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10120155 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20776 FARGO DR CONTRACTOR:ROBERTS CONSTRUCTION PERMIT NO: 10120155 OWNER'S NAME: JOHN&LINDA ADAMS 16636 FARLEY RD DATE ISSUED:01/06/2011 'WER'S PHONE: 4082550402 LOS GATOS,CA 95032! PHONE NO:(408)356-2185 D� LICENSED CONTRACTOR'S DECLARATION r BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.#, G / Z n � ` � / MECI-I r RESIDENTIAL r— COMMERCIALr Contractor p,Qj�/L%S �(&6 Uate — (� — ` 1 hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: PARTIAL DEMO, 1248 SF,OF SINGLE STORY HOUSE (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. 1 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:$8000 1 have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance of the work forwhi h -h' pennit is issued. APN Number:32630124.00 Occupancy Type: APPLICANT CERTIFICATION I certify that 1 have read this application and state that the above inforniation is correct. I agree to comply with all city and county ordinances and state laws relating PERMIT EXPIRES IF WORK IS NOT STARTED to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION. 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 Issued by: - Dater _41 9.18. Signature Date 1 RE-ROOFS: OWNER-BUILDER DECLARATION 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 I hereby affirm that I am exempt from the Contractor's License Law for one of inspection. the following two reasons: 1,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant:_ Date: 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 ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER constrict the project(Sec.7044,Business&Professions Code). - I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: 1 have read the hazardous materials requirements under Chapter 6.95 of the 1 have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& performance of the work for which this permit is issued. Safety Code,Section 25532(a)should 1 store or handle hazardous material. 1 have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the P Health&Safety Code,Sections 25505,25533,and 25534. I.certify that in the performance of the work for which this permit is issued,l shall not employ any person in any manner so as to become subject to the Worker's Owner a oriz g Compensation laws of California. If,after making this certificate of exemption,I Date: =( r 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. CONSTRUCTION LENDING AGENCY hereby affinn that there is a construction lending agency for the performance of work's APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.) 1 certify that I have read this application and state that the above information is Lender's Name 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 Lender's Address upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION costs,and expenses which may accrue against said City in consequence of the nting of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records. ,h all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Licensed Professional Signature Date CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20776 FARGO DR CONTRACTOR:ROBERTS CONSTRUCTION PERNIIT NO: 10120155 OWN'ER'S NAME: JOHN&LINDA ADAMS 16636 FARLEV RD DATE ISSUED:01/06/2011 OWNER'S PHONE: 4082550402 LOS GATOS,CA 95032 PRONE NO:(408)356-2185 ❑— LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG I-1 ELECT 0— PLUMB r License Class `O_ Lie.N / 6:22 Z [I r r ��jj A / / NIECII RESIDENTIAL COMMERCIAL Contractor eeAz?"yzns e�0-5 Dpatep f — C,�, --� I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: PARTIAL DEMO, 1248 SF,OF SINGLE STORY HOUSF (commencing,,itb Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. I hereby affirm under penally of perjury one of(lie 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 perfonnance of the work for which this.penut is issued. Valuation:$8000 Sy.FI Floor Area: 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 