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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-