12050021 CITY OF CUPER'TIN.O-BUILDING PERMIT
BUILDING. 18760 TUGGLE,AVE' CONTRACTOR:BAY AREA:CUSTOIvt PERMIT N,6'n1,20.50021
;I ;BUILDERS'INC;
OWNER'S:NAME-.1-AHAV'RONEN 11002 S DE,ANZA;BL-VD STE Al DATE'.ISSUED:05/02/2012
-OW,NER'STHONE: SANAOSE.�GA 91,129 PHONVNO:068)446-1200; .
LICENSEDf'ONTRACTOR:S DECLARATION c•l„j ”
BUILDING PERMIT INF_O_ BLDG: ELECT PLUMB
Li-C&w Class Lia=#. G( t
- 1VIECH '"' RESIDENTIAL' "' .COMMERCIAL
Contractor(Z,,d_�e 4 acct
v JOB.DESCRIPTIQN:DEMOLISH I100'SOFT SINGLE FAMIWDWELLING
hhere6y affi-niAat fam1icensed under the provisions of Chapter 9 - _
001nmencing with Section 7000)of Division3 6Uthe Business;&Professions
Code'and OaLmy licenscAs'•in full forcc:and effect.
Lhereby affirm,uhder penalty.of perjury one of,the following;fwo declarations'
'have;and,will maintains ce'ificate4consem'to§Jf-,msiire-,0'Woiker's
'Compensation;as'prov ded'fbr,by Section'3700 ofth'elLabortodeg'f&the
performance„of the work,,tor which this Permit is-issued. s
l have and will maintain Worker's'Compensation Insurance;as provided for:by Sq.Ft Floor Area: 'Valuation:$10000.
Section 3700ofYhe Labor Code;forthe performance ofttie+work;foi.whicfi.ttiis "
perm tg s issued: An Number:37529022:00 Occupancy".T.fl
APPLICANT CERTIFICATION
certifythat'I have,read+this apphication%amd(state that;the;,above;information is
correct [,agree to comply with all city!and'county.ordinances and state;IawS.relatimg
t6.,biiildingconstruction„and,hereby,authorize°representatrve"s.ofthiscitytoenfet PERMIT EXPIRES IF WORK•IS NOT STARTED, .
upon the above mentioned.property for:ins ecUon"u oses We a reeRo save I'IH"IN'1go DYAYS OF PERIVII_T"ISS"UANC_E_:QR,
p p rP )" g WI.
'indemnify and keep-harmlesslthe.City ofCupertino�agamstliabilrties'judgments,
costs and expense_s w}iich may,accrue?againstsaid Gity'in•consequence,of the 180'DA t `FRO LAST CALLED INSPECTION.'
g a g p p g P p.._ p __wilP Y Issued by: Date:]
withtall oitliios, ermirce ie iulations per !'canrtno Munnds ACodel"Secti"on
1
_ r
Signature _ Date 0 5x_U r—A
RE=ROOFS:
17 OWNEWBUILDER'DECLAIL4TION, All°roofs shall he inspected pribi,to any'roofing maieriafbeiig installed,Ifsa:roof;is
= installed-with6ictiist obtaining;aminspection,I agree'tojemove all new materials for:
1 hereby affirm-that,l_.am_exempt from°theContractor'sFLicerise caw;for,one of inspe'cuon.
th"e1oll'owingawo reasons:; -
1„as owner f the`property:or iriy employees with=wages as�their'solercompensatiop, 'Signatuie,of Applicant: Date:
,will.do tlie.work!and'the structure_ismot intended or offered for eale,(Sec:704,4,
sions,Code)
dB as own n6frthe;propeity„am exclusively contracting with licensed contractors to ALL,ROOF COVERINGS'TO BFCLASS"A”OR BETTER
construct the proJect;(Sec 7�04'4;.Business&•Prof6ssions Code).
1 herr_ebyaflirm iinderpehalty.of.perjury ooe`of'theafollowing three”
HAZARDOUS MATERIALS,DISCLOSURE
declarations:' =1 '
Cal form a Health&Safety C terials requgements umderChapter 6:95.ofthe
,['have and"will maintain a Certificate of Consentto self-insure for Workers ode Seetions'25505,25533;.and,25534. 1 will mai"nfain
Compensation as provided.for bySection"3x700 of the La_bor;Code;:for{tlie compliance ivith'ttie?Cipertigo Municipal Code;Chapter:912and,the Health
a
performance of the,work for which this.permif is is'sued., Aild SafetionalleI should l use of a�^�shme-t I de;.." wtiould'i"st6re or c�ti ero t hazardou'serial.
