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D-2017-0001 CITY OF CUPERTINO BUILDING PE' IT
BUILDING ADDRESS: CONTRACTOR: PE' T NO:D-2017-0001
18841 BARNHART AVE CUPERTINO,CA 95014-3601(375 16 054) CNE CONSTRUCTION
INCORPORATION
SAN JOSE,CA 95130
OWNER'S NAME: GRAND SUCCESS LLC D• ISSUED:01/10/2017
OWNER'S PHONE:408-391-7329 PH o NE NO:(408)726-2956
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT I 'O:
License Class,,E Lic.#1011892
Contractor CNE CONSTRUCTION INCORPORATION Date 03/31/2018 _BLDG _ELECT _P UMB
MECH X RESIDENT : 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:
DEMO(E)SFD(814 S.F.);GARAGE(225 S.F.)
I hereby affirm under penalty of perjury one of the following two declarations:
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.
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: Val ation:$10000.00
•
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: Oc upancy Type:
and state laws relating to building construction,and hereby authorize 375 16 054
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 EXP ' S IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting of this permit. WITHIN 180 DA S OF PERMIT ISSUANCE OR
Additionally,the applic'"?t understands and will comply with all non-point
source9ulationspcer the Cupertino Municipal Code,Section 9.18. 180 DAYS FRO LAST CALLED INSPECTION.
, Signature ,-¢ Date 1/10/2017 Issued by:AbbyAyende
Date:01/10/2017
OWNER4UILDER DECLARATION
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 p'or to any roofing material being installed.If a roof is
1. 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)
2. 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:1/10/2017
I hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF CO I' 1 GS 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. HAZARD a US 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&Safe Code,Sections 25505,25533,and 25534. I will
maintain compliance with t e Cupertino Municipal Code,Chapter 9.12 and the
permit is issued.
3. I certify that in the performance of the work for which this permit is issued,I- Health&Safety Code,Se don 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,sho d 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 wi h the Cupertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safe Code,$eet oi9s 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized age t. ."/°`
APPLICANT CERTIFICATION Date:1/10/2017
I certify that I have read this application and state that the above information is CON °ll'CTION LENDING AGENCY
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that thea =construction lending agency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this per it 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 ARC¢HTECT'S DECLARATION
and will comply with all non-point source regulations per the Cupertino Municipal
Code,Section 9.18. I understand my plans shall be used as public records.
Licensed
Signature Date 1/10/2017 Professional
D:10 11--00CA
At/ DEMOLITION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISI o ND
4:71.,,,, 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUPERTINO (408)777-3228•FAX(408)777-3333•buildinq(a�cupertino.orq
PROJECT ADDRESS es4.-1 ejarhtIr,Lrt 4vQ APN# ,,,c-,_ 16 s3Se
OWNER NAME �( / /� q )� / O
(a7an success LSC : PHONE /D` 5 l 7. 1 E-MAIL
C it CFffi')s�/?J'�',//f'tQi(i C9/✓J
STREET ADDRESS pp CITY, STATE,ZIPS 1 FAX J
404 S /AA 0�u� d� IN/_�}/1� San .T ase G' 1S-1�j 0
CONTACT NAME rr � p v PHO �M�
t�V�Dtrn Fike(�1 {O$'�q�— � �j� C7y137 =1076t40a, Cyri.,
STREET ADDRESSCITY,STATE, ZIP
5 /ix.re w FAX Ti o se .' 7St3
❑OWNER IA OWNER-BUILDER 0 OWNER AGENT 0 CONTRACTOR 0 CONTRACTOR AGENT 0 AR I 'CT 0 ENGINEER 0 DEVELOPER 0 TENANT
CONTRACTOR N. ` LICENSE NUMBER LICENSE T 'E BUS.LIC#
C CoastM trop I hC t vi f g`1 2— l3 et-06oq-
COMPANY NAME /� / J -
C ,Z Can styU G1/`�/l Inc c, E-MAILE (/le CPA s-g i'vto iY 1 PTO FAX
STREET ADDRESS 44s. /".ie 11/ t 9 (7vv'7 CITY,STATE,ZIP
a,4 i DsQ Cit J r1 o PHONE
406--Y31-?Iv"
1 �I stows
.2_
OF WORK (\i l v Q. O 6 Ct. ( S t R,X I`5.1;t ' Q
1 J ; ks e &[ eh.S -6---4-e-
t
ee v ve vt f Pk. 1-5•0Y t aio4 vt ety-.
