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07080153 -77777 CITY OF Cl]'?ERTINO BUILDING DIVISION p'ERMIT G1N7CJ[ OR Z � MiTION. PERMIT NO. BUILD NG ADDRESS: 0260 DE ANZA BLVD ALLIED CONSTRUCTION 07080153 PERMIT ISSUE DATE OWNER'S NAME: WELLS FARGO BANK NEAL 2021 LAS POSITAS CT. #143 08116/2007 SANITARY NO. CONTROL NO. INE: (925) 729-2324 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH M Z LICENSED CONTRACTOR'S DECLARATION Job Description 0 w P I hereby affirm that I am licensed under provisions of Chapter 9(commencing ;ZUW with Section 7000)of Division 3ofthe Business arylProfessions Co andrayfcenscis TEAR OFF' & RE-ROOF SHINGLES AND HOT BUR 2 PER SQ !may Lfull foreeand tett Lic.g (p W/COATIDIG CLASS 1A ? Li Class p Date Contractor F ARCHI ECTS DECLA ATION i a< I understand my plans shall be used as public records iaV U.� Licensed Professional 'a a OWNER-BUILDER DECLARATION i a 1 hereby affirm that 1 am exempt from the Contractors License Law for the :a O following reason.(Section 703 1.5,Business and Professions Code:Any city or county which requires a permit to conswct,alter,improve.demolLch,or repair any structure - prior which. its issuance,also requires the applicant for such permit to file a signed statement ; ,Ft.Floor Area Valuation ?a that he is licensed pursuant to the provisions of the Contractur's License Law(Chapter 9 q $29000 F=$ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or a that he is exempt therefrom and the basis for the alleged exemption.Any violation of Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of A� Number not more than five hundred dollars(5500). 3 6 9 4 0 0 0 4, U ❑L as owner of the property,or my employees with wages as their salt compensation, will do the work,and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections and Professions Code:The Contractor's License Law dots not apply to an owner of property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements are not intended or offered for sale-If, however,the building or improvement is sold within one year of completion,the owner- builder will have the burden of proving that he did not build or improve for purpose of sale.). ❑1,as owner of the property.am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li- cense Law does not apply to an owner of property who builds or improves thereon.and. who contracts for such projects with a contractor(s)licensed pursuant to the comracoes License Law. ❑I am exempt under Sec. B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: L]I have and will maintain a Certificate of Consent to self-insure for Workers Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑I have and will maintain Workers Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Workers C rep nsati Insura a carticr and Policy number are: ` U Cartier- e G�Policy No.:-S6 1210 /Q� CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars($100) or less.) I certify that in the performance of the work for which this permit is issued.I shall not employ any person in any manner so as to become subject to the Workcrs'Compensation Laws of California.Date . .`i,; Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code you must Z forthwith comply with such provisions or this permit shall be deemed revoked. Z O CONSTRUCTION LENDING AGENCY ��. I hereby affirm that there is a construction lending agency for the performance of �(. the work for which this permit is issued(Sec.3097,Civ.C.) W QLenders Name �Z Lender's Address U O 1 certify that 1 have read this application and state that the above information is h— correct.1 agree to comply with all city and county ordinances and state laws relating to Ubuilding construction,and hereby authorize representatives of this city to enter upon the W ahovc-mentioned property for inspection purposes. LL (We)agree to save,indemnify and keep harmless the City of Cupertino against Mf/j liabilities,judgments,casts and expenses which may in any way accrue against said City f,)Z in consequence of the granting of this permit. Date P" APPLICANT UNDERSTANDS AND WILL E COMP Y WITH ALL NON-POINT Issued b): _ SOURCE ULATIONS. / r� �lGZ�� ""'• �1.-.� �5"��"d / Re-roofs `L� Signature a Applicant/Contractor" Dao T Of Roof MATERIALS DISCLOSURE Type Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety Code,Section 25532(a)? two All roofs shall be inspected prior to any roofing material being installed. C]Yes If a roof is installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment or devices which :mit hazardous air contaminants as defined by the Bay Area Air Quality Management all new r iaterials for inspection. District? ❑Yes No I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building ��of Ldoesshnot currently have a tenant,that it' my ponsibility o notify the occupant of the Date icy 'rcmcntcwhichm riot hssu oCaC�[ti��tr�of—O�u SlgnaturtApplica t 1//r�// S (/!