13010091CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 1 19060 MEIGGS LN
CONTRACTOR: D&D CONSTRUCTION
PERMIT NO: 13010091
AND DEVELOPMENT
OWNER'S NAME: LI'S CAPITAL LLC
PO BOX 3565
DATE ISSUED: 01/17/2013
OWNER'S PHONE: 4082217887
FREMONT, CA 94539
PHONE NO: (510) 579-2353
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL 11
LICENSED CONTRACTOR'S DECLARATION
License Class_ Lie. #
SFDWL DEMO 1288 SQ FT
2
Contractor Ja�t) � V` Date �— L 7 Zo13
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
Valuation: $10000
performance of the work for which this permit is issued.
Sq. Ft Floor Area:
I have and will maintain Worker's Compensation Insurance, as provided for by
APN Number: 37535052.00
OccupancJ TN pe:
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
PERMIT EXPIRES IF WORK IS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating
WITHIN 18 DAYS OF PERMIT ISSUANCE OR
to building construction, and hereby authorize representatives of this city to enter
ST CALLED INSPECTION.
180 DA7-,4,7,-:
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
City in of the
costs, and expenses which may accrue against said consequence
Issued by:Date:
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.
+_ 7 �P' z
- - Date /
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
Signature
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)
1, 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
1 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
Health & Safety Code, Seeti ns 25505, 25533, and 25534.
I have and will maintain Worker's Compensation Insurance, as provided for by
the
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent: Dates
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
CONSTRUCTION LENDING AGENCY
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
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
CUPERTINO
DEMOLITION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION DCA
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 C)
(408) 777-3228 • FAX (408) 777-3333 • building aecuperting.grg
0
C
PROJECT ADDRESS i () ` U Wt(,/c, _ 1
APN # -_� j 1�;_ -�'s _ u'S -
OWNER NAME lS
PH% „^� Y j ��i--7
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E-MAIL
STREET ADDRESS
CITY, STATE, ZIP
FAX
o.nx
CONTACT NAMEpRVui M�4ti,
PHONE D \ L ' _
E MAI `aMaV • \lam - I
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STREET ADDRESS I
$
CITY, STATE, ZIP FAX
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CR"owNER ❑ OwNER.BuaDER ❑ OWNERAGENr ❑ CONTRACTOR ❑ CONTRACrORAGENf ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME O `, � ) �( u
LIC NUMBER R� 262//Q
LICENSE TYPE 2
!/
BUS. LIC #
+ENSE
COMPANY NAME\ ltiC 1"011 a+W
E-MAIL �0l ® YA�tqo % C=0 VIA
FAX !�I v 4�j o-683
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STREET ADDRESS
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CITY, STATE, ZIP �� Imo uj, r y� py,'j !i
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PHONE slO X74 -23
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D
DESCRIPTION OF WORK
L t OJE EX('STILkH.h-"tAC
tam
RESIDENTIAL r�D S�
S
#DWELLING lOFFICE
USE ONLY
FLOOR AREA
UNITS
USE
OCC
TYPE
SO. FT.
VALUATION -'
COMMERCIAL
FLOOR AREA
=
TYPE OF CONST -RUCTION
S
ESTOR7MS 7
1
AQMD JOB NUMBER
RECEIVED B
TOT TION:
By my signature below, I certify to each of the following: I am the property owner or authori d ag4tto 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 anVerify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building construc4on. I auth representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of ApplicanUAgent: Date: —
SUPPLEMENTALFO 'F ON REQUI PRIOR TO ISSUANCE OF DEMOLITION PERMIT
OFFICE USE ONLY
PLAN CHECK TYPE
_ Provide Job Number from Bay Area Air Quality anagement District wrww.baagmd.or2 @ 415-749-4762.
_ Provide three copies of a site plan showing protection for any trees 10" in diameter or more at 3' above grade.
❑ FxPREss
❑ STANDARD
_ Provide letter from PG&E (408-725-3325) stating all gas and electric has been disconnected.
❑ LARGE
_ Provide a letter of inspection, tests, and abatement of any Hazardous Materials. Letter to be initiated by person(s)
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.
f� i
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_2011.doc revised 03/16111
� CITY OF CUPERTINO
Fe—w--m-1 Uf1f, rQ: rrMA'r"P — RITTI BIND nIVISION
FEE ID FLR AREA
s.f.
1 DEMORES 1,288
,r, ur—.....-•. »-»••»�•�
FEE
Plumb. Plan Checti
Llec. Plan Check
mech. Perma 1,
ADDRESS: 19060 MEIGGS LN
DATE: % 7
REVIEWED BY: MENDEZ
12
)iher Elec. Insp.
BP#: �CJ�
`VALUATION: $10,000
APN:
Permit Fee:
$534.00
*PERMIT TYPE: Demolition Permit
PLAN CHECK TYPE:
PRIMARY
SFD or Duplex
PENTAMATION 1 SFDWL-DEM
PERMIT TYPE:
USE:
Plumb./Mech./Elec Permit Fee:
WORK
SFDWL DEMO 1288 SQ FT
SCOPE
FEE ID FLR AREA
s.f.
