11070152 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 18825 TUGGLE AVE CONTRACTOR:PROVISION PERMIT NO: 11070152
DEVELOPMENT,INC.
OWNER'S NAME: CHRISTOPHER Q VIRAY 1288 KIFER RD STE 207 DATE ISSUED:08/16/2011
OWNER'S PHONE: SUNNYVALE,CA 94086 PHONE NO:(408)245-0991
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB r
License Class Lic.N n �O d
rt
�.,� MECH� RESIDENTIAL� COMMERCIAL r
Contractor ►v�"t)S� � ( ate
1 hereby a irm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:DEMO SFDWL-ONE STORY-819SQFT
(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:$7600
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. APN Number:37533055.00 Occupancy Type:
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 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 Na' s,judgments, 180 DAYS FROM LAST CALLED INSPECTION.
costs,and expenses which may accrue agai ity' nsequence of the
granting of this permit. Addition a applic derstands and will comply
with all non-point sourc ations per upertino Municipal Code,Section Issued by: Date:
9.18.
Si 2 (
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:
I,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date:
wiI I 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 ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
construct the project(Sec.7044,Business&Professions Code).
1 hereby affirm under penalty of perjury one of the following 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 Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. I 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(x)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 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 M_waiOW Code,Chapter 9.12 and the
Health&Safety Code,Sections 2 ,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 subject to the Worker's Owner or a d
Compensation laws of California. If,after making this certificate of exemption,I Date:
become subject to the Worker's Compensation provisions of the Labor Code,I in
forthwith comply with such provisions or this permit shall be deemed revo CONSTRUCTION LENDING AGENCY
I hereby affirm 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.)
I certify th9t 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,
costs,and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION
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 Code,Section
9.18. Licensed Professional
Signature Date
DEMOLITION PER PL40,9E
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION V11
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUPERTINO (408)777-3228 • FAX(408)777-3333 •building65cupertino.org /161)1-7 C
PROJECT ADDRESS /slfc y5 ` T APN 0
OWNERNAME / / /a �I PHONE �`� MAIL
STRE51 ADDR /ESS/ ,nofa(�(/� � FAX
CONTACT NAME PHONEi 27- 07/ E MAIL
ZV
STREET ADDRESS Q.C/1 L�/DO� crry.ST (ZIPD / /�7/_/ FAX
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHnECT ❑ENGrNEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC
COMPANY NAME E-MAII FAX 7
STREET ADDRESS CM ZIP CA /�/I PH
DESCRLP'rIONOFWORK
(�
RESIDENTIAL 9DWELLING
FLOOR AREA UNITS U
COMMERCIAL '
y L
FLOOR AREA
TYPE OF CONSTRUCTION N STORIES a
tl�. --� =z
AQMD JOB NUMBER 'E„ TOTAL VALUATION:
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 bu'ding construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature ofApplicant/Ag Date:
SUPPLEMENTAL INFORMATION REQUIRED PRIOR TO ISSUANCE OF DEMOLITION PERMIT �' - u�
—Provide Job Number from Bay Area Air Quality Management District www.baacund.or_Q 415-749-4762.
Provide three copies of a site plan showing protection for any trees 10"in diameter or more at 3'above grade.
Provide letter from PG&E(408-725-3325)stating all gas and electric has been disconnected.
_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. vim
Planning Dept clearance to verify building is not considered an historical landmark.Allow 10 business days.
n�
Provide 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. tit %' '• ".
Provide signed Debris Bin and Recyclable Materials form.
Commercial Buildings OnlY� Provide Fire Dept clearance for fire suppression alarm system review.
DemoApp_201 1.doc revised 03/16/11
City of Cupertino
Public Works Department
10300 Torre Ave.
Cupertino CA 95014
(408)777-3354
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
I a private truck with a bed, 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 be used in Cupertino.
Please check all that apply:
❑ will use a Los Altos Garbage Company bin
Q�I will use a bin and truck owned by the general contractor or the demolition contra r.
❑ I will use a private truck, and not drop a bin.
Recyclable Materials -
Recyclable materials may be collected in private debris bins &containers leased
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.recyclestuff.org.
......................J..................................................................
......
Signature: !/ �'� ��� �1. Date: l'
Name (printed):
Title: �... �l.�� / n�C�pw"- r-,T
Phone:
Project address: Xe 2_� Z_e-� l Il t --- /,w
This form to remain in the project's building permit file for the duration of the project
Revised 1/03
AmeriSci Los Angeles
inc 24416 S. Main Street,Ste 308
Carson,California 90745
Environmental Remediation TEL:(310)834-4868• FAX:(310)834-4772
T B c h n o I o g i e s
PLM Bulk Asbestos Report
Environmental Remediation Tech. Date Received 06/28/11 AmeriSci Job# 911061853
Attn: Mr. Fanelli Date Examined 06/28/11 P.O. #
6472 Camden Ave. Page 1 of 2
Ste. 102B RE: 1106-68; Fred Casido; 18825 Tuggle Avenue Cupertino, CA,
San Jose, CA 95120
(408) 866-4141 www.ertinc.com info@ertinc .com
Client No. / HGA Lab No. Asbestos Present Total % Asbestos
A 911061853-01 No NAD
Location: Sheet Rock Tape Joint Comp. Home- Interior-Wall (by CVES)
by Paola Ducoing
on 06/28/11
Analyst Description:White/Brown,Homogeneous, Fibrous, Sheetrock
Asbestos Types:
Other Material: Cellulose 15%, Non-fibrous 85%
Comment: Joint compound not found in sample.
