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14100179-EXPIREDCITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10121 N FOOTHILL BLVD CONTRACTOR: I lagm I PERMIT NO: 14100179 OWNER'S NAME: FOOTHILL AUTO SERV & DETAIL INC /a77 %ANT f�vD #ISaO DATE ISSUED: 01/12/2015 OWNER'S PHONE: 4088368982 1. aJ . *14f • 03%v PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL E] DEMOLISH (E) GAS STATION (1445 SQ FT); CANOPY License Class Lic. # (1455 SQ FT) AND ALL SITE PAVEMENT AND Contractor if _A� Date IMPROVEMENTS FOR PROPOSED DEVELOPMENT. 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 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 permit is issued. 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 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, costs, and expenses which may accrue against said City in consequence of the 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. J ,_ � vim"^ Date Sienature ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1, 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) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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 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 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 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 forthwith comply with such provisions or this permit shall be deemed revoked. 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 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, costs, and expenses which may accrue against said City in consequence of the 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. Signature Date Sq. Ft Floor Area: I Valuation: $42000 APN Number: 34232070.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: :1 ��G!`f Date % �a f5 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. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. Owner or authorized agent: 6111(-t Date: CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional 7 DEMOLITION PERMIT APPLICATION 0 COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION `� 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 C U P E RT I N Q (408) 777-3228 • FAX (408) 777-3333 • buildinc(aacupertino.orq PROJECT ADDRESS. 1 O � � � �.. � � 1 � I L I APN a 3 3 -7c O\4NER YA1tE F. -JL -.,l a SQrvl, { 6 e4� . 1 HONEq E-\1111. y STREET ADDRESS ' d 12 + N o eQ `� , I ( 8 �4� CITY, STATE; ZIPU c.. olj%^.. c A 9501 FAX 1 + CO\TACT NAME h P-� h cl• ` a 1✓'� PHONE [- g t O-' O 3 I u E•h1AIL STREET ADDRESS ' .r T(P�� nQ�nQ •J CITY. STATE, ZIP I�r .✓01 C `Pte e t FAX y 5 � ❑ OWNER ❑ O%kNER43UR-DF-R ❑ OWNER AGENT xCO\TRACTOR ❑ CONT-RACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER CI TENA\7 CONTRACTOR NAME D� ^ �✓ 1 j ' 11 -NSE NUMBER. LICEYSETYPE BU.S. LIC -a FAX e1 COMPANYNA"{F.. ', �� F-hSAIL I I' STREET ADDRESS . i 7 �� `�'+f;q I v-^ }, �J CITY. STATE,. ZIP ^ rQ c � C � PHONE loj O J DESCRIPTION OPWORK I .: O (`� �jo; (� �` 0 • : Q t 2P^e •<1 C� CP Ao q n- 0 f^—V- 4 $ r t n + t;'enor...}4 s1:...,-.�.�:� 3Ca C f�r"4�tA 1 eYcAlv,l:N. !2 S.rjPWQ''C lei RESIDENTIAL H. DwELLINO OFP USE ONLY Qc. TYPE SO, FT. V F,'AIION FLOOR AREA je7f,' UNITS CONMERCIAL II�� FLOOR AREA 10.0 TYPE OF CONSTRUCTION s f ¢c 4 STORIES ' AQt,ID.JOB .N'U,MBER _ 1 ` � � J #: J ?f/T_ALVA UAT M By my signature below, I certifv to each of the t'ollowing: lain the property owner authorized agent t n the property o�vler's behalf I have read this application and the intarmation I have provided is correct. I have read the Description of Work and verily it is accunite. I agree to comply Keith 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: r Dale_, e 2 SUPPLEMENTAL INFORMATION REQUIRED PRIOR TO ISSUANCE OF DEMOLITION PERMIT OFFICE USE ONLY PIAN CIIECX TYPE Provide Job Number from Bay Area Air QualitX Management District www.baa\lmd ore .rf 415-749-4762. ✓/_ Provide three copies (I3esidential) six copies (C merical) of a site plan showing protection for any trees 10" EXPRESS in diatyuter or more a4 3' above grade. ©STANDARD Provide letter from PG&E (•108-725-3325) stating all gas and electric has been disconnected. L MME MAJOR r c a letter of inspection, tests, and abatement of any Hazardous Materials. Letter to be initiated by person(s) reified in. asbestos; meremv and/or hwardous Material examination. Dept clearance to verif'�• building is not considered an historical landmark. Allow 10 business days. _t,�Planning �p4vide letter of clearance of all vermin from a licensed pest controlcontractor. x lieant shall call tete Public Works Department at 408-777-3104 and schedule a "habltabledwelling" inspection, Provide signed Debris Iain and Recyclable Materials form. Demo.4pjJ_20I3.doe reviser! 