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B-2017-0015CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: D-2017-0015 10792 FARALLONE DR CUPERTINO, CA 95014-4453 (369 34 006) NILSENE BUILDER INC CUPERTINO, CA 95014 OWNER'S NAME: MAGANTI PRANAYA D AND BHARATHI DATE ISSUED: 04/19/2017 OWNER'S PHONE: 408-439-3294 PHONE NO: (408) 993-1229 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class 5 Lic. #1019073 Contractor NILSENE BUILDER INC Date 10/31/2018 —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 (E) SFD (1512 S.F.); ATTACHED GARAGE (483 S.F.) I hereby affirm under penalty of perjury one of the following two 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. 2..'�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. Sq. Ft Floor Area: Valuation: $10000.00 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 APN Number: Occupancy Type: and state laws relating to building construction, and hereby authorize 369 34 006 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 PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally, the ap licant understands and will comply with all non-point source regulations r t e Cupertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. i .Signature Date 411912017 Issued by: AbbyAyende Vvp OWNER L�ECLARATI Date: 04/19/2017 I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS: following two reasons: All roofs shall be inspected prior to any roofing material being installed. If a roof is 1. I,-as owner of the property, or my employees with wages as their sole installed without first obtaining an inspection, I agree to remove all new materials for compensation, will do the work, and the structure is not intended or offered for inspection. sale (Sec.7044, Business & Professions Code) 2. I, as owner of the property, am exclusively contracting with licensed Signature ofApplicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: 4/19/2017 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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. HAZARDOUS MATERIALS DISCLOSURE 2. I have and will maintain Worker's Compensation Insurance, as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the Section 3700 of the Labor Code, for the performance of the work for which this California Health & Safety Code, Sections 25505, 25533, and 25534. I will permit is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the 3. I certify that in the performance of the work for which this permit is issued, I Health & Safety Code, Section 25532(a) should I store or handle hazardous shall not employ any person in any manner so as to become subject to the material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I Worker's Compensation laws of California. If, after making this certificate of will maintain compliance with the Cu er no Municipal Code, Chapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety Code, cti s 2 505, 25533, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent: APPLICANT CERTIFICATION Date: 4/19/2017 1 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 CONSTRUCT 0 LE E NCY I hereby affirm that there is a cons r ction lending agency for the performance relating to building construction, and hereby authorize representatives of this city of work's for which this permit is issued (Sec. 3097, Civ C.) to enter upon the above mentioned property for inspection purposes. (We) agree Lender's Name to save indemnify and keep harmless the City, of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in Lender's Address consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code, Section 9.18. 