14060168211
CITY OF CUPERTINO BUILDING PERMIT
BI I LDING ADDRESS: 10215 S FOOTHILL BLVD
CONTRACTOR: XIE WEN TING AND LIU
PERMIT NO: 14060168
WESLEY W
OWNER'S NAME: XIE WEN TING AND LIU WESLEY W
12601 LIDO WAY
DATE ISSUED: 06/26/2014
OWNER'S PHONE: 4083984841
SARATOGA, CA 95014
PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
SFDWL DEMO, 1,100 LIVING SQ ,455 ATTACHED GARAGE
License Class Lic.#
Contractor Date
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
Sq. Ft Floor Area:
Valuation: $5000
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: 34214076.00
Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
1 certify that I have read this application and state that the above information is
PERMITEXPI WORK IS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating
WITHIN 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 FROM LAST 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
`
Date:
granting of this permit. Additionally, the applicant understands and will comply
Issued by:
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
RE -ROOFS:
Signature Date
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.
r /
/ OWNER -BUILDER DECLARATION
oil
��' """ ttv�i
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
st ct the project (Sec.7044, Business & Professions Code).
I have read the hazardous materials requirements under Chapter 6.95 of the
Wco
11California
Health & Safety Code, Sections 25505, 25533, and 25534. I will
ely, 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 25 5, 25533, and 5534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent: Date :b hkIM-
permit is issued.
I certify that in the performance of the work for which this permit is issued, I shall
no 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
CONSTRUCTI 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 er the Cupertino Municipal Code, Section
Licensed Professional
9.18.
Signature Date (O
CUPERTINO
DEMOLITION PERMIT APPLICATION c(n�
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION D�.!'
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(d)cuperti a gM r
PROJECT ADDRESS �. /
/ j
APN # N
OWNER NAME
PHONE �)
E MAI/ele yla%
STREET ADDRESS, / ,
CITY, STATE, ZIP Qui (i1 /
FAX
CONTACT NAME
PHONE
E-MAIL
STREET ADDRESS
CITY, STATE, ZIP
FAX
OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME i�e V ; l/ j t70W�
LICENSE NUMBER �� r
L�
LICENSE TYPE
BUS. LIC #
COMPANY NAME `` n� ``//LA
07 6 J I
E-MAIL
FAX
STREET ADDRESSyj-)
CITY, STATE, ZIP _O 0
(�
PHONE,1 n�
�C/ /
DESCRIPTION OF WORK
OL o O
yy� 0
RESIDENTIAL
# DWELLING
0
OFFICE USE ONLY
USE OCC. TYPE SO. FT.
VALUATION
FLOOR AREA L le O
UNITS
COMMERCIAL
FLOOR AREA
TYPE OF CONSTRUCTION
#STORIES
AQMD JOB NUMBER
RECEIVED BY:
TO L VALUATION:
J #:
, d0
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 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 con traction. I authorize epresentatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: Date: 6; 2 67 14!
SUPPLEMENTAL INFORMATION RE RED PRIOR TO ISSUANCE OF DEMOLITION PERMIT
OFFICE USE ONLY
PLAN CHECK TYPE
Provide Job Number from Bay Area Air Quality Management District www.baagmd.orQ @ 415-749-4762.
❑ EXPRESS
_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.
❑ STANDARD
_%/ Provide letter from PG&E (408-725-3325) stating all gas and electric has been disconnected.
11 LARGE
Provide a letter of inspection, tests, and abatement of any Hazardous Materials. Letter to be initiated by person(s)
❑ MAJOR
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.
i 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 02/13/13
CITY OF CUPERTINO
F"Rffo FEE ESTIMATOR - BUILDING DIVISION
FEE ID FLR AREA
s.f.
1DEMORES 1,555
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (F'ee Resolution 11-053 Eft' 7%1 13)
ADDRESS: 10215 s foothill
DATE: 06/26/2014
REVIEWED BY: MEndez
APN:
13P#: / �D
`VALUATION: 1$5,000
*PERMIT TYPE: Demolition Permit
_. .. .
PRIMARY SFD or Duplex
PENTAMATION 1SFDWL-DEM
USE:
Permit Fee:
PERMIT TYPE: A
WORK
sfdwl demo, 1,100 livin _sq_455 attached garage
SCOPE
$0.00
FEE ID FLR AREA
s.f.
