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D-2016-0415CITY OF CUPERTINO BUILDING PERMIT BUILDINGADDRESS: 20790 HANFORD DR CUPERTINO,.CA 95014-1824 (326 30 065) CONTRACTOR: PERMIT NO: D-2016-0415 YU ZHANG I OWNER'S NAME: YU ZHANG I IDATE ISSUED: 09/23/2016 I OWNER'S PHONE; 415-830-7141 1 1 PHONE NO: I q I111 DWI WIXK6,1111 I MTN FLO)t 11 DION W41t4 13 BUILDING PERMIT INFO: License Class Lie. # Contractor YU ZHANG Date —BLDG —ELECT _ PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing — MECH X RESIDENTIAL COMMERCIAL — with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. JOB DESCRIPTION: DEMO SFD (1008 S.F.) & GARAGE (568 S.F.) I hereby affirm under penalty of perjury one of the following two declarations: 1. 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. 2. 1 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. Sq. Ft Floor Area: Valuation: $18000.00 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. Date 9-23-2016 I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons:' 1. I, as owner ofthe 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) C' V I, as owner of the property, am exclusively contracting with licensed contractors to construct the project(See.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: 1. 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. z. 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. 3. 1 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 certify that [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 9-23-2016 "N Number: Occupancy Type: 326 30 065 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. by: Kim Dunbar 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: 9-23-2016 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. 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. Owner or authorized agent: 16� " Date: 9-23-2016 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 Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional v - DEMOLITION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408} 777-3333 • building(5�CUpertino.Org CUPERTINO PROJECT ADDRESScp _ n._r y�s'� APN# Awl ff '/r_ OWNER NAME ; - - PHONE r�,,,. / EMAIIerdaqj4j STREET ADD SS v p CITY, STATE, ZIP P'!dIt CONTACT NAME PHONE E-MAIL 264 STREET ADDRESS CITY, STATE, ZIP FAX OWNER ❑ OWNER -BUILDER ❑ OWNERAGIENT � eaNTmvr-Tm ❑ CONTRACTORAGENT ❑ ARCHITECTS�❑� ENGINEER El DEVELOPER ff11 El TENANT CONTRACTOR NAME * LICENSE.NUMBER LICENSE TYPr�j BUS. LIC # COMPANY NAMEt"'A E-MAIL1 U FAX -AA&A2 STREET ADDRESS � q jj - CITY, STATE,,ZIP t, B tl F g 6 PHONE &31Vk� DESCRIPTION OF WORK r>, R Q v RESIDENTIAL ®� # D"LLING FLOOR AREA; UNITS COMMERCIAL" TYPE OF CONSTRUCTION I # STORIES ,AQMD JOB NUMBER . T REC BY VAL ON: J s By my signature below, I certify to each of the following: I am 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 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 to building coustyuction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of ApplicantlAgent: � � Date: SUPPLEMENTAL INFORMATION REQ - D PRIOR TO ISSUANCE OF DEMOLITION PERMIT of FTCE use ONLY Provide Job. Number from Bay Area Air Quality Management District wW'kv.baagmd.org @ 415-749-4762. C'K TSE rov"ide three copies of a site plan showing protection for al)49 re s 10" in diameter or more at 3' above grade. ❑? SSS" ❑ STANDARD P vide letter from PG&E (408-725-3325) stating all gas and electric has been disconnected.. ❑ LARGE Planning Dept clearance to verify building is not considered an historical landmark. Allow 10 business days. ,p V ❑ IvtA,IOR o_ Provide letter of clearance of all vermin from a licensed pest control, contractor. Is Applicant shall .call the Public Works Department at 408-777-3104 and schedule a "habitable dwelling" inspection. rovide Construction and Demolition Recycling Diversion signature form. ommercial,Buildings Only: Provide Fire Dept clearance for fire suppression / alarm system review. vilr DeinoApp_2016.doc Devised 05110116 OWNER -BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE'; AVENUE CUPERTINO, CA 95014-3255 UPERTtt�tt3 (408) 777-3228 • FAX (408) 777-3333 • buildingna.cupertino.org Dear Property Owner(s): An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at: SITE ADDRESS , a � - ° APN ,._. BP# ort. � 3�- Q ' OWNER NAMEJA OWNER ADDRESS�I (� 6o & ` DESCRIPTION OF WORK: N AM I I -tA'c A O� (T N f�4b)OT'' ,'flA A/1'Y'llfl�JP(JJV�>+ � ' '({( We are providing you with an Own r -Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner -Builder. We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our of ficial address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. E 1. I understand a frequent Builder" building permit that ern personally. 1, as an Owner-Buili an unlicensed person and his c providecoverage for those injui insurance coverage for injuries �(�- 2. 1 understandd building PE �t/he construction andl are not hir ! 4,- 3. 1 understand';as an "Ow protect myself from potential fin name instead of my own. 4. I understand Contractor numbers on permits and contra 5. 