03030111 (4) CITY OF CUPERTINO
BUILDING DIVISIONPERMITINE0I2M.A='XII
BUILDING ADDRESS: PERMITNO.
eikRahiNE OV'NE PERMIT LSS A
" SANITARY O OL NO.
ARCHITECTIENGINEER: IsUIIAIN0 PERMIT INFO
BLDG ELECT' PLUMB MECH
=oo LICENSED CONTRACTOR'S DECLARATION
1 M1creby affirm that 1 am licensed under provisions of Chapter 9(commencing Job Description
with So
cdon 7")of Dlvision Sof the Business end Professlum Code,and my lit.is
^�F in full forte and CITCM
,q� License Clea Lk.g DEMO
�H o Dau Corona=
HF ant ARCHITECTS DECLARATION
?K 1 understand my pl ¢bell M used a re
public cords
O t�, Licensed Pmfuslorul
I OWNER-BUILDER DECLARATION
if 1 herthy affirm Nal I am exempt from tM Conva tors License Law for the
L
00 following mason.(Section 703 1.5,Busineu and Professions Cole:Any city or county
which mgot.a permit to CC.Ct.ales,,Improve,demntlah,err roped,any structure
. ZT prior to its issuance.also nyulres the applicant for such permit to Ne a signed statement
£ - that he is licensed pursenuo the provisions of the Contractor's Liecnsc Law(Chapter 9 Sq.Ft. Floor Area ��Y7$$1tta[IOD
y�F$ (commencing with Section 7000)of Division 3 of the Business and Professi�nsCMe)or $Z(JUU
ro3 that he is exempt tberclrom ae basis for lie alleged exemption.Any violation of
M N
Section 7031.5 by any applicant for a pmrsh subjects Ne applicant to a civil penalty of R Q � (]
not mom then five hundred dollen 3 'SV1 r Occupancy Type
p,uownerProperty,a myemployccs widenwageuNei(tole compensation,
will do the work.
and
the twuurtknot s License,
Law
not a(See.7o 6a,Business
and P wh obu Calc:TM v enautora License law does not apply to in owher of NO ASSIGNED IUe11T18�EId QId6s
ow.prettoo whobuilds orimprovech hop,andwho dmsaucbwork M1imulfa,through his
owneer.she iprogdedtoutsohImprovementsencnot ilu ofcmoaered for ask,If,
by eveq she building u improvement Is said a did
one year of c-mpktim.IM CosaOwner.
of
Wilder will have Nc burden of proving We M tlid not build or Improve for perry-se of
sic.).
1.as owner ep she property,am ll..sort conaacting With licensed C conaacton m
Omer d psajcn(Sec..an BusinessaMny Who
Code:)lie Conaaetmi rid
rise Tawdoeslot apply roman with
of Progeny who Wildars improve Neem,and,
who Contracts Law.for such projects with a contractor(s)licensed pursuant to tM Contnnor's
License isw.
❑lam exc nder See ,B&PCfor Nit u-n
Owner Dae \
Sir 4P
ERS COMPENSATION DECLAR<IPN
1 krtbY aurum n r penally of pcnjury arc of the f mn8 dalantions: `V�v
ave end will mein m•Certificate of Cement a self-Insum for Worker'sConpen.
u pmvidcd hof by Seetlon 3700 of lie labor Chair.for Onperfomeme of she
sunk for which Nis Permit is Word.
1 have and will maintain Workers Compensation Insurance,u required by Sections
37W of Ne ls1mr Coda for Ne performmeo of Ne work for which this permit is issued.
My Workers Compensation Insurantt carrier and Policy number am:
Cartier. Policy No.:
CERTIFICATE OF EXEM MON FROM WORKERS' _
COMPENSATION INSURANCE
MN acclionnced nothe ompleteditthe pornhisformehundoddollennIffl)
or lea.)
1 cenify Net in the pmromanec or 0&work for which this Permit Is issued.I shell not
employ any person in any marcher aro as 10 become subject e-tM Worker'Campcuation
Laws of Califomia.Dau
Apy.i.Ot
NOTICE To APPLICANT:If,after making this amificate of Eaemption,you should
beeome Subject m the Worker's Compensation provisions of the labor CMC,you must
.JO f00hwiO Comply with such provisions o Nit Permit mail W deemed red
voke
z� vCONSTRUCTION LENDING AGENCY
[-m Ibe. MO.
Nat Nen is a consaunion lending agency for ase perfomunce of
C'
the work(n which Nle permit b issued(Star.3097,Co.C.)
W Q Lender's Name
z Lcnderi Addrou
V Q I eenify that I have rod Nis application and mate that Ne above infumNun is
(y fir COMM I agree to comply with all city and county ordinehee and sues laws relating to
0 building eonsuucei-n,and hereby MOoim representatives of this city to enter upon the
W aWve-mentioned property hand Caroms
purposes
ti C. liabilities,( )all.to coves e.indemnify and keep
hich Col ey n any way tCity
of C.ime cin,mst sg.iid mt
V z in consequence of the granting of this permit.
^' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL N N-POlrf Issued by: Date
SOUR ULA ONS.
mgnu o pP is ontncto Dau C Re-roofs
ZARDOUS MATERIALS DISCLOSURE Type of Roof
WIIINeap uuuofueure WllCing-ceupamsme Orhandkhesudommaurial
u chstu d by the Patin-Municipal Code.Co.,,,9.12,and Ne Health and Safety
CMe,Section 23532(a)4
pYe AN. All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection,I
Will the applicant or future Wilding Occupant use equipment or devices which g agree to remove P
a Mem"11 r cmuminants u dcGncd by the Bay Area Air Quality Management all new materials for inspection.
O Ye
s I have mad the Wrndom materials requirements undcrchapurti.95 ofeM Califon
nia Hided&SofctyCode,Sa 25505.25533and25534.Tundcrsund Nalifdc Wilding
Coca not cmrcnly have a unapt,Our it is my rea mmihility In nodi tis occupant Ne
a which t W mel prior to issumu of a Centificeu or
Cy L2 Signature of Applicant Dale
own,, agent ate - All roof coverings to be Class "B"or better
Pacific Gas and SE TVA' REPORT �
Electric Company
"EXCELLENT SERVICE IS OUR GOAL"
- THIS IS NOT A BILL!The services marked below have been provided to you at
• NO ADDITIONAL COST.
Dear Valued Customer: D S cl C 1'Z
Address
90�
My name is I Nis- and I came by on i 6 3 A-M. or P.M.
PG&E RepresemaNve Date I Time V
GAS SERVICE
The following appliances have been checked for safe`r nM e(6Ic e`toperation:
❑Heating Appliance Remarks: l' i�l ip)S I W ri11
CJII u uI
❑ Stove/Range
❑Water Heater
❑Clothes Dryer i __ _
❑Other. pppp r
Irl
'I ell
ELECTRIC SERVICE
ay
We checked the electric service problem you have been experiencing:
❑Voltage Complaint Remarks: (AJ t�E rr TU G,,,9 RA q F
❑ Partial Outage r S ( ,�Lj 't"n n t" �4
Complete Outage A S •� (' r itA
Other. t_ I-,, P n' 7" ;7
The problem:
❑Is now connected !J C
❑Is being connected
❑ Is being monitored.We will
notify you with our findings.
❑Is no longer present at .
this time. If it returns, please
call us at 1-800-743-5000.
If customer is present,please ask:
❑ Sorry we missed you. Please call
Is there anything else I can do for you, or that PG&E can follow-up on? us at 1-800-743-5000 and let us
❑ No ❑Yes know when our representative may
return to complete the service call.
i A responsible adult needs to
be present.Thank You.
® See the back of this form
•:mer Phone # (day) for additional services/
Customer Phone # (eve.) information.
Acct. #
Blue=P.G&E copy Yeiic v=Co omer copy
Thank you for the oppo�tunity to serve you.
�I
Pac
c Gas and
EleitiicCompa r SERVI�E REPORT
Electric Company-��
"EXCELLENT SERVICE IS OUR GOAL"
Please note the following marked items below.
❑ We placed the gas/electric service in your name; ❑ We turned on the electricity. However,due to
the meters have been read and left on. your absence the main switch at your meter panel
was left off.To obtain power,follow the instri
❑ If you would like your natural gas appliances
checked for safe and efficient operation, please tions of the circled diagram below.If you live in an
call PG&E at 1-800-743-5000. apartment complex and can't locate your meter
panel,please contact your apartment manager.
❑ We read the gas/electric meter for the Closing Please note:All appliances should be
Bill.The gas meter has been left on. Please placed in the"off^position before turn-
call us at 1-800-743-5000 to have service ing on the main switch.
established in your name.
❑ We read the gas/electric meter for your billing
inquiry.We will follow up with you regarding this
inquiry.
The meter readings are: BUILDING
Gaz
Electric Front
Push handle to'ON".
❑ We performed a routine test or replacement of your,
❑ Electric meter(with momentary electric service
interruption-we apologize for the inconvenience)
❑ Gas meter(without interruption of your ■®
gas service)
We will notify you if we find any problems.
❑ We had to interrupt the gas service to perform r ®®
work on our facilities. Please call us at '
1.800-743-5000 to have service restored. Push lever to"ON". Pull cartnage fuse holder
wi
We apologize for the inconvenience. and re-insert th"ON'
position showing of the
❑ We did not turn the gas on because our lop of the tonnage.
representative was unable to enter the building
to check for safe and efficient operation of your '
gas appliance(s).
English(29hrs./7days) 1-800-743-5000 PG&E M51901111MIIAMN 1-800-893.9555
Outage Information 1-800-743-5002 Numero Telefdnico de Service al Cliente 1-800-660-6789
Residential Energy-Efficiency Information 1-800-933-9555 Dich vu Khrdch Hang Viet Nam 1-800-298-8438
SERVICE POLICY
PG&E's gas and electric service policy is limited to safety checks and minor adjustments to ensure safe and proper operation of
gas and electric appliances at the time of the service call. PG&E is not authorized nor licensed to perform major repairs to appli-
ances or inspections for home disclosure statements or property inspections.A licensed contactor can perform a complete
inspection and provide a written statement of the condition of the appliance for home disclosure or property inspections.
