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15040156CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 18930 BARNHART AVE CONTRACTOR: MS CONSTRUCTION PERMIT NO: 15040156 OWNER'S NAME: DING BIAO ET AL 80 DARRYL DR DATE ISSUED: 04/21/2015 OWNER'S PHONE: 4088289808 CAMPBELL, CA 95008 PHONE NO: (408) 230-5080 YO LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL DEMO (E) 1,080 S.F. SFD License Class Lic.# Contractor Date 1 C-04 / I hereby affirm tha I am license unde t e((iro�s pns 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. 1 hereby affirm under penalty of perjury one of the following two declarations: 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 Sq. Ft Floor Area: Valuation: $8000 rmance of the work for which this permit is issued. I e 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: 37533007.00 OccupancyT 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 WITHIN 180 DAYS OF RMIT 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 1$0 D 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 Z� /1 granting of this permit. Additionally, the applic t understands and will corn ue _ ---- -T - Date: with all non -point source regulations per the pertino Municipal Code, Section 9.18. Signature Date %� 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. ❑ 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 25505, 25533, an 5534. Section 3700 of the Labor Code, for the performance of the work for which this r Owner `'" Dat F / permit is issued. or authorized agent 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 indemnify and keep 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 Date Fm -H CITYOF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION 101 ADDRESS: 18930 BARNHART AVE DATE: 04/21/2015 REVIEWED BY: MELISSA APN: 375 33 007 BP#: -50 it Sr,61- -VALUATION: 1$8,000 PERMIT TYPE: Demolition Permit r PRIMARY SFD or Duplex USE: PENTAMATION 1SFDWL-DEM PERMIT TYPE: WORK DEMO (E) 1,080 S.F. SFD SCOPE Suppl. Insp. Fee -0 Reg. Q OT FEE ID FLR AREA s.f. 1DEMORES 1,080 NOTE. This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, eta). These fees are based on the preliminary information available and are only an estimate. Contact the Deptfor addn'l info. FEE ITEMS (Fee Resolution 11-053 Elf 7/1!13) FEE QTY/FEE MISC ITEMS Permit Fee: $574.00 Suppl. Insp. Fee -0 Reg. Q OT _00 hrs $0.00 ,FES';, Strong Motion Fee: IBSEISMICR $1.04 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $576.04 $0.00 TOTAL FEE: $576.04 Revised: 04101/2015 CUPERI'INO DEMOLITION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildingCcDcupertino.org \ _ / I !L� 1.. Jj� APN # PROJECT ADDRESS � � /CJ � � J i t G� OWNER NAME �/� ,Atmr E-MAIL STREET ADDRESS ' - v CITY, STATE, ZIP FAX CONTACT NAME PHON E-MAIL STRt7 ADDRESS J CTTY, ST ,ZIP I -✓fir a s7 L4 ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR.. r LICENSE BE LICEN'S�YPE BUD # COMPANY NAME E -MA , - z mss_ �' >wAX STREET ADDRESS CITY, STATE, ZIP PjIO gO O Q a p `' DESCRIPTION OF WORK n^ ^ fy AAIva ` RESIDENTIAL # DWELLING OFFICE USE ONLY USE occ. TYPE SO. Fr. VALUATION FLOOR AREA UNITS COMMERCIAL FLOOR AREA TYPE OF CONSTRUCTION F#STORIES AQMD JOB NUMBERRECE TO yALUATION: By my signature below, I certify to each of the following: I am the property owner or authorized ag n 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 const ron I authorize repse4ntatives of Cupertino to enter the above -identified property for ' spec ' n purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED PRIOR TO ISSUANCE OF DEMOLITION PERMIT OFFICE USE ONLY PLAN CHECK TYPE Provide Job Number from Bay Area