1 understand if I employ total value of my construction is considered an "employer" unde L,6. I understand4I am con federal government,; withhold p unemployment compensation fi me to serious financial risk. D VERIFICATION OF INFORMATION each statement below to signify you understand or verify this information.) ractice of unlicensed persons is to have the property owner obtain an "Owner- eously implies that the property owner is providing his or her own labor and material <r, may be held liable and subject to serious financial risk for any injuries sustained by her employees while working on my property. My homeowner's insurance may not s.s. 1 am willfully acting as an Owner -Builder and am aware of the limits of my workers on my property. nits are not required to be signed by property owners unless they are responsible for g a licensed Contractor to assume this responsibility. r -Builder" I am the responsible party of record on the permit. l understand that I may cial risk by hiring a licensed Contractor and having the permit filed in his or her ,are required by law to be licensed and bonded in California and to list their license )r otherwise engage any persons, other than California licensed Contractors, and the at least five hundred dollars ($500), including labor and materials, I may be state and federal law. ;idered an "employer" under state and federal law, I must register with the state and yroll taxes, provide workers' compensation disability insurance, and contribute to rleach "employee." I also understand my failure to abide by these laws may subject 7. 1 understand' under California Contractors' State License Law, an Owner -Builder who builds single-family residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and thnumber of structures does not exceed four within any calendar year, or all of the work is performed under contract wit a licensed general building Contractor. 128. 1 understand as an Own'' r -Builder if I sell the property for which this permit is issued, I may be held liable for deny financial or personal injurie sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or aterials. OwnerBuilderForm 2010.doc revised 04/14/10 `i � 9. I understand I may obt� Revenue Service, the United Ir - and the California Division of It License Board (CSLB) at 1-801 contractors.' i 1(0. 1 am aware of and cor am the party legally and financ �11 1 agree that, as the pa by applicable laws and requ _�312. 1 agree to notify the is information T have provided on you contract; with someone wh assist you with any financial lo: Contractors may in civil cou employee of that individual or f you obtain a permit as Owner -1 those Contractors are properly Please complete I hereby affirm that there is a (Sec 3097 Civ.) Lender Name: more information regarding my obligations as an "employer" from the Internal es Small Business Administration, the California Department of Benefit Payments, istrial Accidents. I also understand I may contact the California Contractors' State 21-CSLB (2752) or www.cslb.ca.gov for more information about licensed mt to an Owner -Builder building permit applied for in my name, and understand that ly responsible for proposed construction activity at the site address listed above. legally and financially responsible for this proposed construction activity, I will abide nents that govern Owner -Builders as well as employers. uer of this form immediately of any additions, deletions, or changes to any of the his form. Licensed contractors are regulated by laws designed to protect the public. If does not have a license, the Contractors' State License Board may be unable to you may sustain as a result of a complaint. Your only remedy against unlicensed t. It is also important for you to understand that if an unlicensed Contractor or m is injured while working on your property, you may be held liable for damages. If uilder and wish to hire Contractors, you will be responsible for verifying whether or not icensed and the status of their workers' compensation insurance coverage. following construction lending agency information.) n lendingagency for the performance of the work for which this permit is issued Lender Address: Before a building permit can be 1 sued, this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to veri ` the property, owner's si na ure. Property Owner's Signature: r n MDate: r [ --------------------- (NOTE: The following Authorize agent of the property owner to a) Excluding the Notice to Property 01 authorize the following person(s) to Owner -Builder Permit for my projec Scope of Construction Project (or E Project Location or Address: Name of Authorized Agent: Address of Authorized Agent: — I declare under penalty of perjury above information and certify its a verification acceptable to the city i signature. I Property Owner's Signature: ----------------------------------------------------------------------------------------------- Form is required to be completed by the property owner only when designating an for a construction permit for the Owner -Builder), M PROPERr er, the execution of which I understand is my personal responsibility, I