S 0507 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY '
CITY OF CUPERTINO BUILDING-ELECTRICAL PERMITNO.
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL S O1^�V 0 17
„BUILDING PROJECT IDENTIFICATION
ILDING ADDRESS: to 111 f�w.�sa �JE.. SANITARY NO. APPLICATION SUBMITTALDATE14
O NER'S ME: PHONE: 'ONTRACTOR fOR'. NAME: LIC NO.
` I NIC CONTROLX
ARCHITECUENGINEER: - LIC O: )pR1iS5: 1 ❑
tr
CONTACT: PHONE: - BUILDING PERMIT INFO
❑ Consultant Pees Paid by Applicant(Initial) BLDG PPLLEMB MECH
LICENSED CONTRACTO 'S DECLARATION I'
QTY. I ELECTRIC PERMIT � ' FEE
1 hereby anion that 1 am licensed underan ons of Chatter 9(commencing JON DESCRIPTION
W 0 0
DOZ with Section](XIB)of Division 3of@e Business vtnofesi
sons Code.and my license i.e - RESIDENTIAL'
PERMITISSUANCE
F,Z LiceneClassnd effect. DSFDWI. DKITCHIiN REMODEL.
I-, [J License Class Lick APPLIANCES-RES I DENTINL ❑ADDITION D PLUMHING REI'II'i'.
Had Date ConlruClur
ARCHITECTS DECLARATIO ❑MUI.II.UNIT ❑STRUCTURAL
Z O E2 PANELS
1 undcrstmd my plans shall he a, us Public rccnrds MODIFICATION
IlPTO200AMPS
0��'p ❑INTERIOR DCHIMNEY
MINGREPAIR
POLL
Licensed Professional 201-ILYXIAMI'S IMPROVEMENT (]SWIMMING P001.5
OWNER-BUILDER DECLARATION \�iolmin�
OVER 1000 AMPS D BATH REMODELfREPAIR DDEMOLI HON
yR�K Q 1 herehy aflimt that I um exempt from the Comoremr's LLaw for the
y 3 a V following reamn IScnlnn](D L5,Business and Pnnlmssinns Crxle r oumY SIGNS M-FICTRICAI, D OTHER
YI LL N which requires a permit to conshuet,alter,improve.demolish.or staeture
uy'0� priorm its issuance,alsorequireame applicant forsuch permiun Rled. Cement SPECIALCIRCUIT/MISC.
"1d,6
that he is licensed pursuant mote provisions mine Cnnaucmr'n Lic (Ch tern
Iy.,pO Icnmmencing with Seninn]IXkBnf Divi.ionln(the l{usiness unJ ns Cu of '1TiMP.METFROR10LEINSP. COMMERCIAL:
a Ii a e' that he is exempt therefrom and the basis for the allogcd exemptiviolation f ❑NEW W.DGME)DITION MOLIT10N
I Section]031.5 by any applicantfor a permit subjects the applicantil penally o POWER DEVICES
nnunmre Chun flue M1nndrcd drillers($5(Xry. DTHNANT FO DSERVICE
,=Q ❑I,as owner of Nc propeny,nnny etnpinyees with wages as thcirnolecnmpensation, SWIMMING POOL HI.ECTRIC IMPROVEME
�� will do the work.and the structure is not mandedoroHemd formic lSec.]OJi,Business DQ'THEk
W,3 end Professions Code:The Contractors License Law does not apply m an owner of OUTLETS-SWITCHES-FIXTURES �A Olt
progeny who builds nr impt'om,thenen,trod who does such ,,,it himself or through
his own eniployee.s,provides that such improvcment.s arc not intended or offered for 'W RESIDENTIAL.ELLC'I R SQ PT.
sale.If,however,the building or improvement is sold within one year ofcnmpletion,the SQ.TK Elvill I&A $/SQ.IT.
