15010129 CITY OF CUPERTINO BUILDING PERMIT
/ BUILDING ADDRESS: 10159 S BLANEY AVE CONTRACTOR:rm7-13,13E PERMIT NO:15010129
DETEBAdWED
OWNER'S NAME: LAKE BILTMORE APARTMENTS DATE ISSUED:03/30/2015
- NER'S PHONE: 6509313457 PHONE NO:
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION:RESIDENTIAL COMMERCIAL
s/ BILTMORE;DEMO OF EXISTING CLUBHOUSE,LEASING
' icense Class 1 l Lic.# BUILDING AND POOL DECK AREA 1500 SQ FT
Contractor QN Date 3
I hereby affirm Kat 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
pensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$50000
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 APN Number:36903008.10159 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that 1 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 FR CALLED INSPE TION.
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 Issued by: Date:
with all non-point source regplations per the Cupertino Municipal Code,Section -
9.18.
RE-ROOFS:
&fi[ �z ? Q� �s :.�s• .a. Date 3 �� /�—' 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
I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date:
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR 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 25505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this
Ownutlotized a ent Date:
permit is issued. ,r,, r� plL (ti
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 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
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255- V
(408)777-3228 FAX(408)777-3333•buildinct0cuoertino.org
CUPERTINO
PROJECT ADDRESS 10159 South Blaney Avenue APN# 369-03-008
OWNER NAME Lake Biltmore Apartments,a California limited partnership- PHONE 650931-3457 - " " E-MAIL mducote@prometheUSreg.corrl
-T
STREET ADDRESS 1900 South Norfolk Street,Suite 150 CITY, STATE,ZIP San Mateo,CA 94403 FAX 650 931-3657
CONTACT.NAME Michael Ducote PHONE 650 931-3457 E-MAIL mducote@prometheusreg.com
STREET ADDRESS 1900 South Norfolk Street,Suite 150 CITY,STATE,ZIP San Mateo,CA 94403. ��650 931-3657
❑OWNER ❑ OWNER-BUILDER 1J OWNER AGENT. . . ❑.CONTRACTOR. ❑CONTRACTOR AGENT . ❑. ARCHITECT.-'❑ENGINEER .❑ DEVELOPER . ❑TENANTI. .
CONTRACTOR NAME TBD LICENSE NUMBER LICENSE TYPE BUS.LIC#
COMPANY NAME - E-MAIL - FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK . Demolition of existing hardscape,clubhouse and leasing building and pool deck area.
RESIDENTIAL #DWELLING OFFICE USE ONLY
FLOOR AREA UNITS USE OCC. TYPE S :FT VALUATION
CON11v1ERCIAL 1,500 sf
FLOOR AREA -
TYPE OF CONSTRUCTION #STORIES
AQMD JOB NUMBER RECEIVED BY: T� VALUATION:
J#:
By my signature below,I certify to of the following: .I am the property owner or authorized agent to act on a property owner's behalf. I have read this
application and the information I hav ovided is correct:I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating o. 'ng construction. I authorize representatives of Cupertino to enter the ab ve-identi ed pioperty for inspection purposes.
Signature of Applicant/Agent: / Date: ` 2
/SUPPLEMENTAL AT N REQUIRED PRIOR TO ISSUANCE OF DEMOLITION PERMIT OFFICE USE ONLY
tir Provide Job Number from Bay Area Air Quality Management District www.baagmd.org @415-749-4762. PLA14 CHECK TYPE
Provide three copies(Residential)or six copies(Commerical)of a site plan showing protection for any trees 10" EXPRESS
,j!pdipineter or more at 3'above grade. El sTAND'A
-`provide letter from PG&E(408-725-3325)stating all gas and electric has been disconnected. ❑ LARGE,
rovide a letter of inspection,tests,and abatement of any Hazardous Materials.Letter to be initiated by person(s) E.MAJoR
certified in asbestos,mercury and/or hazardous material examination.
S,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.
DemoApp_2013.doc revised 02/13/13"
CITY OF CUPERTINO D
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 10159 s blaney ave DATE: 01/22/2015 REVIEWED BY: Mendez
APN: BP#: `VALUATION: 1$50,000
*PERMIT TYPE: Demolition Permit P1.,1NCHECIKTYPF,:
PRIMARY PENTAMATION
USE: Commercial Building PERMIT TYPE: 1COMMLDEI;
WORK biltmore; demo of existing clubhouse leasing buildinq and pool deck area 1500 sq ft
SCOPE
FEE ID FLR AREA
s.f.
1DEMOCOM 1,500
Meeh. Plum Check Plumb. Plan(:heeh PJec.Plan Check
;6101/1. Permit Fee: Plumb.Permit Fee: lslec.Perniit Fee:
Ocher A/ech.Insp. Other Plumb Insp. Other h.lec.Ins?,
:Hach.h:sp.Fee: Plumb. Insp. 1'ee: Elec.Insp.Fee:
NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc . These ees are based on the relimina information available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/131 FEE QTY/FEE MISC ITEMS
Plan (.'heck Fee:
Srippl. PC'Fee
Plztnth.%1ech.i""Flee
Permit Fee: $574.00
Suppl. Insp.Fee-(F) Reg. Q OT p,p hrs $0.00
Plzn�rb.�z11ec•1t./Tlecz
Plumb.,"Meeh.%Elec Permit Fee:
(..;Onstr•uCdOn a'ax:
Administrative Fee:
lt'ntk Without.Perndl?