1DEMORES 1,555
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (F'ee Resolution 11-053 Eft' 7%1 13)
FEE
QTY/FEE
MISC ITEMS
i
Permit Fee:
$557.00
Suppl. Insp. Feer Reg. Q OT
F0.0
1 hrs
$0.00
t :. uner�titritrrt 1' c'c'.�'.
Strong Motion Fee: 1BSEISMICR
$0.50
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$558.50
$0.00 TOTAL FEE:
$558.50
Revised: 04/01/2014
CUPERTINO
PURPOSE
PROCEDURE CHECKLIST FOR DEMOLITION PERMITS
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(d)cupertino.orq
The demolition application should be applied for before or at the same time as the new construction
pen -nit application (these are separate pennit applications and fees). Permit fees are due at the time of
the application/plan submittal. The new construction permit will not be issued until the demolition
pen -nit is issued, unless a letter obtained from the Building Deportment is submitted stating that "The
existing house will not be demolished until the new construction permit is issued". The letter needs to
be signed by both the property owner and general contractor.
REQUIREMENTS
To obtain a demolition perinit in the City of Cupertino, please complete a Demolition permit
application along
with each of the following requirements as it applies to your specific project.
.
Three (3) copies of a Site (Demolition) plan for Residential or six (6) copies for
Commercial will be required showing any trees 10 inches in diameter at 3 feet
above grade on the subject property, and what means will be taken to protect
nese trees.
2.
PG&E must be contacted AS EARLY AS POSSIBLE prior to demolition to
schedule the abandonment. Contact PG&E at (408) 725-3325. A letter from
PG&E shall be provided to the City, stating that all gas and electric has been
isconnected. (This step can be time consuming, so it is important to begin the
process immediately)
3.
Provide Job Number from Bay Area Air Quality Management District
www.baagmd.gov @ 415-749-4762.
d�AS_4.
Check to see if the building is considered an historical landmark. Obtain clearance
from the Community Development Planning Department. Allow 10 working
days.
5.
Provide a letter of clearance of all vermin from a licensed pest control contractor.
io 6.
Important: Prior to the issuance of the demolition permit, the applicant must can
the Public Works Department at (408) 777-3104 and arrange a "habitable dwelling"
'
nspection.
7.
Debris bin and Recycling sheet: read, sign and date. The sheet will remain in the
project's building permit file for the duration of the project.
8.
Commercial only -prior to issuance of the demolition permit, the Fire Department
must review the plans for fire suppression/ alarm systems that shall remain in
service or be modified during Demolition or that shall be replaced with the new
construction.
DemoProcedure.doc revised 2/13/13
CUPERTINO
OWNER -BUILDER DISCLOSURE FORM
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building cDcuaertino.org
Dear Property Owner(s):
An application for a building permit has been submitted in your name listing yourself as the builder of the property
improvements specified at:
SITEADDRE S 2/ d !,
i'
APN 7B-P#
OWNER NAM /l OV�� ADDRESS
LJ
` r0
DESCRIPTION OF WORK:
v ,Po
We are providing you with an Owner -Builder Acknowledgment and Information Verification Form to make you aware of
your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner -Builder. We
will not issue a building permit until you have read, initialed your understanding of each provision, signed, and
returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless
you, the property owner, obtain the prior approval of the permitting authority.
OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION
(DIRECTIONS: Please read and initial each statement below to signify you understand or verify this information.)
Kle,. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -
Builder" building permit that erroneously implies that the property owner is providing his or her own labor and material
personally. I, as an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by
an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not
provide coverage for those injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my
W_
insurance coverage for injuries to workers on my property.
W ` L2. I understand building permits are not required to be signed by property owners unless they are responsible for
the construction and are not hiring a licensed Contractor to assume this responsibility.
��3. 1 understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may
protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her
name instead of my own.
W - L' 4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license
numbers on permits and contracts.
U-5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the
total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be
W., considered an "employer" under state and federal law.
WCL 6. 1 understand if I am considered an "employer" under state and federal law, I must register with the state and
federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to
unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject
me to serious financial risk.
