29431 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL. PERMIT No.
BUILDING DIVISION APPIACATION/PERMIT PLUMBING-MECHANICAL29431
BUILDING PROJECT IDENTIFICATION
BUILDISG ADDRESS: SANITARY NO. APPLICATION SUBMITTAL DAI
I osR�) �i�xs�vi _
OWr Ap1E: UG f� I I
VYANI CI'OR:S NC1uT- SI M �fl•_HO SIC COM'ROLR
VPARCHI'1' '1' G ❑EN: Iv LIC NO'. AD RLS (/�n JLIn1.Av� (—� ❑
L FIC4
CONTACT: PHONE: l BUILDING PERMIT INFO
—Aa`T g{. b ^ -� 1 I�"JO ❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECTPLUMB M�EyCyH
LICENSED CONTRACTOR.. 'SDLCLARAHON QTY. ELECTRIC PERMIT FEE
1 hereby atfrm Na 1 am fanned..dunder provi:ion:of Chapter v(mmmendng JOB DESCRIPTION
DXZ wh"ection]0(X))of Dirmon7ohhe Business and Prmassion,Code.anl my license is RESIDENTIAL:
W O p PERMIT'ISSUANCE
1-1 in full force and effect. ❑SFDWL CIKI'FCl1EN REMODI?I.
QU� Liccnu Claw LicaAPPLIANCES-RISLDGMI'[AL []ADDITIONElPLUMBING Rio PIPIT
F W Date Cnntmemr
ARCHITECTS DECLARATION [IMULTI-UNIT ❑STRUCTURAL
Z FO m Z 1 undcrsmad my plunx.hull he used us Public records PANELS MODIFICATION
UP TO 200 AMPS
OZ—O [I INTERIOR ❑Cf11MNF.Y REPAIR
(F�F'4l Licensed Professional 2UI-IfXIIIAMPS IMPROVEMENT
-� OWNER-BUILDER DECLARATION
QI hereby affirm that I sun exempt from the Convacmrs Licene I.aw for he OVER["AMPS ❑BATH REMOUEUREPAIR (]UEMOLI'TION
X 3 d UF following reason.(Scotian 7031.5.Business and Professions Cade:Any city or county SIGNS ELECTRICAL ❑OTHER
W LL Na which requires a permit re caaaraa,ldi improve.demolish,or repair any structure
^u•OJ prionnslicensed piaim.11.he trovisilcamfor esuch perrail osefv License
ned Law
SPECIAL CIRCUIT/MISC.
Ebythat he is licensed punuam mlhe provisions nfthe Comracmr's License law(Chapmry
Wa00 (contracting with Section lugh at 1111 urn 7ofthc Bt,Inrss and Professions Gmc)or TEMP.METER OR POLE INST. COMMERCIAL'
C,y e c that he is exempt therefrom and the basis for the alleged exemption.Any violation of ❑N W BLDG/AUDITION [I DEMOLIT]ON
X ISN. Section 7031.5 by any applicant for a pernin%objects Ne applicant to a civil penalty of POWER DEVICES NANT ❑I-GOD SERVICE.
4411 not more than Five hundred dollars(SSgO.
(..ZY 1 ROVI:hfENT
ESC ❑Lo the work,the pmpenyor myemntended with wvgcsrtalei(Sec.70,14.Business
SWIMMING Ig01,LLLCI'RIC []OTHER
�b,� will do the work,and the stmaurc is not imm�dcJ for offered 4n sale(Sec.]g1J,Business
W and Profesxims Code:The Commcmr.Lmemm Law does nor apply to on owner of OUTLGI'S-SWITCHES-PIX'I'URIiS
lL'3 ppi who build,or improve%'be ron..,and who doe,stab work himself or through
his own employees,provided that such improvements fore not intended or offered for NEW RESIDENTIAL CLEC TR SQ IT.
sae.If.however,the building or lmpmvancnm
t is within one year of ntplctinn.the
SQ.IT.FLOOR AREA ESQ.FT.
ner-builder will have the burden of proving that he did not build or improse for pur-
pose of sale).
Timm=1,ax owner of the pmpeny,nom cxcbr.ively nnuracting with IicenxJ commctors m tr= TOTAL:
onswct the project(Sec.7044,Business and Professions Cci The Convector's Lis
vens,Law dms no apply to an owner of property who builds or mprnvca Ntrcnn,and Ql'Y.Issued DftitIj T F
who contracts for such projects with reputations)licensed purmant to the Caramel,'% Chet
License law. pj( .
