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00120084
CITY OF CUPERTINO*°""'''�"'� !�yu CO NTRACTOR„INFORMATION. .`. BUILDING DIVISION PERMIT . BUILDING ADDRESS: PERMIT NOO 0 12 0 0 84 20400 MARIANI AV �aAyyeW PERMrr��!-4/ 2 0 0 1 nNER'S NAME: 'VA INE: SANITARY NO. CONTROL NO, ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Description 1 Mmby of on, that I am liavcd under provisions of Chapter 9 (commencing with aTBufecDiviaioalOrthc Buomssand Profrssiors Code. and mylicenxr 6520 SQ.FT.TI, CEILING ONLY REMOVAL OF WALLS in roll rota and effect. llfor Lic.r License GlClassa°.« t ASBESTOS REPORT TO BE SUPPLIED Dam ARCHITECTS DECLARATION I Walc su fid my plans "It he used as public mcerds ) �y/s ter( Licensed Professional OWNER -BUILDER DECLARATION License Law for ,W I hmahy .(firm Net 11. exempt from the Gonion Cole: city or county L3. Baines and Cock: : following max.. (S.I, ere. d.aoa • Permit to construe alar, Impmac, i h, or err which c. a.iYany uluctuo its issu h per prior to its cert enec, also require the 01 for such permit m file a, Lad summcnt wthe provisions of them Law (Chapter 9 maetmentigwit Sq. FL Floor Area Valuation pursuant Profession= 01 (commencing with Section 7”) of Division J of Business Pref $58000 al aged umnapt roti m Nat he r exempt memfrom and the aper for me alleged exicant 1. Any violation of Seamon any �pwr�j rTlsyer Occupancy Type not mom then Bae auedmd dollars (5500) 3 1 6 L},Z Out 6 . 0 0 0 1. as owner of the property, m my employee with wage as Nair sale K.W an. 101 d Inspections - FOUNDA�1q jile P will do the work. and the Structure is nat ntended or offered car We (Sec. IOµ Business and PmfMMom Code: The Contractors License Law does rad, apply to an owner of property who builds orimproves themunend who da=such work himselforthough his 102 - PIERS Own employees,provided Man such improvements are not intended.roRered for sale. It. .'.yxevec the WildingM improvement is cold while am year ufcompleion. the owner. 103 — UFER builder will haw the burden of Moving wt he did not Wild or improve Tor purpose of 104 — RE BAR sale.). 0 I. as Owner of the pmperr , am exclusively contracting with liccmed comme,dn to 105 - ANCHOR BOLTS construct the ymject(Sec.yOas, Business and Professions Code:)The OmMacwr'sU 106 — SEWER & WATER come Law does not pply to an owner of property, who Wilds or improve me¢on, and who contracts for such, projeeu with aaontrxtor(s) licensed pursuant M the Comractor= 202 - UNDERFLOOR PLUMBING License Law. 0 l am..empt under Sec . B A, P C for Ni reason 203 - UNDERFLOOR MECHANICAL 204 - UNDERFLOOR FRAME OwnerDam 205 - UNDERFLOOR INSULATION- WORKER'S COMPENSATIONDECLARATION Ibembyaffirm ender penalty of'do,.ro of the following declaaaoe: 301 — ROUGH PLUMBING ❑Thave had will maintain accditamof Consent mselt-imnm for Worker=compen- 302 — TUB & OR SHOWER etian. as provided Tor by Section 3700 of the Labor Cade for the performance of the 303 — ROUGH MECHANICAL work for which Nis permit is iuued. 0 1 have and will maintain workers Compensation 1 ummuse, as required by Stedon 304 — ROUGH ELECTRICAL 37W of the Labor Code, for am paorsmme, of the wort for which this permit is issued. 