1 DEMORES 1,288
NOTE: This estimate does not include jees due to other Departments (i.e. reanning, Fuuuc »••••»•. ��•-�• - -�• -- _.____
Contact the Dent for addn'l info.
District, eta). inese lees are based un rnr prettirsirtuf
FEE ITEMS (Fee Resolution 11-053 Eft: 7%/%122
,r, ur—.....-•. »-»••»�•�
FEE
Plumb. Plan Checti
Llec. Plan Check
mech. Perma 1,
Plitmb. Pcrmit Fcc:
Elec. Permit Fee:
Orher,ilech. Insp
I)Ater Plumb /nsh
)iher Elec. Insp.
Mech. Insp. Fee:
Plumb. lisp. Fee:
Permit Fee:
$534.00
NOTE: This estimate does not include jees due to other Departments (i.e. reanning, Fuuuc »••••»•. ��•-�• - -�• -- _.____
Contact the Dent for addn'l info.
District, eta). inese lees are based un rnr prettirsirtuf
FEE ITEMS (Fee Resolution 11-053 Eft: 7%/%122
,r, ur—.....-•. »-»••»�•�
FEE
•• -• -
QTY/FEE
•-_ _._ ________ __
MISC ITEMS
Plan Check Fee:
Suppl. PC Fee
Phrmh./11ech./Elec
Permit Fee:
$534.00
Suppl. Insp. Fee:Q Reg. Q OT
Q,0
hrs
$0.00
Plumb./Mech./E, lec
Plumb./Mech./Elec Permit Fee:
Construction Tax:
Administrative Fee.
Work Without Pe/ -mit?
Advanced Ph7hnitig Fees:
I ravel Documentation Fees:
Strong Motion Fee: IBSEISMICR
$1.00
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$536.001
$0.00 TOTAL FEE:
$536.00
Revised: 10/01/2012
CUPERTINO
PROCEDUR CHECKLIST FOR DEMOLAN PERMITS
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building Qcupertino.orq
PURPOSE 11060 1060 Me+�� S L►-,
The demolition application should be applied for before or at the same time as the new construction
permit application (these are separate permit applications and fees). Plan check 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.
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.
rl 1. Three (3) copies of a Site (Demolition) plan 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.
►^" 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)
V'^ 3. Provide Job Number from Bay Area Air Quality Management District
www.baadmd.gov ov_ @ 415-749-4762.
I?I 4. Check to see if the building is considered an historical landmark. Obtain clearance
from the Community Development Planning Department. Allow 10 working
I got; o r►d,I,S r 1--,^ —days.
D' v -ti 5. Provide a letter of clearance of all vermin 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.
Nl 7. Debris bin and Recycling sheet: read, sign and date. The sheet will remain in the
project's building permit file for the duration of the project.
Prior to issuance of the demolition permit (commercial only), 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 3/26/12
BAY AikLA
AIRCZUALITY
MANAGEMENT
D I S T R I C "f
COMPLIANCE &
ENFORCEMENT
DIVISION
Regulation 11, Rule 2
Acknowledgement of
Notification and
Payment of Fees
1/11/2013
D & D Construction & Development, Inc. Job No: 3Y5 t t
P.O. Box 3565 Invoice No: 3BM39
Fremont, CA 94539
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 19060 Meiggs Lane
Cupertino, CA 95014
Start Date January 23, 2013
Completion Date January 30, 2013
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# 3Y511
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 (41 S) 749-4762.
Pacific Gas and
Electric Company`
10900 No. Blaney Avenue
Cupertino, CA 95014
\ko,-dy /O, � 6 !.3
City of Cupertino
10300 Torre Avenue
Cupertino, Ca. 95014
To Whom It May Concern:
SUBJECT REMOVAL OF.GAS AND / OR ELECTRIC FACILITIES
The gas and electric facilities have been removed and / or abandoned at:
f9d 66�P,Pr�fnG on
If you have any further questions, please contact me at (408 )725-3325
Sincerely,
.4,4
__ Service Planning-
i� City of Cupertino
Public works Department
Environmental Programs Division
10300 Torre Ave
Cupertino, CA 95014
t1ram
CUrEREEN (408) 777-3354
Prosrom
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:
Pleas check all that apply:
[ I am not using a Recology debris bin, however, the project is less than 3,000 s.f., 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 Plan with your building permit
application. No fee for this plan. Forms are available at the Building/Public Works counter and online
at www.cupertino.org/environmental. Report the tonnage recycled and disposed, by material type.
Recycling facilities must be selected from the City's approved list of Recycling Resources.
✓ Submit a Construction Recycling Reportform. The report is required before the Building
Department will schedule a final inspection. The report form is available at the Building/Public
Works Counter and online iti,ww.cupertino.org/environmental.
