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D-2017-0031CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: D-2017-0031 21030 GARDENA DR CUPERTINO, CA 95014-1616 (326 08 044) PROVISION DEVELOPMENT INC SUNNYVALE, CA 94085 OWNER'S NAME: SIVAPRAKASAM SURESH DATE ISSUED: 05/24/2017 OWNER'S PHONE: 408-382-1690 PHONE NO: (408) 245-0991 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class E Lic. #858391 Contractor PROVISION DEVELOPMENT INC Date 05/31/2019 —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: DEMOLISH (E) SINGLE FAMILY DWELLING (1215 SQ FT) AND I hereby affirm under penalty of perjury one of the following two declarations: GARAGE (640 SQ FT). t. 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 performance of the work for which this permit is issued. 2. I have and will maintain Worker's Compensation Insurance, as provided for by _ ti�j ^ Section 3700 of the Labor Code, for the performance of the work for which this Sq. Ft Floor Area: Valuation: $16000.00 I 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 APN Number: Occupancy Type: and state laws relating to building construction, and hereby authorize 326 08 044 representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep har City of Cupertino against liabilities, judgments, cost�Fl pen ich PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said City in consequeace^aMr of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally, the applicant under end wi ply with all non -point source regulations per t pertino ipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Sign ate- Issued by: Kim Dunbar OWNER -BUILDER DECLARATION Date: 05/24/2017 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 r. 1, 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) z. 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: 05-24-2017 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. 1 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 Dist a.I-- Worker's Compensation laws of California. If, after making this certificate of will maintain, compliance with the Cupertino Municipal Cod er exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety Code, Sections 22W590 s 35533, 4. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authoriznf: APPLICANT CERTIFICATION Date:05-24-2017— I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY correct. I agree to comply with all city and county ordinances and state laws I y affirm that there is a construction lending agency for the performance relating to building construction, and hereby authorize representatives of this city f 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 05-24-2017 professional DEMOLITION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION ,0300 TORRE AVENUE o CUPERTINO.. CA 9501:4-3255 (-- (408) 777-3228 • FAX (408) 777-3333 • buildma�cupno org CUPERTINO I PRO.iEC AJDREss 21030 GARDENA DR., CUPERTINO. CA 95014 At'�' 326-08-044 OWINFKNAME SIVAPRAKASAM & UMASHANKARI SURESH pF1ONt408-382-1690 e-,vSAIL SURESH@NUTANIX.COM ; U SHANKARI@YAHOO.COM__ srREEI ADDRFSS 17998 ARROYO LANE. I c-rt�-_ sr.ATE. /IP SARATOGA, CA 95014 FAN eci?:IAcr tiAnrr_ JOHN HA R�'a 1' 408-245-0991 JOHNHAHA99@GMAII_COM sTKeFr:\uu F`S 510 LAWRENCE EXPRESSWAY. 