24085 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
Building Project Identification PERMIT N24085 4 0 8 5
Building Ad mss: Z
00' 81L-t wQ� (y p
where ams: one:
e - CITY OF CUPERTIN0.6UILDING DIVISION �_' 'a a�
c^^ atnr'aNarne:�V ie No APPLICATION / PERMIT —L (�
BUILDING-ELECTRICAL-PLU IBING-MEOIIAMCAL CATEGORY CONTROL M
Architect/ nttr. Lie No:
QTY ELECTRICPERMIT FEE BUILDING PERMIT INFO
Add.: PER,WTISSUANCE ❑ ❑ ❑
LICENSED CONTRACTOR'S DEL
I hereby affirmthstlam Bcensedunderproviaer9(commmc- APPLIANCESRF.SIDENTIAL JOB DESCRIPTION
Ingwi(hSe on7OOO)ofDTWsian3oftheBusineaasCode,andney Allo
license la In fullforce and effect. PANELS �'•
License Class Lk,p
Date Contractor
ARCHITECTS DEC TION 201-10W AMPS
2 1 understand my plans shall be used as Ic records. OVER 1000 AMPS SQ.FT.FLOOR AREA f/SQ.Fr.
_O
boy" Licensed Professional SIGNS ELECTRICAL
�¢ OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MISC
Z t., Ihereby affirm that lam exempt from the Contractor's License Law for the
following reason.(Section 70315,Business and Professions Code:Any city or
O 7FMP.MEI'Ei OR POLE INST.
r cvuntywhich nyubnapermlttoconstruct,ilter,improve,demollah,arrepalr
any structure prior to its Issuance,also requires the applicant for such permit to POWER DEVICES
c.U file a signed statement that he Is licensed pursuant to the provisions of the
Contactor.License Law(Cha er9(commencin with Section 7000)of Divi- VALUATION
m In R SWIMMING POOL ELECTRIC
H�O� sion3o(the Buslnessad['ro(esslonsCode)orthathebaxemptthere(romand
yi the basis for the alleged exemption. Any violation of Section 70315 by any OUTLETSSWITCHESEXTURES I;w
u�pG app1mat lots permit subjects theappllcant to a civil penalty of not more than �`�J
(F�$ Ove hundred dollars(SW. NEW RESIDENTIAL ELECTR SQ.FT. STORIES TYPE CONSTRUCTION
WW ❑I,as owner will
o t property,or my employees with wage as their sok
Za .]a&ccompen.tion,Businethework,and thesaion tructure,Is de:The Contractor's
License
d for
Law
❑ vie(Sec apply to Business,and Professions Code:The or Imp mm License law
[/j$$ dna out torn imseror ot properthrong hiswho builds
emplrlmpmovidedreoRand OCGGROUP RES.UNITS
EE.•
who doementsaorkhimselfedorwfcredown e.If,heerxcr thebuildtsuch
improvementsarcnaktendedoroffeco for ale.If,however,thebundingve TOTAL:
Improvement bsold within omycaro!<ompletian,the owner-bupderwlll have
t en of proving that he did not bund or Improve for purpose of sale.). QTY. PLUMBING PERMIT FEE FLOOD ZONE APN
"N1,as owner of the property,am exclusively contracting with licensed PERMIT ISSUANCE
contrsctoa to construct the project(Sec.704,4 Business and Professions Code:
The Contractor's Licerue law don not apply to an owner of property who
Wilds or Improves thueon,and who contracts for such Objects with a ALTER-DRAINk VENT-WATER(EA)
eg0.t[ator(a)licensed pursuant to the Contractor's License Law. FEE SUMMARY
L,J 1 am exempt under Sec. B k P C for this mann BACK FLOW PROTECT.DEVICE
OUTSI—DE FEES
Owner Data RECEPT N
DRAINS FLOOR ROOF,AREA,COND. SANITARY Y_ N_
WORK MAN COMPENSATION DECLARATION FIXgUgESPERTRAP SCHOOL TAX Y_ N_
❑1 hereby af(Imn that 1 have a certlOote of consent to self-Insure,ora RECEIPT N
certificate of Workers Compensation leaurance ora certifled copy thereof f5ce. GAS EA.SYSEEM-1 WGA OUTLETS PARK FEE Y N
3800,Lab CJ — RECEEPTN
Collcy M GAS EA.SYSTEM-0VER 4(EA)
BUILDING DIVISION FEES
Ce^nified copy Is hereby famished. PLANCHECK FEE
rtified copy is filed with the city Inspection division. GREASE/WDUSTRL WASTE INTERCEPTOR
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASETRAP PAID
COMPENSATION INSURANCE SEWER-SANITARY-STORMEA.200171. Date Recei ted
(This section need not M completed If the permit Is for one hundred dollars
($100)orka.) WATER HEATER W/VENT/EFOTR ENERGYFEE Y_ N_
I canny that In the performanceof the wok forwhich this permit is tweed,
I shall not employ any person In any manner so as to become subject to the WATER SYSTEM/TREATING
Workers'Compensation laws of California.Date PAID
OZ Applicant NEW RESIDENTIAL PLh1B. SQFT. Date Recei ted
Z O NOTICETO APPLICANT:ILaItermaking(hisCertlflate of Exemption,you
Hshould become subject to the Workers Compensation provisions of the Labor TOTAL:
W
Code,you=at forthwith comply with such provisions or this permit shall be BUILDING FEE
� 7 doemed revoked.