1 understand my plans shall be used as public records. Licensed Signature Date 4/19/2017 Professional DEMOLITION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • (BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildinga-cupertino.org PROJECT ADDRESS No 7i 2 l T \ APN # � ` �� ( -0—u OWNER NAME g PHONE S A y f �y E; NL4ILj�� VN Sell STREET ADDRESS CITY, STATE, ZIP FAX CONTACT NAME p A PHONE E-MAIL V\1 i e) �.; )T ce STREET ADDRESS 11p,1c6C V\&- e s+ed4 t J # Z I C CPrY,STATE, ZIP G� R-ri rle FAX 146S - r> 44 ?-q 6 L4 5 ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT JW CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITEcr ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTORNAME ®n C) 'tl \ l• LICENSE NUNM_i ER LICENSE TYPE BUS. LIC# COMPANY NAME �I E-MAIL f,1 is FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK (7 1 c I RESIDENTIAL j ` #DWELLING ©FFICE USE ON_ LY USE o.CC: TYPE SQ Fl _:---VALUATiON'- FLOOR AREA 9s t- UNITS COMMERCIAL FLOOR AREA TYPE OF CONSTRUCTION # STORIES i t AQMD JOB NUMBER J#: RECEIVED BY TOTAL VALUATION: t8L► 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 pro 'de i 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 buil ' g c n tion. I authorize representatives of Cupertino to enter the above-identifid property for inspection purposes. Signature of Applicant/Agent: Date: 0 11 k /gei— t SUPPLEMENTAL INFO TIO REQUIRED PRIOR TO ISSUANCE OF DEMOLITION PERMIT OFFICE USE ONLY:..: ; TYPE Provide Job Number from Bay Area Air Quality Management District www.baUmd.org @ 415-749-4762. �NDss J rovide three copies of a site plan showing protection for any trees 10" in diameter or more at 3' above grade. %P STANDARD _P Ovide letter from PG&E (408-725-3325) stating all gas and electric has been disconnected. (� -I..ARGE Planning Dept clearance to verify building is not considered an historical landmark. Allow 10 business days. I] AWJOR_ 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 2016. doe revised 03129116 W 1 9 1W Awa 252 Hillsdale Avenue San Jose, California 95136 1-800-4-HYDREX 01-30-2017 Prepared for: Moe Jahli PAB Construction 408-499-6595 Regarding: Property Owner Deepak Maganti 408 439-3294 10792 Farallone Drive COMMUNITY DEVELOPMENT DEPARTMENT Cupertino, CA 95014 BWI-DiNG =iSiON -.. U111" II'1J`iNO Upon performing a rodent inspection for the property noted above, no evidence of active mi tivity was 1 c� under or above this structure. IVB ID This set of p( ans ork3 specificasti(x[s MUST t:e kef)t at llie lcf.l Jason Fielder site dHaft¢ coilstlu floir. R is iuf'ilawful to rrake tiaity chaioges oi, cal[a,� afloias oii noire, or to deviate tlar i efl crrr7, w if1 oLit alfiPl'oval fro rr7 the tcaulldiii g Official. Lie. OPR 10302 T i,h) stai,q)[i'arl of this holaarr ai,id slaa„dficafior'r^s SI-iAI I. NOT Itc held to pei,m4 oi° to ft:c rain aafor, rovoal oP the vlolaation or aw°i}( « i,,ic`a r o as C„if Oidt o uaricc ou Strata: Lava,. Thank you for this opportunity to present to you the quality and professional services of Hydrex Pe4 aon%ro l mpany o Santa Clara County. For immediate service, or if any questions arise, please call any of our I0iendly helJafTul St,siIydrex (JAI/Y^1/Ir 1-800-4-HYDREX (1-800-449-3739), PH# 408-978-0211 l°ta"11'Lf i:)Eis, imi i IhC f:l ;10 17 00 15 Hydrex Pest Control is a full