Fl Iamexcmptunder See. ,B&PCfonhisrenmo a, ecklivillo illoolift RIMWill
•Owner Date VALUATION
WORKER'S COMPENSATION DECLARATION 1
I herby affnn under penalty of perjury nuc of the following Juaamtipnx: DAS oil
EJ I have and will maintain a Certificate of Consent to self-inxum for Wodeis Co.,.- 1 S'TORIP_S '1'YPLC0NS1'RUCI'101
%anion,m-prmidcd fur by Section 3]q1 of Nc Lulwr Ctdc,for the Pcrform:mce of the
work fm which This pemnit is issued.
FI I have and will maintain Worker's Compensation Inmrunce,as exprired by Satin,
7](0 of dee Labor CnJa fnnhc performnncc nfthe work for which this Permit is tented. GAS-EA.SYS -I INC. UTLOCC.GROUT' APN
My Worker's Compcnsulioo Insurance cannerand Policy number art: EM
A.Policy Na: EMA. YSTE, A I
CERTHICATF.OF EXEMPTION FROM WORKERS' GREASFJINDUSTRL 'IE INTERCLI'NR
COMPENSATION INSURANCE BUILDING DIVISION FEES
('This section nuc)not be campletcd if the pcnnit is foronc hundred dollars[51 W)
nor less.) - C ECK FEE
I cenily thw In the perLrnnuna ofthe work for which this permi.....zoed.lahu" SFW[R-SANITARY-STGRMEA.200FT.
not employ any perm, any manner so as to heroine subjecnu the workers'Campen- F.NF.RGY WiC
Z smipn Lawsof Callfomla.Dmc
Applicant ING FEE
y NOTICE TO APPLICANT.If,after making Nis Cenifcate of Exemption.you should WATER SYSTENbTREATING
F' become subject m the Worker's Compencation provisions of the Latur Calc,you must SOILS FEE
forthwith comply with WO provisions or this permitshall he deemaf revoked. WATER SERVICE
a
CONSTRUCTION LENDING AGENCY NEW RESIUEN'fIN.PLMB. SQ.FII PATO
UI hereby affirm that lherc is a csmstmction lending agency for the perfommnce of Dam RaeiplN
the work for which this permit is issued(Sec.7(19],Civ.C.)
0 1"' LenJefs Name TOTAL:
UW Lender,Address TOTAL:
1 certify Nal l have read Nis application rind%tate That the aMve iafmmmion is BUILDING IEE
F' N Iturnel.1 agree to comply with all city and county ordinances and slam laws reforms to QTY. MECHANICAL.PERMIT FEE
U •Z huildingeomwetion,and hereby authorize mpresemmivecof Nis city menmr upon the FmIr"NUHNG
511C FEE
above-mentioned property for impaction putpo,es. PERMIT ISSUANCE
(We)agree to once,indemnify and keep harmless the City of Cupertino against CTRIC F
liabili(ies.judgmenm,c.sl., adexpcnses maymm re yaameagoinsteaid CJy ALTER OR ADD TO MECH. FEIi
in em c reare of the granting of Ihx rnit.
APPLI,ANT UNDERSTANDS U Wil.C JMPLY WIT ALL NON-POINT AIR HANDLING UNIT(TO IfLo(X)CFM) MECHANICAL PEIi
Sf t CE REGULATIONS.
Q AIR HANDLING UNIT(OVER 10,000 CFM) CONSTRUCTION TAX
Smurcof ApplicanVCnntmmor
mCan EXHAUST HOOD Will HOUSING MI'fIGAI'[ON FEE
HAZARDOUS TRIALS DISCLOSURE
Will Nexppllcumorfumrchui HEAPING UNIT CIO H)0,0V)BTU)
as defined by the Cupcnino Municipal Cade.Chapter 9.12,and the Health and Safety
Code,Section 25572(al^ HEATING UNIT(OVER 100.100 BTU)
❑Yes E]No PAID
VENTILATION IAN(SINGLE RfSID) Ore Receipt.