M62-0362 5/97
Thank you for the oppo,rtunity to serve you.
I
: F 1 r l.rw ri _o rr-F
City of Cupertino Urban Runoffs
Management Program <$uiidin
PROJECTDATA FOR1'I '
When is This Form Required?
Except for interior improvements, fence, trench and re-roofing projects, all applicants must f p-ouc iuid:
submit this form to the Building Department prior to issuance of a building permit. Complefing;p ,2',
of this form is not required if the project has less than 500 square feet of new impervi 1 1,P face:
,
Area of new impervious surface(if overall reduction, specify) ZS s
q. ft.
Part 2 information required? Yes 0 No fill
What is an Impervious Surface? 3
Impervious surfaces prevent the passage of water into the soil. On-site, these surfaces incluile'building:',.: :;''. .'o
rooftops, paved patios, covered patios, driveways, parking lots, paved walkways, sidewalks and 'stieets
For More Information
For more information on improving stormwater infiltration contact the City of Cupertino Public Warks*'°7_.
Department at(408)777-3354.
I. General Project Information (Applicants for all non-exempt projects to complete this section):
a. Project Name: Kc,1� Lie Eli G"I Ec y e✓ APN # 3
• b. Applicant Name:'_
C
c. Project Address: 220 rplinc, T)rWe
d. Project type: X Residential ❑ Commercial ❑ Industrial ❑ Public/Institutional
e. Project Description (examples: 1" floor addition,2nd story addition, patio, shed, pool/s M
:ft r �LL7" C�c�,c{If1D/1 C U
2003
f. Approximate area of land disturbance: 1� 3�
sq.. ft. .
2. Project Size and On-Site Impervious Surface (Complete if New Impervin
s Surfac500 SO FT 1
a. Total site size (entire lot, not just immediate project area): 9 ��5
sq. ft.
b. Existing impervious surface area(i.e., amount at entire site before project starts): 3271 sq. ft.
i-
impervious surface area
c. Percent increase/replacement in im
P (=area of new impervious surface/area of existing
'•" impervious surface x 100%):_
14 %
Total impervious surface area after project complete area of existino
Y ' P J P ( D impervious surface . area of new
impervious surface): 9140
. sq. ft.
e . Total impervious surface percentage (total impervious surface area/total lot size x 100%):
r 54.7%
Signature.,.
Date: F-t✓Sl, 13, 2tCl
J 8/27/02 revi { d
�) �ia,.��..�••n�rL.,.a.uvL�n.__ti.u[by.l.L� .+./-- .1 • �_ • ...�.vM�.�-.�.�{M.J•Sn�.+n�
L
EXUDF
d41
7 �1'
CUPEkTINO
Assessors Parcel Number: 2 G c) -015`00
Name of owner. ak G� 2Lw1-� S
Projectaddress. _2205'q C.Akpu\t'lg -DRIVtF CueaKTINOi (',Ca95011-
Contact person.-gr—_GBE zFE1QVEI.•p1 Phone. a!-2- 7592
Fax.
Net square footage of lot. 7 3 ;Z5 S.F.
Existing Proposed
Square footage: First floor: 1 ro 3 I. 32 2,2 S 1 - 32
Second floor: O 0
Garage: (160 - 00 G6Z. 56
TOTAL: 2,5 I / . ?2 2,9 t 3 . 82
Are there at least two 10 foot by 20 foot clear spaces inside the garage? OY N
On what floor(s) is work being done? FltsT
Brief description ofwork. I�ernocle� n,us�irvt 0g ee c�tn9 -1 p ctretti v�
} NP cry. ae O -ot icdd��n nevi � o 42 Awe lid oa ,,n, i
C7� mow/ acv i 'Pl(W
Code editions: 19 C (Y -N) (Y -N)1 MC (Y-N)
199 C (Y - )19 C (Y - )
MAR 2 0 2003
BY
•
4
Plan Rev iew.Process,Work-Book - ` :'Page 4-Revised 5/17/00
OILS PROJECT DATA
• GENERAL INFORMATION:
ctural Plans. Report any discrepancies to PROJECT ADDRESS: 2209 CAROLINE DRIVE
GOVERNING CUPERTINO, CA
JURISDICTION: CITY OF CUPERTINO
BUILDING INSPECTION DEPARTMENT, ,
Jed by others. The Owner or Contractor ZONE: R-110
1,.