a C CONSTRUCTION LENDING AGENCY SEISMIC FEE
I hereby affirm that there is a construction lending agency for the perform TOTAL: ELECTRICFEE
(� OZ once ilthe work for which this permit is issued(Sec.3097,Civ.C.) PLUMBING FEE
Lender's Name
LL F lender'.Address QTY. MECHANICAL PERMIT FEE MECHANICAL FEE
OW I certifythat l have read this application and statethatthe above Information
S iscormet.I agree to comply with all city and county ordinances and state laws PERMIT ISSUANCE FEES PAID:
> N relating to building construnion,and hereby authorlu reprexntativn of this
Z city to enter upon the above-mentioned property for inspection purposes. ALTERORADDTOMEOH.
(We)agree to save,indemnify an d keep harmless the City of Cupertino Date Receipt#
O against liabilities,judgments,cents and expenses which may k any way accrue AIR HANDLI NO UNIT CFO 10,OW CFM) SUBTOTAL:
against said Ci Inco s sena/o!}/ly gr/sating of this ppe�rmit� p
AIR HANDLING UNIT 10.000 CFM) CONSTRUCTION TAX
foatumo App / y t to�� EXHAUST HOOD(W/DUCT) CONSTRUCTION TAX PAID:
HAZMI DOUS MATERIALS DISCLOSURE
Will lheapplicant or futumbulldingott pantstomorhandlehavardous HEATING UMT(TO 100,000 BN) Date Recel til
material as defined by the Cupertino Municipal Code,Chapter 9.12,and the - —
Health and Safety Cede Section 25532(a)7 HEATING UNIT(OVER 100,000 BHJ) TOTAL
01
❑Ycsu No
Will the a pplicant or uture bu ilding occupant use equipmset or devices VENTILATION FAN(SINGLE RESID) ISSUANCE DATE
which emit hamedous air contaMants as defined by the Bay Arca Air
Quality Management District, BOILER-COMP OFR'OR 100,000 BTU) (� p D
4have read the haraYcs (-1 r us No �materials requirements under Chapter 6.95 of BOILER-COMP(OVER 100,0008TU) 4,q
the
understand
Health building
Code, Stela 2550.5,ve atenant,
nanthat
I
reapomandthat notify
the occupant of
tce mquiyments which
thatb meti my NEW RESIDENTIAL M[iCH. SQ.FT AUG .11
responslbllity to notify the occupant of the requirements which must be met
prior to issuance of a Certificate of Occupancy.
Owner or authoriuda agent Date
B TOTAL: ISSUED BY: V Nla
OFFICE COPY
6ARSOrn'Y INC.
Main AENiminl
Yom.
1571 Alveno Streel
August 10, 1992 San teendro.CA94577
(510)695-6247
FAX(510)895.6505
Joseph P. Healy
Lyncon Inc.
175 Lewis Rd. Ste. X20
San Jose, CA 95111
RE: Method of procedure for Atlantic Financial Q the Vallco Village Shopping Center.
Dear Mr. Healy,
After Inspection of the aforementioned location, bulk samples were collected and analyzed
at Forensic Analytical Inc. The tests Indicated asbestos to be present in the floor mastic
that was used to glue the tiles to the floor. In response to this we are in the process of
removing the mastic.
The work will be done under full containment with a three stage decontamination facility
as required by state and federal regulations. Containment shall be established using
• polyethylene sheeting and negative air pressure will be maintained at a minimum of -0.02
inches of water at all times during the abatement process. An Independent Industrial
Hygienist shall be procured by Barsotti's for visual and air clearance monitoring. Tyvek
suits and NIOSH respirators shall be used at all times during abatement. Additionally,
Barsotti's will conduct personal air monitoring as required. All work shall be conducted
as required by all regulatory agencies.
If you have any questions or need additional information, do not hesitate to call.
Sincerely,
Barsotti s Inc.
Jeff Rogers
Operations Manager
Northern California division
oir
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