RESIDENTIAL Q 5 #DWELLING OFFICE USE ONLY
FLOOR AREA 4 ( t UNITS USE - OC.. TYPE SQ.FT. VALUATION -
COMMERCIAL
FLOOR AREA
TYPE OF CONSTRUCTION #STORIES 1
AQMD JOB NUMBER REC I I BY: .- TIIIAL VALUATION:
J#: o i- T OI G,,c 10 ,o
By my signature below,I certify to each of the following: I am the property owner or authorized agentIto act the p iperty owner's behalf. I have read this
application and the information I have pro;sed is correct. I have read the Description of Work and verify it is acc .ii . I agree to comply with all applicable local
ordinances and state laws relatin: . , Il'-,g construction. -_. inn representatives of Cupertino to enter the above identified property for inspection purposes.
Signature of Applicant/Agent: Date: d(/O7 (1''o 17
SUPPLEMENTAL I ORMATION REQUIRED PRIOR TO ISSUANCE OF DEMOLITION P RMIT OFHCE USE ONLY
IV1Crovide Job Number from Bay Area Air Quality Management District www.baaqmd.org @ 415-749 ,762. PLAN CHECK TYPE
Provide three copies of a site plan showing protection for any trees 10"in diameter or more at 3'abo e grade. © mss
0 STANDARD
I Provide letter from PG&E(408-725-3325)stating all gas and electric has been disconnected.
// ❑_LARGE
Planning Dept clearance to verify building is not considered an historical landmark.Allow 10 busin ss days.
0 MAJOR
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 dwell' g"inspection.
V Provide signed Debris Bin and Recyclable Materials form.
_Commercial Buildings Only: Provide Fire Dept clearance for fire suppression/alarm system revie .
DemoApp 2016.doc revised 03/29/16
CNE Construction
4045 Moreland Way
San Jose, CA 95130
Regulation 11, Rule 2
Acknowledgement of
Notification and
Payment of Fees
11/10/2016
Job No: 4YO77
Invoice No: 3XC39
The Bay Area Air Quality Management District (BAAQMD) aclulowledges receipt of your payment and
your Asbestos Removal or Demolition flan described as: Demolition
Site address 18841 Barnhart Ave
Cupertino, CA 95014
Start Date December 7, 2016
Completion Date December 14, 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 immediately
copy the District by fax or by mail.
REGULATION 11-2 REVISION BAAQMD J# 4YO77
REVISION # START DATE COMPLETION DATE
2 I I I l
3
4 i r
NOTE: This form is not intended as a verification of either the completeness of your original notification
or of its compliance with BAAQMD Regulation 11-2. If you have any questions about this
acknowledgment, please call our office at (415) 749-4702.
II II::1 R '1
iter°iilldiling Il elpartumn't
aiEVH. =..D F�Ui COM CW:III..WI C
Revue ed a3yAbby Ayaride
[WEO U MI
COMPLIANCE &
ENFORCEMENT
BAY AREA
A.iP,QLiAr_1TY
DIVISION
1'AANAOEM LNT
D i s 'I" R I c 7
CNE Construction
4045 Moreland Way
San Jose, CA 95130
Regulation 11, Rule 2
Acknowledgement of
Notification and
Payment of Fees
11/10/2016
Job No: 4YO77
Invoice No: 3XC39
The Bay Area Air Quality Management District (BAAQMD) aclulowledges receipt of your payment and
your Asbestos Removal or Demolition flan described as: Demolition
Site address 18841 Barnhart Ave
Cupertino, CA 95014
Start Date December 7, 2016
Completion Date December 14, 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 immediately
copy the District by fax or by mail.