Air Quality Management District www.baagmd.or; @ 415-749-4762. Provide three copies (Residential) or six copies (Commerical) of a site plan showing protection for any trees 10" ❑ EXPRESS in diameter or more at 3' above grade. ❑ 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) El MAJOR certified in asbestos, mercury and/or hazardous material examination. Planning Dept clearance to verify building is not considered an historical landmark. AIlow 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 02113113 am COMPLIANCE BAY AREA ENFORCEMENT AtkCWALmt DIVISION MwNA43-6MEN1r DI S T h 1 CT TV General Contractor 229 Staples Ave San Jose, CA 95127 Acknowledgement of Notification and Payment of Fees 3/16/2015 Job No: 4M049 Invoice No; 3NN'93 The Bay Area Air Quality Management District (BAAQMD) acknowledges receipt of your payment and _your # emo l or. clition Plan described as: iletnol tioiu .. Site address 18930 Barnhart Avenue Cupertino, CA 95014 Start Date March 25, 2015 Completion Date April 5, 2015 Removal amounts of friable AGM 0 linear fleet 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# 4MO49 REVISION # START DATE COMPLETION DATE NOTE: This farm 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. ....a". .✓., ,.:�$,.. r.. �. ..., .: fa',w_,Sk,v ... tt� ... , ,�axn.. ..ani .,.�� , .e .. .. 2 ! ! J r 3 4 ! r ! r 5 0 ! NOTE: This farm 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. ....a". .✓., ,.:�$,.. r.. �. ..., .: fa',w_,Sk,v ... tt� ... , ,�axn.. ..ani .,.�� , .e .. .. Certificate of Analysis PLM Asbestos Identification tel - 7114-899-8"# ft ee - 888-743-4998 fax - 71.4899-7098 UN W%w.Ir,tltr iotlab.com 1041 S. Placentia Avenue. Fuiterton, CA 92411 Asbestos Testing & Inspection Mike Hickey 14680 Secretariat Ct. Morgan Hill, CA 95037 Date Collected: 2/17/158 Date Received: 2/17/2015 Date Analyzed: 2/18/2015 Date Reported: 2/18/2015 Report Number: Project Number: Project Name: Project Location: r Environmental Laboratory Services, Inc. 556488 Barnhart 18930 Barnhart Ave Cupertino, CA Collected By: Mike Hickey Claim Number: PO Number: Number of Samples: 2 Lab/Client ED/Layer Location Material Description Color Composition (%) 556488-001 Interior Sheetrock and Joint White 65% Sulfate I Compound 21 % Cellulose 10% Carbonate 4% Paint Chrysotile <1 % Total Asbestos <1% 556488-002 Interior Sheetrock and Joint White 65% Sulfate 2 Compound 21% Cellulose 10% Carbonate 4% Paint Chrysotile <1 % Total Asbestos <1% Hung Bi - Analyst Ian Reyes - Approved By Bulk sample(s) submitted was (were) analyzed in accordance with the procedure outlined in the US Federal Register 40 CFR 763, Subpart F, Appendix A; EPA-6M/R-93/116 (Method for Determination of Asbestos in Building Materials), and EPA -600/M4-82-020 (US EPA Interim Method for the Determination of Asbestos in Bulk Insulation Samples)Samples were analyzed using Calibrated Visual Estimations (CVES); therefore, results may not be reliable for samples of low asbestos concentration levels. Samples of wall systems containing discrete and separable layers are analyzed separately and reported as composite unless specifically requested by the customer to report analytical results for individual layers. This report applies only to the items tested. Results are representative of the samples submitted and may not represent the entire material from which the samples were collected. "None Detected" means that no asbestos was observed in the sample. "<I%" (less than one percent) means that asbestos was observed in the sample but the concentration is below the quantifiable level of 1%. This report was issued by a NISTINVLAP (Lab