24182 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
Building Project Identification PERMIT NQ,
Building Address: _ 2 4 1 O 2
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I'
r,ers are: a one: APPUC0,LON SUBMIL LAL
j A-Hour h CUh�F1,Xi f2 �'(�iSF,�`32m0 CITY OF CUPERTINO-BUILDING DIVISION N'a/.�'�
cono-acmra Name: T Lm.No: APPLICATION / PERMIT -L-t- VT•`
L
&rI L '017:S1 CATEGORY �COMAOL X
BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
Architect/Engineer. Lie No:
G G QTY ELECTRICPERMIT FEE BUILDING PERMIT INFO
Addiess: P _ei, fe *LET ❑ EJ 1:1LICENSED CONTRACTOR'S DECLARATION
Ihereby
afflcnthat lsmlicensed heunder Butdessand of Cssions9de,and rte- APPLIANCESRESiDENT1AL JO 16. 045440 r—
Ingwlth5ectlon7000)offAWston3 ofthe Buslneesand Profeesfona Codc,and - I�ri�'Nfy'R�J,
DRECRIPTION
license le in fullforce and effect. PANELS
License Class LIeN
Date Cormmmr UP TO 20DAM
ARCHITECTS DECLARATION 201-1000 AMPS
N I understand my plareshallbe used as public records. OVER 1000 AMPS SQ.FT.FLOOR AREA $/SQ.FT.
O
�j Licensed Professional SIGNS ELECTRICAL
kFi,+ OWNER-BUILDER DECLARATION
Thereby affirm that lam exempt from the Contractor's License Law/or the SPECIALCIRCUU/1,419C
Zpo Q�q�( following reason.(Section 7031.5,Business and Professions Code:Any city or
TEMP F
5 cotmo
z ❑ emantywhich requires a permit to utruct,alter,improve,def6h,or repair .METER OR POLE INST.
7Q any sbucture prlorm uslsaunce,alwrequlrea theeppllnntfrn such pBnNt to
U Rle a signed statement that he 6 Bcensed pursuant to the provisions of the POWER DIiVIGE$
Ow Contractor's License Law(Chapter 9(commencing with Section 7000)ofDWI-
30<rn slon3 ofthe Business and ProfenlmuCode)orthat he is exempttherefromand SWIMMING POOL ELECTRIC VALUATIO�Nt^
O? the basis for the alleged exemption. Any violation of Sectio7031.5 by any OUTLETS-SWITCHES-FIXTURES
[�Gy51 �y?i the basis for aperMted exemption.
An violation
civil penalty of na room than VV V
five hundred dollars($500). NEW RESIDENTIAL ELECTR
�n F-11,as owner of the property,or my employees with wages as their sale SQ.FI. STORIES TYPE CONSTT kIX:'IION
compensation,will do the work and the structure is cot intended or offeredfor
q mile(Sec.761E Be.[.and Puofesslrnu Code:The Contractors License law
$$ does not apply to an owner of property who builds or improve thereon and OCC—GROUP RES.UNITS
whodonsuchworkhtm Umthraughhlsownemployees,providedthatsuch
Improvements arcnot Intended oroffered forsek.IL however the Irili ing or TOTAL:
impravement6soldwithln mayearofcomplenion,the owner-builderwill have
the,burden of pmvtng that he did nabuddorlmprove forpurpossofsakJ. QTY. PLUMBING PERMIT FEE FLOOD ZONE APN
LJ I,as owner of the property,am exclusively contracting with licensed PERMIT ISSUANCE
contractors to construct the Project(Sec.7044,Business and Professions Code:
The Contractor's License law does rad apply to an owner of property who ALTER-DRAIN&VENT-WATER(1?A)
Wilds or improve thereon,and who contracts for such p(ojeets with a
151 chu(s)licensed pursuant to the Contractors License Law. FEE SUMMARY
am exempt under Sec B&P C for this reason BACK FLOW PROTECT.DEVICE. QUTqinrITrS
DRAINS FLOOR ROOF,AREA,GOND. SANITARY Y_ N_