Insur n ��asprovided for
y Y� 9 p. air-
I have and will mamtan Workers Compensation_ . _
`. a ce;�
Seohon,3 7OO�,ofthe„Labor Code;for the performianceofthe work°fo�whichthis contaminants as defined byithe Bay'Area Aih Qualrt��Managenient DistrictFhwill,
maintain comphaoceEwith,theCuperfihoMunicipal Code,,�,Chapter9.12 aridwttie.'
permit isJssued. Health&Safety Co".e,Sections 2 505;25333,and-25534.
certify that,in the pe-rformaiic6ofthe'wotk for`wliichthis�permit is?issied,I shall
not;employ an} person m any,manner so,as to become+sub�ectto the Worker's Ow r_or,authorizeds nt r
Compensatioglaws of Cahfoinia:,if,after rnakmng:this;certificate of exemption,tt _ _Date.
beco'rme subject to,the+Worker's Compensauonjpfovisioris,ofthe,Labi6rCode,I music
forthyvitli'com_I –”
ply pro"visions'•oraliis�germif`shall be deemed revoked: CONSTRUCTION I ENDINGAGE"NCY;
I hereby'a irn- that[here lis a constructionlend utg agenoy for the�perfommance`of iiork's
APPLICANT.CERTIFICATION" for`whi&ihis permit's issue&(Sec 3097,"CiVQ
I certify that I.have'read'(his application and state,that ]rove information is Lemdcr'.,s.Nime. -.
correct.I"agree,to comply;with all city^and county ordm`ances and state;l'awst(elatinga
to'.building-construction and;hereby�authonze,representative"s.of"thisI itytoe.__ 'Lender'si-Address
upon the above mentioned property for'inspection'purposes.-(We),agree to save
indemnifyand keep harmles-s`the City"of.Cbpeq_ino against liabilities judgmenfs,
costs,and expenses which.inayraccrue against said;Grtyin consequence ofthe ARCHITECT'S'1)ECLARATION
g{antnig.of this permit:Additionally,they:applicanvunderstands and,will coiiiply h inders_tand mya plansshalf be user]as'"public�;recoidL
Withallsnon-point source regulations pecthe',Cupeitino,MunicipalCode„Section
L'icenscAProfessl6fild
Signature - Date
>, a.
CITY:UF CUPERTINO
F.EE' ESTIMATOR- B'UILDI-NG DIVISION
.. ,ADDRESS: 1:8160.Tuggle;Ave DAM'D6t02I2012' REVIEWED BY: ,Sean.
BP#.° � � pL' 'VAL'UATION:; $10 00.0.
'PERMIT'TY_P,E- Demolition Permit
PRIMARY - PENTAMATION;
SFD.or Duplex 1 SFDWL-D.EM.
USE: PERMIT TYPE::,...
WORK ''Deim0 sh 11`OOss ft°sin' le'.famil °dyiiellin`
SCOP_.E'
`FEE:;ID . FIR AREA., ,,.
'SC
1 DEMORES '�;�00
11,-ch. �'.ran:C.,hech� /'liuul> 1'la:�:(=;hecTti
�)iFtei 11,c1>.:'i`nel>- f lJl7ttr 1'luait;,IrEsp� 011�et�Cls� Irrst�.
,lle;ch lattv. lcc`°Insp
NOTE ,Th"isSesdM to does not`ineluiie fees due to other"Dep zrtment§�(t_e..Pldnning„Public Works,Fire;,Sanilary-Sewer District,School'
District,eic. : •These'ees are'based:on.the`reltrnina".'in ormation�availalile and are:onl.'an_=estimate `contact the°De t dor arldn'hin'o;,
FEE ITE'MS.(ree.Resolution 13,','0-53.E,f MIT 'FEE QT.Y%FEE MISC ITEMS
I'IMI Check,FCOF
Permit Fee.:
Suppl:;Tn§p, Fee; :Reg. �.OT Q;Q hrs
rt .
��„OI2Sl7'uy:t<iYt' IJs\? ,
F - _
�;I•P�Inri'T.T:4$i'XT.I�'C'l'sE?(;' -
l�;'��r1s 61'tJ.!rszri l-'<>1•hi�l`)_ a _ - -
StroriV,Motion'.F'ee: lBSE1SNIICR. $1-:00� Select am Adrriinistrative'Iiem.
