23486 (2) 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