APN NUMBER: 326-03-015
nless otherwise noted. Minimum Cement LOT SIZE: 75'x125' = 9,375.0 SF
rk shall conform to the latest edition of
USABLE REAR YARD: 5,080.22 SF (SEE DIAGRAM BELOW),
APPLICABLE CODE: UNIFORM BUILDING CODE 1998
o ASTM—C33 and shall have a minimum REOUIRED SETBACKS:
C150 Type I or Type 11. FRONT 20' ACTUAL SETBACKS (MAIN DWELLING):
25'
REAR 20' 54'-10"
and 040 or GR60 as noted on the SIDE 5' & 10' 4'-7" & 24'-1"
PROJECT DESCRIPTION: DEMOLITION OF EXISTING GARAGE-AND,,.A
undisturbed soil regardless of elevations CONSTRUCTION OF REPLACEMENT
ONE—STORY GARAGE/DWELLING UNIT
on.
• LOT COVERAGE:
TOTAL ALLOWABLE SF: 45% OF LOT SIZE = 4,218.75 SF:
ALLOWABLE SF FOR 30% OF USABLE REAR YARD =
REMODELLED ACCESSORY BLDG. 1,524.0 SF
EXISTING LOT COVERAGE: (E) GARAGE)
and alt reinforcing steel. PROPOSED LOT COVERAGE:
as nearly as possible the neat lines (E) MAIN DWELLING FMAAMP
S.
(N) DWELLING UNIT BY_ ;�
shall be founded over firm and native N
d. O PORCH 46.10 SF
dation spaces. Provide 1 access within 20" (N) GARAGE 676.27 SF
REMODELLED ACCESS, BLDG. TOTAL 1361.36 SF
(EXISTING TO BE DEMOLISHED)
TOTAL PROPOSED LOT COVERAGE: 2992,68 SF
TOTAL CHANGE IN LOT COVERAGE: }481.36 SF
;'tise
I t .'. .,. .. � •. :" to� ,1 � rT�
•
. ....:t.�{ .,.,., .. ._ c.r t4 . .r,....f..._.Mlw... .. . . '• 1 . '- :.• Y ^,o' i �tt •
°l
SANTA CLARA COUNTY 1P P.. 408-792-5010
VECTOR CONTROL DISTRICT 1-800-675-1155
y
976 Lenzen Ave. o�'. Technician's #
San Jose, CA 95126 oq y^` www.sccvcctor.org
Technician OOMRO`°
RODENT HOME & YARD INSPECTION FORM
SRI `�GGz- , Address: ��r5 ( [ ,:in tr.,C. //r City: Ccc.
ig Owner O Tenant O Previous Visit:
11 A ATTRACTANTS FOUND: O Pet food/birdseed O Fruit O Nuts O Citrus O UncoverediaFbage ca COLIE�s(snail &
1i-slugs) O Vegetable garden O Harborage O Other
ENTRY & ACCESS POINTS TO BUILDLINGS NEEDING REPAIR: O Vent screens, attic7space-tpen
o es in roof
NQ O Pet doors O Open doors & windows O Chimney O Fences O Trees O Patio cover O !nO Unfinished construction O Pipes, cables&wiring entering walls&foundation O Under/around20[]3
O Over-lapping roof lines O Other
By—
NIAANIMAL DAMAGE TO: O Lawns O Gardens O Flower beds O Roof O Vent screens O Fo ations O Sidewalks
O Heating ducts O Insulation O Wiring O Plumbing O Other
THE FOLLOWING IS NEEDED FOR YOUR PROPERTY
0 TO MINIMIZE OR ELIMINATE RODENT PROBLEMS
O Weather stripping around garage and house doors O Remove any trash accumulation
O Keep sheds tightly closed O Seal where pipes/wires enter building
O Keep crawl space covers in good condition and secured O Spark arrester needed on chimney
O Seal all openings where roof-lines overlap O Replace and/or reinforce all vent screens
O Harvest all ripe fruits, citrus and nuts from trees and off ground O Ivy or other plants thinned and/or removed
O Keep all garbage cans covered and secured O Keep all doors and window closed after sunset
O Keep all pet doors closed and secured O Take all pet food and containers inside by sunset
O Cut back all trees. bushes and shrubs approx. 24-36 inches from roof
O Store all firewood approx. 18"above the ground and 12" away from any structure
Comments:
PROPERTY OWNER/TENAT PLEASE NOTE:After all entrances are sealed shut, any rodents left inside the structure
should be trapped with a snap trap. Traps should be baited with oatmeal,walnut meat, or peanut butter
• CAUTION: Do not use any rat poisons inside structures
THE ABOVE CONDITIONS HAVE BEEN FULLY EXPLAINED TO ME
SIGNATURE Own./tenant): DATE:
5653 REV 602
3732 CHAPTER PARK DRIVE IaENcHMnRK
SUITE A
SAN JOSE.CA 95138
TEL 4018.449.7594
TOLL FREE'. 900.999.7424
FAX: 409.449.3949
March 12, 2003
Mr. Ragbe Zenwaldi
22059 Caroline Drive �5 S
Cupertino, CA 95014 gild U0f��
Re: Asbestos Sample Collection
BUILDING INSPECTIONS 22059 Caroline Drive, Unit A, Cupertino ((�� �{ nn
Benchmark Project#: E03-446-ASC U IS Ll ��
Dear Mr. Zenwelbi: MAR 2 0 2003
ENVIRONMENTAL ENGINEERING
In accordance with our verbal agreement, while working undeBae= .1s.lon-of-a--
California Certified Asbestos Consultant, Industrial Hygiene Associate4n Armstrong
performed a limited building survey for asbestos containing materials (ACM) at 22059
SPECIALIZED TRAINING Caroline Drive, Cupertino, CA on March 7, 2003. Benchmark inspected materials in
general accordance with the Environmental Protection Agency (EPA) National Emission
Standards for Hazardous Air Pollutants (NESHAP) building demolition requirements. A
• total of seven (7) samples were collected. The following table provides information on the
materials sampled.
