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15110188CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10101 ADRIANA AVE CONTRACTOR: BABEL CONSTRUCTION PERMIT NO: 15110188 OWNER'S NAME: ZHOU YUE AND YU JING 3939 ARDEN FARMS PL DATE ISSUED: 11/25/2015 OWNER'S PHONE: 4088918059 SAN JOSE, CA 95111 PHONE NO: (408) 561-7041 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL License Clmm, Lica# DEMO (E) 1,975 SF DWELLING AND 733 SF GARAGE Contractor, 1 ? I `C� iuc, OD—ate I hereby affirm "that I. am licensed under the provisions of Chapter 9 (commencing,with ISection7000) 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 ad 4ill 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: $6000 erformance of the work for which this permit is issued. have and will maintain Worker's Compensation Insurance, as provided for by sof Section 3700 the Labor,Code, for the performance of the work for which this APN Number: 32620028.00 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 �,�B[IN 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 FROM LAST CALLED INSPECTION. indemnify and keep'harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the Issued by: Date: l 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. + 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. f ❑ 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; I' . ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER I, as owner of the,property; ormy 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 HAZARDOUS MATERIALS DISCLOSURE construct the project Sec :70,14, 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 andiwill maintain a Certifcate 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 thework 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, Secti 5 25533, and 25534. Section 3700 of the Labor'Co&Jor the performance of the work for which this Owner or authorized agent: Date: 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 ofCalifomia. If, after making this certificate of exemption, I CONSTRUCTION LENDING AGENCY become subject to the:VWorker'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.) l 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;an#ce p 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 `� its Date CUPERTINO DEMOLITION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE o CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(a-cupertino.org 0d10 C) PROJECT ADDRESS 0 APN # r O OWNFRNAME,jy� r n PHON,& r' p, ` E-MAIL 25 lJFAX STREET ADDRESS lJ \ r CITY, ST PTE ZIP l C Pt -eve CONTACT NAMEP(ST o E-MAIL STREET ADDRESS CITY,E, ZIP FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME — LICENSE NUMBER� C� `V 1 b LICENSE T — BUS. LIC # COMPANY NAME �o \ E-MAIL ` n\n�`^�� t ^'�� ` Y �� lA uAX STREET ADDRESS CITY, STAT ZIPP r^ PHON I C�� / 7c)q 1 DESCRIPTION OFWORKD V l t `- r..) G I n all a3S a �- (nc4 �--------- � J3 ' 4 DWEJ.LING OFFICE USF "ONLY RESIDENTIAL SF taA4qkJNITS ®V FLOOR AREA - USE : , 'OCC. TYPE ALUATION . COMMERCIAL FLOOR AREA — TYPE OF CONSTRUCTION # STORIES — AQMD JOB NUMBER RECBY, T T VALUATION: By my signature below, I certify to each of the following: I am the property owner or authorized agent to act o r the roperty owner's behalf. I have rad this application and the information 1 have provided is correct. I have read the Description of Work and verify it is a ate. I agree to comply with all applicable local ordinances and state laws relating to buildA cos ction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: ATION REQUIRED PRIOR TO ISSUANCE OF DEMOLITION PERMIT' SUPPLEMENTAL I;ray OFFICE USE ONLYmber "r,.'PLAN CRECKTYPE" _ Provide Job Nufrorea Air Quality Management District wWw.baagmd.orQ @ 415-749-4762. " _ Provide three copies of a site plan showing protection for any trees 10" in diameter or more at 3' above grade.0.'ExPRESs; _ Provide letter from PG&E (408-725-3325) stating all gas and electric has been disconnected. El -,STntvDnRD 0 ialtGE _ 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. ❑ Mi JOR . 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. DenroApp_2011.doe revised 03/16/11 CITY OF CUPERTINO 'FEE ESTIMATOR - BUILDING DIVISION L& F"Cr� per" it 1`NE VOTE. Th is, estimate does not include fees due to other Departments (L e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). I fiesefees are tPasea on the preliminary information avatiatple ana are only an estimate. Contact ine Dept for aaan -i info. FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13, ADDRESS: 10101 Adriana Ave DATE: 11/25/2015 . REVIEWED BY: Phuong Plan ("heck 17ee: APN: 326 20 028 BP#: *VALUATION: 1$6,000 *PERMIT TYPE: Demolition Permit TYPE: PRIMARY SFD or Duplex USE: PENTAMATION 1SFDWL-DEM PERMIT TYPE: WORK, Demo(E 1,975 SF