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23486 APPLICANT TO FILL IN INFORMATION WITHIN RED LIN =US LL POINT PEN ONLY Building Pmact ldenri(le.11. ' 'ZA PEILWT NO. Budding Address: �zdeji" tee.. 23486 k 555 Ct . nen one: ate. 2 y CITY OF CUPERTINO-BUILDING DIVISION �J er. er Lie,Na: APPLICATION / PERMIT Canmattor a Name: JCO n BUILDING-ELECTRICALPLUMBING-MECHANICAL CATEGORY CONTROLN Architect/Englneen Lie.No: s QTY - ELECTRIC PERMIT FEE BUILDING PERMIT INFO Address: PERMITISSUANCE LICENSED CONTRACTOR'S DECLARATION I hereby affirm that am licensed under pmvLdons of Chap(er9(commmc APPLIANCES RESIDENfIAL JOB DPSCRD'IION ingwith Section 7000),(Divislon3ofthe Buslnessand Professions Code,and my Livemis In s force and effect. PANELS LicensZ)V e Gla® LICM Date Cmdractor UP TO 2DOAMPS ARCHITECTS DECLARATION 201-1000 AMPS QZ [undertaxed my planssha0 be used as public records OVERILUOAMPS SQ.Fr.FLOOR AREA $/SQ.FT. GO U Licensed Professions[ SIGNSELECTRICAL ¢w OWNER-BUILDER 1DECLARATION n a SPECIAL CIRCUIT/MISC I hereby afRrm that I son exempt from the d Poefiessi License Law for the following reason.(Sc<Ion 70115,Business and Pmfealone Code:Any city or O 1:. TEMP.METER OR]'OLE INSf. countyystmdumprequires aortoltspermitnet aL requttruct, stheapmvgdemolbh,orrctt any atroctvrc tatemelte Issuance,also sed pursuant to forauches of t e POWER DEVICES u, Ole a signed &dement that he is r9 licensed pursuant to the provisbe of the Ou, Won 3 of the License taw rofesser9(mmmenWtheIseection reptth10e)of rman- 0� elon3ofthe Business and Professions Code)orthat heiseumpttherefmmand SWIMMING POOL ELECTRIC VALUATION Q the bean+for the alleged exemption. Any violation.civil of Section 7011.5 re any OUILETSSWITCHESEXTURES ',.P O a m<~c five applicantndred for.permit ars($ jectatheappllcantloa tivil penalty,(eat morelhanO five i,as nendolof he pr. NEWRESIDENTIALELECTR SQFT. STORIES TYPECONSTRUCTION ❑I,as owmr of the property,or my employee with wages as their wle compensation,will do the work and the structure Is not Intended or offered for 5a O sale(Sec.70K Business and Professions Cade:The Contractors License Law 4j $ does not apply to an owner of property who builds or Improves I harem,and OCC.GROUP RES.UNITS 0.0. whodoessuchworkhbroelforlhrough hlsownemployees,provided that such Improvements are not Intended oroffered foraale.If,however,thebuilding or TOTAL: Improvement issold withinoneyearofcompletion,lhe owner-bu lderwlll have ! rdenotproving m at he did not Wild orlenprove for purpose ofsele.). QTY. PLUMBING'PERMIT FEE H.ODDTONE APN "1,as owner of the property,am exclusively contracting with licensed PERMIT ISSUANCE contractors to construct the project(Sec.7044,Business and Professions Code: The Contractors Llcerue Law doe net apply to an owner of property who ALTER-DRAIN&VENT-WATER(EA7 Wilds or Improve thereon, and who contracts for such Iu jects with a c,,L�5actor(s)licensed pursuant to the Contractor's LI...Law. BACK FLOW PROTECT.DEVICE FEE SUMMARY I am exempt under Sec. B k P C for this reasonOUTSIDE Fr—Ls • Owner Cate DRAINS FLOOR ROOF,AREA,COND. SANITARY Y_ N_ RECEIPT a WORKMAN COMPENSATION DECLARATION FIXilIRES PER TRAP $CIdOOL TAX Y N ❑I hereby affirm that I have a certificate of consent to self-Insure,ora RECEIPT M 38000,Lab ab C.7 afWorken'CompensaHon insurance oreoertlfkd copy thereof(Sec. GAS E.A.SYSTEM-1 INCA OUTLETS PARK FEE Y N 38 Conry M GAS BUILDING RDCE T EA.SYSTEM-OVER 6(EA) DM Y DI VISION FEES Candied! copy is heed with to city GREASE/INDUSTRL WASTE INTERCEPTOR PLANCHECICFEE Cenlfled copy V filed with the city inspection division. CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE TRAP PAID COMPENSATION INSURANCE SEWER-SANITARY-STORM EA 20)PT Date Rewi tN (fhla section need rad be completed If IM permit is(Drone hundred dollars ale0)orless.) aWATER HEATER W/yEM'/Fj,ECTR ENERGY FEE Y N .I certify that In the performnceafthe work for which this permit is issued, I shalt not employ any person In any manner so as to became subject to the WATpt SYSTEM/TREATING Workers'Compensation Laws of California. Date PAID 0 Z Applicant Z O NOTICE TO APPLICANT.If,after making Fh Cnrtlficale of Exemption,you NEW RESIDENTIAL PLMB. SQFT. Date Recei tic Fshould become subject to the Workers'Comperuatlon provisions of the Labor TOTAL: W Code,you at forthwith comply with such provisions or this permit shall be _ W > deemed revoked. BINE W F3 CONSTRUCTION LMDING AGENCY SEISMIC FEE 1 C I herebyafflrenthat there is a mnrtractlon lendingagenry forthe perform- ELECTRIC FEE Z arm ofthe work forwhichthis permit is issued(Sec.3097,CIv.C.)