service pest control company specializing in Termite Control, Wood destroying fungi control, Wood repairs and reconstruction, Bird control, Rodent control and General pest control services for residential, commercial and industrial establishments. We use the latest technology and the most recent and effective pesticides available on the market. Nilsene Builder, Inc. 21060 Homestead Rd Cupertino, CA 95014 Regulation 11, Rule 2 Acknowledgement of Notification and Payment of Fees X 5AO19 Invoice No: 3YR84 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 10792 Farallone Dr Cupertino, CA 95014 COMMUNITY ftTP011.MN G MOON — CUPERTNO Start Date April 12, 2017 DIP DI IIS II" ) Completion Date April 20 2017 Ns wet of jokan and ul.ratra.ifirc cams ms i UST b kept at the joLl Nita: during ("0110uctbri It iv unlawful to u'n ake arrh changes ar niteraHCdns a;r`i same, orto deviate the e rcrrrr, without approval Removal amounts of friable ACM 0 linear feet 0 square feet 0 cubic feet fruarn the, IBulldhng Oficial. Should it become necessary to revise this plan, please do so in the spaces provided I a� ,��1 #.4 �` � ��� rW'4yV � 1 of tew � t'l fi I I f a .� �!� xr a i 5lvaal crT t4aar viaxl�stiaaPi of any copy the District by fax or by mail. )mvi, bin of inn City Ordinance e wrState Law By REGULATION 11-2 REVISION f-"rriaLrMl NO REVISION # START DATE COMPLETION DATE 1 2 1 I I 3 II I I 4 5 1 NOTE. This form is not intended as a verification of either the completeness of your original notification or ofits compliance with BAI4QMD Regulation 11-2. If you have any questions about this acknowledgment, please call our office at (41 S) 749-4762. S COMPLIANCE & ENFORCEMENT BAY �4::lt � A' AmowuAl.rry DIVISION M A NAU r;mr,r,N'r D I S T ,R- I C. T Nilsene Builder, Inc. 21060 Homestead Rd Cupertino, CA 95014 Regulation 11, Rule 2 Acknowledgement of Notification and Payment of Fees X 5AO19 Invoice No: 3YR84 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 10792 Farallone Dr Cupertino, CA 95014 COMMUNITY ftTP011.MN G MOON — CUPERTNO Start Date April 12, 2017 DIP DI IIS II" ) Completion Date April 20 2017 Ns wet of jokan and ul.ratra.ifirc cams ms i UST b kept at the joLl Nita: during ("0110uctbri It iv unlawful to u'n ake arrh changes ar niteraHCdns a;r`i same, orto deviate the e rcrrrr, without approval Removal amounts of friable ACM 0 linear feet 0 square feet 0 cubic feet fruarn the, IBulldhng Oficial. Should it become necessary to revise this plan, please do so in the spaces provided I a� ,��1 #.4 �` � ��� rW'4yV � 1 of tew � t'l fi I I f a .� �!� xr a i 5lvaal crT t4aar viaxl�stiaaPi of any copy the District by fax or by mail. )mvi, bin of inn City Ordinance e wrState Law By REGULATION 11-2 REVISION f-"rriaLrMl NO REVISION # START DATE COMPLETION DATE 1 2 1 I I 3 II I I 4 5 1 NOTE. This form is not intended as a verification of either the completeness of your original notification or ofits compliance with BAI4QMD Regulation 11-2. If you have any questions about this acknowledgment, please call our office at (41 S) 749-4762. Tuesday, April 18, 2017 at 11:40:13 AM Pacific Daylight Time Subject: ASBESTOS RENOVATION & DEMOLITION JOBS Payment Confirmation Date: Monday, March 13, 2017 at 1:46:04 PM Pacific Daylight Time From: customerservice@govpaynet.com To: nilseneinc@gmail.com riGOV )�'YNET i o ik, " rpuL�tII��DIe �Nday �0 [,ay 24 Hour Customer Service #: 888-604-7888 ASBESTOS RENOVATION & DEMOLITION JOBS Payment Confirmation PLC: BAY