Code 200358-0) and CADOHS- ELAP (Cert. No. 2540) accredited laboratory and may not be reproduced, except in full without the expressed written consent of Patriot Environmental Laboratory Services, Inc. This report may not be used to claim product certification, approval or endorsement by NIST, NVLAP, ELAP or any government agency. Page 1 of 1 lel - 4 -9700 (Me - 85-346-8900 qK fix- 408-638.0445 Lab Use Only 9;<0www.Patrbtlabsom Report Number. i'N6 Paragon IMwo, San bsk CA9531 CHAIN OF CUSTODY PAM& fnirtronmenta! I.aboratnry Servkes, Inc. ' Client: Asbestos Testing & Inspections Inc. Project No.: Contact Person: Mike Hickey Project Namemen t a Client Address: Project Location: 14580 Secretariat Ct., Morgan Hill CA 95037 18930 Be nhart Ave, Cupertino CA Contact Phone:408-710-7979 Sam a Collected By: Mike Hickey Contact Fax: Authorized by: Mih Claim: PO,#: How do you Want your ort? (Circle) Mail Fax Web E-mail: mike@haztesdng.com Special Instructions: Analysis Requested Turnaround Timebusiness hourstdays) RUSH (4 hours) ❑ f RUSH (8 hours) [] 1 24 Hr ® j 48 Hr[:] 1 72 Hr ❑I Other (specify)E] TT atilt li7de penarorsnda%V&%M=9aeta —.-fuss hoeilnYian80MTAT. ="CAL-*Wr&dT"Pn*dzxwrAT 7zv& AlIlibeill PCM (fiber taunt) NIOSH 7400A ❑ PLM (bulk asbestos) EPA 600/R-93/116 ® Point Count 400 0 CARB 435 Point Count 1000 0 Gravimetric Reduction ((3mvimetrlc Redudbn Requhm Minimum 10hr TAT) [::] MicrobioloaV North -Viable Air Spore Trap, SOP IV.4.1m12m ®Viable (Colony ID & Enumeration) Air ❑ SMb/Bulk ❑ Non -Viable Surface Tape LNVSwabBuk, SOP IV.4.3m/4m t l (Samples must be received by the labombDry within 24hm or coladbn or muft maybe invalid) Total Collform and E. coli - Surfaces, Saabs, and Bulk Solids, Liquids (nornpotabl% non -wastewater) - Presence / Absence ❑ Cherril Lead by Flame AA - EPA 3030BJM20mod, NIOSH 7082mod: Paint ❑ Ah ❑ lit Wipe ❑ Water (.potable) ❑ SodsiSollds ❑ Lead Waste Palo (by Flamm AA) 1: TTLC Total Threshold by EPA 3050B mod ❑ 2: STLClCAL WET Title 22 CCR Ch11 Article 5 App 2 ❑ 3: TCLP EPA 1311 ❑ Note: PAmmproWdo At *Awoz Zoo grrsma (spp nm if ib.) of sample afar oampAeto profile. Chix* hereto perform ad teal nor kr dW osW ❑ Rotometsr Calibration ❑ pH testing (soils, misa so/ldas a aquids) FPA s1m ❑ client Seip ° $M11pIC Type Date SUTOW Location Sampled l�d Sample (Material type, dknenaions, ate) Start Ttm Stop Tons Avg (tPM) Total w. Total Vol (" I Tot. A 1 2117/15 interbr Shestrock & joint compound 2 lmarlw Shestrock & joint compound -T -T Relinquished B Print Minae Oq SI n: girt i?ate:a'rT Time: Received 8 Print Sign: "' ' Date: {''] Time: >r Relinquished B Print Sign: Date: Time: Received By: (Print) Sign: Date: Time: wletltod or Sltiprnmt I Preservation During Shipnmt: Cond Ition of Samples: Acceptable: YEs / No Comments: Note: Patriot's holding time for all samples submitted is 30 days fpr solid samples, 7 days for digests, and immediate for lead in air after anaVdcal results are reported. Unless cuslorm pmvides writ w Inshuctions to extend holy v time, samples will be disposed of in accordance with local, stab and federal laws. Paye 1 of v.8.16.2014 L-INvalPatdot CoC W Pacific Gas an Electric Company DATE: I (S - CITY OF CUPERTINO 10300 TORRE AVE CUPERTINO CA 95014 10900 No. Blaney Avenue Cupertino, CA 95014 SUBJECT: REMOVAL OF GAS SERVICES (CUT @ MAIN IN THE STREET) ON: VL -1 k a" SUBJECT: ELECTRIC SERVICES WAS CUT AT POLE ON: LcO 3U 6 Divi vlli-�- vbi I 01— If you have any further questions, please contact me at (408) 725-3325 Sincerelyl Pacific Gas & Electric Company DeAnza Service Planning 408/725-3325 Wxi�`""' 1 City of Cupertino Public works Department 00 CUPERTINOGREEN Program Environmental Programs Division 10300 Torre Ave Cupertino, CA 95014 (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. debris bin service provider franchised to do business`hi Cupertino Debris from a project 3,000 square feet or more in Cupertino can be collected and disposed by using: '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 ff aste 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 f om. 