W, L- 7. 1 understand under California Contractors' State License Law, an Owner -Builder who builds single-family
residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by
licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work
is performed under contract with a licensed general building Contractor.
KA18- I understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for
any financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction
defects in the workmanship or materials.
OwnelBuildeYFonn 2010.doc revised 04114110
I understand I may obtain more information regarding my obligations as an "employer" from the Internal
Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments,
and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State
License Board (CSLB) at 1-800-321-CSLB (2752) or www.csib.ca.gov for more information about licensed
((,c Iontractors.
W` L'I0. 1 am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I
am the party legally and financially responsible for proposed construction activity at the site address listed above.
VL,L11. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide
by all applicable laws and requirements that govern Owner -Builders as well as employers.
�12. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the
information I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If
you contract with someone who does not have a license, the Contractors' State License Board may be unable to
assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed
Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or
employee of that individual or firm is injured while working on your property, you may be held liable for damages. If
you obtain a permit as Owner -Builder and wish to hire Contractors, you will be responsible for verifying whether or not
those Contractors are properly licensed and the status of their workers' compensation insurance coverage.
CONSTRUCTION LENDING AGENCY
(DIRECTIONS: Please complete the following construction lending agency information.)
I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued
(Sec 3097 Civ.)
Lender Name: Lender Address:
Before a building permit can be issued, this form must be completed and signed by the property owner and
returned to the agency responsible for issuing the permit. Note: A copy of the property owner's driver's license,
form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued
to verifv the property owner's signature. /
Property Owner's Signature: Date:
------------------------------------------------------------------------------------------------------------------------------------------
(NOTE: The following Authorization Form is required to be completed by the property owner only when designating an
agent of the property owner to apply for a construction permit for the Owner -Builder).
AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF
Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby
authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an
Owner -Builder Permit for my project.
Scope of Construction Project (or Description of Work):
Project Location or Address:
Name of Authorized Agent:
Address of Authorized Agent:
Tel No
I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the
above information and certify its accuracy. Note: A copy of the property owner's driver's license, form notarization, or other
verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's
signature.
Property Owner's Signature:
Date:
OwnerBuilderForm 2010.doc revised 04/14/10
4S
4 0"
TP. POST
EL EVATION
NOTES
1.
THE DEVELOPER SHALL INSTALL THE "TREE PROTECTION" DEVICES
PRIOR TO THE START OF GRADING OR CLEARING WORK.
2.
THE CITY RESERVES THE RIGHT 70 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.
T.
CONSULT ORDINANCE 7TS OF THE CITY OF CUPERTINO FOR PERMIT
REQUIREMENTS AND EXCEPTIONS.
S.
TEMPORARY CHAIN LINK FENCING IS AN ACCEPTABLE SUBSTITUTE TO
THE WOOD CONSTRUCTION.
TEFF PROTECTION STANDARDS
CITY OF CUPERTIN10-
I 'DETAILS / r- IT " , W., 'V=n, - 7-1 1
APPROVED BY : DATE ; �()/
I � ? 1175 Dell Ave Campbell, CA 95008 r`�°'N
c << 408-378-0441 aiiMp
K%�llDy WdS HCl E 1-888-KILLROY (1-888-545-6769) ►rr .rr/w _ .. o� .:..
www.Killroy,com
May 20, 2014
To Whom It May Concern,
Killroy Pest Control has inspected the property at 10215 S. Foothill Blvd.,
Cupertino for pest infestation.
No infestations were found during the inspection.
If you have any questions please call me at (408) 378-0441 vm 105.
Sincerely,
Andrew Gibson
Pest Management Professsional
Killroy Pest Control, Inc.
www.killroy.com
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.
Rco 1s the only debris bin service provider franchised to do business in Cupertino.
vP'�L W
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.£, 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 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/enviror2mental. Report the tonnage recycled and disposed, by material t)pe..
Recycling facilities must be selected from the City's approved list of Recycling Resources.
✓ Submit a Construction Recycling Reportform. 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 i4,viv.cupertlno.oiglenyironmental.
Signature: r Date: G/2
Name: (printed) I-WlhS G "' j /, /y
Title:
Phone: 3 q�—��
P.,rojectAddress: e, 6Wtz-1— aLvQ ,
This form to remain in the project's building permit file for the duration of the project.
