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13120154CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20832 GREENLEAF DR CONTRACTOR: ATLANTA PERMIT NO: 13120154 CONSTRUCTION INC OWNER'S NAME: HUANG LA.I-CHING AND MEEI HWA ET AL 2625 MIDDLEFIELD RD #164 DATE ISSUED: 12/19/2013 OWNER'S PHONE: 6504920120 PALO ALTO, CA 94306-2516 PHONE NO: (408) 518-0132 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL 5 (� ? j 3 7y 3 y 7 SFDWL DEMO 3469 SQ FT TO INCLUDE 2644 LIVING tk License ClassLic. # AREA, Contractor A } 1 fdll (On, " Nkl Date 12 /Y "13 GARAGE 825 1 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. 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: 32630172.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION 1 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 DAY AST 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 /� /9 /?� granting of this permit. Additionally, the applicant understands and will comply Issued by: Date: v with all non -point source regulations per the ertino Municipal Code, Section 9.18. �/ RE -ROOFS: Signature Date t/2 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) 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. 1 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 255� 5533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this r Owner Date: /2`1 /3 permit is issued. or authorized age 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 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 CUPERTINO DEMOLITION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION LA 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 O� J (408) 777-3228 • FAX (408) 777-3333 • building Acupertino.org PROJECTADDRESS 20,gn 6fley,Ieo (vr APN# 3Z9 30 172 OWNERNAME FuSfbruok VfntUr GL� PHONq��/� ` l2 `01Z,V E-MAIL���J�ll�p�: �l �:ifr. LU► STREET ADDRESS G t1 Pair 1 rr d f I n CITY, STATE ZIPj_y5 (, - yK v7 y FAX G ^ Sf- 1-12 CONTACT NAME Chr 13 wkn rL PHON /SG U �-O' 7C (� 7 E-MA W �'t5 hun I � n+a,"i, cow STREET ADDRESS Z3Z// Purl�iq l bi J b CITY,STATE, '41P C A qjgO;� /fi FAX e!' �' E3 OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME R la 9r `I Q iv a n j [ LICENSE NUMBER 7 3 7 " q LICENSE TYPE BUS. LIC # 2 L'' r� 0 ,An COMPANY NAME fart S 1�0 E-MAIL �rm h Lt`7 60j 1 do • (o v' 1 FAX (q&f)291 -2I S Z STREET ADDRESS r, ( j I 1 ., ' r O` ^ t% CITY. STATE, ZIP OAP DESCRIPTION RK OI/�I� dOlf1) RESIDENTIAL -] FLOOR AREA 3 k DWELLING UNITS OFFICE USE ONLY USE TYPE VALUATION COMMERCIAL FLOOR AREA TYPE OF CONSTRUCTION 0 STORIES ' J AQMD JOB NUMBER J#: qD10 RECEIVED B�- TOTALv�G ATION: 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 h 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 construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: I2- lO `'3 SUPPLEMENTAL INFORMATION REQUIRED PRIOR TO ISSUANCE OF DEMOLITION PERMIT Provide Job Number from Bay Area Air Quality Management District www.baagmd.org @a 415-749-4762. Provide 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. _ Provide letter from PG&E (408-725-3325) stating al l gas and electric has been disconnected. 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. 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. OFFICE USE ONLY PLAN CHECK TYPE EXPRESS El STANDARD ❑ LARGE ❑ MAJOR DemoApp_2013.doc revised 02113113 IM-7 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 20832 Greenleaf Dr DATE: 12/18/2013 REVIEWED BY: MENDEZ APN: BP#: "VALUATION: 1$10,000 *PERMIT TYPE: Demolition Permit P/A,% (_:; H C,S PRIMARY SFD or Duplex USE: PENTAMATION 1SFDWL-DEM PERMIT TYPE: WORK sfdwl demo 3469 to include 2644 of living space and garage 825 sq ft SCOPE FEE ID FLR AREA s. f. 1 DEMORES 3,469 Pholl.h. P/o.1 ( hcc! /Jcc. /Tort C;h,-c.