B-2016-0409CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: D-2016-0409
1091 NOVEMBER DR CUPERTINO, CA 95014-4129 (362 16 011)
PERFECT HOMES
CONSTRUCTION
SAN JOSE, CA 95136
OWNER'S NAME: HUANG MICHAEL CW AND YIH-SHIN
DATE ISSUED: 09/02/2016
OWNER'S PHONE: 408-896-8457
PHONE NO: (408) 910-0779
LICENSED D ONT A TOR' DECLARATION
BUILDING PERMIT INFO:
License Class @ Lic. #556533
Contractor PERFECT HOMES CONSTRUCTIQht Date 02/28/2017
—BLDG _ELECT _PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
MECH X RESIDENTIAL _ COMMERCIAL
with Section 7000) of Division 3 of the Business & Professions Code and that my
license is in full force and effect.
JOB DESCRIPTION:
DEMO EXISTING HOME (1190 S.F.); ATTACHED GARAGE (449 S.F.)
I hereby affirm under penalty of perjury one of the following two declarations:
r. 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.
z. 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.
Sq. Ft Floor Area:
Valuation: $25000.00
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
362 16 011
representatives of this city to enter 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
PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting of this permit.
Additionally, the applicant understands and will comply with all non -point
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
source regulations per the Cupertino Municipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 8/2/2016
Issued by: Abby Avende
OWNE -BUIELDE�DECLARATIO
Date: 09 02/201
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. I, 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 (Scc.7044, Business & Professions Code).
Date: 9/2/2915
I hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
r. 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. I 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 District I
Worker's Compensation laws of California. If, after making this certificate of
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
exemption, I become subject to the Worker's Compensation provisions of the
the Health & Safety Code, Sectio s 25505, 25533, and 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
Owner or authorized agent:
APPLICANT CERTIFICATION
Date: 8(2/20]6
1 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
I hereby affirm that there is a construction lending agency for the performance
relating to building construction, and hereby authorize representatives of this city
of 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 8[2/2010
Professional
9d
CUPERTINO
DEMOLITION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(a1cupertino.org
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PROJECT ADDRESS � ` ' � � � ✓
APN # ;,C
OWNER E
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E-MAIL
STREET ADDRESS 4ZGW\e
CITY, STATE, ZIP
FAX
CONTACT NAME
PHO
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CITY, STAT , ZIP r
FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACT NAM
LICEN B
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LICEN T�,PE
BUS. LIC # 21 ftll j't 5
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FAX
STREET ADDR SS CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK , `e y I I
RESIDENT L
# DWELLING
OFFICE USE ONLY
USE
OCC, TYPE
SQ. FT.
VALUATION
FLOOR AREA
UNITS
COMMERCIAL
FLOOR AREA
TYPE OF CONSTRUCTION # STORIES
AQMD JOB NUMBERi ��
RECEIVED BY!'G .:
A Gut
TOTALLVALUATION
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By my signature below, I certify to each of the following: I am the property owner or authorized agent to act bn the roperty 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 cons ction. 1 e representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: _ Dater
SUPPLEMENTAL INFORMA N REQU D PRIOR TO ISSUANCE OF DEMOLITION PERMIT
OFFICE USE ONLY
PLAN CHECK TYPE
- Provide Job Number from Bay Area Air Quality Management District www.baagmd.or¢ @ 415-749-4762.
❑ EXPRESS
Provide three copies of a site plan showing protection for any trees 10" in diameter or more at 3' above grade.
❑ STANDARD
letter from PG&E (408-725-3325) stating all gas and electric has been disconnected.
_�,ovide
❑ LARGE
J Planning Dept clearance to verify building is not considered an historical landmark. Allow 10 business days.
❑ MAJOR
A/Provide letter of clearance of all vermin from a licensed pest control contractor.
'/Appli ant shatthe Public Works Department at 408-777-3104 and schedule a "habitable dwelling" inspection.
clion
✓ P1 e Consuc and Demolition Recycling Diversion signature form.