wh It Im5 _ APN Number:32630124.00 Occupancy Type permit is issued. APPLICANT CERTIFICATION I certify that I have mad this application and state that the above infonhation is correct.l agree to comply with all city and county ordinances and sour laws relating PERMIT EXPIRES IF WORK IS NOT STARTED to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agreeto save WITHIN 180 DAYS OF PERMIT ISSUANCE OR indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION.costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply �7 with all,non-point source regulations per the Cupertino Municipal Code,Section Issued by: / Date: 9.18. C(j Signature Date RE-ROOFS: ❑ OWNER-BUILDER DECLARATION All mofs shall be inspected prior to any roofing material being installed.If a mof is installed without first obtaining an inspection,I agree to remove all new materials for 1 herehy affirm that 1 am exempt from the Contractor's License Law for one of inspection. the following two reasons: I,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date: will do the work,and the structure is not intended or olTerxd for sale(Sec.7044, Business&Professions Code) I,as ownerofthe propeny,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER construct the project(Sce.7044,Business&Professions Code). I herehy affirm under penally of perjury one of follmring three HAZARDOUS MATERIALS DISCLOSURE declarations: I have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain a Certificate of Conserv to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain 'Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino NI unicipal Code,Chapter 9.12 and the Health& perfonnance of the work for which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material. I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices%,[rich emit hazardous air Section 3700 of the Labor Code,for the perfonnance of the work I'or which this con l aminants as defined by tire Bay Area Air Quakily Management District I mill maintain compliance%lith the Cupertino Municipal Code,Chapter 9.12 and the permit is issued. Health&Safety Code.Sections 25505,25533,and 25534. 1 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 subjcei to the Worker's Ownero ;Oboriz g Imo_ Compensation laws of California. If,after making this cenificate of exemption,I Date: become subject to the Worker's Compensation provisions of the Labor Code,I must forthwith comply with such provisions or this penhit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby acorn that there is a construction lending agency for lire performance of work's APPLICANT CERTIFICATION for which this pemtit is issued(Sec.3097,Civ C.) 1 certify that I have read this application and state that the above information is Lender's Name 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 Lender's Address upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep han less the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION costs,and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records. with all non-point source regulations per the Cupertino Municipal Cale,Section 9.18. Licensed Professional Signature Date Pacific Gas and Electric Company' 10900 Na.Blaney Avenue Cupertino; CA 95014 City of Cupertino 10300 Tone Avenue Cupertino, Ca. 95014 To Whom It May Concern: /7 E7 E/L ON�f� SUBJECT REMOVAL OF GAS The gas A4 ez oa�F •14ient hN�been removed . ll ^^ on If you have any further questions, please contact me at (4080725-3325 Sincerely, 11t7 Service Planning DEMOLITION CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION ADDRESS: 20776 fargo dr. DATE: 12/21/2010 REVIEWED BY: bob s. APN: ja'(p 30 IXLL BP#: X01 aQ s�� 'VALUATION: $8,000 *PERMIT TYPE: Demolition Permit PLAN CHECK TYPE: PRIMARY SFD or Duplex PENTAMATION 1SFDWL-DEM USE: PERMIT TYPE: WORK SCOPE FEE ID FLR AREA s.f. 1DEMORES 1,248 Mech. Plan Check Phon6.Plan Check Elec.Plan Cherk ,blech. Perniii Fee: Plumb. Pencil Fee: F.lec.Permil Fee: Other Mech.Insp, Other-Plumb