hereby ;t as my agent(s) to apply for, sign, and file the documents necessary to obtain an ption of Work): Tel No am the property owner for the address listed above and I personally filled .out the acy. Note: A copy of the property owner's driver's license, form notarization, or other be required to be presented when the permit is issued to verify the property owner's Date: OwnerBuilderForrn 2010.doc revised 04114110 �1Pacific Gas and Electricom, aw- 61SIVE DELIVER ENERGY.' SEPT. 23, 2016 YU ZHANG 20790 HANFORD DR. CUPERTINO, CA 95014 RE: 20790 HANFORD DR. CUPERTINO CA 95014 Order Number: 111712935 To whom it may concern, The gas meter at the above referenced address has been removed and the gas service was cut off at main on (09120116). The electric service & meter at the above referenced address has been disconnected and removed on (09122116). Sincerely, Jam, Aw Justin Pigg Project Coordinator I Pacific Gas & Electric Co I DeAnza Division{ 10900 N Blaney Ave. Cupertino, CA 95014 1 2Pytbocle.com IOfflce: 408.725.2165 M -F 7:OOAM — 3:30PM **AVAILABLE BY APPOINTMENT ONLY" "5afety is a full time job; don't make it a part time practice' Randazzo Enterprises, Inc 13550 Blackie Road Castroville, CA 95012 Regulation 19, Rale 2 Acknowledgement of Notification and Payment of Fees Mi 4XO21 Invoice No : 3VU94 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 20790 Hanford Dr Cupertino, CA 95014 Start Date September 26, 2016 Completion Date September 28, 2016 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# 4Xa21 REVISION A START DATE COMPLETION DATE 1l 2. C !—I -%i 2 3 4 5 NOTE: This form is not intended as a verification of either the completeness of your original not f cation 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. =V� :tg COMPLIANCE & 'i'' l ENFORCEMENT BAY AR EA DIVISION A[RQ-UAL1TY MANAGVM.RNT L) IS T R t CT Randazzo Enterprises, Inc 13550 Blackie Road Castroville, CA 95012 Regulation 19, Rale 2 Acknowledgement of Notification and Payment of Fees Mi 4XO21 Invoice No : 3VU94 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 20790 Hanford Dr Cupertino, CA 95014 Start Date September 26, 2016 Completion Date September 28, 2016 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# 4Xa21 REVISION A START DATE COMPLETION DATE 1l 2. C !—I -%i 2 3 4 5 NOTE: This form is not intended as a verification of either the completeness of your original not f cation 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. fCity NAI, of Cupertino Public works Department 1lti Environmental Programs Division 10300 Torre Ave CUPERTIN�OGREEN Cupertino, CA 95014 prone -Ow (408) 777-3354 Construction and Demolition .Recycling Diversion Requirements and histructions Covered projects, or all construction, demolition and renovation projects that are 3,000 square feet or ntcrre are required to complete a Waste Management Flan fol• the City of Cupertino demonstrating that 60% of the material generated is recycled, .in compliance with ordinance CMC 16,72.05.0, At the conclusion.of the project a Construction Recycling Report must be filed with thePublic 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. ):rIs bin service provider Debris from a project 3,000 square feet or more in Cupertino can be collected and disposed by using; Please check all that apply: IV I am not using a Recology debris bin, however, the project is less than 3,000 s.f,, e.g. buildings, patios, sidewalks, driveways. 11 I will use a Recology debris bin, By Agreement with the City, Recology will prepare my required Waste Management flan & Recycling Report, Contact Recology: (408) 725-4020. CI I am not using a Recology debris bin. I will provide the following Submittals to the City's Public Works Department, showing that l 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: . ,Subinit ca Construction. and .Dentolition IYaste Afanagernent Plan.. with your budding penni.t application, Mofeefor this plan, .dorms are available at the BulldinglPublic Mor ks counter and online, at www.cupertirao.orglcni,ir-onr77entcd. Report the tonnage recycled and disposed, by niaterical type, Recyc.lillg facilities Must be selected from the City's approved list of Recijcling Resources. ✓ Stabrnit a Cornstruction Reeyclirzglteliortforr7a, Tire r'epor't is reyraived before the Building Deprartrnent will schedtde a fin al inslmctior7. The r°eportforrrz is available Flt the buddini;/Ptrblic Warks Counter and online 14,wiI� cr.a crtirro.crrglenvironrt2entrtl. Signature: Name: (printed)___.- Y._.0— 2H NJ Title: _ DWK r Phone:_ G� h(AA4.ne 730 711Project Address: ��-7qn This form to reanain hi the project's building permit file for the dur°ration of the projeeL. Revised 317112 1 Date: TYPICAL BAPK PRQTEe'l`>:pN Nal' T'o SC/r{ 4 -Fear kM i en * iYPZAL TREE PROT5=10N FENCXW NOT TO SCALE 1. prior to nrry cous(niction operations contractor shall con9MA'and maintain, for cacti protertod trey oil a constraction site, a protertive t'e:icing which enoimlcs the outer turrets of the mifimil root zone(CRZ) of'tbe tree to protect it fxorn construction activity. Tho CRZ is calculated. 