CONTRACT MANAGEMENT
Material Sam le # Location Percent Asbestos
Stucco 446-3-7-1 B Exterior, wall #1 ND
Stucco 446-3-7-2B Interior, wall #4 ND
Stucco 446-3-7-3B Exterior, wall #2 ND
Roof felt 446-3-7-4B Roof ND
Roof felt 446-3-7-5B Roof at wall #3 ND
Composition shingle 445-3-7-6B Roof, right side ND
Com osition shin le 445-3-7-7B Roof, left side ND
ND=None Detected
Findings:
Laboratory results (see attached) indicated that the samples of the roofing material and
stucco analyzed did not contain asbestos. A material is considered by the EPA to be
asbestos-containing if at least one sample collected from the area shows asbestos
present in an amount greater than one percent (> 1%).
Presumed Asbestos Containing Materials (PACM)
Only the roofing material and exterior stucco were sampled. All other finishing and
building materials within the residence are presumed to contain asbestos until sampled.
Prior to disturbing, suspect materials should be sampled.
w
Page 2 of 2
Mr. Zenwaidi
Benchmark Project#: E03-446-ASC
The laboratory that conducted the analysis was LA Testing located in South Pasadena,
CA.
We appreciate this opportunity to provide professional services for this project. If we can
be of further assistance, or if you have any questions concerning this report, please do not
hesitate to call me at(408)448-7594.
Sincerely,
Benchmark vi n ntaI gineering
Terri MacFarl e, C C
Environmental Field Service Manager
Enclosure
The analytical results and chain of custody are attached.
EMAR2
03/11/20e3 10: 01 1-323-254-JW LA TESTING MARKET* PAGE 01/03
159 Pasadena Ave
South Pasadena, CA 9103044
Phone. 323 254-9960 Fax: 323 254-9982 TE$T�AIG
Attn.: Tuesday, March 11, 2003
Benchmark
3732 Charter Park Drive-Suite A Ref Number: PS031873
San Jose, CA 95136
POLARIZED LIGHT MICROSCOPY (PLM)
Performed by EPA 600/jtt-93/116 Method*
Project: 22059 Caroline Dr., Cupertino, CA
Sample ASBESTOS NON-ASBESTOS
Sample Location Appearance Treatment % Type % Fibrous % Non-Fibrous
446 3.7 1B Exterior wall#1 Tan Crushed/Dissolved None Detected 2%Cellulose 98%Matrix
Non-Fibrous
Homogeneous
445.3-7213 Interiorwall#4 Tan Crushed/Dissolved None Detected 2%Cellulose 98%Matrix
Non-Flbrous
Homogeneous
446.3.7 3B Exterior wall#2 Tan Crushed/Dissolved Nona Detected 2%Cellulose 95%Matrix
Non-Fibrous
H
Homomogeneous
IgA l°J �1t�
446.3.7 4B Roof Black Crushed None Detected I V•15% ZCellulose, t385%JMatrlx
Fibrous 1 �pR 2 G
Homogeneous --
446.3.7 5B Roof at wall#3 Black Crushed None Detected Ilulose 85%Matrlx
Fibrous
Heterogeneous
446.3.7 6B Right side of roof Red/Black Crushed None Detected 20%Cellulose 75%Matrix
Fibrous 5%Synthetic
Heterogeneous
Comments: For all obNously heterogeneous samples easily separated into subsample,s,and for layered samples,each component is analyzed separately.
Also,"#of Layers"refers to number of separable subsamples.
NV samples analyzed by ELAP 1981 Method.
r
Angelique Petrosyan Approved
Analyst Signatory
13 sdaimtn: PLM boa Dew known to ml4 s esoestoc In 9 ardwi Defeatists or samples which eonwh asbestos. Thus negative PLM results cannot be
guaranteed. LA Tesgng suggests that mobbles reported as<t%or nine detedl9d be taste,w M sister SEM or TEM. The ow"o test report 1619164 f
only to the nems tested. THs report my not be reproduced,smav In full,without wallen approval by LA Tial The above test moat not be used by
the client(a clalm product endomement by NVLAP nor any agency of the United states Government. Laboratory is not responsible for the accuracy of
results when requested to physlvlly separate and nnalym layered samples.