In,sp. Oiher Flee.1, .Bach.hup. Fee: Plumb. hisp. Fee: Elec. Insp.Fec: NOTE: Thesefees are based an the preffininan,in orntalinn available and are only ate estimate. Contact dee Det or adcln'I info. FEE ITEMS (Fee Resohuion 09-05I Eje 7/1/10) FEE QTY/FEE MISC ITEMS Plan Check Fee: SnppL PC Fee Plumb.lMech./Elec Plan Check: Permit Fee: $507.00 Suppl. Insp. Feed Reg. O OT FO.0 hrs $0.00 Plumb.11fech./Elec Unil Fee: Phmth.4fech./Elec Permit Fee: Conevuction Tax Acoustical Review Fee: lVork Without Permit' Planning recc: Travel Documentation Fees: i Strone Motion Fee: IRSEIS,MICR $0.80 Select an Administrative Item Bldt;Stds Commission Fee: IRCeSC $1.00 SU13TOTALS: 1 $508.80 $0.00 TOTAL FEE: $508.80 Revised: 12/07/2010 CITY OF CITY OF CUPERTINO DEMO CUPERTINO PERMIT APPLICATION FORM APN# 3� 30 I r— f Date: I Z — Building Address: 2o -7 —( (.,© -77 (v Mailing Address (if different from building address): Owner's Name: Phone: !� oNu -i i4J4MS Yom -Z5-S -De-( oz Contractor: Phone :4 o?, _ Z I g�j- TZU66,,LTS C-v�,57-/LLPc;1m>y Fax: 'fOo- 756 - cfY6(o Contractor License #: o `j 1 (0 Z7— Cupertino Business License #: Contact: L)A0 1 1-S Phone: goe6 — �1 p _c/3 6 3 Fax/e-mail: Residential I \ Sq Footage 1 Commercial ❑ Sq Footage Job Description: e e_ML Valuation: Project Size: .Eor Express ❑ Standard Large ❑ Major ❑ Please complete relevant portions of the Green Building Checklist & attach it to the application or if applicable, include on the plan set & the sheet index. Quantity Fee ID Fee Description Fee Group Permit Type 1DEMORES Demo-Residential B 1SFDWL-DEM 1DEMOPRES Pool Demo Residential B 1SFP00L-DEM 1BCBSC Cal Bldg Standards B ALL PERMIT Commission Fee TYPES IBSEISMICRE Seismic Residential B Revised 12/06/10 Inc Errik T e c h n o l o g i ea s December 20, 2010 Dave Roberts 16636 Ferley Road Los Gatos, CA 95032 Attn: Mr. Dave Roberts Re: Asbestos Renovation/Demolition Inspection Site: 20776 Fargo Drive,Cupertino,CA ERT Project #: FV1012-07 uta Dear Mr. Roberts; 90 o NVr ERT performed asbestos inspection and testing Inside the residence on the date of 12/15/10. ERT obtained various samples from select building materials associated with the home suspected to contain asbestos.Those samples were submitted to an amedited laboratory for analysis and characteriration service using PLM. Lab analysis of the samples indicates the presence of 15%asbestos in the linoleum in the Idtchen and bath bathrooms, 3%asbestos in the mastic of roof inside the attic, plus <1% asbestos in the interior home sheet rock tape joint compound material. The handling,work pram,and disposal of asbestos is regulated and restricted by certain governmental agencies.The BAAQMD and EPA regulate asbestos containing materials at greater than >1%. Cal-OSHA regulates occupational exposure to asbestos at less than <I%. BWMD Wit require that all asbestos greafEr than >1% must be removed km the residence prior to scheduled renovation/demolition activity. Cal-OSHA will require that the contracts performing the renovation or demolition on the structure must protect their employees from asbestos emosure in accordance with the Asbestos In Construction Standard 1529.1101. ALL work involving asbestos should be perfomhed by a licensed asbestos abatement contractor. If you have any questions, please contact ERT. 1180 K Califaroin Boubvard e Floor Walnut CNOK CalMomla iiiam www.ortincsom (8118)88th1888 Info&WInc.Com 1� Inc Envlronmentel Remeron T a c t= h n o Note: The inspection or testing performed maybe inherently limited in scope and nature. No guarantee Is expressed or implied that all asbestos has been identified in the home or at the sub)ect property. Inaccessible areas of the home underneath floors, behind walls,above ceilings were not inspected orsub)ect to testing. If you have any questions or concerns regarding the content of this report, please contact myself at(925) 395-1875. Respectfully Submitted, V Frank valerga, SST, CLC, REA 1800 N.CGIMomla Bauk"rd, Ftoor %fnut CreOic CRMma 94696 www.ertlnc.00m (000)800-1800 info®ertinc.com y AmerlScl Los Angeles z441 � eoaD74AMERISCI CacmD05 a TEL:(310)8344868•FAX:(310)834-4772 .