4105 c'n-sr,TE til' SUNNYVALE. CA 94085 i' 408-245-071 OWNFR ❑ OAkNFR-BCILDEK OAV\LR 4G1=>T ix; ll:,i(-I OR ❑CONR VC -VOR AGL>l ,�X AR( -F;Il llr'T GA(A"�llh I)P:A'71(liEr. _ ro'\ I RACTOR sANfle JOHN HA jCyfiI WN9HeR I It ^:sr l vr1= DBP, 858391 ha"^I'A^` `!MF PROVISION DEVELOPMENT. INC. I " rt JOHN HAHA99@GMAIL.COM 408-245-0711 ReLr.A°DRESS 510 LAWRENCE EXPRESSWAY.105 II l slnre_711' SUNNYVALE, CA 94085 ''1'O'E 408-245-0711 Dk;SC'KIPIIO" OF WORK DEMOLISH EXISTING STRUCTURE AND REMOVE EXISTING CONCRETE WALKWAYS/BLOCKS ON PROPERTY KESIDEN-I ML 1215 SO FT f I OOR 4REA �..1 Nile oFFrcE "s,ont,i _ ISE j OCC' TY I SC1 F -. AAL!'MON C,)n1,�1CF( IAL 0 SO FT� f FLOOR AR1 \ _ ---------- . _.---- ---- --- - ' — lPI'I.OFCUNCiRUCiIOti V_B ;,, - VI -3 AQ441)IOf9 N um'FR j.. 58245 RF(E F"FI) BI': �� (>��'A:.I 4llQ . D� 0,my signature below. 1 ce t:'' to ercl o!'0i,,' it r o,��r,_ , . , the ;Top' -1-1 (M TIC' (n ,.. ' lied I" ,1'-! or the ro,,el7v' me er - •,i 1 rpphcation and the iriforrnatio ) i i .:\ e u (�'iaed I, e c (�: h::� e � id uu f) .urir tier of V'` (: h � ( :r It 1 ,eeur I �rce t , co � ; r11 , c 1 :e ' c,. ordinances ans d Mate lawrelaim- to h I Idrn- co:.sr:uc�m 2u r�r �� Ferrexnta,i� es of ( fpc:tlrr t„ C".ICL illc hoc e Iden'ificd proncn; lon,�. e uun„ u, SLPPLLMI.N"IA' IN! 01 v1 ,.I'(t. Ria?I lk! I' 1'I:IOlZ I(I 11' 'A"( orruF l.to�ly � - F1,�1A( I (K17FF_ X t'rov-1C1C.IobNuITIbc iron' I'.�� ,��ca - u,,„, �n�� cr.Icn< I)I�cjicl, x_ Yrcvide three cubic, ( , �iu 111illi -hOv I!:,,' nmlc j(i �, 1 "'c' Iri:ir; ' Hour. ,r rr ahc)cc glade- -._ � Sr-t�r)arzn x I'rov ide letter from 1'(J&,[ 1'9(IS 7 � ; ' I:ur c,_ ,1 I �,. ,illd , ic'(tu 1( lith ecu alscr llW ucc)- I'lannim,, Dept cicarimce to �, I Ifs buiidl :,not c ),Isid clue; an hist(riaJ I,111,11 im_ A110Nc 10 hecrr�csS NON'S. ( __ ��6�V u ""OR x Provide letter of clearanrc of Al vcrml) lion. ti iic�iiscd pct control cOnll,ictnr. X Applicant Shall call t e Publicaork- Uepa mint a: X08-, d l(14 and Seheciulea 'h�tbit.)i)Ic dwelling' inspecti�. x l'ro rde signed Dehns lair; ; nd Rcc� clahie �1atcriaLc 1nrrn. t- N/A Commercra! [311ildin>s Onl1';idc I -Ire ( t clearance ii)rtire supPre,tiloralarm em rev'leNr- Dem” 11;t 10, o ,loc ri i ice;- i %9 miPacific Gas and Electric Company. E DELIVER ENERGY." MAY 207", 2017 DAVID BAKER 21030 GARDENA DR. CUPERTI:NO, CA 95014 PE: 21030_GACRDENAWZCU1P P_CTN0, CA = 95014 Order Number: 1.1122235 To, wham it may concern, The gas meter at the above referenced address has been removed and the gas service was cut off at main on (04116116). The electric service & meter at the above referenced address has been disconnected and removed on (05/08/17),. Sincerely, Justin Pigg ,Justin Pigg Project Coordinator I Pacific Gas & Electric Co i €9eAnza Divisions 10900 N Blaney Ave. Qspertino, CA 95014 32PYQ P,Gom 10ffice: 408.725.2165 M -E 7:OOAM -- 3:30PM "AVAI€ABLE BY APPOINTMENT ONLY-* "Safety is (I full time job: dant make it a pari time I)ractice" CUPERTINO Building Department 4r REVIEWED FOR CODE COMPLIANCE 4 Reviewed By: SEAN HATCH Date: 05/22/17 Recquiat'ion 11, Rule 2 n- COMPLIANCE & ENFORCEMENT B A Y A R r A Notification and AikCom,,,i-rry DIVISION Payment p { o Fees �+ ?44A NAGE MtN i' p �l dlS f L 'lJ G o:F John Ha 510 Lawrence Expy, #10 5 Sunnyvale, CA 94085 '5/ 17/2017 Job No: 5B245 tnvoice No: 3ZK84 The Bay Nrea Air Quality Management :District (BAAQMD) acknowledges receipt of your payment and your Asbestos Removal or Demolition Plan described as: Demolition Site address 21030 Gardena Drive Cupertino, CA 95014 Start Date May 29, 2017 Completion Date June 8, 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 ii-aniediately copy the District by Fax or by mai I. REGULATION 11-2 REVISION — — BAAOMD J# 53245 REVISION # START DATE COMPLETION DATE 3 1 5 I --------- NOTE: This fornz is not intended cis a verification of either the completeness ofyaur original notification or of its compliance with .BAA0*fD Regulation I1-2. Ifyou have any questions about this acknowledgment., please call our office at (415) 749-4762. CUPERTINO Building Department REVIEWED FOR CODE COMPLIANCE Reviewed By: SEAN HATCH Date: 05/22/17 t City of Cupertino Public works Department Environmental Programs Division 10300 Ton e Ave Cupertino, CA 95014 12cueEnrINO GR9C'M Prngrant (408) 777-3354 CoDsWuction and Demolition Recycling Diversion Requirements and Znstruetious Covered projects, or all construction, demolition and renovation p.rojem 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 matet-ial generated is recycled, hi compliance.With ordinance CMC 16.72,050. At the conclusion of the project a Construction Recycling Report inust be tiled with the Public Works Departrmnt/Envir-on.mental Division shoving 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, Recology' is the amly debris bits service provider franchised. to do business t Cupertino. Debris from a project 3,000 square feet or more in Cupertino can be collected and disposed by using: Please cheek all that apply: CJ I am not using a Recology debris lain, however, the project is less than 3,000 s.f., e.g, bufldings, patios, sidewalks, driveways. [1 will use a Recology debris bin.. By Agreement with the City, Recology will prepare rxty required Waste Manageirrent 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 raid Demolition Waste Management ivitl7 your building peralit application, llro fee for this plan. •Forms are.. available, at the Building/Pt{b/tc Works coLLrttG'r and online at 71nt;rv.ccrpertino. rgleTtviror7raaeT7ta.1. Report III(,' tonnage recycled and disposed, ky nsatarial oym. Recycling.gicili.ties Trtu l be selectedfroin the Cio,'s approved list ofRecrcling.Resources. ✓ S7.rb7rtit a Cor isti,tictiotz Recvelittg -Report.. form 117e i-eport is regLLir-ed bgfrrre the BLtilcliTig DepuT tr7zent �a�i1l schedrzh� a frr7rrl inspe tear-7:17Tcfort fot in is available cit the BuildingfPtrblic Works• Counter and online tai% i�r �A=iit�rr r7frniertfctl. Sigtrature: p _ Date: Name: ,(prhited)_ dlUHN Title: ARM11-yc-T�°Irrze�s i DL -NT Phone: q0 -T -21#S`- c991 Project Address: 7-1030 (aA PU* M. `"Up��+��C�IUppTT=A This four to remain in the proiect's baddin r c for N�lt+�li�rlErd TAN19.ject. Revised 3/7.12 Building Department REVIEWED FOR CODE COMPLIANCE Reviewed By: SEAN HATCH Date: 05/22/17 SOUTH BAY. PEST CONTROL Residential Commercial industrial May 17, 2017 Sivaprakasam Suresh 21030 Gardena Dr. Cupertino CA, 95014 RE: Vermin Inspection To Whom It May Concern: The above property was inspected for vermin on May 17, 2017. In completing the inspection, there was no pest activity (insects or rodents) found in the structure. There is gopher activity in front and