D-2017-0033CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: D-2017-0033
18890 BARNHART AVE CUPERTINO, CA 95014-3602 (375 33 011)
CHUEN YANG YANG
SAN LEANDRO, CA
94579
OWNER'S NAME: RAI NIRAJ AND AGRAWAL LORI
DATE ISSUED: 06/01/2017
OWNER'S PHONE: 408-799-8605
PHONE NO: (510) 213-9981
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class a Lic. #897965
Contractor CHUEN YANG YANG Date 06/30/2017
— BLDG —ELECT —PLUMB
MECH X RESIDENTIAL COMMERCIAL
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.
JOB DESCRIPTION:
DEMO SFD (814 SF); GARAGE (225 SF)
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
C 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
Sq. Ft Floor Area:
Valuation: $10000.00
permit is issued.
APPLINT •RTIFI ATION
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
APN Number:
Occupancy Type:
and state laws relating to building construction, and hereby authorize
375 33 011
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 applicant understands and will comply with all non-point
source regulations er the Cupertino Municipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
SignaturDate 06-01-2017
Issued by: Kim Dunbar
OWNER-BUILDER DECLARATION
Date: 06/01/2017
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 of Applicant:
contractors to construct the project (Sec.7044, Business & Professions Code).
Date: 06-01-2017
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. 1 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 Cupertino Municipal Code, Chapter 9.12 and
exemption, I become subject to the Worker's Compensation provisions of the
the Health & Safety Cotions 25505, 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: 06-01-2017
1 certify that I have read this application and state that the above information is
CONST UCTIONLEN14G
correct. I agree to comply with all city and county ordinances and state laws
I hereby affirm that there is a construction lending agenc for a performance
relating to building construction, and hereby authorize representatives of this city
of work's for which this permit is issued (Sec. 3097, Civ
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 06-01-2017
professional
DemoApp_2016.doc revised 03/29116
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City of Cupertino
� J
Public works Department
Envirornnental Programs Division
10300 Torte Ave
CUPERTIMOGREEN
Cupertino, CA 95014
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 flan 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 inforination 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 from a project 3,000 square feet or more in Cupertino can be collected and
disposed by using:
Please check all that apply:
❑ 1 am not using a Recology debris bin, however, the project is less than 3,000 s.£, e.g. buildings, patios,
sidewalks, driveways,
❑ 1 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.
❑ 1 am not rising a Recology debris bin. 1 will provide the following submittals to the City's Public
Works Department, showing that 1 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 andDemolition Waste Management Plan with your buildingperrrrit
rrpplicati.on. No fee for this plan. Forms are available at the BuildirrglPublic PVor ks counter and online
at tvvvrv.caapertirro.org/envir•onrraerrtal. Report the tonnage recycled and disposed, by material type.
Recycling facilities must be selected fi•orra the City's approved list of Recycling Resources.
✓ Stabntit a Corrsti tactivra Recycliarg Report forrar. The report is required before the Building
Departrraerrt }t,ill sclrerlttle a faraal inspection. 2'lre r•eportfor•rri.is available at the Buildlrrg/Ptrblic
Morns Counter and online rvvvvv.cupertino.org/errvij_o{rrrrentrrl.
Signature:
Narne:
Title:
Phone:
Project Address:
This form to remain in the project's Wilding permit file for the duration of the project.
Revised 317112 1
ate:
SOS PEST CONTROL
214 Christich Lane #103
Campbell -5
CA9.50.08
Rpdent Inspectioxt C!"rance
Date *, Rimy 26, 2017
Ro: Propedy. Add9890 res ' g- 1.. . .Bamhart tt�, CA 95014
'To wham''it Moy conoel=
T1 rte ty At the-,4bqv-o-I asp t a fort :any 1h-fe$..tq io. ii. hts, N
adiv& infestafto was ffound, IVYou have any hriher qiies-bo-�a, pievgff our ox MI
aw CC at
(408)
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Bratich H Field Repre.setitafive
Regulation 11, Rule 2
COMPLIANCE &
o=hwr A ENFORCEMENT Acknowledgement of
B A Y A P. L A Notification and
AiPLO_UALITY DIVISION
ISI AKA:C4.LUE N-� Payment of Fees
Nirai Rai
27550 Edgerton Rd
Los Altos Hills, CA 94022
J#:513246
Invoice No: 3ZK85
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 18890 Barnhart Ave
Cupertino, CA 95014
Start Date May 30, 2017
Completion Date June 25, 2017
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# 5B246
REVISION # START DATE COMPLETION DATE
1
2
3
4
5 ! I 1 1
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 (415) 749-4762.
Pacific. Gas and
Electric Company"
DATE:06/01/17
CITY OF CUPERTINO
10300 TORRE AVE
CUPERTINO CA 95014
90900 No. Blaney Avenue
Cupertino, CA 95014
SUBJECT: REMOVAL OF OAS SERVICES CUT @ MAIN IN THE STREET ON: 15890
BARNIHART AV_E ON 021,21./17
SUBJECT: ELECTRIC SERVICES WAS CUT AT POLE ON:
18890 BARNHART AVE ON 05/31/17
If you have any further questions, please contact me at (408) 725-2076
Sincerely, .-
Maris Kennedy
Pacific Gas & Electric Company
DeAnza Service Planning
408/725-2076
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RAI
j uP� uQu RESIDENCE
I ILL,
xcn 18890 BARNHART AVENUE
CUPERTINO, CA
AIN: 375-33A11
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