/ r/ All roof coverings to be Class"B' or better Owner or authorized agent Date CITY OF `;UPEkTINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRESS: PERMIT # OWNER'S NAME: PHONE # =i5r GENERAL CONTRACTO ► ,,� , t FAX # oZ I am not using any subcontractors: Si anature Date r, _t_ -1-1.. a_ ,-,+,.. 4-r., o �,-„� ��,,,-..,la+P +he following information: riease ULLUCK app ucauze auLn vi LLL GLL� SUBCONTRACTOR - ... L— _---- --- ---- BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/ Contractor Signature Date OTo Y 0153 CITY OF C'UPERTINO %RM REROO CUPEFtTINO PERMIT APPLICATION FORM APN # z/0 0 Q 7 ° - BUILDING Date:—G Energy BUILDING BSEISMICRE Building Address: BUILDING BSEISMICOM 0 00 Ow ame: BUILDING Phone is 'f,125t BUILDING BUSLIC Jr Contractor: BUILDING L cense Contact: J Cupertino Business License #: Type of F,00f Covering: Existi ' Prod• 9 Built -Up roof Built -Up Roof Asphalt Shingles ❑ Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles Other (Specify) ❑ Wood Shingles ❑ Other (Specify) , L ❑ Provide I.C.B.O. Report # `_ Nui er of existing coverings VTo be Removed �, ❑ Provide Mfgr. Installation Specs. I Have Read, Understand and Will Comply With Ci ertino's Tear Off Policy: Job Description: / Residential ❑ Commercial s fr `� .0 Fire Zone: Yes ❑ No 0 Confirmed with Planning DeDt. if EJ there are any restrictions: Cost of Projecx: Type of Constn_ction: Occupancy roup: Qty. if Rap T__ TT T)Pcrrintion Fee Group Applicable ren ILF BPERMFEE _ .. --- ---r ---- Bldg Permit Fees - BUILDING BENERGY Energy BUILDING BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING Community Development Department Building Division City of Cupertino 10300 Torre Avenue Telephone: (408) 777-3228 Fax: (408) 777-3333 Building Department Subject: Re -roofing policy for the City of Cupertino 1. Prior to permit issuance, you must agree to comply with 1997 UBC Standards and manufacturers specifications on re -roofing. 2. New roof coverings shall not be applied without first obtaining all inspection and written approval from the building inspector. A final inspection and approval shall be obtained from the bu: lding inspector when the re -roofing is completed. 3. All roofs shall be inspected prior to any roofing installation. 4. To receive a final sign off from the City, the following steps are required: 1) Pre -inspection and/or tear off apprc,val. 2) In -progress inspection approval. 3) Final inspection approval. a) Spark arrester installation. 5. If plywood is installed, a plywood nail inspection is required. 6. Any roofing which is applied without f first obtaining an inspection, will require the removal of all new material down to the sheathing, so a proper City inspection can be performed. 7. NOTE: If you call for a plywood nail inspection and the job is not ready, you will be charged a re -inspection fee of $176.18. The re -inspection fee must be paid before another inspection can be scheduled. IMPORTANT: 1. Flat roofs must have a minimum of 1/4 " per foot slope and demonstrate that there is no ponding. 2. An I.C.B.O. report is required to be on he job site at the time on inspection. I understand and will comply with the above stated policy on re -roofing. Homeowner's Name: job Site Address: oqic�if Roofing Company Name: l il/I Ao4 (Z 4 �J'f 1/4 Applicant's Signature: _ Date:" --67 Greg Casteel Building Official Revis(d 11/2/04 3 ITEMS OF 3 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: B1}:: Lot: APN ........: 36940004.00 DATE ISSUED.......: 08'16/2007 RECEIPT #......... BS000002399 REFERENCE ID # ...: 07080153 SITE ADDRESS .....: 10260 DE ANZA BLVD SUBDIVISION ...... CITY CUPERTINO IMPACT AREA ...... OPERATOR: patg COPY # : 1 OWNER WE:JLS FARGO BANK NEAL ADDRESS .......... CITY/STATE/ZIP ...: SAN FRANCISCO CA, 94163 RECEIVED FROM CS:2W INC. CONTRACTOR DONAVON RITTENBACH LIC # 23449 COMPANY ALLIED CONSTRUCTION SERVICES ADDRESS 2021 LAS POSITAS CT. #143 CITY/STATE/ZIP ...: LIVERMORE, CA 94550 TELEPHONE (925)724-2324 FEE ID UNIT QUANTITY AMOUNT PD -TO ---------- -DT THIS REC -- NEW BAL ----------------------- BPERMFEE VALUATION -------------------- 29,000.00 358.56 0.00 358.56 0.00 BSEISMICRE VALUATION 29,000.00 2.90 0.00 2.90 0.00 BUSLIC FLAT RATE 1.00 107.00 ---------- 0.00 107.00 ---------- 0.00 ---------- TOTAL PERMIT ---------- 468.46 0.00 468.46 0.00 METHOD OF PAYMENT AMOUNT REFERENCE ------------------- NUMBER ----------------- --------------- CHECK 468.46 #1520 --------------- TOTAL RECEIPT 468.46 Aug 16 2007 10:58AM Oakland Office 510-638-8404 p•2 D7000153 January 24, 2002 Mr. Randy Norman Wells Fargo Bank Corporate Properties Group 85 Cleaveland Road Pleasant Hill, CA 94523 Re: Limited Asbestos Survey for The Planned HVAC and Carpet Replacement Projects Wells Fargo Bank Cupertino Branch (AU# 99478) 10260 South De Anza Boulevard, Cupertino, California ACC Project No. 