dwelling. and 733 SF q_arage SCOPE Suppl. Insp. Fee:(j) Reg. C) OT F"Cr� per" it 1`NE VOTE. Th is, estimate does not include fees due to other Departments (L e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). I fiesefees are tPasea on the preliminary information avatiatple ana are only an estimate. Contact ine Dept for aaan -i info. FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13, FEE FLR AREA MISC ITEMS Plan ("heck 17ee: SuppL PC .Fee FEE ID Permit Fee: $574.00 Suppl. Insp. Fee:(j) Reg. C) OT 0..0 (s.f.) $0.00 Perinft.Fee" 1DEMORES 2,708 [Fork Wilhont perpnhz A(*ancetl Planning 7*s(al-ei.00.ti�rie;Til�iti'oli Fees: Strong Motion Fee, IBSEISMICR $0.78 Select an Administrative Item Bldg Stds Commission Fee: IBC'BSC $1.00 'Xv� A-111� . . . . . J $575.78 $0.00 70t xkt k�';-- $575.78 tE F"Cr� per" it 1`NE VOTE. Th is, estimate does not include fees due to other Departments (L e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). I fiesefees are tPasea on the preliminary information avatiatple ana are only an estimate. Contact ine Dept for aaan -i info. FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13, FEE QTY/FEE MISC ITEMS Plan ("heck 17ee: SuppL PC .Fee Permit Fee: $574.00 Suppl. Insp. Fee:(j) Reg. C) OT 0..0 hrs $0.00 Perinft.Fee" TqX'- [Fork Wilhont perpnhz A(*ancetl Planning 7*s(al-ei.00.ti�rie;Til�iti'oli Fees: Strong Motion Fee, IBSEISMICR $0.78 Select an Administrative Item Bldg Stds Commission Fee: IBC'BSC $1.00 'Xv� A-111� . . . . . J $575.78 $0.00 70t xkt k�';-- $575.78 Revised: 10/01/2015 COMPLIANCE & ENFORCEMENT BAY A rc r AiRQ-14AUTY DIVISION MA N:AiII.MFNT D1s'rit. i c.r Grand Nest Construction 13428 Christie Drive Saratoga, CA 95070 Regulation 11, Rule 2 Acknowledgement of Notification and Payment of Fees J#: 48442 invoice ND: 3RX95 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 1.0101 Adriana A onve Cupertino, CA 95014 Start Date November 18, 2015 Completion Date November 19, 2015 Removal amounts of friable ACM 0 linear feet 0 square feel 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 SAAQMD J# Id.442 REVISION # START DATi. COMPLETION DATE 3 4 _._.......I J...._.^ l._._.._...1. _._ NOTE: Thic form is not intended as a verification of either the completeness ofyour original notifr.cation or ofits compliance w4t17.8A.4Q.9D Reg7.ilation 11-2. Ifyou have any questions above this aclrnowledgment' please call our office at. (415) 7.49-4762, s8 � 10900 No. Blaney Avenue Cupertino, CA 95014 DATE: [ 1 2-3- f CITY OF CUPERTINO 10300 TORRE AVE CUPERTINO CA 95014 SUBJECT: REMOVAL OF GAS SERVICES (CUT @ MAIN IN THE STREET) ON: SUBJECT: ELECTRIC SERVICES WAS CUT AT POLE ON:; If you have any further questions, please contact me at (408) 725-3325 Sincerely, Pacific Gas & Electric Company DeAnza Service Planning 408/725-3325 71 KA(Gay Was !rare. October 13, 2015 Wesley Liu 7246 Sharon Drive San Jose, CA 95129 1111111 / RE: 10101 Adriana Avenue Cupertino, CA 95014 Dear Mr. Liu: The above -noted property has been inspected and there were no infestations noticed at time of the inspection. Sincerely, Andrew Gibson Pest Management Professional Killroy Pest Control, Inc. 888-545-5769, Ext. 105 www.killroy.com Killroy Pest Control 1175 Dell Avenue, Campbell, CA 95008 408-378-0441 PURPOSE 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) 777-322& • FAX (408) 777-3333 • building0a.cupertino.org The demolition application should be applied for before or at the same time as the new construction pennit application (these are separate permit applications and fees). Pen -nit fees are due at the time of the application/plan submittal. The new construction permit will not be issued until the demolition permit is issued, unless a letter obtained from the Building Department is submitted stating that "The existing house will not be demolished until the new construction permit is issued". The letter needs to be signed by both the property owner and general contractor. REQUIREMENTS To obtain a demolition permit in the City of Cupertino, please complete a Demolition permit application -along with each of the following requirements as it applies to your specific project. 1. Three (3) copies of a Site (Demolition) plan for Residential or six (6) copies for Commercial 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 these trees. F 2. PG&E must be contacted. AS EARLY AS POSSIBLE prior to demolition to schedule the abandonment. Contact PG&E at (408) 725-3325. A letter from PG&E shall be provided to the City, stating that. all gas and electric has been disconnected. (This step can be time consuming, so it is important to begin the / process immediately) 3. Provide Job Number from Bay Area Air Quality Management District www,baagmd.gov @ 415-749-4762: i 4. Check to see if the building is considered an historical landmark. Obtain clearance L/ from the Community Development Planning Department. Allow 10 workup d—Y—s 5. Provide a letter of clearance of all vennv1 from a licensed pest control contractor. 