owner-builder will have the burden of proving that he did nm build nr improve for par
pose of>uley AUG
❑I.as owner of the properlm y,nexclusively contracting with licensed contrecmn to 'roTAL',
construct the project(Sec.Intel Business and Professions Code:)The Contractors Li- -Y
remse Law does not apply to an owner oflooperty who builds or improves ithemor.and QTY. LUMBING PERMIT FEE 'r1
whocortmes for such projects withacomrumnr(s)licensed pucsunnttothe Conuuclor's LIDS^ I ,('
License law. PERMITISSUA F. Gh ��pEHrnvo
D l ma exempt under Sec. ,H&P C fartnis reason
ALTER-DRAIN& ENT-WATER(CA) VALUATION
Owner Dam
WORKER'S COMPENSATION DECLARATION LC I J OA_
I herchyaffinn under penally of perjury ane of the following declarations:
it
D l haveund willntuimainu Ceniftcam of Consent far Wada',ComPcm DRAIN:-PLQOR,ROOF, RHA.CGND. -
mlion,as Provided far by Section 3]00 of the L.N,r Code,home Performance of the STORIES TYPIi CONSTRUCT[ON
work for which this permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,m required by Section
3700 ofrhe Labor Code,for the performance of the work for which this pavan l somed. - I' -iwqo)t OCC.GROUP APN
My Wor er's Com ens hon nsuranceca 'rand Felt ����qq�
Comer. �,,,...,.�J$Policy ��p nX - O - J 1
CERTTFIIo CA�TF0FEXEMIMON FROM WORKERS'
COMPENSATION INSURANCE S A
(This section email to rempleted ifthepcnnit is forone hundred dollar IS10)1 ^ BUILDING DIVISION FEES
m less.) III PLANCHECK FEE
I verify that in the vrfomtunce ofthe work for which this permit is issued,lshall yn�It
not employ any person in any nommar no as to become subject to the Workers'Compel "( ' YS ENERGY PEF
r O z .cation laws of California.Date WATER HEA / .li -
0 Applicant GRADING�tOE
q tr NOTICE'TO APPLICANT:If,after making this Cenilicate of Exemption,you should
a became object to the Worker's Compenmtion provisions of the Labor Code,you must SOILS FEH�'4
forthwith comply with such prnvimml this pal shall be deemed revoked. VCE
Ila
z CONST RUCTION LENDING AGENCY MW ESIDBNT
Ut0 I hereby affirm that there is a conaryiama
ction lending agency for the Nrnme nl' Dam sw
RciptX
heworkwork for which this permit is isma(See.3097,Civ,C.)
LJw Lenders Name TO
Lender x Address 4942 TOTAL /
1 cenify rhvt I have rcaJ this applicminn and state Nat the uMsve information i. - BUILDING FEE
it V) mrecr.l agree mcomply with all city end nmmy ordinances mA ma¢laws relatingm QTY. MECHANICAL PERMIT ' FEE
'UZ hiddingcnnstnctiml and hereby anthvrmrepresentativesofthic citymenterupnn the 'HSMIC FEE
above-mentioned property for inspection purposes.
(We)agree to save,indemnify and keep harmless Ne City of CuNatino against PERMIT'ISSUANCE El, TRIC FEE
Iiabilities,judgmems.costs and expenses which may in any way acme against said City ALTERORADDTOMECH.
in consequence ofthe granting of this permit. PLUM NO FEE
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT 0010,006CFNE
SOURCE EGl�I1IIy%TQION MIiCHANI' LFEE
y(yp - ""fes �p AIR HANDLING UNIT(OVER IkOhl)CFM) CONSTROCPI TAS
Sim oYYYYfAV///��FF IIIIccaarmlContrectoalG� W to EXHAUST HOOD IW/DUCT) HOUSING MITIG ION FEE
HA RDQUS MATERIALS DISCLOSURE
Will the applicant or future building nccalum score or handle hazardous matelot HEATING UNIT(TO IIl0A0(I IT TO)
as all by the Cuprobm Municipal Code,Chapter 912,and the Health and Safety
Code,Section 25532(a)P HEATING UNIT(OVER 1nk,mX)HTC)
❑Yes C]No VENTILATION FANS INGLE RESID) PAID --
Dale Receipt X
Will'he upplictanrantras building pudic Fl rawequipmentor Management
BOILER-COMP THE OR 100,0010RTU)
emir ter? us air contaminants as detinet ray Ne Hay Arca Air Quality ManagementTOTAL:
Dismn?
❑Vas 7N BOILER-COME(OVER I(XI,(XXI BTL)
I have read the haavl mamrials requm
immas undr Chapter 6.95 of the ClCAIR CONDI'1'IONI3R ISSUANCE ATE
brain Health&Safely Code,Sections 25505.25533 and 2553.1.1 understand that if the NEW RESIDENTIAL MECH. SQ.En
building docs not currently have a lenanl than it is my responsibility to notify the occupant
of the astamerach,Much mu f M mel prior to vmanee of a Centra le of Oc,pansy.
Owner or anthonied agent - Date TOTAL ISSUED BY:
OFFICE
Robert Spence & Associates Inc
cons kmh Environment Health Sfety
° ECE W FE'=l july 18,1997
Mr. Steve Malan AUG 51997
Hewlett Packard
Facilities Engineering
Cupertino Site OperatioR�.DG.INSPECTION DEPARTMENT
19111 Pruneridge Ave. MS 44LAGITY OF CUPERTINO
Cupertino, CA 95014
FAX(408)447-5255
Subject
Asbestos Building Materials Abatement
Peppertree Cafeteria
Dear Steve,
On July 11, 1997 aggressive clearance sampling techniques were used to evaluate the
abatement and cleanup of the asbestos containing floor tile and mastic for the above
location.