1041-182.72 Dear Mr. Norman: Per your request, ACC Environmental Consultants, Inc. (ACC), performed a limited asbestos survey of the property located at the above refers nced site on January 18, 2002. The survey of the branch was performed to identify suspect asbestos -containing materials that maybe impacted . during the planned HVAC and carpet replacement projects. Common suspect asbestos -containing building materials that may be impacted by typical HVAC and carpet replacement projects may include but are not limited to, the following materials: HVAC Replacement Suspect Asbestos Mater: al List • Boiler Insulation • Pipe Insulation, Elbows & Fittings • Duct Insulation • Mudded Duct Joints • Vibration/ Expansion Joints • Asbestos -cement Piping/Flues • Wall Materials • Roofing Materials 44t i Carpeting Replacement Project Suspect Asbestos Material List • Flooring and Associated Adhesive • Baseboard and Baseboard Adhesive • Carpet Adhesive • Leveling Compound Building components not associated with the pl«nned HVAC and carpet replacement projects were not sampled. Bulk Sarlple Results ACC performed limited bulk sampling of suspect ast estos-containing materials on January 18, 2002. Twenty-nine samples of suspect materials were subrr fitted for analysis. Copies of the laboratory results are enclosed. R Aug 16 2007 10:58AM Oakland Office 510-638-8404 p•3 W. Randy Norman January 24, 2002 Page 2 The samples were delivered to Forensic Analytical Sp,:cialties, Inc. of Hayward, California, an independent laboratory that participates in the bulk sample proficie:icy analysis program conducted by the United States Environmental Protection Agency (EPA) and is accredited by the National Voluntary Laboratory Accreditation Program (NVLAP). The samples were analyzed using Polarized Light Microscopy with dispersion staining to estimate percent composition by volume. Samples with less than 1% (<l%) asbestos are designated as "Trace Asbestos." Samples with no observable asbestiform minerals are designated as "no asbestos detected." Summar, of Results C?C�,yyy: - � _� � 'v'ii _: �p{.+ Y_.-� - �� LF1' ,a-} LPiilf.�.. •�.- _ PE -01-01, Pipe Elbows Mechanical Roor-t Above the No Asbestos Detected N/Q 02 DI -02-01, Duct Insulation Attic Mechanical Roora and Above No Asbestos Detected N/Q 02,03 JC -03-01, Drywall and Joint the Attic Interior Walls ani Ceiling 3% Chrysotile Asbestos in 1800 SF 02, 03, 04 Compound Joint Compound; No Asbestos (Mechanical Detected in Paint; No Drywall Room Only) in Sample PI -04-01 4" TSI Pipe Insulation Above the Attic and 10% Chrysotile Asbestos; 5% 80 LF Mechanical Room Amosite Asbestos CM -05-01 Brown Ceiling Tile Janitorial Closet behind V x 1' No Asbestos Detected N/Q Adhesive Ceiling Tile, Corridor Hallway Rooms and Cus :omen Area CT -06-01 V x V Gray Ceiling Tile Janitorial Closet: Corridor No Asbestos Detected N/Q (Painted White) Hallway Rooms, and Customer Area GM -07-01 Gasket Material On Su 1 Air I►uct 90% Chrysotile Asbestos 160 LF N/Q SV -08-01 Gray Sheet Vinyl Flooring Men's and Worr en's No Asbestos Detected with Fibrous Backing BA -09-01 Gray Baseboard with Restroom Floor., Janitorial Closet, Corridor No Asbestos Detected N/Q Baseboard Adhesive Hallway, Lunchroom, and Customer Area FA -10-01 12" x 12" Gray Floor Tile Top Layer at Janitorial Closet No Asbestos Detected N/Q and Adhesive FA -11-01 12" x 12" Tan Floor Tile and Lunchroom Bottom Layer a,: Janitorial No Asbestos Detected N/Q and Adhesive FA -12-01 12" x 12" Gray Floor Tile Closet Area Bottom Hallwa,, under Carpet No Asbestos Detected N/Q Land Adhesive CA -13-01, Yellow -Brown Carpet Throughout, Underneath the No Asbestos Detected N/Q 02 Adhesive DT -14-01 Gray Duct Tape Ca et Above the Attic and 70% Chrysotile Asbestos 25 SF Mechanical Ro-mm Area LC -15-01, Off -White Leveling Underneath the Carpet at No Asbestos Detected N/Q 02 CR -16-01, Compound Composite Roofing Various Locations Roof Canopy Area No Asbestos Detected N/Q 02 03 RF -17-01 Material Black Roofing Felt Underneath the Transite 75% Chrysotile Asbestos 7800 SF Shingles Throughout the Main TS -18-01 Gray Transite Shingles,... Room I Main Roof Area 20% Chrysotile Asbestos 7800 SF Aug 16 2007 10:58RM Oakland Office 510-638-8404 p-4 Mr. Randy Norman January 24, 2002 Page 3 Based on the sample results, the planned HVAC and c arpet replacement projects may impact asbestos - containing materials. The final scope of work should be reviewed against the asbestos survey information. If asbestos -containing materials will be disturbed during the projects, all work should be performed by licensed asbestos abatement contractors working under standard Wells Fargo asbestos program requirements. Please contact me at (510) 638-8400 ext. 107 if you hive any questions. Tim Fallin Program Manager Cal -OSHA Certified Asbestos Consultant (CAC #95-1690) cc: Lahn Horton lgs:tf