•k trr/t_ t'<tiui[l i'�: Plumb, Pemil Fcr: le'c. Prrmi/ F<c: --L- Other Mech. Insp.El--L- Other Plumb Insp.ET-1- Other Elec. Insp. El Uech. Insp. Fee Plumb. Insp. Pee: Elec. Insp. Fee: NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). Thesefees are based on the preliminta information available and are only an estimate Contact the Dept or addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff 711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: ,Suppl. PC Fee t'luml�.lillech. %Gl ec' Permit Fee: $696.00 Suppl. Insp. FeelS Reg. Q OT 0.0 hrs $0.00 Plumb./Nlech./Elec Plumb./Mech./Elec Pei-mit Fee; <:onsiruction T(I.V. �1 drnlnistrative Tee: 4"oYk Without Permit' Advanced Planning Fees: A I rcrvel Documentation Fees: Strong Motion Fee: IBSEISMICR $1.00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $698.00 $0.00 TOTAL FEE: 1 $698.00 Revised: 10/01 /2013 I City of Cupertino It ` Public works Department Environmental Programs Division n,"[27" 2 10300 Torre Ave Cupertino, CA 95014 CUPERTINO 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/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: ❑ I am not using a Recology debris bin, however, the project is less than 3,000 s.f., e.g. buildings, patios, sidewalks, driveways. [y� 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%9. 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 this plan. Forms are available at the Building/Public Works counter and online at www.catpertino.org/envirazme?ztal. 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 Report form. 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 wiviv.cupertino.orQleitvironmental. Signature: Name: (printed)_ Title: _ Phone: _ Project Address: Chr15tophei, Huan tr ✓) yq2 -oILU OY 3 3 6t--ern It 4 f Or L u pfr rk o, CA M1 This form to remain in the project's building permit file for the duration of the project. Revised 317112 1 Date: /2 - 17- 13 �1 443y-rirst Street #276, Livermore, CF, � �1 INVOICE# 1 1-877-804-8626 www.polarispest.com ©facebook.comlpolarispestelimination 312 4 9 BILL To L oS*Odle VPnture 2 3261 Po -grid 9 P Lw ws1fvs cA gL/�ly SERVICE ADDRESS 431 Grtenl r4P G DETAILED SANITATION REPORT YE5 DESCRIPTION AMOUNT TERMS NET 30 DAYS CLASS 61YI AMOUNT PAID 1 THIS IS YOUR INVOICE. IT IS PAYABLE UPON RECEIPT. UNPAID BALANCES ARE NOT SHOWN ON THIS INVOICE. (Vote: Prior to use, all food handling areas and surfaces should be cleaned with soap and water. Target Pest Products Used/or Code Interior/Exterior Amount Interior/Exterior Interior/Exterior Interior/Exterior Interior/Exterior Interior/Exterior Interior/Exterior COMMENTS�S�f' 1-7 1 t' ,-14 - "(--3 o C o ve r ' A I v1 Thank you for your business. X/41yl C9A VfJDate ) Customer Signature Technician Signature PRODUCT USED 16400 A- Tempo WP - (Cyflutrin) B - Demand CS - (Lambda Cyhalothrin) C - Borid - (Orthoboric Acid) D - Contrac Blox - (Bromadialone) E - Terro Ant Killer I I - (Borax) F - Kicker - (PyrethriniPiperonylbutoxide) G - BP-100 - (Pyrethrin/Piperonylbutoxide) H - BP-300 - (Pyrethrin/Piperonylbutoxide) I - Maxforce Roach Killer Bait - (Hydramethylnon) J - Maxforce Ant Granular Bait - (Hydramethyinon) K - Talstar CA Granular - (Bifenthrin) L - Advance Carpenter Ant Bait - (Abamectin 131) M - Rozol Tracking Powder - (Indiandione) N - Maxforce FC Roach Killer Gel - (Fipronil) O - Gentrol IGR Conc. - (Hydropene) P - CY Kick - (Cyfluthrin) Q - Intruder HPX (Cyfluthrin/Piperonylbutoxide) R - Purge III - (Pyrethrins / Piperonylbutoxide) S - Suspend - (Deitamethrin) Ifto 3125-377-AA 1- Rat Snap Trap 10182-361-AA 2- Mouse Snap Trap 9444-129-ZA 3- Rat Glue Tray 12455-76-AA 4- Mouse Glue Tray 149-8-ZA 5- Bait Station 4816-707-AA 6- Wind Up Ketch All 11450-9-AA 7- Tin Cat 64248-14-AA 8- Fly Machine 64248-6-AA 9- Trapper Mouse Pro 64248-6-AA 10- Fly Lite Glue Board 279-3168-ZA 11- Gopher Getter Type 2 (Diphacinone) 36029-24 