. Owner ECL RECEIPT p
WORKMAN COMPENSATION DECLARATION FIXTURES PER TRAP SCHOOL TAX Y N_
❑i hereby of@m that I have a l..R a of consent d self-insure,pythemof ora RECEIPT N
cenifiLab of Worken'Comperwtlonlvurance on certified ropythemof(Sec. GAS.F.A.SYSTPM-1 INCA Poli lab CJ PARK PPE Y_ N_
Paltry N GA&EA.SYSTEM-OVER 4 MA) 131 NG DIEIPT N
Com any BUILDING OI VISION FEES
nCertlfied copy is hereby te city
nCenlfied copy is filed withh the city inspection division. GREASE/INDUSIRL WASTE INTERCEPTOR PLANCHECK FEE
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE TRAP PAID
COMPENSATION INSURANCE
Qhiasection need CO be completed If the permit isfor one hundred dollars SEWER-SANITARY-STORM FA2nOFT Date Recei t#
($100)car fess6 I
WATER HEATER W/VENT/ELFCTR ENERGY FEE Y N
I cectlfy that in the performance of thework farwhlch this permit b leveed,
I shall not employ any person in any manner ro as to become subject to the WATER SYSTEM/TREATING
Workere Compensatlonlawsof CzBfomla.Date PAID
0 Z Applicant
Z O NOTTCETO APPLICANT.H,after making th6Cenificateof Ezemptlon,you NEIN RESIDCNUAL PLMB._SQFT. Date Recel t#
Fahoutd Woone .Noct mthe Workers Compensation provimro of the LaborCC TOTAL:
N Code,you=at fanhwlth comply with such provisions orth6 permit shall be j
> deemed revoked. D INCA
CLp - CONSTRUCTION LENDING AGENCY SEISMIC FEE _
Z Ihereby affirm that there 6 a construction lending agency for the perform TOTAL: ELECTRIC FEE
O once of the work for which this permit is Issued(Sec.3097,Civ.C.) ELECTRIC FEE
V lenders Name -
LL F Lenders Address QTY. MECHANICAL PERMIT FEE MECHANICALFEE
O W IcartifythatI have mad thisappBntionand inatethetheaboveln(ormmlon
d 6rorrect.I agree to comply with all city and county ordinances and state laws PERMIT ISSUANCE FEES PAID:
} W relating to building construction,and hereby authorize representative of this
F Z city to enter upon the above-mentioned property for Inspection pu rpeses. ALTER OR ADD TO MECH.
Me)agree to save,Indemnify an d keep harmless the City of Cupertino Date Receipt#
V against liabilities,judgments,massed expenses which may in anywayaixme AIR HANDLING UNIT(TO 10,000 CFM) SUBTOTAL:
against said City in consequence of the granting of this peemlL
AIR HANDLING UNIT(OVER I OWOCFM) CONSTRUCTION TAX
SI tore of Applicant/Contractor Data EXHAUS'THOOD(W/DUCT) CONSTRUCTION Tj
HAZARDOUS MATERIALS DISCLOSURE �L `
Will the appllcant or Noire building occupant store or handle hazardous HEATING UNIT(TO 100,000 BTU) Date Recei t#
mrteriilascith by the Cupertino Munlcipa l Code,Chapter 9.12,and the
Healthand Suety Code Section 2S532(a)7 HEATING UNIT(OVER 100,000 BTLO •FO
❑Yes No
Will the applies at or Lure building occupant use equipment or devices VENTILATION FAN(SINGLE RESID) ISSUANCE DATE
which emit hazardous air contaminants as defined by the Bay Area Air
a
Ilty Management D6tdR7 BOILER-COMP(PHP OR 100,0(10 BTU)
�I Yes qNo
have read the bazar Pus materials requirements under Chapter 6.95 of BOILER-COMP(OVQ2100,000 BTU) R1 p w
the California Health A Safety Code,Sections 25505,25533 and 25534.1 h� 4W 8 D
understand that if the building does net currently have a tenant,that it 6 my NEW RESIDENTIAL MECH. SQ.Ff