02/13;'13 s^ CITY OF CUPERTINO M` FEE ESTIMATOR - BUILDING DIVISION 19 ADDRESS: 10121 N FOOTHILL BLVD DATE: 10/29/2014 REVIEWED BY: MELISSA f'lu�t E "hcA l ��e: APN: 342 32 070 BP#: 14090172-14090182 `VALUATION: 1$42,000 PERMIT TYPE: Demolition Permit (1111) K F) t PRIMARY USE: Commercial Building PENTAMATION PERMIT TYPE: 1 COMMLDE WORK DEMO (E) GAS STATION & CANOPY 3 SCOPE 300S.F.) FEE ID FLR AREA (s.f. 1DEMOCOM 3,300 0I—,,. NOTE: This estimate does not include fees due to other Departments (ie Planning, ruottc worsts, rtre, 3antrary Sewer valrtct, acauut n:�.,.:Th— f—r ora hacad an tho nroliminary information availahle and are only an estimate. Contact the Dept for addh 7 info. FEE ITEMS (Fee Resolution 11-053 Eff 71/!13) FEE QTY/FEE MISC ITEMS f'lu�t E "hcA l ��e: Permit Fee: $860.00 Suppl. Insp. Fee -O Reg. OOT 0,0 hrs $0.00 ltrri?b. ;1lecrr., LCL- P"i-mil 1'ec. r- I Strong Motion Fee: IBSEISMICO $11.76 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $2.00 SUBTOTALS: $873.76 $0.00 TOTAL FEE: 1 $873.76 Revised: 08/20/2014 American Integrated Services, Inc 1070 Horizon Dr., Ste. A Fairfield, CA 94533 Regulation 11, Rule 2 Acknowledgement of Notification and Payment of Fees 10/27/2014 Job No: 4J933 Invoice No: 3LP05 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 10121 N. Foothill Blvd Cupertino, CA 95014 Start Date November 10, 2014 OFFICE COPY Completion Date November 28, 2014 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 iimnediately copy the District by fax or by mail. REGULATION 11-2 REVISION BAAQMD J# 4J933 REVISION # START DATE COMPLETION DATE 1 I I l 2 I I l I 3 4 ! I l I 5 I I I I NOTE. Ibis fonn is not intended as a verification of either the completeness of your original notification or of its compliance with BAAOMD Regulation 11-2:'Ifyou have any questions about this acknowledgment, please call our office at (415) 749-4762. - COMPLIANCE & ENFORCEMENT BAY AREA AiRQUALiTY DIVISION MANAGEMENT ' D I ST R I C T American Integrated Services, Inc 1070 Horizon Dr., Ste. A Fairfield, CA 94533 Regulation 11, Rule 2 Acknowledgement of Notification and Payment of Fees 10/27/2014 Job No: 4J933 Invoice No: 3LP05 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 10121 N. Foothill Blvd Cupertino, CA 95014 Start Date November 10, 2014 OFFICE COPY Completion Date November 28, 2014 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 iimnediately copy the District by fax or by mail. REGULATION 11-2 REVISION BAAQMD J# 4J933 REVISION # START DATE COMPLETION DATE 1 I I l 2 I I l I 3 4 ! I l I 5 I I I I NOTE. Ibis fonn is not intended as a verification of either the completeness of your original notification or of its compliance with BAAOMD Regulation 11-2:'Ifyou have any questions about this acknowledgment, please call our office at (415) 749-4762. - BAY AREA AIR QUALITY MANAGEMENT D I S T R I C T A REMINDER If there are any changes to any aspect of the notification submitted, including the starting or completion dates, amounts of RACM removed, changes in contractor or waste disposal site, you must inform the District per Section 401.5. 401.5 Schedule Changes and Up -dates: Any changes to any aspect of a notification submitted in accordance with Section 11-2-401.3 must be reported to the APCO. These changes shall include, but are not limited to, changes in the notified starting or completion dates, changes of amounts of itACM to be removed, and changes of contractor or waste disposal site. It shall be the responsibility of the person making the initial notification of intent to remove asbestos or perform demolition activity to ensure that the APCO is notified of any such changes. if a lob starts prior to the reported starting date or continues past the completion date as shown in the notification of intent to remove asbestos or to demolish, this shall constitute a failure to notify. Failure to notify the APCO of a iob fees as would have been due had the job not been cancelled or postponed. Revisions to the information stated in the notification form must be made in writing using the Acknowledgement Letter form and can be faxed to 415-749- 4558. 939 ELLIS STREET, SAN FRANCISCO, CALIFORNIA 94109 (415) 771-6000 H:\Enforcement\ASBESTOS\RE M I N DER.docx Pacific Gas and Electric Company' August 18, 2014 City of Cupertino 10300 Torre Ave Cupertino, CA 95014-3202 10900 No. Blaney Avenue Cupertino, CA 95014 SUBJECT: GAS AND ELECTRIC REMOVALS AT 10121 N. FOOTHILL BLVD, CUPERTINO 95014 To Whom It May Concern: The gas service at the subject property has been cut off and removed as of August 11th and the electric service has been removed as of August 15, 2014. If you have any further questions, please contact me at (408) 309-3812. Sincerely, Anita Davidoo Pacific Gas & Electric Company DeAnza Service Planning 10900 N BLANEY AVE CUPERTINO CA 95014 Cc: File OFFICE COPY `1c SlGENTlAL GoMMERc,q( 4N)vj— Pest Control 6800 Sierra