- TOTAL: U Lenders Name PLUMBING FEE LL1.endereAddress QTY. MECHANICAL PERMIT,, FEE MECHANICAL FEE 0 W 1moifythatl have read lhisappllcationand slalelhatthe above information 6 bmrrect.I agreeto comply with all city,and county ordinances and stale laws PERMIT ISSUANCE FEES PAID: ). relating to building construction,and hereby authorize representative of this H Z city to enter upon the above�m,rdkmal property for Inspection purposes. ALTIRORADDTOMECH. Date R2Ce1 Iq � — (We)agree to save,Indemnity an d keep harmless the City of Cu perHno AIR]iANDENG UMT RO 10,000 CFM) P again es,judgme and expenses which may In anywayamve SUBTOTAL: ag tsald Ci In con enceo he granting of this permit. 4 _qr� AIR HANDLING UNTT(OVER IO,ODOCrM) CONSTRUCTION TAX ig um of Applicant/Contractor Data _I EXHAUST HOOD(W/DUCD CONSTRUCTION TAX PAID: HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hazardous HEATING UNIT(TO 100,000 BTU) material as defined by the Cupertino Municipal Code,Chapter 9.12,and the Date Recel B Health and SafetyCade Sedion 25532(a)? HEATING UNIT(OVER 100,00)BTU) TOT ❑ Ye No Will the applicant orfutum building occupant use equipment or devices . VEND LATION FAN(SINGLE REBID) ISSUANCE DATE which omit hazardous air contaminants as defined by the Bay Area Air Quality Management District? BOILER-COMP OHPOR 100,00)BTU? ` Y.a n❑No have read the hazardnot rtuterialsmqulremenNunderChapter6.95of BOILER-COMP(OVER 100,(X10 BTU) pps� the Czlitorola Health A Safety Code,Sections 25505,25513 and 25534. I p- h understand that lithe building doe not currently have a tenant,that It is my NEW RESIDENTIAL MECH. SQFT. A I Y mor to Issuance notify lhe occupant must be rrct APR �^ prior Lssuance,fathe also(Occupy req H Ownerm.whorizedagent Data ISSUED BZ 92 TOTAL: OFFICE COPY . OII F.rt �:kence Robert Spence & Associates Inc Consultants Environment Health Safety April 2, 1992 Ms. Kathleen Popovec Corporate Real Estate & Construction Tandem Computers Incorporated 10400 N. Tantau Ave., LOC 248-04 Cupertino, CA 95014-3544 Subject: Floor Tile Mastic Abatement, 10555 Ridgeview, Cupertino Rooms 1393, 1353 and 1499A Dear Kathy, Presently we are in the process of removing the asbestos containing mastic in three areas of the Tandem Computers building located at 1055 Ridgeview, Cupertino. All of the work is being done under full containment. We are using a three room • decontamination chamber that includes a shower. The containment area is kept at a negative pressure to the surrounding areas by a minimum of -0.02 inches of water. Air sampling is being completed during the abatement to make sure that all fibers are contained inside the containment area. Please call if you have any questions. IdJnUS , J ) u PLOq' PLANS S' cerel , � 1992 SCUD BLDG2 INSPECTION DEPARTMEM DATE o ert- Spen S, CIH, REA Of QUEMN Y PLANNING DEP DATE C{ZFCertification: Robert W. Spence tion: Accredited Asbestos Project Supervisor #209 B1 DG• DEtion: Accredited Project Abatement Designer #209 Pq tion: Accredited Building inspector #179 tion: Accredited Management Planner #179 ication: Asbestos Abatement Competent Person ! OFFICE CM 3 Vista Verde Way Portola Valley, CA 94025 Office 415.851.7492 FAX 415.851.3297 RPR 05 192 20:25 TANDEM RE/CONST 234 P02 Robert Spence & ASSOC TEL :415-851-3257 Rpr 05 .92 15 :58 No .001 P .02 Robert Spence & Associates Inc Consultants Environment Health Safety April 5, 1992 Ms. Kathleen Popovec Corporate Real Estate & Construction Tandem Computers Incorporated 104W N. Tantau Ave.,LOC 248-04 Cupertino, (".A 9.'A)14-3.544 Subject: Pleur Tlle Mastic Abatement, 10555 Ridgeview, Cupertino Rooms 1393, 1353 and 1499A Dear Kathy, I have inspected the construction site and tested the building materials in rooms 1393 and 1353 on the first floor and room 1499A on the second floor of the building located at 10555 Ridgeview, Cupertino. The building material tests indicated that asbestos is present in the mastic that was used to glue the tiles to the floor. In response to this finding we are in the process of removing the mastic. All of the work is being done under full containment per EFA guidelines. We are using a three room decontamination chamber that Includes a shower. The containment area is kept at a negative pressure to the surrounding areas by a minimum of -0.112 inches of water. Barsotti'b is the licensed abatement contractor • that is removing the mastic. Batsutti's employees wear full protective equipment that Includes full disposable suite and NIOSH approved respirator, Air sampling is being completed during the abatement to make sure that allfibersare contained Inside the containment area. Please call if you have any questions. S�itw�R��1P�'Y `Robert Spent�e, SA Robert W. Spence EPA Certification; Accredited Asbestos Project Supervisor 4209 EPA Certification: Accredited Project Abatement Designer 9209 EPA Cerllflcation: Accredited Building Inspector#179 FPA f ertificatinn: Accredited Management Planner 4179 OSTIA Certification: Asbestos Abatement Competent Perann . 3 Vista Verde Way Purtola Valley, CA 94025 Office 415.851.7492 FAX 415.8513297 1 I