Cast air sampling pumps were used to collect the clearance air samples. Attached to
each pump,via a small diameter plastic hoses,was a 25 mm black cowl filter cassette
containing a 0.8 micrometer mixed cellulose ester filter. The filter cassette was
located approximately four feet above the ground. The pump Flow rate was
calibrated before the sampling began and again at the end of the sampling. The start
and end times for the sampling were recorded and from this information the total
amount of air sampled was calculated.
Each sample was assigned a number and information for each sample was recorded
on an Environmental Health Air Sampling Sheet.
After the pumps were set up and calibrated,an electric leaf blower was used to blow
all surfaces fru the containment area. Electric fans were used to keep the air
circulating in the room during the clearance sampling.
The clearance air samples were sent for "rush" analysis to the Forensic Analytical,
Hayward,California,a NIOSH PAT proficient laboratory.
All clearance air sampling was completed using as a guideline the U.S.
Environmental Protection Agency (EPA), AHERA regulations. Electron Microscopy
was used to analyze the air samples. The U.S. Environmental Protection Agency
clearance level for TEM is 0.02 structures per cubic centimeter of air. The first round
of clearance air sampling passed. All air samples in all areas were below 0.02
3 Vista Verde Way Portola Valley, CA 94028
Office 415.851-7492 FAX 415.851.3297
structures per cubic centimeter of air.
The results of the clearance air sampling are attached.
please call if you have any questions.
S,L7!y
cni, REA
. rEP071897/894
Rabat W.Spence
Cal/OSHA Certified Asbestos Consultant 89-M
EPA Certification: Accredited Asbww Project Supervisor 0209
EPA Certification: Accredited Project Abatement Designer 0209
EPA Certification: Accredited Building Inspector 0179
EPA Certification: Accredited Management Planner 0179
OSHA Certification: Asbestos Abatement Competent Person
AL 18 '97 05:21Fw FMIC MYTICFI P,1
n�Ra .K .
Amlya-i sm �:..__ __-------__•
sus F paum ?'n D o F�*i.Subs 9451S Pia a 510
1. +1rfi Fit A1C X218
� �be•;t�",.b.:faiPmr�
' 01. fhww,c�y7;
T�,anamialsion Eigctron Microl�copY
Smart
Clieat: Clieot Aurben 2878
Robert 0940re 6 Aeaoeiate6, IRC, Qepdrt eueber! 218881
Date Aaceiwd, 07/12/97
1 Vista Verde OayA 9{028
Portals Valley. ------------------
P.O. pun,-- -._
-.--__---- _-•.--- Page, 1
Job ID, DP-070797
lite, Rowlett Paokard Campus, PePPer Tree Cate, Cupertino
--- ------- ---••- -------
---------____ -'
Dau Ali Aaalyt. Plbats ltru0t Ecrue
Bangle Laban
. gunner Number Coll. Volum lana• per ea Poe as per ---
____
NP-071197-04 1975101{ 07/11/97 116].0 0.0044 0. 0. S.
0.108 pose filter-
RP-071197-07 19791025 07/11/97 1263.6 0.00{6
@.sea pare filter.
HP-071197-00 19751026 07/11/97 1253.1 0.0046 0.
0.Gas pore filter.
NP-071197-09
19751027 07/11/97 1243. 0.0046 0. •. O.
0.088 vera ItItar.
Hp-671197-10 19751026 07/11/97 1221.0 0.0047 0.0067 0.0189 61.
*.Sao pore filter.
---------------------------------
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wa„wymw+,aw�p,�tiaw.+krww r.M'•o.�wlnawrti dnM++r.,r.yrinw Wu.s a.«,...e
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Inspection Query for a Specfic Permit 9/12/97
� ERMIT#MUS ST(SITiUS1ST EEjT LRo`t#.IMINS4ESCRIPT !EM VXTEDESIREI DateD.ne
• 50507 19111 PRUNERIDGE U/G PLBG 8/15/97 8/15/97
S0507 19111 PRUNERIDGE ELECT-R/PEPRTREE 8/18/97 8/18/97
S0507 19111 PRUNERIDGE under round plumbing 8/19/97 8/19/97
S0507 19111 PRUNERIDGE UNDG PLBG 8/20/97
S0507 19111 PRUNERIDGE UNDGRND PLBG H.P. 8/21/97 8/21/97
S0507 19111 PRUNERIDGE UNDERGRD PLBG 8/25/97 8/25/97
10507 19111 PRUNERIDGE REBAR 9/2/97 9/2/97
10507 19111 PRUNERIDGE REBAR 9/11/97 9/11197
•
•
Page 1
Inspection Query for a Specfic Permit 9/12/97
Ins ecto,Units PARIF,all![Co'_d'e7
CC 3F
CC 4P
CC 3P P
C 3P P
CC 3P P
CC
CC 2F
II •
Page 2