305 — FRAME My Workers Compeaadon Tann a e carrier and Policy number am: 306 - HOEDOWNS terrier: policy No.: CEItTIFTCATEOF EKEMp ION FROM WORKERS' 307 - INSULATION COMPENSATION INSURANCE 308 - SHEETROCK (Thr xetimnced.1 be completed if the Permit is fm one hundred call. (SIM) 309 - EXTERIOR LATH m les) I1ce,uly that in the perfnmmxec of the work for which this Permit is Wood, I shall net 310 - INTERIOR LATH emph,tuy perm in any mmncr w as In become cobjeet to the WOrkas Compensation 311 — SCRATCH COAT Laws of California. Dam Applicant 313 - ROOF NAIL NOTICE TO APPLICANT. If. arm, making this Cenifie da of Exemption, you should TleMom subject w the Worker's Compersoom povicansaf Jen Labor Code, you must 501 - FINAL ELECTRICAL ENERGY forthwith comPlywith=ma m oath+=-itanall x doomed mvaked. 502 - FINAL PLUMBING ENERGY CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY I emby a ium that Inc. I,. constmainn lending agency far me perftur. arta of 504 - FINAL BUILDING ENERGY IM workfor which this parmlt is issued IS.. 3W7, Civ. C.) j LcrtersName 505 - FINAL ELECTRICAL Lenalm's Address 506 — GAS TEST p I cattily that 1 ban rad this appliotion end sup that lie above information is correct. I agree to comply with all city and county ONinames and sum laws mating m 507 - FINAL PLUMBING building contra Lian, and hereby suthorin representatives of this city to comr upon the 08 FIN MECHAN CAL' U ab.n.ca nduned property for iapcctioa Purposes. (We) agree to saw. indemnify and keep harmless the City Of Cupcnino against 9 F I N UL L pl Bablllfie, judgmcna. toile and expenses which may In my way acme against and City A G > in coaryOcnce of the granting of this Introit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT 51 Issued by Date SOURCE REGULATIONS, Re -roofs 516 Type of Roof NAL BUILDING Signature of ApplicwVContracmr HAZARDOUS MATERIALS DISCLOSURE am Will the applicant orruum Wilding occupant store or handle husedous motorial as defined by me Cupertino Municipal Code. Chaps, 9.11. and the Health and Safety Code. Section 15532(a)T - All roofs shall be inspected prior to any roofing material being installed. ❑Ye ON. If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or mom Wilding Occupant use equipment or devices which emit hantious air contaminants as defined by the Bay Arta Air Quality Management all new materials for inspection. DutricR 0Yes GNu 1 have mad the baarmms mamoalsrequiremcnts unkr Chapmr 6.95of the C.Ilfof- .ishealthkSafetyCade,Stearns 25505.15533 xJ2553a. Imulersund dal iflW Wilding does not currently ban a tenxa mat it is my responsibility In refry Js accurate Of the Date maimmenu whim must bo met poor to issuance or a ccm6oem or Occupancy. Signature of Applicant All roof coverings to be Class "B" or better Owner as xthomed agent Dam 12/21/00 21:55 MINERT-ARCHITECTS i 4087773333 9 V MINERT Architects To: Chuck Chevalier Company: City of Cupertino Building Department Fax: 777-3333 CC: N0.036 D01 • Date: 12/22/00 Job #: 4108.00 Number of pages with cover sheet: 4 From: Daniel Dixson Project: Syva Packaging Facility 20400 Marian Ave. Ref. ID. #00120084 REMARKS: O urgent O for your use D reply ASAP X commetits please • Chuck, Please find attached a copy of -the asbestos report that was performed by MACS Lab, Inc. Let me know if this information is satisfactory. If there is more information hat you need please contact me as soon as possible. I can be reached at 408-944-9111 for further assistance. Thank you, Daniel Dixson • 2033 Concourse Drive San Jose, California Telephone 408.944.9111 Telefax 408.944.9116 This fax will be followed by a mailed copy: Yes Cl No 0 1221/00 21:55 MINERT-ARCHITECTS 4 4087773333 498237 DEC.21.2000 1:00PM DADE NG INC FRC ,FROM : MACS Lab. Inc. FAX NO. : 408 727-7065 • MACS Lab, Inc. 2070A Walsh Avenue Santa Clara, CA 95050.2542 (408) 727-9727 SYVA MS -94 20400 Marian! Cupertino CA 95014 Analyst: TAB (signature) N0.036 D02 0 N0.272 P.1/3 Dec. 20 2000 SS:36PM P1 Bulk Asbestos Analysis Report PLM P(Imn to ccW- t: Tom McKay Contact phone: 408-96"817 FAX phone: 408-996-9a16 I Analysed an: Oecember 00, 2000 al: f 4:4. CerrMandiep Invdce number. 