AREA AIR QUALITY MANAGEMENT DISTRICT DATE: 03/13/17 8047 375 BEALE STREET, SUITE 600 SAN FRANCISCO, CA 94105 FOR: ASBESTOS RENOVATION & DEMOLITION JOBS TRANSACTION INFORMATION Applicant's Name: MOE JALILI Type of Payment: DEMOLITION Applicant's Phone #: 408-992-1229 Com an Name (if P y applicable): NILSENE BUILDER, INC. Email Address of 09227E Person Making NILSENEINC@GMAIL.COM Payment: $3.00 Contractor: NILSENE BUILDER Job Location Address: 10792 FARALLONE DRIVE, CUPERTINO, CA95014 Renovation/Demolition Removal Amount (of 1574 Regulated Asbestos): Choose One: SQ FEET Project Start Date: 4/12/2017 CARDHOLDER INFORMATION NAME: MOHSEN JALILI ADDRESS: 21060 HOMESTEAD ROAD CITY, STATE ZIP: CU PE RTI NO, CA 95014 PHONE #: 408-992-1229 CARD #: xxxx-xxxx-xxxx-9468 The service fee is not refundable. COMMUNITY DEVELOPMENT DEPlR MENN BUHILMN MA00N- CUFERTMO AP P- E I"11 G hr s wet of Ipkans tiarry sl.) crfirccalio ns MUST be kept :at the jofl cito, ataai ing cnu'rs[ro. ctbr. It is unlawful twrrraalke any chaingtes or (.CZra Hans wr`i suir e, or to deviate thera*hrorr, wntlrnut approval trnanr the, IBulldhng Official. C"Ifm stairplin7 of this hr vra wird cpecif,.aarierru 131 iAL [ NO fro held to perrmxt or W fry an approval of Vw violation of ,any pmvi, bin c.rf Garry City Ordinance wcState Lawn. By. TRANSACTION REFRENCE #:-g,,l,SS7624 NII F1, KI I N0 ;10 17 00 15 03113/2017 16.45-.34 TRANSACTION DATE/TIME EDT PAYMENT INFORMATION APPROVAL #: 09227E PAYMENT AMOUNT: $90.00 SERVICE FEE: $3.00 TOTAL AMOUNT: $93.00 ATTENTION CARDHOLDER: If you have questions about the processing of your payment, please call GovPayNet at 888-604-7888. Page 1 of 2 Thank you for using GovPayNet © 2007 Government Payment Service, Inc. Form #: EUP Page 2 of 2 P��0- V I � 0 yq2 �' rc, \1 0 Y--\ e ov- , CVPP(*4f)0 CUII)Ell 1140 �I° IIiIII PiiIin IDepartirnen't REVHEWEI) F�&R CODE. CONMI[AANG- Revk:me�J a3yAbby Ayeinde Date, 0,10917 ----------- DIfEVELOPMENT DEPARTMENT BMILMNG MV00N — CUPERTMO u'OMMUNITY s� AP P- ROVE [1) lr\ his sot of I E wnariT si.)ecifficaflons MUST be kept at the jof.l 'ne ally ("hainges Or tblr� It �s unlawful to alk its: during (")110ucla 6 o^ C' tSe 'IlRera'Hon's c i same, or to deviate therehrorr, without approval frown the, IBulldhng Official. Ifm stairiplug of this pkvr� and specincations .131 -IAL[ NO � 1::)o Y), c held to pvirmftor W tx an approval of Vw violation of any — IJP 4h cq my City Ordinance w State Law By'ie )600 DA I PFFIAM I NO 20 17 00 1 E5 CUII)Ell 1140 �I° IIiIII PiiIin IDepartirnen't REVHEWEI) F�&R CODE. CONMI[AANG- Revk:me�J a3yAbby Ayeinde Date, 0,10917 P acific, 1-i"as and Electric C i r i p a n y DATE. 04/18/17 CITY OF CUPERTINO 10300 TORRE AVE CUPERTM CA 95014 10900 No. Maney Avenue Cuperflno, CA 95014 COMMUNITY DEVELOPMENT DEPARTMENT BMILMNG MV00N — CUPERTMO MAIN IN TM lzl� AP P- ROVE [1) SUBJECT: REMOVAL OF GAS SERVICES (CUT @ %"IIW sito, during conouctbr. It is unlawful to 'rake any chainges or aReraHons of i some, or to deviate the rehrorn, without approval 10792 FARALLONE DR qL18,/17� frorin the, Bulldhng Official. C"Ifm,stairiping of this pkvrr anct specincations .131 iALI NO 1::)o held to permft or W tx an approval of Vw violation ot any SUBJECT: ELECTRIC SERVICES WAS CUT AT POLE ON: )mvisbin of Wray City Ordinance w State Law By. 10792 EAR, LL DR 04/12/17 P11DA I ::F1,MH �:':Q 17 00 15 IBM Sincerely, M a I I r('1 (-,e"n ' n --e d y Pacific Gas & Eleciic Company DeAnza Service Planning 408/725-2076