Signature:
Name: (printed).
Title: _
Phone: _
Project Address:
- zi - Z 7 �
VI �
This form to remain in the project's building permit file for the duration of the project.
Revised 317112 1
Bay -Valley Pest Control, Inc. Account o.
A
120 Kennedy Ave. (08) 3 0 ' 221.
SyLE
Campbell, CA. 95008 (408) 244-6744
Service Contract
(650) 966-1313
Service Address
Billing Address
Map _g52G2
IP, ANSON
L! 'S CAPITOL LLC
Name_ _�—
Name
18060 MEIGGS LANE
P. 0. e01A, 7586
Address
Address
CUPE^TINO CA 05014.
MENLO PARK CA 94026
Attn:
x Street
Hm Ph.
Hm HmPh.
Bs. Ph. (408) 221-7887
(408) 211-7887
Type of Service: ONE–SHOT: RAT **FOR_LExRENCc**
Guaranteed for a minimum period of Months. The first months service will be
$ and $ for every following months period.
(initial Cost)(Monthlyor Bi-Monthlyrate) (Frequency) See Contract Terms below
CALL N WAY 112 HH. 221-788/tOO I If1S ?G c��i orl
2 – 88/nz'
r F�c.t t Se- v i c-e-1I�a_c fi Any
Contract Terms: One -Year Obligation (after first year, contract may be canceled time)
May Cancel by calling our office anytime after chargeable follow-up
services, otherwise service will be continued and charged until terminated.
Waiting Periods for retreating (Trouble Calls):`�
Exterior Services: 14-21 days (all insects)
Interior Services: 14-21 days (all insects except ants, roaches, & rats/mice) t; b,
3 day waiting period for Ants inside
21-30 days waiting period for Roaches
7-14 days waiting period for Rats/Mice
Please Read before signing: Cancellation of this contract before the expiration date (Contract Terms) will
result in a minimum charge of 50% of the remaining contract amount: Contracts
allow our customers to have affordable service with a Guarantee at a discounted
rate.
Moving: Should you move or sell your home, notify Bay -Valley Pest Control immediately
in writing. Failure to provide us with written notification of your move will result in
charges and/or liabilities for services rendered at contract service address.
Maintenance Services: Maintenance services are designed to control the migrations of insects into your
home. When your yard is treated periodically the problems occurring inside your
home should be reduced and in most cases, you should require less servicing of
the inside. You will be sent a post card prior to each service, if at that time you
have noticed increased activity of certain insects inside, please call to arrange to
have the inside treated at that time.
Special Instructions: UGlCa�1 {�DC)EVI Gs LJ' 7 -
byv
ho L" i 04
Our Guarantee: The term guarantee shall mean that the pests are
controlled to the satisfaction of the customer. Necessary return services
within the guarantee Reriod will be at no additional cost for covered pests.
Xnatu
_ Time
Date Source
Sold by
C.O.D.
X Technician Signature
��
IV A Bay -Valley Pest Control (408) 370-1603
L 120 Kennedy Av. (408) 244-6744
L Campbell, Ca. 95008 (650) 966-1313
E
BAY Y RODENT INSPECTION REPORT
PEST CONTROL
Inspection Date '� !
Customer Name: I fj, An 5&rt Account #: 433 f
Service Address: 15 o P e I Q Q S LCL A -,P- Map Grid: F5.) C�
�L) ry- rno, kik- ySoi�
Identification: Rats Mice Other
Points of Access
i
Recommended Repairs and
f
�_Tja&= • 1� -.7 -A
--r
NOTE 1: If You (the homeowner/manager/tenant) have elected to do the repairs necessary to prevent rodents
from re-entering the structure:
o Above repairs must be done 10-14 days from the inspection date (not before, unless your technician
states differently). These repairs must be done timely.
If no activity has been seen or heard, begin repairs. If any questions prior to repairs, call our office.
o You will be notified by phone or post card, approximately 4-6 weeks following the original Inspection date
for a "no charge follow-up service". If repairs are complete and correct, we will remove and dispose of
any left over bait.
o If repairs are not done on time the guarantee will be compromised.
NOTE 2: If you elect Bay -Valley Pest Control to perform the repairs necessary to exclude rodents from the home:
o Call to set-up or confirm an appointment for the work to begin.
o Costs quoted on this report are for the above found repairs including materials, labor and guarantee.
If any new or additional conditions to this report are found they will be discussed with the homeowner
and quoted separately.
Rodent Exclusion Quote $ /K
Customer Authorization for Repair Work
(you will be notified by phone for scheduling)
Guarantee and Repair Information: Refer to your contract for specific guarantees.
o In some cases, certain repairs may need to be done by a contractor or other suitable business, If this is the
case, your guarantee will only be for repairs done by Bay -Valley Pest Control. The above quote will include
only repairs we are qualified to do, the technician will adviseyou if these circumstances aDneac Examalps-nf-