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 tiivt,iv.mtnertino.orelenvironmental. Signature: Date: Name: (printed) jY'►-t._ 'i`L_�rw Title: e 6v Phone: U6 Project Addres This form to remain in the project's building permit file for the duration of the project. Revised 317112 1 4 4% TYP. POST ELEVATION NOTES, I. 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, B. TEMPORARY CHAIN LINK FENCING IS AN ACCEPTABLE SUBSTITUTE TO THE WOOD CONSTRUCTION. N ITREE PROTECTION STANDARDS CITY OF CLIPERTIN�v 6-4 APPROVED BY ; DATE ITE ' @ETA ILS r.l e I N Bay-Valley Fest Control (408)370-1603 120 Kennedy Ave. (40,8) 244-6744 Campbell, CA, W08 (68a) X66-1813 L BAY Y RODENT INSPECTION REP69T PEST CONTROL Inspection Date "✓ Customer Name: to ,f" Mfr .� f Wd�o Account* .1 761- Service Address: , ,r kr � ; , „ . 0044k,Mao Grid Identification: 'X Rats Mice Other Points of Access it ,,,,,„ mm r Recommended Repairs and Suggestions f3atk;tatipns Located' a NOTE t; If You (the homecwnedmanager/tenant) have elected to do the repairs necessary to prevent rodents from re-entering 0/e struettoe; d4ys from the insp on, Oato, (not"before, unless your/lachrtrgr p,, states differently),; These repairs must be done timely, If no actlMly, has been seen or heard, begin repairs. If any questions prior to repairs, call our,oftice, o You will be notes d by phone approximately 4.6 weeksfol1owin0*`or"0Wal Inspection date for a "no icharge 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 orimprojmised. NOTE 2; if you elect Bay-Dalley }gest Control to perform the repairs necessary to exclude rodents from the home; o Calc to set-up or confirm an appointment for the wont to begin., o Costs quoted an fil tis report are far the above found repair Including materials, labor and guarantee, If any now or addltlOnal conditions to this report are found they +,will be discussed with the homeowner and quoted sepaletely I td t,4clusion Quote r yl r Btir�tRepairTirn �" CustomerAu+rrization for Repair Work (you will be notified by phone for scheduling) articl Repair information Defer 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,-galley Pest Control, The above quote wilUinclude stnl "rates "we ard� qualified to do, the technician will advise you if these circumstances ap06r,;'Examples of work Bay-W, Wy` Pest Control would not perform, but may be mentioned in this report are; Tree/86shfShrub trimming or removal, Garage door replacement, Roof work, Dry Wail or Siding, Painting of repaired areas, etc.. o Repairs not to be done by Bay-Valley Pest Control, r4 or—R0cMet) J" o Additional Comments, if a 4 44 //rr,i�/j��i r-� d1 % oM Cu #ct+iuiargnat re ' Technician Signature -- - -- T 699E 9Gd56 tl3 `ONI1213dt10 CL LU LUw'3AV 2i3NN4Q_A8A1ddt/ INVHNMVS 0£6841NdJV S<— Was emm -1 Ifl uw G G Q la 4d O 5 U � Li W U C J UI e: N o 0.H H H alp u vi f r 1 1 ©(m u r Z 00 tj CL x 2 y_ w W LU06. M W a w u uj m WW M i w w w z 00 offo zc Lu 1 rxxl W W W a V 1 I I 1 H � i 1 1 K j 0—IN Z WAgi fs, ZLUUJ 12 w' S filQ g N m LLJ s 0 w � m oao� U I I r 5 i o 0 a N ¢a�w a UJ C3 ZH € W W.I 9 2� J _ - �_ F yet - LU ¢ i 0 c r uj g CL Qc z - x I 86 8 �Lu Cl)� g to 8nu3 8 ds o� _ rfl� � �a r ,-mss a�� _� pR _„ a