Analysis Detonated by IA Testing,I.C.(NVIAP Air and 90k*200232-0,State:CA 2283,AZ AZ0621,TX 433 W)
03/11/2003 10: 01 1-323-254-f2 LA TESTING MARKET* PAGE 02/03
159 Pasadena Ave
South Pasadena, CA 91030
Phone: (323) 254-9960 Fax: (323)254-9982 TESTING
• Attn.: Tuesday, March 11, 2003
Benchmark
3732 Charter Park Drive-Suite A Ref Number: PS031873
San Jose, CA 95136
POLARIZED LIGHT MICROSCOPY (PLM)
Performed by EPA 600/R-93/116 Method*
Project: 22059 Caroline Dr., Cupertino, CA
Sample ASBYSLos NON-ASBESTOS
Sample Location Appearance Treatment % Type % Fibrous % Non-Fibrous
446.3.7 7B Left side of roof Red/Bladc Crushed None Detected 20%Cellulose 75%Matrix
Fibrous 5%Glass
Heterogeneous
• I
IrrJ `' �o� III
i ►ylpR � 0
ay --
Comments:For all obviously heterogeneous samples easily separated Into subeamples,and for layered samples,each component Is analyzed separately.
Also,V of Layers"refers to number of separable subsamples.
`NY samples analyzed by ELAP 198.1 Method,
Angelique Petrosyan Approved
Analyst Signatory
• DIscalfrefe: PLM hes been known to nose asbestos In a smell peroemsga of samples which comm asbnocs. Thus negallve PLM results Cannot be
guaranteed, LA Testiw ng sugq.t,that.,no.re,,oAad as 0% noe ndetected be torted with either SEM or TEM. The above lest ra,o relate. 2
MY to the Items tested, This moon trey not be reproduced.except In full,without whim eppmwl by LA Testing. The above last must not be used by
the vient to claim product endorsement by NVLAP nor any agency of the united States government. Laboratory is not responsible Tor me accurso,of
results when requested to physlolly separate and analyse layced sairylex.
Analyse perfomned by LA Tntin9,InC.(NVLAp Ar and Bulk 0200232-0,Stale:CA 2293,AZ AZ0921,T%93369)
03/11/2003 10: 01 1-323-254-f2 LA TESTING MARKET PAGE 03/03
BENCHHMARK
1 JW313
Project Number: CO3.44m AU_ Dal= g7'p3 , T echnic�an.
Project Location: ,9_ 59 CAroltrte7 br. GuACr�no CR _
Client Name: Company:
F
ject Type Type Of Analysis Turnaround Time
s6estos Bulk EPA 6 Same Day 3 Hr o Hr
Lead-based Paint EPA SW846-7420, FLAA 4 Hou
Lead Risk Assessment Dust \/Vipes. Pain( Chips 48 Hour
Lead (bvaler) Air, Soil 72 Hour
Mold/Fungus/Bacteria SN13138, GFAA, Nater 5 Day
Indoor Air Quality TEiNI/eull( (Chatfield) Other:
Other: Other:
TTP = Test Till Positive
Homogenous Malerial 1 Sample .Number Location Of Samples ,Analysis
Material Group Component SpecdficaUon
I
•3 •-1- l tJ tl� -�.i�
28 ! r all'r
• 36 , u-wz
z Rood �u r 44 _ I - B Z4 AT- L)an+" _
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• • Building Department
10300 Torre Avenue
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Cu ertino,CA 95014
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Lwi r'Y Telephone(408) 777-3228
CITY OF Fax(408)777-3333
q:UPE0`T9N0
PROCEDURE FOR DEMOLITION PERMITS
BEFORE DEMOLITION PERMITS CAN BE ISSUED,THE FOLLOWING STEPS MUST
BE COMPLETED:
' SIGNATURE/DATE COP III�IJi (rjJ. UJ_ ISI`J�U�f�'U`�
1. Owner to make sure property is located within the City of Cupertino limits.
2. Provide a current prelimina/y Title Report or a"Lot Book-GuaranteeZ-whichshows
�� 11 ownership of property,open Deeds of Trust,and a legalldes�gi&o`ra fbi!gepoit is to
be issued within thirty (30) days prior to issuance of the demolltippongpenr
3. Provide the Building Department with a letter and self- I i re�s� 'd 21Sv"016��to h�1el sent
to all persons having entitlement to the property,advis them that the property is to
be demolish and they have 15 days to respond if they.d b e of the
� ( demolition. Example: Lending institutions,banks,lease holders,partnerships,etc.
I Check to see if the building is considered an historical landmark. Obtain clearance
from the Community Development Planning Department. Allow 10 working days.
5. The permit fee shall be based on the valuation of the demolition work.
A lot plan will be required showing any trees(10 inches in diameter at 3 feet above
II de on the subject property,and what means will be taken to protect same. Two
rn _,,=silses of this plan are required for review by the Planning Depar ent.
7. Provide a letter of inspection, tests,and a ateme f any Hazard s M terials. Letter
IJ to be initiated by person(s)certified in asbestos and/or hazardous material
V
� examination.