Commercial Buildings Only: Provide Fire Dept clearance for fire suppression / alarm system review.
DernoApp_2016.doc revised 05/10116
LEGEND
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10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 - FAX (408) 777-3333 - buil6ng(acuperting.org
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DESCRIPTION OF NNTORK
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RESIDENTL DWELLING OFT"WE USE ONLY
FLOOR AREA L"SE 'S
COMMERCIAL
FLOOR AREA
TYPE OF CONS I RLICTMN SIORIES
AQNIDJOEI
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... ... .... .. ..
By Illy Signature below, I certify to each of the following: I am the property owner or authofizedagent to actbn the ropertv owner's behalf. I Ime read this
IppliC16011,Md the information I II provided is correct- I have read the Description ot`Work, and verily it is accurate. I agree to comply with all applicable local
ordinances and State laws relating to building crams on, J)P,4VIoe representatives ofCupertino to enter the above -identified property for inspection purix)qes.
Signature ofApplicant/Agent Date:
UPPLEMENTAL IN FORNIAbN REQ04D PRIOR TO ISSUANCE OF DEMOLITION PERMIT OFFICE, 1, SE. 01NIA
vide Job Number from Bay Area Air Quality Management District Nkw%v.baaqI11d.org @�j, 415-749-4762.
Provide three copies ofa site plan showing protection for any trees 10" in diameter or more at 3' above grade. E'X P R K SS
letter from PG&E gas has been disconnected.
vide (408-725-3325) statirn, all and electric
ning Dept clearance to verify building is not considered an historical landi-nark. Allow 10 business days.
VIAJOR
Provide letter ofclearance ofall vermin front as licensed pest control contractor.
t/Applicant shaP C, 11 the Public Works Department at 408-777-3104 and schedule a "habitable dwelling" inspection.
WL: 1 16
fk
,
C Demolition Recycling Diversion finnn.
WDA"' It signature
.....Pt"OVICe OIISI-LICJo and
Commercial Buildings Only: Provide Fire Dept clearance for fire suppression / alann System review.
Do Bufldhng Department
[3EVH.�.W.D CODE COWI[JANCE
Rev�ewed a3yAjby Ayande
DatE�P n9/�:'n/'l6
DemoAl)ja_2016.doe reviseci 0-5/10/16
-tino
City of Cupel
de is Public works Department
Environmental Programs Division
10300 Torre Ave
Cupertino,, CA 95014
CUPERTINO GRE E4
Progrom (408) 777-3354
Construction and Demolition Recycling Diversion
Requirements and Instructions
Covered projects, or all construction,, demolition and renovation projects that are 3,000 sguare 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 CHIC 16.72,050, At the conclusion of the project
a Construction Recycling Report must be filed with the Public Works Depai°tliiciit/Envii�oiiiiientaI 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.
Recology is the only debris bin service provider franchised to do business in Cupertino
Debi -is from a project 3,0010 square: feet or snore in Cupertino can be collected and
disposed by using:
Please check all that apply:
0 1 am not using a Recology debris bin, however, the project is less than 3,000 s.f, e.g. buildings, patios,
sidewalks, driveways.
If will use a Recology debris bill, By Agreement with the City, Recology will prepare my required
Waste Management Plan & Recycling Report. Contact Recology: (408) 725-40M
0 1 am not using a Recology debris bill, 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'Deniolition ff"aste Manag�einent Plan ivith jiour building perinit
ol.y.)Iicalion. Nofee
166 this plan. F0177is are availoble at the BuildhiglPublic JVorks counter and online
at Rcy)ort the tonnage recycled and disposed, by inaterial tyl)e.
RecYclingfiacilities nicest be selectedfi-oin the City fq)proved list of Recycling Resources.
v' Siibi)iitciCoitsti-ttctii?iiReejycliiigl?cl)o)-t-foi�trr, Vice report isrequired beC/ 71
fibre the Buil i g
Dcl)arlinent ii4lischediele an final insj)ection. Die re],701-11forw is available (it the BuildinglPublic
JF6i*Y Coun(ei- and online wwiv
Signature:
Name: (printed),
Title:
Phone:
Project Address:
Cul"E':5TINO
This fonil to reinaiii ill the pro ect', o
J btfilding r the dur c) tile 11,09ect.