`ram PLM Bulk Asbestos Report Environmental Remediation Tech. Date Recelvod 12/16/30 Amerl5cl Job N 910121573 Attn: Mr. Fanelli Date Eaamined 12/16/10 P.O.• 6472 Camden Ave. Pelle 1 of 3 Ste. 1028 RE:FV1012-07; 20776 Fargo Dr.; 20776 Fargo Dr. Cupertino. CA San Jose,CA 95120 Client No./HGA Lab No. Asbestos Present Total % Asbestos 1 910121573-01 No NAD Location: Garage Paper Islillon (by CVES) by Peale Ducoing Analyst Deenlptlon:Buck,FfaRogoneoua.Fipous,Barrier Paper an 12/18110 Asbestos Types: ORwr Malarial: Cellulose 65%, Non-fibrous 35% 2 910121573-02 No NAD Location: Drywall Tape Joint Compound (by EVES) by Paola Ducting Analyst Daeriptlon:Wtl1lN8rown.Homogeneous.FaDrywallon 12716/10 Drywall Asbestos Types: Other Material: Cethdass 15%, Non-fibrous 85% Comment Joint compound na found In saWt& 3 910121573-03 No NAD Location: Skim Coat Texture (by CUES) by Paola Ducaing Analyst Description:White!&own.liortngameolta.Nor'Fiprous.Drywall on 12/16/10 Asbestos Types: Other Material: Collulose/5%. Non-fibrous 85% Comment•. Slim Coat not found In sample. 4 910121573-04 Yea 15% Location: Linoleum tohdhen Brown 1 Orange (by CVFS) by Paola Ducoing Analyst Dasc poen:Brown/Grey.Homapxbous.NtirWlbrotm,Linoleum on 12118110 Asbestos Types:Clrysot0o 15.0% Other Material: Cepulose 5%, NonAbmus 80% See Reporting notes on last page AmeriSd Job 0: 910131573 Page 3 of 3 Clionf M. - Fnvimnmunfvl Romerdstir..Toch. AmariSci Job#: 910131573 Page 2 of 3 Client Name: Environmental Remedlation Tedi. PLM Bulk Asbestos Report FV1012-07; 20776 Fargo Dr.; 20776 Fargo Dr. Cupertino, CA Client No./HGA Lab No. Asbestos Present Total %Asbestos 5 910121573-05.1 No NAD Location: Drywall Tape Joint Compound (try CVES) by Paola Ducoing on 12118/10 Analyst Description:lAgtitalBrowrr,Homogeneous;FarmW,Olyvrail Asbastes Types: Other material: Cellulose 15%. Non-fibrous 65% 5 910121573-05.2 Yes Trace(<1 %) Location: Drywall Tape Joint Compound (by CUES) by Pada Ducoing on 12/16I10 Analyst Description: Belga,Haropenews,Na Fibrous.Joint Compound Asbestos Types:Chryaoole c1.% Other Malarial: NortAbmus 1 gg% 8 910121573.06 Yes Trace(<1 %) Location: Drywall Tape Joint Compound (by CVIES) by Pada Oucoing on 17/16110 Analyst Description:Beige.Homogeneous,Non-Fihmus,Joint Compound Ashostos Types:ChrysoNe 41.% Otho MstsAal: No"brous 100% 7 910121573-07 yes 15% Location: Uncle=Hall Bathroom Gray/Blas (by CVES) by Paola Oucoing Arntyst Daacrlptlon: eigd BGrey,Hornogeneaus,Fibrous. m on 12/16/10 Lagteu Asbastes Types:Chrywille 15.0% Other Ma AM: Cellulose 5%, Non-fibrous 60% 8 910121573-08 Yes 16 % Location: Linoleum Cop Bathroom wlShewer Yellow (by CVES) by Paola Duooing Analyston.12116/10 OssvlPtlorl:Belpe/Grey,Homogeneous,Fbmus,Linoleum Ashoates Types:Chryso@e 15.0% Other Material: Cellulose 5%, Nondibmw 6o% 9 910121573-09 No NAD Location: Stucco (by CVES) by Paola Oucoing Analyst Desedptisn: on 12/76110 Orem.Hetempxrewa,NortFmrou0.Certesltr7iow,9tlroco Asbestos Typos: OMW Material. Non4anous 100% Soo Reporting rotas on last page City of Cupertino Public Works Department 10300 Torre Ave. Cupertino CA 95014 (408)777-3334 Debris.Bins Debris from a project in Cupertino can be collected and disposed of in either: 1. a Los Altos Garbage Co. bin (call 725-4020 to order), OR 2. a bin owned by the project's general contractor or demolition contractor, and hauled by a vehicle owned and registered to that contractor(contractor should be prepared to prove ownership), OR 3. a private truck with abed, but no bin The Los Altos Garbage Company is the only debris bin service provider franchised to do business in Cupertino. Bins from other leasing companies may not beused in Cupertino. Please check all that apply: I will use a Los Altos Garbage Company-bin I will use a bin and truck owned by the general contractor or the demolition