14080037CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 22772 ALCALDE RD
CONTRACTOR: ROCHA'S COMPANY
PERMIT NO: 14080037
OWNER'S NAME: NEEL DHAMDHERE
2191 MONTICELLO AVE
DATE ISSUED: 08/06/2014
OWNER'S PHONE: 4082213918
SAN JOSE, CA 95125
PHONE NO: (408)593-7405
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL
❑ LICENSED CONTRACTOR'S DECLARATION
INTERIOR DEMO ONLY- SEE DETAIL SHEET 5A
License Class (! ZD Lic. # SS l 1 12
Contractor Date
I hereby affirm that I am licensed u der tl 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.
Sq. Ft Floor Area:
Valuation: $700
I have and will maintain Worker's Compensation Insurance, as provided for by
APN Number: 34244014.00
t>ccupalic) .1 `pc:
Section 3700 of the LaborCode. for the performance of the work for which this
permit is issued. �r
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
PERMIT EXP ORK IS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating
WIT 80 DAYS OF P ISSUANCE OR
to building construction, and hereby authorize representatives of this city to enter
180 DA O ST CA LED INSPE I N.
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
the
jn `�
costs, and expenses which may accrue against said City in consequence of
Issued by: Date cf�
granting of this permit. Additionally, the applicant understands and will comply
with all non -point sou a regulations per the Cu 'no Municipal Code, Section
9.18.
— >
Signature Date
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.
❑ OWNER -BUILDER DECLARATION
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
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)
1, as owner of the property, am exclusively contracting with licensed contractors to
HAZARDOUS MATERIALS DISCLOSURE
construct the project (Sec.7044, Business & Professions Code).
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will
I hereby 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 Cupert' o 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 , 2553 d
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized gent: Date
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
CONSTRUCTION LENDING AGENCY
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
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 per the Cupertino Municipal Code, Section
Licensed Professional
9.18.
Signature Date
CUPERTINO
DEMOLITION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building-cupertino.org
PROJECT ADDRESS �r% 2 A'L CvA-I-q , 1 9 "
J r1•— 4 — Q /
/�
APN # 34
OWNER NAME ( Y FTL -b1 (l� ' ' `l/ �
PHONE /, og ^` 2 _ � / • (�
G %. 41
Yj A.Ii,L •
STREET ADDRESS / 1112- (A vim' L / , L.- - \
f
/oq-IA JJ
CITY, STATE, ZIP /I• J �� / /t ��
FAX
CONTACT NAME
J
ShV(` R
PHONE
E-MAIL
STREET ADDRESS
CITY, STATE, ZIP
FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME / /
(/ L
LICENSE NUMBER
LICENSE TYPE
BUS. LIC #
COMPANY NAME
VA
E-MAIL
r
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK / �'w /] 6 I (' T'I'/) /'V' e
RESIDENTIAL
# DWELLING
FFICE USE ONLY
USE OCCTYPE so, FT. VALUATION
FLOOR AREA
UNITS
COMMERCIAL
FLOOR AREA
-"TORIES
TYPE OF CONSTRUCTION
f
AQMD JOB NUMBER
1 /
RECEIVED BY: TO r��M ION
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the prope half. 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 t buildin onstru ion. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature Applicant/Age Date: /
of
SUPPLEMENTAL INFOFMrA'TION REQUIRED PRIOR TO ISSUANCE OF DEMOLITION PhkMIT
OFFICE USE ONLY
PLAN CHECK TYPE
rovide Job Number from Bay Area Air Quality Management District w %vw.baagrnd.ora @ 415-749-4762.
rovide three copies (Residential) or six copies (Commerical) of a site plan showing protection for any trees 10"
❑ EXPRESS
_
❑ STANDARD
in diameter or more at 3' above grade.
❑ LARGE
Provide letter from PG&E (408-725-3325) stating all gas and electric has been disconnected.
❑ MAJOR
Provide a letter of inspection, tests, and abatement of any Hazardous Materials. Letter to be initiated by person(s)
_
certified in asbestos, mercury and/or hazardous material examination.
anning Dept clearance to verify building is not considered an historical landmark. Allow 10 business days.
Ovide 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.
DemoApp_2013.doc revised 02/13/13
CITY OF CUPERTINO
lit Ill TIFF FQTIMATOR—RITILDING DIVISION
FEE ID FLR AREA
s.f.
1DEMORES
ofiw, ET Li
Thsnih. tors/� 1%;1 .
NOTE: This estimate does not include jees due to other Departments (i.e. rianning, ruoac rvorKs, ,r[re, auauury newer
n:..._:... ..... TL6..o-1 s tha nraliminany infnrrnatinn availahle and are anh, an estimate. Contact the Dent for addn7 info.
"&at,
FEE ITEMS (Fee Resolution 11-053 Ef: 711:73)
ADDRESS: 22772 alcalde rd
DATE: 08/06/2014
REVIEWED BY: Mendez
Plant Check Fee:
APN:
BP#: ��Q�3
*VALUATION: $700
*PERMIT TYPE: Demolition Permit
"
PRIMARY SFD or Duplex
Plaonh.: 11ech.:'l le
PENTAMATION 1 SFDWL-DEM
PERMIT TYPE:
USE:
Permit Fee:
i
Suppl. Insp. Fee -(F) Reg. Q OT
0.0
WORK
interior demo only- see detail sheet 5a
SCOPE
FEE ID FLR AREA
s.f.
1DEMORES
ofiw, ET Li
Thsnih. tors/� 1%;1 .
NOTE: This estimate does not include jees due to other Departments (i.e. rianning, ruoac rvorKs, ,r[re, auauury newer
n:..._:... ..... TL6..o-1 s tha nraliminany infnrrnatinn availahle and are anh, an estimate. Contact the Dent for addn7 info.