Revised 317112 1
City of Cupertino
Public works Department
Environmental Programs Division
Id
10300 Torre Ave
Cupertino, CA 95014
CUPERTINO GREEN
Frog ram
(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.
Rco 1s the only debris bin service provider franchised to do business in Cupertino.
vP'�L W
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.£, 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 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/enviror2mental. Report the tonnage recycled and disposed, by material t)pe..
Recycling facilities must be selected from the City's approved list of Recycling Resources.
✓ Submit a Construction Recycling Reportform. 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 i4,viv.cupertlno.oiglenyironmental.
Signature: r Date: G/2
Name: (printed) I-WlhS G "' j /, /y
Title:
Phone: 3 q�—��
P.,rojectAddress: e, 6Wtz-1— aLvQ ,
This form to remain in the project's building permit file for the duration of the project.
Revised 317112 1
COMPLIANCE &
ENFORCEMENT
BAY A RE A
A►RQUALITIr DIVISION
MANAGEMENI-
D l S T K I C T
Grand Nest Construction
13438 Ward Way
Saratoga, CA 95070
Regulation 11, Rule 2
Acknowledgement of
Notification and
Payment of Fees
5/30/2014
Job No: 4G351
Invoice No: 3JL34
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 10215 S. Foothill Blvd
Cupertino, CA 95014
Start Date June 14, 2014
Completion Date July 15, 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 immediately
copy the District by fax or by mail.
REGULATION 11-2 REVISION BAAQMD J# 4G351
REVISION # START DA'1"E COMPLETION DATE
I
2
4
5
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. Ifyou have any questions about this
-acknowledgment, please call our office at (415) 749-4762.
DATE: June 24, 2014
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:
JUNE 11th ,2014 @ 10215 S Foothill Blvd, CUPERTINO CA
SUBJECT: ELECTRIC SERVICES WAS CUT AT POLE ON:
June 23rd 2014 10215 S Foothill Blvd CUPERTINO CA
If you have any question contact us at (408) 725-3325
Sincerely,
John Gambucci
Pacific Gas & Electric Company
DeAnza Service Planning Dept.
10900 N BLANEY AVE
CUPERTINO CA 95014
D
m
c
N
N
➢v•
m 3.0
M9
mem
�zT
0
O m
mx0
m
c
v
z
c�
4f
z
m
m
7J
m
m
D
m
A
T
r
m
0)
m
m
rn
x
m
m
y •1 tN d 4A
N
ZrC tom" Off'
cPdmFl O m im'_ $ O
Oi ZO ➢ 2 m iG C)-4Z� ��� + O i `ro �(A
n HA '� Plyp.' O O b N m m A Y n....,� \l
^� 0]C Il Ayl M P}•m O� T ~ A .. /mom
` a z G ni• `i -1 O r y -i 1'/ 4 M -• n. •:Aca t/
c - m Mo ca o -4 m x_ n, y z -� v S� ■O■��
r1 rr-- > p_ fy O c
m� m m 7a i Ci z� M MW S y