Revised 317112 Ers fo Buildlip Department
FREVH.�.WED FDR CODE COWI[JANCE
Revuewed ByAjby Aya,ide
DatE:P n9/�!::'n/'�6
[SAIRMY-OMMO
F-"Jgo�r M.O� I I lL : 'L 9 'k IM31"'1111101
MIT=- PA
Tyler Schmautz
-AWNT
DeAnza Service Planning
4018-725-2018
CUIIIIERTINO
Builial ih IIDepartimen't
FREVH.�.WED FDR CODE COWI[JANCE
Revyew u3yAjby Ay&,ide
DatE�P n9/�l::'n/'�6
10900 No. Blaney Avenue
Cupertino, CA 95014
moms
Perfect Flornes C011Su-L1Cfi0n
382 Lasseripark Circle
San Jose, CA 95136
Regulation '11, Rule 2
11 "1 PT
Notification and
Payment of Fees
8/30/2016
Job No: 4W724
Invoice No: 3WA19
The Bay Area Air Quality.Managerrient District (BAAQN/1D) acknowledges recelpt of your payment and
your Asbestos Removal or Dernolition Plan described as: Deniolition
Site address
Start Date
Conipletion Date
1091 Noverriber Dr
Cupertino, CA. 95014
Septernber 6, 2016
September 10, 2016
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 firu-nediatcly
copy the District by fax or by mail.
REGULATION 11-2 REVISION' BAAQMD J# 4W'724
REVISION 4 START DATE COMPLETION DATE
2
. .. .... .. .......... ..... .
3
4 ------ --- --
5
NOTE.- This lbrin is iiot intewle(l eis a verification (Y'either the conilVeteiiews o1your original nol�flcation
or ofils conqViance ivith BAAQAfT) Regulotion 11-2. 4'-Vou have a)ry qucwlions about this
acknowled�,,mew, lVe ase call our (# 62.
fice (it (415) 749-47
CUPIER"TINO
13Wldling IIDeIpairtrrient
FREVH.�.Wl..D F�OR CODE COWI[.W�CE
Revuewed By:hjby Ayande
u)atE�n9/�!::'n/'l6
COMPLIANCE &
ENFORCEMENT
BAY A ik r, A
A I R Al TY
DIVISION
M A N A G V M N I
D i s r iz i i
Perfect Flornes C011Su-L1Cfi0n
382 Lasseripark Circle
San Jose, CA 95136
Regulation '11, Rule 2
11 "1 PT
Notification and
Payment of Fees
8/30/2016
Job No: 4W724
Invoice No: 3WA19
The Bay Area Air Quality.Managerrient District (BAAQN/1D) acknowledges recelpt of your payment and
your Asbestos Removal or Dernolition Plan described as: Deniolition
Site address
Start Date
Conipletion Date
1091 Noverriber Dr
Cupertino, CA. 95014
Septernber 6, 2016
September 10, 2016
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 firu-nediatcly
copy the District by fax or by mail.
REGULATION 11-2 REVISION' BAAQMD J# 4W'724
REVISION 4 START DATE COMPLETION DATE
2
. .. .... .. .......... ..... .
3
4 ------ --- --
5
NOTE.- This lbrin is iiot intewle(l eis a verification (Y'either the conilVeteiiews o1your original nol�flcation
or ofils conqViance ivith BAAQAfT) Regulotion 11-2. 4'-Vou have a)ry qucwlions about this
acknowled�,,mew, lVe ase call our (# 62.
fice (it (415) 749-47
CUPIER"TINO
13Wldling IIDeIpairtrrient
FREVH.�.Wl..D F�OR CODE COWI[.W�CE
Revuewed By:hjby Ayande
u)atE�n9/�!::'n/'l6