"&at,
FEE ITEMS (Fee Resolution 11-053 Ef: 711:73)
FEE
-
QTY/FEE
MISC ITEMS
Plant Check Fee:
Plaonh.: 11ech.:'l le
Permit Fee:
$574.00
Suppl. Insp. Fee -(F) Reg. Q OT
0.0
hrs
$0.00
i
Strum; Motion Fee: IBSEISMICR
$0.50
Select an Administrative Item
Bldt Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
j $575.50
j $0.00 TOTAL FEE:
$575.50
Revised: 07/10/2014
AmeriSci Los Angeles
24416 S. Main Street, Ste 308
Carson, California 90745
TEL: (310) 834-4868 • FAX: (310) 834-4772
PLM Bulk Asbestos Report
Environmental Remediation Tech. Date Received 07/31/14 AmeriSci Job # 914072407
Attn: Mr. Fanelli Date Examined 08/01/14 P.O. #
6472 Camden Ave. Page 1 of 1
Ste. 1028 RE: RF1407-23; Neel Dhamdhere; 22772 Alcalde Road Cupertino
San Jose, CA 95120 CA
Client No. / HGA Lab No. Asbestos Present Total % Asbestos
01 914072407-01 Yes Trace (<O.1 % pc)
Location: Sheetrock Tape Joint Comp Home Interior Walls & Ceiling (by 1000 pt ct)
by Paola Ducoing
on 08/01/14
Analyst Description: Beige/Brown, Heterogeneous, Fibrous, Composite
Asbestos Types: Chrysotile <0.1 % pc
Other Material: Non-Asbestos/Inert 37.2 %
Comment: Heat Sensitive (organic): 18.7%; Acid Soluble (inorganic): 44.1 %; Inert (Non -asbestos): 37.2%
Reporting Notes:
(1) 1000 Point Count Anal sis performed on Inert Residue remaining after 480C heatd Cl acid treatments
Analyzed By: Paola Ducoing ; Date Analyzed: 8/1/2014 GC I
'NAD = no asbestos detected; Detection Li %; Reporting Limits: CVES = 1%, 400 Pt Ct = 0.25%, 1000 Pt Ct = 0.1%; NA = not analyzed; NAPS
= not analyzed / positive stop; NVA = No Visible Asbestos; PLM (polarized light microscopy) Bulk Asbestos Analysis by EPA 600/M4-82-020 per 40
CFR 763 (NVLAP Lab #200346-0, CA ELAP lab #2322); Note: PLM is not consistently reliable in detecting asbestos in floor coverings and similar NOB
materials. TEM is curre ly the only method that can be used to determine if this material can be considered or treated as non -asbestos -containing in
New York State (also s EPA Advisory for floor tile, FR 59, 146, 38970, 8/1/94). NIST Accreditation requirements mandate that this report must not be
reproduced except in ful ith the approval of the laboratory. This PLM report relates ONLY to the items tested.
Reviewed By:
Fwd: 914072258E RF 1407-23 Neel Dhamdhere
Subject: Fwd: 914072258E RF1407-23 Neel Dhamdhere
From: "ERT INC." <rfanelli@ertinc.com>
Date: 7/31/2014 11:42 AM
To: Glenn Massey <gmassey@amerisci.com>, Kristina Arellano <karellano@amerisci.com>,
Javier Cortes <jcortes@amerisci.com>
I need 1000 PLM point count on sample # 01 sheet rock on 24 hour TAT. Thank You.
Environmental Remediation Technologies Inc. (ERT)
www.ertinc.com
(800) 660-1808
---------- Forwarded message ----------
From: Javier Cortes <Icortes@amerisci.com>
Date: Wed, Jul 30, 2014 at 9:25 AM
Subject: 914072258E RF1407-23 Neel Dhamdhere
To: info@ertinc.com, "ERT INC." <rfanelli@ertinc.com>, aundrea@ertinc.com,
thowell @ertinc.com
914072258E
Javier Cortes
Asbestos Lab Manager
AmeriSci Los Angeles
24416 S. Main St # 308
Carson, CA 90745
310-834-4868 Phone
310-579-5548 Cell
310 834-4772 Fax
www.amerisci.com
Attachments:V)
914072258E.pdf,.1 C 379 KB
1 of 1 7/31/2014 3:07 Ply
Please Reply To:
AmeriSci Los Angeles
24416 S. Main Street, Ste 308
AMERI SCI Carson, California 90745
TEL: (310) 834-4868 • FAX: (310) 834-4772
FACSIMILE TELECOPY TRANSMISSION
To: Mr. Fanelli From: Paola Ducoing
Environmental Remediation Tech. AmeriSci Job #: 914072407
Fax #: Subject: PLM 1000 point count 24 hour Res
Client Project: RF1407-23; Neel Dhamdhere;
Email: info@ertinc.com,rfanelli@ertinc.com,aundrea@ertin 22772 Alcalde Road Cupertino CA
c.com,thowell@ertine.com
3
Date: Friday, August 01, 2014 Number of Pages:
Time: 11:58:59 (including cover sheet)
Comments:
CONFIDENTIALITY NOTICE: Unless otherwise indicated, the information contained in this communication is confidential information intended for use
of the individual named above. If the reader of this corrununication is not the intended recipient, you are hereby notified that any dissemination,
distribution or copying of this cortununication is prohibited. If you have received this communication in error, please immediately notify the sender by
telephone and return the original message to the above address via the US Postal Service at our expense. Preliminary data reported here will be verified
before final report is issued. Samples are disposed of in 60 days or unless otherwise instructed by the protocol or special instructions in writing. Thank
you.
Certified Analysis Service 24 Hours A Day • 7 Days A Week
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