responsibility to a he spilt of the requirements which moat be met (1
�prior to issu fOccupanry. SEP 4
. R -y-yz- 19,
Owner or authorized agent Date CII
TOTAL: ISSUED BY:�
OFFICE COPY
SEP 02 '92 08:50 TANDEM RE/CONST. 041 P02
r
obetrt Spence & Associates Inc
• Consultants Environment Health Safety
July 16, 1992
Ms. Patricia Doehrman
Project:Manager TandemComputers COPY
Corporate Real Estate & Construction
10400 North Tantau Avenue
Cupertino, CA 95014-3544
Subject: Building 208, Asbestos Building Material Analysis
10400 Ridgeview Ct-, Cupertino
Dear Pat,
I have inspected and tested the building materials in the approximately 60,000
square:feet of Building 208. The areas inspected include all areas of the first and
second floor. No asbestos containing materials were found in any of the samples
down to a level of detection of one percent as specified by the EPA. Thirty-eight
building material samples were collected. The building materials tested include the
following:
Baseboard and mastic
Floor tile and mastic 0�
Sheet vinyl floor covering a asti��
• Ceiling tale SEA J* n
ONO
COPY�� Drywall BBQ /NSP4 '`�Drywall tape and compound per„- Nw
Demountable walls p6 Nfp,
Attached are the results of the sampling. Please call if you have any e'stions.
c lye
4
Robert Spence, S, CIH, REA
TC070792/421
Robert W. Spence
EPA Certification: Accredited Asbestos Project Supervisor #209
��1R�kMfy EPA Certification: Accredited Project Abatement Designer #209
le EPA Certification: Accredited Building Inspector#179
4� 4,P� EPA Certification: Accredited Management Planner #179
Ham¢ 'yOSHA Certification: Asbestos Abatement Competent Perspn
W No. R 4 ^
i . *
Expires
'. APjA ��`�
CFA��(�
' 3 Vista Verde Way Portola Valley, CA 94025
Office 415.851'7492 FAX 415.851.3297
SEP 02 192 08:51 TANDEM RE/CONST. 041 P03
Tandem Computers
• Building 208
Asbestos Building Materials Assessment
TC070701B Ceiling tile, Type 1 ND
TC070702B Ceiling tile, Type 1 NO
TC070,03B Ceiling tile, Type 1 NO
TC070704B Ceiling tile,.Type 1 ND
TC070705B Ceiling tile, Type 1 ND
TC070706B Ceiling tile, Type 1 ND
TC070707B Ceiling tile, Type ) ND
TC0707085 Ceiling tile, Type 2 NO
TC070709B Ceiling tile, Type 2 NO
TC070710B Baseboard and mastic ND
TC070711B Baseboard and mastic ND
TC070712B Baseboard;and mastic NO
TC070913B Baseboard'and mastic NO
TC070714B Baseboard.and mastic ND
TC070715B 12" X 12" Floor tile NO
TC070716B 12" X 12" Floor tile NO
TC070717B 12" X 12" Floor tile NO
TC070718B 12" X 12" Floor file NO
. TC070719B Sheet vinyl floor covering NO
TC070720B Sheet vinyl floor covering NO
TC070p21B Sheet vinyl floor covering NO
TC070722B Demountable wall NO
TC070723B Demountable wall ND
TC070724B Demountable wall ND
TC07d725B Demountable wall NO
TC07072613 Demountable wall ND
TC070727B Drywall ND
TC070728B Drywall ND
TC070729B Drywall ND
TC070730B Drywall NO
TC076731B Drywall NO
TC070732B Drywall NO
Taping c
e NO
Ta
compounds and to
TC070733B p g p P
TC070734B Taping compounds and tape NO
TC070735B Taping compounds and tape ND
TC070736B Taping compounds and tape NO
TC070737B Taping compounds and tape NO
TC070738B Taping compounds and tape NO
NO Not detected down to the analytical level of detection. of 1%