT @ MAIN IN THE STREET) ON: IrLo % Q WtJ f 4r- e lJ'- C-ce"(Jr 15 SUBJECT: ELECTRIC SERVICES WAS CUT AT POLE ON: U/411 ,ce 1 �42 5f Zl l �r If you have any further questions, please contact me at (408) 725 -3325 Sincerely, C"N Pacific Gas & Electric Company DeAnza Service Planning 408/725 -3325 En CM CUSTOMER Bay Area Design & Constructions 22080 Wallace Drive Cupertino, CA 95014 -0128 GENERAL COMMENTS / INSTRUCTIONS REPORT PROVIDED BY Clark Pest Control (Branch 10) 199 Topaz Street Milpitas, CA 95035 408 - 639 -8667 Inspector: Foster Brusca License #: CA — FR25312 Integrated Pest Management Detailed Report Time In: 9:20am Time Out: 9:50am Date: 4 -28 -15 An infestation or re- infestation of pests such as ants, roaches, rats and mice can and may be reintroduced into a structure at any time. The inspection performed is not a guarantee or warranty of any type that the structure does or does not have an infestation of pests. This inspection should be considered as one of many tools to help identify the presence of pests that might be on the interior and exterior of the structure. It was requested by Beverley and Bay Area Design & Constructions to perform an exterior ground level inspection of the property because it will soon be demolished and the City of Cupertino is requiring a letter from a pest control company indicating that there are no pests on the property. CONDITIONS / OBSERVATIONS At time of the 4 -28 -15 inspection of the property the following conditions /observations were found; • Mature overgrown landscaping located around property • Garage door was open at time of inspection • Storage shed located behind garage was open • Foundation vent screen located near air - conditioning unit had large hole at the bottom • Sub area access cover was loose INSPECTION FINDINGS 4 -28 -15 inspection findings of the property • There was no evidence of rats, mice or other pests found inside the garage or shed • There was no apparent rub marks from rodents around the foundation vent screen hole that was found, • The large tree located in backyard appeared to have no bird nests • There was no evidence of rats or mice found on the exterior of property at time of inspection. • The subarea access was opened and a visual inspection performed only 2 feet inside sub area from access because this is where evidence of rats and mice would be found and there was no evidence of rat or mice AREA COMMENTS Clark Pest Control has determined that there was no rats, mice or other destructive pests found at time of the 4 -28 -15 inspection. Fps4r_ - &-USCa 04o M (o �!O — No(ol CLARK PEST CONTROL, PO Box 1480, Lodi, CA 95240 • P: 800.936.3339 • F: 408.247.3209 • cla ftest.com I h (10) 1 -/. 10'-0" - ,A flo 1?rclpfr VIEW ANGLE VrElprr VXW ANGLE T2 I MIPOACAPY I-FEE PeOMCF/ON FfNUN6 TO EVINN T'o MINN 7 7WFIf , L — ------------------ PAW Akt'-4 A N \ VrElprr VXW ANGLE T2 I MIPOACAPY I-FEE PeOMCF/ON FfNUN6 TO EVINN — ------------------ PAW Akt'-4 N \ 50 OfOKItf VXW ANGI-f \ \ \\ ZL \ AMPA \ ", \ \ \\ \\ P Exl- -live ri�n- f7A 7 i \ M F511AIN A NEW DRIVEWAY WN-I-ACT PPA/f I-ANO-15GAFT 7T/11"OpAkly I-PEr PFGrtfG7-/OM FtfNON6 EXI571,110 TRTE 7-09EMAIN 7-fllPOPAPY7-PfC PR'GlrFG77ON,-jffNG1NG ..... . .... 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