REGULATION 11-2 REVISION BAAQMD J# 4YO77
REVISION # START DATE COMPLETION DATE
2 I I I l
3
4 i r
NOTE: This form is not intended as a verification of either the completeness of your original notification
or of its compliance with BAAQMD Regulation 11-2. If you have any questions about this
acknowledgment, please call our office at (415) 749-4702.
II II::1 R '1
iter°iilldiling Il elpartumn't
aiEVH. =..D F�Ui COM CW:III..WI C
Revue ed a3yAbby Ayaride
[WEO U MI
Pacific Gas and
r: Electric Company,.
WE DELIVER ENERGY.""
NOVEMBER 30, 2016
ETHAN CHEN
18841 BARNHART AVE.
CUPERTINO, CA 95014
RE: 18841 BARNHART AVE— CUPERTINO 95014
Order Number: 111857196
To whom it may concern,
The gas meter at the above referenced address has been removed and the gas service
was cut off at main on (09120116).
The electric service & meter at the above referenced address has been disconnected and
removed on (11118/16).
Sincerely,
�� A
90
Justin Pigg
Project Coordinator j Pacific Gas & Electric Co I
DeAnza Division) 10900 N Blaney Ave. Cupertino, CA 95014
J2PY0oae.com jOfdce: 408.725.2165
M -F 7:OOAM — 3:30PM
**AVAILABLE BY APPOINTMENT ONLY**
"Safety is a full time job; don't make it a part time practice"
111111:' I
6uflI iiiing II epartime tt
FREVH.�.=..D FDR CODE COMi'[JANCE
SOS PEST CONTROL
214 Christich Lane # 103
Campbell, CA 95008
Rodent Inspection Clearance
Date : October 28, 2016
Re: Property Address: 18841 Barnhart Ave. Cupertino, CA 95014
To whom it may concern:
The property at the above location was inspected today for any infestation of rodents. No
active infestation was found, if you have any further questions, please call our office at
(408) 866-6609.
Thank you,
Mike Stadmiller
Branch Il Field Representative
CUIIIIERTINO
lquifldlir:q Il ell ar°tirr ent
FREVH.�.WED FDR CODE COWI[JANCE
IMIN City of Cupertino
Public works Department
Environmental Programs Division
FFIRIl 11 10300 Torre Ave
1� 9 Cupertino, CA 95014
CUPERTINO GREEN
Program (408) 777-3354
Construction and Demolition Recycling Diversion
Requirements and Instructions
Covered projects, or all construction, demolition and renovation projects that arc 3,000 square 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 CMC 16.72.050. At the conclusion of the project
a Construction Recycling Report must be filed with the Public Works Department/Environmental 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.
Debris from a project 3,000 square feet or more in Cupertino can be collected and
disposed by using:
Please check all that apply:
14 I am not using a Recology debris bin, however, the project is less than 3,000 s.£, e.g. buildings, patios,
sidewalks, driveways.
❑ I will use a Recology debris bin. By Agreement with the City, Recology will prepare my required
Waste Management 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 & Demolitions Recycling Packet from the Building Department and
complete the following:
✓ Submit a Construction and Demolition Waste Management Plan with your building permit
application. No fee for this plan. Forms are available at the Building/Public Works counter and online
at www.cupertino.org/environmental. Report the tonnage recycled and disposed, by material type.
Recycling facilities must be selected from the City's approved list of Recycling Resources.
✓ Submit a Construction Recycling Report form. The report is required before the Building
Department will schedule a final inspection. The report form is available at the Building/Public
Works Counter and online www.cupertino.org/environmental.
Signature:
Name: (printed) N�$L
Title: C Cvu r
Phone; 4c$ f 3ai f --
Project Address:,_1( 8 I_
This form to remain in the project's building
Revised 317112
&r 6t0 i.
l
FREVH.�.=..D FDR CODE COWI[JANCE
Date: oI%o� fif17-