Will the applicant or future building occupant use equipment or devices which BOILER (7HP OR 10TOW BTU)
ma
emit b: Jous air contaminants m defined by the Bay Area At,Qualify Management TOTAL:
Dismal? BOILER-COMP(OVER I00.01X1 BTU)
Cl Yea ❑Nn
I have mad the haurdous materials requirements under Chapter 6.95 of the Cali-
hand.Hea al @ Safety Coal Sections 2.5505.25533 and 25574.1 uadersmn l that if the NEW RESIDENTIAL MEC II. SQ.IT.
building does not commonly have a terem,that it is my responsibility to notify Ne occupant
of are requirements which must be met prior to ismnna of a L'mificam of Occupancy.
Owner or awhorizcd ageO AL:nt Date ISSUED If Y:
OFFICE
Robei�'t Spence ?. Rssoc TEL : 415-851-3297 Sep 18 , 92 13 : 51 No . 001 P . 01
Robert Spence & Associates Inc
Consultants Environment Health Safety
TO: 141Ldi 4
From: 'BoT3 400rNe.1£-
Date: 91"
Subject: /4'3ZAUres euny"
• Total number of pages including cover page 3
If you do not receive all the pages, please call us at (415) 851-7492
pF'r'kCv VED
10 ACCORDANCE WITH THE CITY Of
CUPERTINO CODES AND ORDINANCES
GATEate ' Original to follow by:
SIGNED N U.S. Mail
This set ot�p—an;a;d t,,ftcah MUST l 1 Federal Express
be kept on the job at all times and it is un,
lawful to make any changes or alterations ( ) Courier'
on same without written permission front ( j No Hard Copy to Follow
the building Depi., City of Cupertino.
The stamping of:his plan and specificeNoRS
SHALL Not he hod to permit or to be, all
approval of the violation of any provisip�
,1 any City Ordinance or Stets Lem 0 ❑p�,
� UD
SEP 18 1992
COM BLDG: INSPECTION DEPARTMER
OFFICCITY OE CUPEMNQ
3 Vista Verde Way Portola Valley, CA 94025
Office 415.851.7492 FAX 415.851.3297
Robert Spence & Assoc TEL : 415-851 -3297 Sep 18 , 92 13 : 51 No . 001 P . 02
Robert Spence & Associates Inc
Consultants Environment Health Safety
July 16, 1992
Micro Modular Systems
10000 Ridgeview Court
Cupertino, CA 95014
Attention: Mr. Kevin Antonelli
Subject: Asbestos Building Material Analysis
10500 Ridgeview Court, Cupertino
Dear Kevin,
I have inspected and tested the building materials in two locations in the building
located at 10500 Ridgeview Court, Cupertino. The areas inspected included the first
floor stockroom and the second floor area next to the area identified at 2.G17. 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. Ten building material samples
were collected. The building materials tested included the following:
Ceiling tile
Drywall
• Drywall tape and compound
The building material samples were analysed by Polarized Light Microscopy using
EPA Method, 1987 (40 CFR, Pt. 763, Subpt. F, App. A, pp 293-299). The work was
done by the R. J. Lee Group, Berkeley.
Attached are the results of the sampling. Please call if you have any questions.
ncere ,
Robert Spence, , CIH, REA
cc: Mr. Fred Hornbeck
DE091792/444
�t80Nf,{ Robert Spence
Cal/OSHA Certified Asbestos Consultant
40 QS
W. So'• EPA Certification: Accredited Asbestos Project Supervisor #209
4
'4"'y EPA Certification: Accredited Project Abatement Designer #209
yQe %� EPA Certification: Accredited Building Inspector#179
co No. REA-02824 g,;' EPA Certification: Accredited Management Planner #179
* Expires:06 3
OSHA Certification: Asbestos Abatement Competent Person
OF CA��FC�a`p
3 Vista Verde Way Portola Valley, CA 94025
Office 415.851.7492 FAX 415.851.3297
Robert Spence 9 Assoc TEL : 415-851-3297 Sep 1S 92 13 51 Ho . 001 P . 03
Micro Modular Systems
10000 Ridgeview Court
Asbestos Building Materials Assessment
First Floor, Stockroom
DE091701B Drywall ND
DE091702B Drywall ND
DE091703B Taping compounds and tape ND
DE091704B Taping compounds and tape ND
Area Next Area 2.G17
DE091705B Drywall ND
DE091706B Drywall ND
DE091707B Taping compounds and tape ND
DE091708B Taping compounds and tape ND
DE091709B Ceiling tile ND
DE091710B Ceiling tile ND
• ND = Not detected down to the analytical level of detection of 1%