OWN 8. P.G.&E. must be contacted as early as possible prior to demolition to schedule the
abandonment. Contact P.G.&E. at(408)725-2126. A letter from P.G.&E.shall be
provided to the City,stating that all gas and electric has been disconnected.
„ >
9.-Provide a letter of clearance of all vermin from a license nem trol contractor,or �C
/ call the Santa Clara County Vector Control Distric t(408) 792-5 0 6-9' 3
10. Important: Prior to the issuance of the demolition permit,the applicant must call the
Public Works Department at(408) 777-31x4 anTairange a"habitable dwelling”
inspection.
11. Debris bin and Recycling sheet: read,sign and date. The sheet will remain in the
project's building permit file for the duration of the project.
1,f 12. Prior to issuance of a commercial interior demolition permit, the Fire�nt must
7� 1 review the plans for fire suppression/alarm systems that shall remain in service or be
• modified during demolition or-that-shall.be.replaced with the new-constructian. Over-the
counter commercial interior demolition permits can be issued only on Tuesday,
Wednesday or Thursday from 1:30 to 2:30 p.m.
Revised 1/07/03
Printed on Recycled Paper
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NO ATTACHMENTS
RIPLINE
1"4 PLAN
A SIDES (TYP) TO BE KEPT
CL AN
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EXIST I NO GROVND 2•p•
I I/¢ROCK OR EOUAL
12"DIA.
TYP. POST
ELEVATION
NOTES:
I. THE DEVELOPER SHALL INSTALL THE " TREE PROTECTION" DEVICES
PRIOR TO THE START OF GRADING OR CLEARING WORK.
2. THE CITY RESERVES THE RIGHT TO ISSUE A "STOP WORK" NOTICE IF
THE "TREE PROTECTION" DEVICES ARE NOT INSTALLED OR IF THE
DEVICES ARE NOT MAINTAINED PROPERLY.
• 3. SEE THE PROJECT GRADING PLAN FOR SPECIFIC TREES THAT REQUIRE
PROTECTION. ALL SPECIMEN TREES REQUIRE PROTECTION UNLESS
OTHERWISE NOTED.
4. NO EXCAVATIONS WITHIN THE "TREE PROTECTION AREA" ARE ALLOWED
UNLESS UNDER THE SUPERVISION OF A REGISTERED TREE SERVICE COMPANY.
S. ANY FILLING WITHIN THE "TREE PROTECTION AREA" SHALL BE DONE IN
ACCORDANCE WITH A DETAILED IMPROVEMENT PLAN APPROVED BY THE CITY.
G. NO TRIMMING. CUTTING,OR PRUNING OF DESIGNATED TREES CAN OCCUR
WITHOUT A REGISTERED TREE SERVICE COMPANY.
7. CONSULT ORDINANCE 778 OF THE CITY OF CUPERTINO FOR PERMIT
REQUIREMENTS AND EXCEPTIONS.
8, TEMPORARY CHAIN LINK FENCING IS AN ACCEPTABLE SUBSTITUTE TO
THE WOOD CONSTRUCTION. 'v
TREE PROTECTION STANDARDS
CITY OF CUPERTINO• w 6-4 'I
APPROVED BY : DATE
STANDARD DETAILS cl E 1N
City of Cupertino
Public Works Department
10300 Torre Ave.
Cupertino CA 95014
• (408)777-3354
Debris Bins
Debris from a project in Cupertino can be collected and disposed of in either a:
• Los Altos Garbage Co. bin (call 725-4020 to order), OR
• bin owned by the project's general contractor or demolition contractor, and hauled
by a vehicle owned and registered to that contractor; (contractor should be
prepared to prove ownership) OR
• private truck with a bed, but no bin
The Los Altos Garbage Company
is the only debris bin service provider
franchised to do business in Cupertino.
Bins from other leasing companies may not be used in Cupertino.
Recyclable Materials
Recyclable materials may be collected in private debris bins or containers leased
from ANY company, as long as the materials are both:
• separated by type of material into separate containers, AND
• are not contaminated by garbage.
Separated recyclable materials are materials that are separated into individual
containers, each containing just one type of recyclable material. Typical examples of
recyclable materials include: metal, wood, concrete, steel-reinforced concrete,
asphalt, tree trimmings, white goods, toilets (hardware removed), rocks and clean fill
dirt. Separated recyclables must ultimately be recycled or otherwise reused, and not
disposed of in a landfill.
Contractor should be prepared to provide the name and phone number of any
. recycling companies being used on the project. A list of local recycling companies
can be found at: www.recvclestuff.org,'
1/03
• City of Cupertino
Public Works Department
10300 Torre Ave.
Cupertino CA 95014
(408)777-3354
Debris Bins
Debris from a project in Cupertino can be collected and disposed of in either:
1. a Los Altos Garbage Co. bin (call 725-4020 to order), OR
2. a bin owned by the project's general contractor or demolition contractor, and hauled by a vehicle
owned and registered to that contractor(contractor should be prepared to prove ownership), OR
3.. a private truck with a bed, but no bin
The Los Altos Garbage Company is the only debris bin service provider
franchised to do business in Cupertino.