Lane • Dublin, California 94568 • 925-556-1249 (p) • 925-556-9086 (f) October 29, 2014 RE: Rodent Inspection City of Cupertino Building Department Delivered via email: don. ludla»a(ae,erm.com, melissan(�cupertino.org To Whom it May Concern: On October 27, 2014 the vacant building located at 10121 N. Foothill Blvd, Cupertino CA was inspected for evidence of an active rodent infestation, or lack thereof. • No evidence of rodent activity was found Feel free to contact us with any questions or concerns. Sincerely, Bill Heyes Manager Day & Nite Pest Control Co. OFFICE COPY "The Difference is Day & Nite!" �iltif 1„ f,, City of Cupertino Public works Department Environmental Programs Division 10300 Torre Ave '! Cupertino, CA 95014 CUPERTINO GREEN - ftimm (408) 777-3354 Construction and Demolition Recycling Diversion. Requirements and Instructions Covered projects, or all construction, demolition and renovation projects that are 3,000-scluare 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. 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: ❑ lam 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. f/ 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 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 www. cupertino.orelenvironmental. Signature: Irl �) I Date: (' Name: (printed) n L. `J I Q r^ Title: Cdra-Cl" Me),&der Phone: q *),S - V W' - 03 Project Address: 10 1 21 N. E COPY This form to remain in the project's building permit file for the duration of the project. Revised 317112 1 j Waste Management Plan Environmental Programs Division Construction Et Demolition Debris 408 777-3354 City Of Cupertino environmentat@cupertino.org CUPERTINOGREEN v MUST BE SUBMITTED WITH PERMIT APPLICATION. All projects which exceed 3,000 square feet must recycle 60% of the material generated. Permit applicants that fall within the Covered Projects guidelines are required to complete the following Waste Management Plan for the City of Cupertino. At the conclusion of the project, the permittee must file a "Construction Recycling Report" 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. Ask your hauler, recycler or site cleanup vendor to assist you with this plan. Weight tags of all material recycled and disposed must be submitted once the project is completed in order to receive a Final Building Inspection._ Project Name: F,44 '.I i Seri-�1` 6 6e1- - ( Permit No: Location: T o i )-1 Prepared By: 1...-A'trr"\ Phone: `T 25- If "' 3 i`t Company Name: IE IN - W,.,1Email: J an, a aw. e_, Company Address: i 1 �"� t rem v '500w, (, C. e e l� C Project Type: ❑ New Construction Demolition Renovation Project Square Footage: --2- l odol A. Material to Recycle or Reuse. The facility to which the materials will be hauled should be chosen from the attached list of facilities. Alternative facilities, special salvage or reuse options may be requested by the Environmental Programs Division, Public Works. Check all boxes that apply for each material type 21. This is your plan—you can make changes on your final report. MATERIAL a W D Q O U Cr o N p DESTINATION FACILITY (indicate "to Newby Island LandfillZ by Recology" or provide name of facility for self -haul) Mixed C&D Debris N zv 1 S Asphalt & Concrete VS�'Y• C <<: a r Brick / Masonry / Tile V1, Cabinets, Doors, Fixtures, Windows Carpet Carpet Padding/ Foam j Cardboard j Ceiling Tile (acoustic) N� Dirt / Sod I IVe . Drywall (unpainted) I e Landscape Debris Z t Metals S I Roofing Materials IV Wood / Lumber ' Other Material (list): Trash • e d Self -Haul ❑ Roll -off Box (franchlised w/ City of Cupertino) ❑ Both Approval by the Environmental Programs Division, Public Works of this ellaiias plyi ' h��� shall be a condition of any building or demolition permit for all covered(JFFICE NOTE: If you enlist the services of a hauler or clean-up company to take the materials to o facility for you, ensure they are aware of the Construction and Demolition Recycling Program and CMC 16.72.050 and can provide you with the required information. Inform the hauler they must take material to an approved facility and are required to provide weight tickets showing proof of recycle. 1 understand I am responsible for complying with the requirements of the Cupertino C&D Ordinance. I agree to submit a Final Report for this project within 60 calendar days after completion. / Applicant Signature:' �'1—_ Date: (° 12 �'t I Covered Projects include all construction, demolition and renovation projects that are 3,000 square feet or greater. Applicants seeking building or demolition permits for the above mentioned projects are required by Ordinance 16.72 to recycle or reuse 60% of the material discarded. Z The City of Cupertino contracts with Newby Island Landfill, owned by Browning-Ferris Industries (BFI) for waste disposal. Revised:1110/12