contractor. I will use a private truck, and not drop a bin. RF: CEIVED Recyclable Materials . oEC 212010 Recyclable materials may be collected in private debris buzz�lur CoatHIAMIMsed from ANY company, as long as the materials are both: 1. separated by type of material into separate containers, AND 2. are not contaminated by garbage. Separated recyclable materials are materials that are separated into individual containers, each containing just one type of recyclable material. Typical examples of recyclable materials include: metal, wood, concrete, steel-reinforced concrete, asphalt, tree trimmings, white goods, toilets (hardware removed),rocks and clean fill dirt. Separated recyclables must ultimately be recycled or otherwise reused, and not disposed of in a landfill. Contractor should be prepared to provide the name and phone number of any recycling companies being used on the project. A list of local recycling companies can be found at: www.recvcicstuff.org. ..........:....��...` ............................... .. Signature: Date: —/d Name(printed): DA Of L Qp/�bR i S Title: G�iY UtiR� Cv. t 2r2f oZ -Phone: Project address.' Fc­c, o Drama-1" c �'Jo1f4 nu form m Zemin in the pojeet's building pmdt rile fhr the dm on of the Poj=L Ae.imd IM3 t, 'd XH3 13C83SH-1 dH WdE0 :8 0102 80 ADW Service Address: 1" TQroY Map Grid: 83D .n Identification: � Rats I Mice Other l Points ofAccess rAjr) tiQ } Snf\.ACe^" 01ct rvc(�w� Y�Z �/G VH. — fsr Recommended Repairs and Suggestions: Bait Stations Located: NOTE 1: If You (the homeowner/manager/tenant) have elected to do the repairs necessary to prevent rodents from re-entering the structure: o Above repairs'must be done 10-14 days from the inspection date(not before,unless your technician states differently). These repairs must be done timely. If no activity has been seen or heard, begin repairs. If any questions prior to repairs, call our office. o You will be notified by phone or post card,approximately 4-6 weeks following the original Inspection date for a "no charge follow-up service". If repairs are complete and correct, we will remove,and•dispose of any left over bait. o If repairs are not done on time the guarantee will be compromised. NOTE 2: If you elect Bay-Valley Pest Control to perform the repairs necessary to exclude rodents from the home: o Call to set-up or confirm an appointment foi the work to begin. o Costs quoted on this report are for the above found repairs including materials,labor and guarantee. If any new or additional conditions to this report are found they will be discussed with the homeowner and quoted separately. Rodent Exclusion Quote $ Customer Authorization for Repair Work (you will be notified by phone for scheduling) Guarantee and Repair Information: Refer to your contract for specific guarantees. o In some cases, certain repairs may need to be done by a contractor or other suitable business, If this is the " case,your guarantee will only be for repairs done by Bay-Valley Pest Control. The above quote will include —— only.repaits.we.are qualified to do,the.technician.will advise you if these circumstances appear. Examples of work Bay-Valley Pest Control would not perform, but may be mentioned in this report are;Tree/Bush/Shrub trimming or removal, Garage door replacement, Roof work, Dry Wall or Siding, Painting of repaired areas,etc.. o Repairs not to be done by Bay-Valley Pest Control: o Recommendations: Additional Comments, if any: Customer Signature Tec'h'nician Signature s I I \ \ I \ ftc aAk \ I I I I I ITS I Icx In DOI M, xmm #I I I ' cz I -1mr3Bdl �I> .!7 n �O �I; vm m �7 on n z>, } l!r4r Izxm SON"H= -.SCI Nj NZ I p o f 'I I 33 m �_ -oos ft I!CN. 1 .;-`� aemlec�e+w.+ f 'Q e w ' '� n O 5.M I I 12g3!`LR O 7 3 Y, N_ I I N "�I I I N I I I \ I I \ \ RqT lady. I I � \ • o I I � V 000��I � I I � CLOG F Z o ) M�o IE: 2 j DID DEMOILMON SIM PLAN 1/1611 11-011 A1J1.�lRCtIPI?A Im MG-esv.rs xyR wnaal MSw xwm-.Is amlYlf-R-I-10 Af10.^It MSA RMID-% vi CC- I I