6. 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. 7. Debris bin and Recycling sheet: read, sign and date. The sheet will remail u1 the project's building permit filefor the duration of the project. 8. Commercial only -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 during Demolition or that shall be replaced with the new construction. DemoProcedure.doc revised 2/13/13 DATE: Pacific Gas and Electric Company Customer Service Planning &. Local Design 10900 N. Blaney Ave. Cupertino, CA 95014 RE: GAS ABANDONMENT REQUEST To Whom It May Concern: I request to have a letter sent to the City of Cupertino, Building Division, 10300 Torre. Ave, Cupertino, CA 95014 to verify the removal of the Gas and/or Electric Meter(s) at the following location. SERVICE Cupertino, CA 95014 CROSS STREET: LOCATION APPLICANT............................................................................................................................................... .......................................................................... ADDRESS........................................................................................................... ................................................................................................................. EMAIL............. ............................:..... ..... ....... ........... ........................................................... PHONE................................................................................ CONTRACTOR....................................................................................................................................................................................... ............................. ADDRESS.................................................................................................... ........................................................................................................................ EMAIL................................................................................................................................ PHONE ........................................... :.................................... ACCOUNT # ACCOUNT IS: ❑ OPEN ❑ CLOSED PARTY RESPONSIBLE FOR BILLING: ❑ APPLICANT ❑ CONTRACTOR ❑ OTHER: REASON FOR 7 REBUILDING ❑ YES ❑ NO ABANDONMENT: . I NOTE: Abandonment fees are at custoraer's expense.and is collected prior to construction. DO NOT SCHEDULE DEMO CONTRACTOR UNTIL ADVISED BY PG&E OF CUT SCHEDULE. FOR OFFICE USE ONLY GAVE / MAILED APPLICATION TO CUSTOMER: ❑ YES DATE: ❑ NO PG&E Cleraance.doc revised 03/27/12 -i01(1� City of Cupertino Public works Department ga Environmental Programs Division 10300 Torre Ave Cupertino, CA 95014 eUaeariNo 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 Department/Envi.rorunental 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. ce provider fra Debris from a project 3,000 square feet or more in Cupertino can be collected and disposed by using: Plea check all that. apply: I am not using a Recology debris bin, however, the project is less than 3,000 s.£,e.g. buildings, patios, sidewalks, driveways. ❑ I 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 Management Planwith your building permit application. No fee_for thus plan. Forms are available at the.Buildi.ng/Public Forks counter and online at 1alrvw.crcperfirr.o.org/environrraentcil. Report the tonnage recycled and disposed, by material type. Recycling facilities must be selected fi-ona. the City's approved list of Recycling Resources. ✓ Submit a Construction. Recycling Reportform. The report is required before the Building Department will schedule a final inspection. The reportform is available at the Building/Public T,Yorks Cortnter and onlihe iyviv.cuoertino.or (11environm.ental. Signature: / Date: ( k —o( Name: (printed) Title: � Phone: Project Address: This form to remain in the project's building permit fife for the duration of the project. Revised 317112 1 4 S! st O" I %i 'TYP.POST EL EVATION NOTES: 1. 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, S. 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. S. TEMPORARY CHAIN LINK FENCING IS AN ACCEPTABLE SUBSTITUTE TO THE WOOD CONSTRUCTION 1 11111111 I m I I "I'll VO VOO1V VS 0 AVAA13NNOUVE06L u09-6zq (900 ga ...... A v nA N., ZHO 19 4:s 1--1 M LL. 0 a 3AOH NOISnD 3NI3 'UM M.00,00.06N HI M, ®o HJ.WON zz 913 X wl I I I J v 9 Rl� IN IJ x€ p -Malmm k? q M M ml ZIM II it i Z z L --- Wict 3.00,00.06N HI M, ®o HJ.WON zz 913 X wl I I I J v 9 Rl� IN IJ x€ p -Malmm k? q M M ml