back yard. Should you have any questions, please do not hesitate to contact me at 650-964-7272. sincerely, Bert Cardoza Pest Control Operator Lic. 4 OPR 9025 218 Sherland Av I Vie 1NcCU'Prni RTI 650 50 964-7272 408 929-7272 [I -s Building Department REVIEWED FOR CODE COMPLIANCE Reviewed By: SEAN HATCH Date: 05/22/17 TYPICAL BARK PVOTE:CTTON NOT TO MAL� 4-Foas FMQ-4 FEWCM TYPICAL. TREE PROTECTION FQMCI IO NOT TO SCALE 1. Prior to any cons-truoiion operations contractor shall construct and maintain, for each protected tree on a construction site, a protective fencing which encircles the outer Eirn3#s of the critical root zone(CR 2) of tiro fret to protect it from constrnctian activity. The GitZ is calculated 1,25 feet times the -diameter of the trunk ineasured in inches 4.5 feet above the natural grade), 2. Al] protective fencing shall be in place prior to commencement of any site work and remain in pi ace until all exterior construction activity at the site has been eornpleted. 3. Protective fencing shall be at least six (6) feet lugb, clearly visible, and shall have a tree protection sign affixed to the fence every twenty (20) feet h such a manner to be clearly visible and legible to workers on the site at a distance of twenty-five (25) feet, The sign(s) shall read `°Free Protection Zone Keep out", 4. The owner shall cause. the required fencing and signage to be installed and maintained for the duration of the construction, 5. In situations whoro a lrroteotecl trce remains in ft imnred'tate.area of intended construction and the irm maybe in danger of being damaged by construction equipment or other activity, the contractor or subcontractor shall protect the tree with 2"M4' lumber encircled %ori i mire or other means that do not damage the tree, The intent is to protect the trumt` of the tree against incidental contact by large construction equipment. b, Material Storage: No storage or placement of materials infendcd for use in construction or waste materials accumulaSed due to excavation or demolition shall be placed within, the limits of the critical root zone of any protected ire. 7. Equipment CleaningtLiquid Disposal: No cgnlpnrent shall be cleaned or other liquids, including, without limitatson, paint, oil, solvents, asphalt, coneret% mortar or similar materials deposited or allowed to flow into the critical root zone of a protected Isco. 8, Tree Attachments: No signs, wires or oilier attacbmws, other than those of a protective nature, shall be attached to any protected vcc. 9, Vehicular Traffic: No vehicular and/or construction equipment tra-Me or parking shall take place within the critical root zone of any protccied tree other thaat on existing s1reetpavemenL 10, No heavy equipment,1noludingbut not limited to trualm, tractors, trailers, bulldozers, excavators, skid steer tractors, trenchers, compressors, and hoists, shall be allowed inside the drip -line of any prot=ttd tree on any construction site. 11, Grade Changes: No grade changes shall be allowed within the limits of the critical root zone of any protected tree unless ad�quate protective construction methods are approved in advance in writing by the city, 12, Impervious Paving: No paving with asphalt, concrete or Other impervious materials shall be placed within the Bruits of the critical root