,ldvanced Planning Fees:
Travel Documentation Fees:
Strong Motion.Fee: 1BSEISMICO $14.00 Select an Administrative Item
Bldp,Stds Commission Fee: IBCBSC $2.00
SIIBTUTALS: $590.00 $0.00 `' TOTAL FEE: $590.00
Revised: 01/06/2015
Pacafle Gas and Electric Company 10900 N.Blaney Avenue
DeAnza Division Cupertino,CA 95014
D
City of Cupertino
10300 Torre Avenue
Cupertino, CA 95014
To Whom R May Concern:
SUBJECT REMOVAL OF ELECTRIC FACILITIES
The gas feed has been removed and/or abandoned at:
10159 S. Blaney Ave. on 3/13/15
if �ou have any er questions, please contact me at (408) 725-2146
S �Aa
Pond
Service Plannil(g
Terminix National Accounts
1287 Old Willow Place
San Jose, CA 95025
March 4, 2015
Mr. Greg Collins
Prometheus Real Estate Group
1900 S Norfolk Street, Suite 150
San Mateo, CA 94043
Dear Ms. Collins,
On March 4, 2015, I performed a pest inspection at the Biltmore Apartments located at
10159 S Blaney in Cupertino.
I inspected the interior of all the leasing office. There was no visible evidence of rodent
fecal droppings or any other pest issue at the leasing office. If you have any questions,
please do not hesitate to contact me.
Sincerely
Jim Griffen
National Account Manager
Terminix International
State License#FR16184
510-378-8355
Regulation 11, Rule 2
COMPLIANCE &
ENFORCEMENT Acknowledgement of
�B A Y A K u A Notification and
AIRQUALrry DIVISION
Payment of Fees
MANAGEMENT
D L S T R .1 C T
3/6/2015
i
Randazzo Enterprises,Inc Job No:4L902
13550 Blackie Road Invoice No:3NK13
Castroville,CA 95012
The Bay Area Air Quality Management District.(BAAQMD)acknowledges receipt of your payment and
your Asbestos Removal or Demolition Plan described as:Demolition
I
Site address 10159 S.Blaney Ave.
Cupertino,CA 95014
Start Date March 19, 2015
Completion Date March 23;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# 4L902
REVISION# START DATE COMPLETION DATE
1
2
3
4
5
NOTE. This forin is not intended as a verification of either the completeness of your original notification
or of its compliance with BA,4QMD Regulation 11-2. If you have any questions about this
acknowledgment,please call our office at(415) 749-4762.
Z-CON SPECIALTY SERVICES,INC.
ZANOTTI CONSTRUCTION
ENVIRONMENTAL CONTRACTOR
1645 Old Bayshore Road,San Jose,CA 95112
Phone: 408-451-9512 Fax:408-451-9514
Email: ZCONSSI()aol.com
Contractor's License No.803805
WORK COMPLETION LETTER
DATE: MARCH 20,2015
SUBMITTING TO: CLARUM HOMES
ATTENTION: STEVE
RE: 10159 S.BLANEY
CUPERTINO,CA
Z-CON SPECIALTY SERVICES,INC. REMOVED,TRANSPORTED AND DISPOSED OF THE FOLLOWING ASBESTOS
CONTAINING MATERIALS:
APPR 6,048 SF OF SHEETROCK WALLS AND CEILINGS
WORK WAS PERFORMED TO EPA,BAAQMD AND CAL OSHA REGULATIONS.FULLY CERTIFIED AND PROTECTED
WORK FORCE.CONTAINED WORK AREA.WET REMOVAL METHODS USED.ALL WASTE MANIFESTED AND
DISPOSED AT AN APPROVED LANDFILL.
E)cwC&Zavi&Wv-Pres,ici�
}
L ,
Page 2
Subject: Demolish—Submittal No. 1 Approved
Name: Biltmore Clubhouse
Address: 10159 S Blaney Avenue, Cupertino
APN: 369-03-008
Permit No.: 15010129
All conditions, requirements and recommendations are to be completed at the
(Owner/Developer)'s expense.
Storm water from surface or roof drains, other general surface runoff water or condensate from
any residential HVAC equipment shall not be discharged to the sanitary sewer.
Yours very truly,
MARK THOMAS &COMPANY, INC.
District Manager-Engineer
r
For: Richa 1 d . T aka
If you have any questions or need additional information, please can Thanh Nguyen at
408-253-7071.
U:\Administration\Con•espondetice-General\Letters\2015\Letter#15-096 Cupertino Building Department_15010129_Demolish_10159 S Blaney
Ave-BTLTMORE_Sub 1 Approved 3-25-15.doc
SUPPLYING SANITARY SEWERAGE SERVICES FOR:CITY OF CUPERTINO,PORTIONS OF THE CITIES OF SARATOGA,SUNNYVALE,LOS ALTOS AND SURROUNDING UNINCORPORATED AREAS