96618 Laboratory manager, lo•� lab Sample Client Sample Number Aeboetoe F7DAr9 r Number end Description detected? A eSent fi0rtfi711C5 L9fi619-1 1 Floor adhesive - Rm 408 • 196619-2 2 —� Nonfriable D. White homogeneous adhesive. Balance of sample Is mleaeeous and organic: binders. Wallboard - Rm 408 compound. Balance of sample is unepecllled non-fibrous material. Friable e 0 186619,9 9 N. D. 1 b/b Fiberglass Gray homogeneous vinyl. Balance of Meomerh flooring - Rm 408 sample is polymer and unspeeffled non-fibrous material. Nonfrcable L96619-4 11 Joint oomvound - RIM 408 9661" 5 M60nteCh flooring - Rm 704 L96619-6 6 Wallboard - Rm 704 a. Off-whhe homogeneous joint compound. Balance of sample la unspeoliad non-nbrous matetfal- Gray homogeneous vinyl. B81ane9 sample is polymer and unspecified non-fibrous material. 1 % Cellulose Off-wnhe homogeneous piaster! compound. Balance of sample is URSPe0lfled non-fibrous material- •' Chyeofile, Alnostte. Crocidolite, Tremdhe, Actinelae, and Arlthophrnite are asbebts fiber& Nd. N~e Detoetee CC .Polrn Counted Sam ropeq mq �, 00 OpreeyoOd 0=1 wI�y i�0 .an w Pew+ sa a a wMC6 LAID, nm Ti® O eb aB+ Y m11t04. a01nP1-0 wqi >e OOSOOlw7 ilial 6111 �r10�0, T00t ppuar 00 (ap0 Of POQO�aI p,v, G0P I f1 la7) Pert ley- 9y000R F: ADOOnOb A O! om00t O EPw rne0�vd. PertDn pcs as oPprovmats. 6110Cy lob is an aavem+d bGOaoyy al M WOorN VO4mry letlera0y awOO�tArOn /� /� fame .. !Na( W ii labwemy n0rn00r 101tNe. No OrpOdet OMORYnNO by MVIAP o. 0100 U.Sab OMPI AZGaywfiefn m% m I'M dmmOd er a * to I s de loo. S. GOt DOPT of HeWM EIAP zagV. ?hi. ,novwt :11 +or nl�v fm +hen fiber SO* to Ips Oon 10y, TEM On01♦•sIs should be used. 0abot"n IITh f0. ubOOWe li oPOroe Willis Or 010 N OPOr Tetefts Page 1 �1 ' 12/21/00 21:55 MINERT-ARCHITECTI 4 40E7773333 NO.036 903 DEC.21.WOO 1:01PM DaDE BEW INC N0.272 P.2/3 FRC.FROM . rozCS Lab. Inc. FRX N0, 408 727-7065 10 20 2880 06: 37PM P2 • MACS lab, Inc. Bulk Asbestos Analysis 2070A Walsh Avenue Sarna Clara, CA 95050-2S42 Report (408) 727.9727 Lab Sample Client Sample Number Arbosloe Fibers present Remarks _ Number and Description detected? L96618-7 7 N•O. 1 % cellu celllose oM•urnae homogeneous adhesive. Balance of sample is micaceous and Floor adhesive - Rm 704 organic binders. Nonlriable L96619-8 8 N. 0. 120/6 Ce utose fisi� of she 1s uunsp till mound - Joint compound - Rm 704 riorrimrous metedal. Friable End of report. • 3 • A. • • Wisoole. Amosim. CreeldorRe, Tremolite, Actinolite, cmd Andtophylllte are aabestee }bens. N.D. None Devoted PC -paint Counted NM Gape 2 12/21/00 21:55 mNER r Ir _ , 40B7??3333 a 21-21 e ee1PM o E BEI WGIn §}. ƒ I7 . Lm@ |! : �dos. LIZ ' � 7 f ; 2m I l �) S ' knB o »� vo ;.2■xa �.•A■o-e� ,• 0 # |» ; �■,o-o!� i2]` , f$ 7\°7]Aq §\ °7 Tof o03'',2�O� \ t§ >! + IDAe. o; ° ] E 7� 2© �<V `I_XI�xIX| k NO. 036 v . .�-■,.9a ! � mA&§ `2 §' ■!; �. � � � a z=§!■ . a■fie■ ■ §orb 9 �<V `I_XI�xIX| k NO. 036 v . .�-■,.9a PCM (Air) PLM (BU « 14ad (%Lpes,w paikil) TEM @KBU14 ISEM Driax_- ASbC0W./Le3d lwils.Water TEXILead G _t: 00M 8Z '0BG size :* _ -out .qe,SOW :60 � ■ §orb 9 �?; 2\ c2 ■log PCM (Air) PLM (BU « 14ad (%Lpes,w paikil) TEM @KBU14 ISEM Driax_- ASbC0W./Le3d lwils.Water TEXILead G _t: 00M 8Z '0BG size :* _ -out .qe,SOW :60