Bins from other leasing companies may not be used in Cupertino.
Please check all that apply:
9 I will use a Los Altos Garbage Company bin
I will use a bin and truck owned by the general contractor or the demolition contractor.
❑ I will use a private truck, and not drop a bin.
Recyclable Materials
• Recyclable materials may be collected in private debris bins or containers leased
from ANY company, as long as the materials are both:
1. separated by type of material into separate containers, AND
2. are not contaminated by garbage.
Separated recyclable materials are materials that are separated into individual containers, each
containing just one type of recyclable material. Typical examples of recyclable materials
include: metal, wood, concrete, steel-reinforced concrete, asphalt, tree trimmings, white goods,
toilets (hardware removed),jrocks and clean.fill dirt. Separated recyclables must ultimately be
recycled or otherwise reused, and not disposed of in a landfill.
Contractor should be prepared to provide the name and phone number of any recycling companies being
used on the project. A list of local recycling companies can be found at: www.recyclestuff.org.
.............................................................................................
Signature: ����a ddl� Date: 5-;26—63
Name (printed): ICa 6 ei2T S e (A.IX� Z
Title: OW M tet? 272-5._1�
Phone: '7/�0' S I `� — qat 9 —7
• Project address: EO ;Y-91 CRl�OwNb= .`()R . Ci.tPI Ii?T( No"CN 950/'/f
This form to remain in the project's building permit file for the duration of the project.
Revised 1103
�PCLARA COG FIRE *EPA lTMEN H
SANTA CLARA COUNTY
14700 Winchester Blvd., Los Gatos, CA 95032-1818
_ (408)378-4010 • (408)378-9342 (fax)•w .sccfd.org
January 14,E2003
City of Cupertino
Mr. Greg Casteel, Building Official
10300 Torre Avenue
Cupertino, CA 15.014
Subject: Building Demolition Request
Dear Mr. Casteel:
The Santa Clara County Fire Department is continually looking for buildings that are
being demolished to use for fire training exercises such as search and rescue,
ventilation, and forcible entry exercises. These training exercises have proven to be a
valuable tool in teaching and reinforcing our employees' knowledge of firefighting. If
an owner wants to donate property that is scheduled for demolition, the following
procedure is followed:
• The owner contacts the fire department Training Division with the address of the
property.
• The Training Division checks the location to see if the building meets their needs
and verifies that the property is owned by the requesting individual.
• • The fire department signs a hold harmless agreement with the owner. (The fire
department assumes liability for their employees while at the site.)
• The Training Division will notify all the surrounding neighbors that a fire
training exercise will be conducted.
This program has been very successful with our agency. By using an available resource
in the community, the community benefits as well as the fire department. We would
appreciate your assistance in asking your building department to notify builders of our
request and give them a copy of this letter.
Thank you.
Sincerely,
ti
Prank Arnierich
Deputy Chief/Training Division
FA:jh
DEMOLITION REQUEST.LTR.)H.011403
•
Organized as the Santa Clara County Central Fire Protection District
Serving Santa Clara County and the communities of Campbell,Cupertino, Los Altos,
Los Altos Hills, Los Gatos, Monte Sereno, Morgan Hill,and Saratoga
Al
City Hall
� ` 10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: (408)777-3228
CITY OF FAX: (408)777-3333
*CUPEki IN®
BUILDING DEPARTMENT
DEMOLITION REQUEST
Date
Addresses of all interested parties:
Reference : Loan number(if applicable)
• Dear Sir or Madam:
Please be advised that the owners at
Cupertino, CA 95014, Assessor's Parcel number are requesting
demolition of their house/building.
Please notify us within 15 days if you have any objections.
Our address is: City of Cupertino
Building Dept.
10300 Torre Avenue
Cupertino CA 95014
If you have any questions, please call me at (408) 777-3228.
Sincerely, >.
Susan Winslow
Administrative Clerk, Building Department
Printed on Recycled Paper
SON-11WITY OF DEMO RTINO* 3 l /
oCITY OF
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CUPERTINO PERMIT APPLICATION FORM
SAPN# Date:
3 - n o
Building Address:
9,(3LItjF ZR ,
Own 's Name: Pho e #:
3E EG
Contractor: License#:
Contact: Phone #:
jpplicandContractor:
Building Pe t Info:
BldgElect Plumb Me
Jo ascription: -- ----- - --
esidential: t ° Co eal:
Sq.Ft. Floor Area: $/Sq.Ft.:
Architect/Engineer: Valuation:
Type of Construction: Occupancy 6ro
Qty. if
A licable Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILIDNG
BSEISMICOM Seismic Commercial BUILIDNG
BSEISMICRE Seismic Residential BUILIDNG
BPLANCHK Plan Check Fee BUILIDNG
BUSLIC
Business License BUILIDNG
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