- •
B'lcig;Stds C' iiiinisMon Fee: IBCBSC
SUBT®TAL�S $525:`00 $0 00` "u T®TALF,gEE $525.00
�_ _
Revised ,04/01/,2012,
.. _ .. w _ ss �.i"�l .115 _tea"u•Y:Y.'.r_ �i�au��S a '' °i„ .��j'k
D'EMO'LITION PERMIT:APP`L1CATlON
COMMUNIT`(,DEVELOPMENT"DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•.CUPERTI.NO, CA 9501,43255
(.4'08)'777-3228 . FAX(4,08)77743333.•buifdinq6l,cubertihoorq
G.U,P E RT l N,O
PROJECT ADDRESS
a a 1141
OWNER NAME'. ' PHONE -
,
STREET D _ T1 (G^�\,! FAX
V
CONTACT NAPHONE
ME E-MAIL
'STREETADDRESS CITY,STATE, ZIP FAX
s
R. ❑.OWNER:31ADER ❑,OWNERAGENT =❑ CONTRACTOR ❑CONTRACT-MAGENT ❑ .AACHrI'ECP ❑6TlGINEER ❑ DEVELOPER ❑TENANT'
CONTR AC'COR:NAN[E / LICENSE;NUMBE ^J ��i LIcm&TYPE I3Us.I IC`#' ( J C
DESCRIP.CION OF'WORK
:RESMENTiAL #'DWEI;LING` olFiCEII3EOiY11 v
'FLOORARE'A /(J - UNITS [ISE OCC: TY EE S ..FL. s.u?tCFT6TiOTF
;COMMERCIAL _ _ it
FLOOF,-ARA _ _ 'TV ikp _
TYPE OF CO2VSTRUCTION , / #STORIES * � '
V c
3
..........
,AQMD JOB NUMBER_ 7FE�ELSSEDYH�T-. TOTALVALUATION:
By+aiy,'•signature below,I.'certify to'each of the foll_owtng ;I-cmc X`owner or authorized agbnt to.acf on'tlie?propertg'owaer s:behalf. d have r�thiapplicat onandthe;information I.have�proVided is correct. ave theDescription of Workand Yenfy iris accurate. I:agreelto complywith all appcal
ordinancess acid state,laws,Telatrng,torbuildin nstruc tliorize•representadves of Cupertino to eater the,above=identified property for.hispect s
Signature;ofApp_licani/Agent `Date:
SUPPLEMENTAL;INFORMATION^RE��, ° D PRIOR TO,ISSUANCE OF..DEMOI:ITION'PERMIT e1�IIST cis ;
Provide i6b:Num6er firom.Bay Area Air,.Quality;Management District www;baag.md:or!Z @415-7494762..
_ .
►✓Provide three,cop_ies!'of.asite plan'showing protection f6vany trees,l0"in diameter or`more-at 3'above grade: w
%o Provide letter;from PG&E(408=725=3325).stating all-:gas and:electric.has been.disconnectedc,
✓Provide a,letter ofMpection;'tests,and.abatement of any'Hazardous Materials.Letter`to'be initiated;by persons}
certified in,asbestos;.mereury°and/or hazardous'material examination'. a
._- _ _
✓Planning Dept clearance`to verify building is riot cons idere d,an historical landmark.AlIow 10 business'days.
✓P.iovide letter`of:cle_arance,of all vermin from a,licensed.pest control contractor-.
Applicant shallcall the Public Works Department at 408-777J104,and schedule,a"habitable dwelling"':inspection
-
fProyide signed Debiis'Bm and',Redclable,Materialsform. _�
Commercial Buildings Only;'Provide File Dept'clearance f,fre,suppiession'/alarm system review: � —..
DemoApp_2011.doc.r,.evised 03/16/11
_ _ _• CityOf Cupertino
- _ 1;0300,Tore(venue
Cuperhino, CA'9501.4=3255
C U.P E RT N'0 = -_ - Fax 4'W7-7
CON'TRACTOR./StJBCONTRACTOR LIST`
JOBADDRESS.�,��7 p i ✓e— PERMIT
OWNER'S, AME: "PHONE .
N
GENERAL;CONTRACTOR:"' ;�,,`� ��� C BUSINESS.LICENSE#,'
a
ADDRESS': i.e.2 QT..Y fPCODE:- • '. Zq
*aOur-municipal code requires all'b.usinesses wor ing:in thefcity4o have'a;City~of,Cuperfno:business license:
`- ' NO BUILDING-T-INAL OR 'FINAL;-:OCCUPANCY- INSPECTION(S) WILL-BE *SCHEDULED UNTI'L"TTHE'
GENERAL._C0NTRACTOR .AND"AtiL.SUBCO T, HAVE` 'OBTAINED A. CITY OF CUPERTINO' _
= B,U$INESS;-LICENSE:
-I.am.not using any.subcontractors . _ _ -_ - _ — z_t
ignature' = Date=-
PFlease check,applicable subcontractors'.and,complete.the following'inforitiAtion:
e! : S'UBCONTRACTOR'. BUSINESS NAME- BUSINESS_LICENSE#
_cabinets &Millwork _
Cement Finishing
ElectiicaL. -
Excavation _-
- Eencing:.