B 911061853-02.1 No NAD
Location: Sheet Rock Tape Joint Comp. Home- Interior-Wall (by CVES)
by Paola Ducoing
on 06/28/11
Analyst Description:White/Brown, Homogeneous, Fibrous,Sheetrock
Asbestos Types:
Other Material: Cellulose 15%, Non-fibrous 85%
B 911061853-02.2 Yes Trace (<1 %)
Location. Sheet Rock Tape Joint Comp. Home- Interior-Wall (by CVES)
by Paola Ducoing
on 06/28/11
Analyst Description: Beige, Homogeneous, Non-Fibrous,Joint Compound
Asbestos Types:Chrysotile <1. %
Other Material: Non-fibrous 100%
C 911061853-03 No NAD
Location: Sheet Rock Tape Joint.Comp.Home- Interior-Wall (by CVES)
by Paola Ducoing
710 on 06/28/11
Analyst Description:White/Brown, Homogeneous,Fibrous, Sheetrock F.= :
Asbestos Types: i
Other Material: Cellulose 15%, Non-fibrous 85% - u
Comment: Joint compound not found in sample. a
Note : Cal-OSHA regulates occupational exposure to asbestos at less than <1% and
above . The contractor performing demolition of the structure must protect his/her
employees from asbestos exposure in accordance with Cal-OSHA Asbestos In
Construction Standard 1529 . 1101.
See Reporting notes on last page
r�
AmeriSci Job#: 911061853 Page 2 of 2
Client Name: Environmental Remediation Tech.
PLM Bulk Asbestos Report
1106-68; Fred Casido; 18825 Tuggle Avenue Cupertino, CA.
Note: The handling, work practices, and disposal of asbestos is regulated and
restricted by certain governmental agencies. All work involving asbestos should'
be performed by a licensed asbestos abatement contractor.
Client No. / HGA Lab No. Asbestos Present Total %Asbestos
D 911061853-04 No NAD
Location: Ceiling Brown Board Panels (by CVES)
by Paola Ducoing
on 06/28/11
Analyst Description:White/Brown,Heterogeneous, Fibrous, Ceiling Panel
Asbestos Types:
Other Material: Cellulose 90%, Non-fibrous 10%
E 911061853-05 No NAD
Location: Window Putty Exterior Windows (by CVES)
by Paola Ducoing
on 06/28/11
Analyst Description: Beige,Homogeneous, Non-Fibrous,Window Putty
Asbestos Types:
Other Material: Non-fibrous 100%
F 911061853-06 No NAD
Location: Tar&Gravel Exterior Roof (by CVES)
by Paola Ducoing
on 06/28/11
Analyst Description: Black, Homogeneous, Non-Fibrous, Roofing
Asbestos Types:
Other Material: Non-fibrous 100%
G 911061853-07 Yes 5 %
Location: Penetration Mastic Exterior Roof (by CVES)
by Paola Ducoing
on 06/28/11
Analyst Description: Black/Grey,Homogeneous, Non-Fibrous, Penetration Mastic
Asbestos Types:Chrysotile 5.0%
Other Material: Non-fibrous 95%
ERT performed asbestos inspection on June 27, 2011 . ERT obtained samples from the
structure submitted to lab for analysis using PLM. Bay Area Air Quality
Management District regulates asbestos at greater than >1%, and will require the
exterior roof mastic be professionally removed from the home prior to demolition.
D. Fanelli, CAC #92-0067 ,
Reporting Notes: r-Certified Asbe� " /consultant/DOSH
Analyzed By:Paola Ducoing ;Date Analyzed:6/28/2011 /`/
'NAD=no,asbestos detected, Detection Limit<1%;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 cLntly only method that can be used to detertnlne If this material can be considered or treated as non-asbestos containing In
New York State(als Advisory for floor tile, FR 59, 146,38970,8/1/94). NIST Accreditation requirements mandate that this report must not be
reproduced except ie ppr al of the laboratory. This PLM report relates ONLY to the Items tested.
Reviewed By: L• 2 41 I
Note: The ins ection and testing performed maybe inherently limited in scope and
nature. No guarantee is expressed or implied that all asbestos in the home or at
the subject property has been identified. PLM analysis has been known to miss
asbestos in a small percentage of -samples analyzed. No attic./crawl space inspected
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REVISIONS:
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SHEET TITLE:
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DATE PROJECT NO,
CURRENT-FRONT ELEVATION6-22-2011 10-1291
SCALE DRAWN
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OF SHEETS