1.25 feet times the diameter of the tzunk measured in inches 4.5 feet above the nattmd grade). 2. All proteotive fencing shall be in place prior to Wnaracummeat of any sitowork and remain in place until all exterior construction activity attire site has been oomplew, 3. Protective ftoing shall be at least six (6) feet higb, clearly visible, and shall havo a tree protection sin affixed to the fence every twenty (20) feet suvh a manner to be clearly visible and legible to workers on the site at a distance of twenty five (25) feet. The signs) shall read "Tree .Protection Zone Keep our. 4. Tho owner shall cause the required fencing and signage to be installed and maintained ibr the duration of the oomtrneiion. S, In WQations whem a protected too rtmah)r, in the immediate area of intended aonstmccfian and the tree may in dangor of being damaged by corrstructiou equipment or other motivity, the etmtwolor or suboontractor shall protect the tree with 21'x4" lumber enciralod with wire or other xueans that do not damage the free. The hitent is to protect the trunk of the tree against incidental contact by large construction cquipmo t. G. Material Storage: No storage or p146irwt of materials intended for use in cond-niedon or waste materials accumulated due to excavation nr dewc,Htioa shall be placed within the limits of the oritieal mot zone of any protected tree. 7..Equipmeat CleatringlLiquid Dk;pnsal: No equipment shall be oleaned or Mier liquids, Including, without limitation, painoil, solvents, aspha]4 coacretp, mortar or similar reaterzals dopo€iited or allowed to flow into the critical root zone of a protected troo. S. `Free Attachmeaw No signs, wirds or outer attachrn enta, otber that those of n protective nature, shall be attached to any profeo W tree. 9. VetdoulaT Traffic: No valzicular and/or construction equipment traffio or parking shall take place within the critical root zone of any protected free other than, on existing street pavemcnr 10. No heavy cgxdpmcn4 including but not limited to trucks, tractors, trailers, bulldozers, oxceva Lots, slid steer tractors, [ranchers, eorupressors, and hoists, sbatl be allowed inside the, drip -line of any protected hee on any ODnstruction site, 11, Grade Changes: No grade okngrs shall be allowed within the Hmi.ts of the critical root zona ofany protected tree unless adegrrstte lrotecetive cousiruction methods are approved in advance in tori ting by the city, 12, impervious Paving: No paving with asphalt, oonoreto or other impeMous materials shall be placed within the Brits of the crit cal root zone of Et protected tree, unless expressly permitted by thepubltc works D7 pt 13. RootPnining: All roota two inches or larger ht diameter wldch are exposed as aresult of trenching or other excavation sliall he cut ofi'scluare With a. sharp medium tooth saw acrd covered with natural rrbor burl ap within two hours of hiftiai exposure, 14, All public sidewalks shall remain optm, tree and clear for public access, unless oiosurp is permitted by the Publin Warks Deparhnent. TREE PROTECTION SM10ADD REVISED 5143 6-4 RPM EXTERMINATORS P.O. Sox 41246 San ,lose, CA 95160 (408) 445-1738 rudepest.eorn NAME \,j ka'� ADDRESS CITY % SIJ 9d` In Pu�� by G<d+ SINGLE SERVICE AGREEMENT THE SER'V'ICE: RPM Exterminators shall render one service only for: ❑ ANTS ❑ BLACKWIDOWS DATE ^ r ✓ �� PHONE C�r�r �1'(7 ZIP with one nest) service on; r ❑ FLEAS; RATS ❑ OTHER ❑ ROACHES ❑ EARWIGS ❑ SILVERFISH ❑ MIC A -j iA5C1&&0' '21, � S��& MATERIALS: 0A Cer The materials used shall conform with Federal and State ordinances. The work will be performed in a safe manner. INSURANCE: RPM Exterminators shall maintain all necessary insurance policies during the entire term of the agreement. It is understood that while the purpose of the service is to prevent damage by pests, RPM Exterminators shall not be responsible should such daanage occur. WARRANTY. RPM Exterminators gives no warranty on single service agreements. However, we. do warranty regular service. Please see terms of agreement below. TERMS OF AGREEMENT: In the event that RPM Exterminators is notified within 30 days of this date the company agrees to initiate regular pest control service on a yearly basis for an annual fee of payable It is further agreed that in the event it becomes necessary to employ council for the collection of any indebtedness under this agreement, the owner agrees to pay reasonable attorney fees fixed by the court and interest of 1 V2% per month, 18% per an- num on accounts 30 days past due. TERMITES & FLYING INSECTS: This agreement does not include flying insects, termites or other wood destroying organisms. However, we do offer our regular customers a discount on termite inspections. The charge for the one service will be 1-7�� \6A �. iccnscd 5crvicc Technicia7) nAuthorized (See back for pesticide information) 2,0q`u OU -I've G��'�nn�, No Ndi� �0r pL,O,r PLANS CHECKED By DATE pLA NING DEPT OUPERTINO jo! Co� i j-, of any BY DATE Z() L�:� ;ore �'m'wb1`� Looe; -4 By -,'-(JPERTINO . ;,ling Denartment COMPLIANCE Cay OFFICE Copy Na��-orad 9�r��,�e..