1\ F O Z 0 3 Nm -4r O (lX 7' F3'.. n
\\_\J n N •R fn T Imn O' $ Y_ N r D t O
c. (<in vv zm m v1.0 �x
[1 I�1 m �. < O �! fR x O x m' �. N O
r� m m A m Frc �' S y 5 n
n
oz z �� m� A Am ■}I ry
m m M a
Mx -0 N w z x /1I
c a z> rq o so "-+ m
nm tty my mn+ a
v m ^f
trl ,may n2 Im+F ¢ O S O
i4 Z O !h w 2 w A 7c y A
x ys
w cR �A. r iqm • � o ' s a
p O w.mC r
-io wo rn4 m npy
S m n =m ,m iim :m N 1,I
9 m C n r
°z o
° 0
a
a
3
Ul
iV
-
N �Om
� N - C C1 '•
OW U m'
b it
6i N S. ..1 N i9fii'
Z
e� N rn rn
r A.s3ccn oinv Nl s _ _ ..• i
C6
o o m y(n mc) T o z K r]C�— x0 m n p Oln W 0
s 4 0 0 c3 x
vn wNi m m
F wn,v� �4� R tf1 < p o y o 0
n O`n w w O Win" } a�N �"'_•v' - x A O y� 0
D
gZ e• tD —I OZ O A D a�a+�w AN .T in o'�wi.�i Nwo' i Oao 2
3u o� y 6 Q`� 3 p ��tbd�6oNdobb �ob mo fn6bo b Amo A
3 N O 3a p y3. ti- p >� X X X X X X X X X X x X X X X N X (`}p� X m
Y CT W A OJ OJ N T N W W + N ' • !A
"' R 5 V ! A C <n la A
'0 !1 II n II D
U fi cm S tS p S� • y' \ ^.. W N T T W N Oe W N G dJ Ja
� n C - m z
� HP&
+ � pp.tb\A+ n x P•:� ,\ fJ
nFm]o 0[)O v� a',pin rn �'v�.nm�n p mvi Fn (n cn Fn
Ivn sn � a n w c. ZA�_,A ,loti A N W o cntimm � mFNi <n �
n'u� nfi '�O" 1 a D£J r + D + TT'nyy-T14 OIy TCj �O(J QTrIO T£> {)OT O
c m £J
XV
CO _ N o C ram X TO()XDtn
�` cp �_'A�
'4E ic
1 {�1Ny1 y D O
2
7° m m m
O N N z P -A1 +
a ° +
+
w O m
p m
T m
ti m
a
O
3
O
r
Z
nor
z
o — —
m �m
m�v
ITT m`�
A
O
m
m
r
Z
m
N89050'00"E 144.13' — —
m rr==JF
II i)
II II
k I!
O II y f m II
�m II
�w = ; i
II /v M o II
II y Da II
oc — —v—_--- rr--=--------====—JJ 0 m�
r___ i{ Z mo II
m {
Tcmm {{ I+
O I m®0o m I) I
Z! -vzm II II
O X O m
®
-<
Nv < I =J
cn I o a� ^� II
zTmz
'I � mczixa II II
rn I < Z o°° II II
PEI
I Z �_______________�------�
2 — — — — — — —
_ I m I
L -----
r I >
0 ooO o
mmm I �m { v 2
o I W m I `' 2
' omm L
mmA
b !!
- _� o cr ;i r , - _s 1 y fA
-
W O U R «
W '�
p p J C y m ...
z m
Q r < m' m ■
NORTH
y °' S89050'00"W 144.01'
r p =}. 3 m 6, C C 2
p Km °m$ V �o p N o P§ D
W O 3� --Sia �0 O! Q
ro o 0
O m O. m
® to ocn �om O cog
3•C v
S < 2 a aC "�
0 w' 0 Zi 3 O iTa _
N z
m - m m Z% m
m (Q
n
II
I
HKOLWq2to
1-1019ii
II
II
Li
i
C
y
1
r
0 a
mm
rn
V
ti
z
1-•1��1
111
G)
G
�
0
0
n
m
m
X
m
o
m
a
Z
m
v
v
1408)
I, Z-529-608-
10215• • BLVD.•
y •1 tN d 4A
N
ZrC tom" Off'
cPdmFl O m im'_ $ O
Oi ZO ➢ 2 m iG C)-4Z� ��� + O i `ro �(A
n HA '� Plyp.' O O b N m m A Y n....,� \l
^� 0]C Il Ayl M P}•m O� T ~ A .. /mom
` a z G ni• `i -1 O r y -i 1'/ 4 M -• n. •:Aca t/
c - m Mo ca o -4 m x_ n, y z -� v S� ■O■��
r1 rr-- > p_ fy O c
m� m m 7a i Ci z� M MW S y