zoite of a protected tn�, unless expressly permitted by the public works DF -?t 13. Root Pruning, Ali roots two inches or larger in diameter which are exposed as a result of trenching or other excavation shall. be cut off square with a sharp medium tooth saw and covered with natural fiber burlap ,;�7tJtin two hours of initial exposure, 14, All public. sidewalks sball remain open, ties and clear for public ace--sa, unless closure is perrritieri by the Public Wcr,_ks Department_ TREE PROTECTION YMM REVISED 5113 5-4 Reviewed By: SEAN HATCH Date: 05/22/17 Udic. TIENT ie job ges or prove[ )T be any X244.5 x244.2 S890 54'00"E ci • _ 4-5-.4 X245.1 X24.8- - DR. - - _AC GARDENA - - - _ _ 310.00 ai 9 (R /W: 6 0 ) � U Q AC 245.1 X243.5 a) a� 0 Ya CONC C cz 244. 44.2 X244.1 X2436 X243.8 X243.5 0 JOHN HA, AIA 0� 44. X243..5 CONCJ X243.4 510 LAWRENCE EXPWY. X244.4 X243.6 SUITE # 105 SUNNYVALE, CA 94085 X244.8 Q S89° 54' OO��E - - - - - - - - - - - - Xa4�� - -- -- TEL: (408) 245-0991 TEL: (408) 245-0711 4� 8 0 244.8 i 105.03 X243.8 6 ��r 1q_ o X244.3 GROUND W X244.1 AC MR. SIVA. SURESH X244.8> d4�/6x244.5 44.9, O X244.3 z w X244.1 � 17998 Arroyo Lane Saratoga, CA 95070 244.6 4811. (b p 44.1 U x243. (408) 382-1690 X245.2 m �ON M X�.4 BRICK WALL 243.9X i 243.9 CONC CURB 2 44.9 // J O g�� / x244.8 X244.6 -�� $�-En �1 X�4 / 4 --5----5--44.1 i & GUTTER 244. �A- 8 X2 5.9 NO TREES ARE ON THE PROP R Y. / 244.4 X244.2 x244.% X244.3 ' / / 44.5 / X244.3 i Z 0245.2 SSCO X244. GROUND / x244.2 CONCX244.1 / \ TO BE REMOVED w X245.0 GROUND X244. (f� 45.1 / wr 0 °C0 0 45.4X245.5 i X244'C� " / \ 245.2x X245.5 245.1 45.0 / X CUND X244.2 44 4 NEIGHBOR NITY E D MILDNGDIVISION CUPERTIN W APPROVED \ 4�5.2 X244.6 X244.8 HOUSE > ThisLpl nd specifications MUST be kept at t • � sited rig o r ion. It is unlawful to make any chaXx245 244.7 4. X245.4 BRICK P LAN+& \ TO B E R E M OV' 4 2 X 4 4. 3 X2 (� altera on or to deviate therefrom, without ag Q from the Building Official. The a ping of this plan and specifications SHALL N I,el rmit orJQ be an approval of the violation o visallATCH ny City Ordinance or State Law. X 45.2 X245.3 1 STORY HOUSE X244.9 � i � BY FLORA �I STA > X245.3 / TO BE DEMOLISHED 244 8 / / Q PERM DATE /17-0031 w A VE. O X245.5 X244.8 / ;�.OX 244.8 CONC I i Z V M� Q o w R/W: 6 Op CV 245.2 / 45.1 45.4 x2 TO BE REMOV D x244.6 X14 ' / 245.1 244.9 X2 .3 r Z CV W ~ / 5.2 4 4. 9 X24 6 BRICK X 2 10� Q V Ln ° CD .TO BE REMOVED \ / i i � X245.5 x245.2 CONC / W X245.2 � \ -TO E OVED X245.1 � X246.3 E / / X245.5 CONC X245.0 X245.3 X25.4 /x245.0 TO BE V D/ X244.4 AC X245.4 245 3 CONC X245.8 \ X245.5 4.2 4.9 \ / X245.3 X"DW245.7 X245.2 x245.0 GROUND X245.4 245.17 GROUND X245.5245.0,X � � 245 4 \X2-45 � x24..8 245.6 X245.4 X245.7 X244.7 X244.5 �� X.45. - - CONC WALL M _ - - X245.5 X24 JU9° 54� 00��45.3 x245.3 44.3 2--- 45.8 - 45.6 GA X 247.9 - -- --- - - -- -- - - 125. 0 245 4 � 5 ONC CURB &GUTTER X45.6 '� 20x2 PUBLIC UTILITY EASEMENT Scope of work: Demolish (E) Single SITE/DEMO PLAN C NC Family Dwelling (1215 sq ft) and Garage (640 sq ft). APN: 326-08-044 DW NEIGHBOR HOUSE DATE PROJECT No. m5/16/17 16 -1567 SCALE DRAViN AS SHOUIN JH/Gy SHEET DEMO PLAN CUPERTINO Building Department OF SHEETS REVIEWED FOR CODE COMPLIANCE Reviewed By: SEAN HATCH r1r 100/17 Udic. TIENT ie job ges or prove[ )T be any