Eloor
' I
Pacific Gas and
Elect.is Company"'
10900 No. Blaney Avenue
Cupertino, CA 950,14.
Cityof Cupertino
103,00'Torre,Avenue
Cupertino, Ca, 95014
To Whom ItMay Concern::
SUBJECT REMOVAL . ELECTRIC:.FACILLTIES!
w -
The, ;electric facilities have been.removed and /or abandoned at:.
8 Ttm k)'c on S(( L -
If you have any further questions, please contact me at (408)7251325
Sincerely;
VYi
S:eivice Planning
Asbestos Mainagement Groups of California, Inc.
34M!Helen Street
Oakland,CA 4608
Phone(51;0.),6.544441.%.Fax('51'.0)'654-8447
Date: April 30,2012
Owner: Bay Area*,C,UStom.Builders
1002 S'.DeAnzaBlvd.
San Jose,Ca.05'.120
Project: 187,60 Tuggle;DrivesCupertno;Ca:,
Asbestos Management Group of'California,Inc,.,certi_fies(bat all_asbestq°s,
containing material,which were contracted to be removed,,,at the above'project
site,were removed and,disposed of in accordance,with all governmental
regulation"s,and the contractFdocurnents. All requirements of the contract.have,
been met.and,the projectrsite has'been,demob'iIized:
(7� Formatte fi;Font:QuigleyWiggly,20 pt;Italic,
Font color.C_ustom,Color(RGB(Z9,129,189)),
Signature
Tory Newman,Project Manager
Name-.&Title `
1
Uj
r _
CD
_________.
__---_.---_.-___.__-___._______._. _.- .______________________--_________ -- ..._.___._ _ __._____--___-_-----_-_-_ ________.__________.. _ _ --.------- --•
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EXISTING CONCRETE BLOCK WALLS TO REMAIN ��
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1
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-
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CONTRACTOR TO COORDINATE
_
WITH PG&E RELOCATION OF v � ■
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EXISTING SMART METER C�
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6"DIAMETER TREE TO
BE REMOVED/ /\ % �' -� ' 4--'—1✓`' ►�t Int _a
v`IN' _ h• �t i 1 I
< /•jam`. �.y v d�
/rte < �•, ( > /AY
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j` `<�iw 4" DIAMETER AVOCADO
TREE TO REMAIN; f>
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-44
= ji-
411370 RAMON DRIVE,
4" DIAMETER APPLE
TREE TO REMAIN SUNNYVALE, GA 94087
1 Tel: 408.203.4686
�- 408.726.0017
� r-11
- SSU APPLE
` • ? - I ANCES
wA ,
/ 9"DIAMETER LOQUAT --'' ''+' TREE TO REMAIN Description Date
TREE TO BE REEMOVE
9" DIAMETER
!; 1 PLANNING SUBMITTAL 12.21.2011
D
4, �, �,f I 2BUILDING SUBMITTAL 02.28.2012
3 :PLAN CHECK COMMENTS-A 03.2012
4 :REVISION 1 03.2012
DIAMETER ALBIZIA , s
JULIBRISSIN TREE TO ,
BE REMOVED �AY
, --
/ \� _ _�-- ••— 5`. L1I Dl
G4Mfi UNITY DEVELOPMENT I
63U LDING V 15iON-Ct�Q
.
- - -- oo at'I6 M e kept at tti�
'_,, � UST b t
( p iG`
I _ 1 h S sel�PIWnP and s
9 tion. It�S un�a`nt#� I to make any Checked By: Checker
job site Burin constr�l� ame,or to deviate
changes or alterations tI lal.
_i without approval ft; r`rrtla@
therefrom, Building
-.
ecificatloAt I-N® `
The stamp ng of this plan be ans approval of t
i
-�J - a pr val he v�ot4tion
be held to permit or to
of any provisions of any City Ordinance or State 1v�
,,•BY
>> DATE / DEMOLITION
PERMIT NO.
PLAN
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C .
oplo
OFFICE C
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4 ,
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Drawing Scale: 3/16" = 1'-0"
Job No.
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p€E