1\ F O Z 0 3 Nm -4r O (lX 7' F3'.. n
\\_\J n N •R fn T Imn O' $ Y_ N r D t O
c. (<in vv zm m v1.0 �x
[1 I�1 m �. < O �! fR x O x m' �. N O
r� m m A m Frc �' S y 5 n
n
oz z �� m� A Am ■}I ry
m m M a
Mx -0 N w z x /1I
c a z> rq o so "-+ m
nm tty my mn+ a
v m ^f
trl ,may n2 Im+F ¢ O S O
i4 Z O !h w 2 w A 7c y A
x ys
w cR �A. r iqm • � o ' s a
p O w.mC r
-io wo rn4 m npy
S m n =m ,m iim :m N 1,I
9 m C n r
°z o
° 0
a
a
3
Ul
iV
-
N �Om
� N - C C1 '•
OW U m'
b it
6i N S. ..1 N i9fii'
Z
e� N rn rn
r A.s3ccn oinv Nl s _ _ ..• i
C6
o o m y(n mc) T o z K r]C�— x0 m n p Oln W 0
s 4 0 0 c3 x
vn wNi m m
F wn,v� �4� R tf1 < p o y o 0
n O`n w w O Win" } a�N �"'_•v' - x A O y� 0
D
gZ e• tD —I OZ O A D a�a+�w AN .T in o'�wi.�i Nwo' i Oao 2
3u o� y 6 Q`� 3 p ��tbd�6oNdobb �ob mo fn6bo b Amo A
3 N O 3a p y3. ti- p >� X X X X X X X X X X x X X X X N X (`}p� X m
Y CT W A OJ OJ N T N W W + N ' • !A
"' R 5 V ! A C <n la A
'0 !1 II n II D
U fi cm S tS p S� • y' \ ^.. W N T T W N Oe W N G dJ Ja
� n C - m z
� HP&
+ � pp.tb\A+ n x P•:� ,\ fJ
nFm]o 0[)O v� a',pin rn �'v�.nm�n p mvi Fn (n cn Fn
Ivn sn � a n w c. ZA�_,A ,loti A N W o cntimm � mFNi <n �
n'u� nfi '�O" 1 a D£J r + D + TT'nyy-T14 OIy TCj �O(J QTrIO T£> {)OT O
c m £J
XV
CO _ N o C ram X TO()XDtn
�` cp �_'A�
'4E ic
1 {�1Ny1 y D O
2
7° m m m
O N N z P -A1 +
a ° +
+
w O m
p m
T m
ti m
a
O
3
O
r
Z
nor
z
o — —
m �m
m�v
ITT m`�
A
O
m
m
r
Z
m
N89050'00"E 144.13' — —
m rr==JF
II i)
II II
k I!
O II y f m II
�m II
�w = ; i
II /v M o II
II y Da II
oc — —v—_--- rr--=--------====—JJ 0 m�
r___ i{ Z mo II
m {
Tcmm {{ I+
O I m®0o m I) I
Z! -vzm II II
O X O m
®
-<
Nv < I =J
cn I o a� ^� II
zTmz
'I � mczixa II II
rn I < Z o°° II II
PEI
I Z �_______________�------�
2 — — — — — — —
_ I m I
L -----
r I >
0 ooO o
mmm I �m { v 2
o I W m I `' 2
' omm L
mmA
b !!
- _� o cr ;i r , - _s 1 y fA
-
W O U R «
W '�
p p J C y m ...
z m
Q r < m' m ■
NORTH
y °' S89050'00"W 144.01'
r p =}. 3 m 6, C C 2
p Km °m$ V �o p N o P§ D
W O 3� --Sia �0 O! Q
ro o 0
O m O. m
® to ocn �om O cog
3•C v
S < 2 a aC "�
0 w' 0 Zi 3 O iTa _
N z
m - m m Z% m
m (Q
m
1// m
O
m
mm mf -
O o �v11
O Z O A
r-----� 1 mnD
m
I I / -mi -.-j PR
{ I mm
+ � m m
HKOLWq2to
1-1019ii
a
i
C
y
1
r
0 a
m
rn
o
z
I
B
n
.
cA
a
HDL DEVELOPMENT LLC
_ r
7
m
1// m
O
m
mm mf -
O o �v11
O Z O A
r-----� 1 mnD
m
I I / -mi -.-j PR
{ I mm
+ � m m
o
m
\ m
� z
0o m
HKOLWq2to
1-1019ii
I'1'111�
RESIDENCE
•
•
—s T*wn
a
HDL DEVELOPMENT LLC
_ r
7
1408)
I, Z-529-608-
10215• • BLVD.•
"
BONNET WAY 0 SARATOGA, CA. 95070
CUPERTINO, CALIFORNIA 95014
m 0
119034
APN# •
o
m
\ m
� z
0o m
I'1'111