499-370-AAA 12- Vendetta Cockroach Gel (Abacmetin B1) 1021-1828 7173-113 13- Maxforce Select Roach Killer Bait Gel (Fipronil) 432-1259 64248-1 4-AA 14- Phantom (Chlorfenapyr) 241-210 2724-351-ZA 15- Termidor SC (Fipronil) 7969-210 499-470-AA 16- Dupont Advion Cockroach 352-652 9444-183-AA Bait Gel (Indoxacarb) 9444-158-AA 17- Dupont Advion Ant Gel (Indoxacarb) 352-746 432-763-ZA 18-Maxforce FC Magnum Pro Cockroach Bail Gel (Friponil) 432-4160 State Law requires that you be given the following information: PESTICIDE DISCLOSURE STATEMENT Caution: Pesticides are Toxic Chemicals Structural pest control board companies are registered and regulated by the structural pest control board, and apply pesticides which are registered and approved for use by the California Department of Pesticide Regulation and the United States Environmental Protection Agency. Registration is granted when the state finds that based on existing scientific evidence there are no appreciable risks if proper use conditions are followed or that the risks are outweighed by the benefits. The degree of risk depends upon the degree of exposure, so exposure should be minimized. If within 24 hours following application you experience symptoms similar to common seasonal illness comparable to the flu, contact your physician or poison control center at 1-800-876-4766 and your pest control company immediately. For further information, contact Polaris Pest Elimination 1-877-510-9766: For health questions, the County Health Department (listed below), For application information, the County Agricultural Commissioner (listed below). For regulatory information - the Structural Pest Control Board (1-800-737-8188. 1418 Howe Avenue, Suite 18, Sacramento, CA 95825-3280). COUNTY AGRICULTURAL COMMISSIONER COUNTY HEALTH DEPARTMENT Alameda 510-670-5232 Alameda 510-267-8010 Contra Costa 925-646-5250 Monterey 831-759-7325 San Francisco 415-285-5010 Santa Clara 408-299-2172 San Mateo 650-363-4700 Solano 707-421-7465 Marin 415-499-6700 Santa Cruz 831-763-8080 Sonoma County 707-565-2371 Contra Costa Monterey San Francisco Santa Clara San Mateo Solano Marin Santa Cruz Sonoma 925-370-5008 831-755-4525 415-554-2600 408-885-4231 650-573-2757 707-421-6629 415-499-6841 408-454-4066 707-565-4742 Poison Control Center Structural Pest Control Board 800-876-4766 800-737-8188 �15 1 q q y6sg-�Ux NOV-05-2017- Moe BAY ARLA A I K C� l_JA L1TY MANAk"LMLNI 0 1 .x 'r Ii ! C, 1' 13:36 BAY AREA AIR QUALITY MGNT COMPLIANCE & ENFORCEMENT DIVISION 1 415 928 0338 Regulation 11, Rule 2 Acknowledgement of Notification and Payment of Fees 11 l5/2013 Atlanta Development & Construction, lnc. !#: 4DI63 10969 N Wolfe Road Invoice No: 3FP68 Cupertino, CA 95014 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 20832 Greenleaf Drive Cupertino, CA 95014 Start Date November 7, 2013 Completion Date November 28, 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. RI, GULAT.ION 11 -2 REVISION 1.3AAQMD J# 4D163 REVISION # s,rAIZT DATE COMPLETION DATE 4 St----- NOTE: This farm is not inlcnded as a venXication gf'citller the completeness gl`vour uriginul nrxificativn or nf'it,s compliance yvit!? 13fIAO1VID Regulation 11-2. 7f yrni have an questions about this acknowledgment, please call our uf)ice at ("475) 749-4762. P. 02 464 Pacific Gas and Electric Company City of Cupertino 10300 Torre Avenue Cupertino , Ca. 95014 To Whom It May Concern: SUBJECT REMOVAL OF GAS AND/OR ELECTRIC FACILITIES 10900 No. Blaney Avenue Cupertino, CA 95014 The gas and electric facilities have been removed and/or abandoned at: - Gas service cut at main in street on: 11/19/13 at 20832 GREENLEAF DR CUPERTINO CA 95014 - Electric service cut at pole on: 12/04/13 at 20832 GREENLEAF DR CUPER'fINO CA 95014 Sincerely, 4 fz��� 13 Pacific Gas Electric Compan DeAnza Service Planning