S0175APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING - ELECTRICAL PERMIT NO.
BUILDING DIVISION APPLICATION/PERMIT PLUMBING - MECHANICAL S 017 5
BUILDING PROJECT IDENTIFICATION
DING ADDRESS: SANITARY NO. APPLI TION SUBMITTAL DAI
1 n1 D BUID ( QV
OWNER'S E. P E: C CT E• IC NO:
cm"- *W N/C CONTROL #
CHI Cr/ENGINEER• L A S ❑
MWALD
❑ Consultant Fees Paid by Applicant (Initial)
LICENSED CONTRACTOR'S DECLARATION f QTY ELECTRIC PERMIT I FEE
A a
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
❑ SFDWL
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with Section 70(x1) of Division 3 of the BusineVProfes Code, and my li cense is
I hereby affirm under penalty of perjury one of the following declarations:
PERMIT ISSUANCE
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in full force and eff
MODIFICATION
DRAINS - FLOOR, ROOF, AREA, COND.
sation, as provided for by Section 3700 of the Labor Code, for me performance of the
APPLIANCES - RESIDENTIAL
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License Class Lic. #
Date Contra
h Q WW
ARCHIT ECT S D
❑ I have and will maintain Worki;w 'I n quired by Section
PANELS
In
I understand my plans shall be used as public records
GAS -EA. SYSTEM -1 INC. 4 OUTLETS
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GAS - EA. SYSTEM -OVER 4 (EA)
UP TO 200 AMPS
Licensed Professional
201 -1000 AMPS
Z
OWNER - BUILDER DECLARATION
SEWER - SANITARY - STORM EA. 200 FT.
OVER 1000 AMPS
a W t
I hereby affirm that I am exempt from the Contractor's License Law for the
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SIGNS ELECTRICAL
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following reason. (Section 7031.5, Business and Professions Code: Any city or county
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which requires a permit to construct, alter, improve, demolish, or repair any structure
SPECIAL CIRCUIT/MISC.
C)
prior to its issuance, also requires the applicant for such permit to file a signed statement
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that he is licensed pursuant to the provisions of the Contractor s License Law (Chapter 9
TEMP. METER OR POLE INST.
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(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
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that he is exempt therefrom and the basis for the alleged exemption. Any violation of
PERMIT ISSUANCE
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
above - mentioned property for inspection I S.
(We) agree to save, Ind ify a harmless the City of Cupertino against
POWER DEVICES
ALTER OR ADD TO MECH.
not more than five hundred dollars ($500).
liabilities, judgments, costs e s . h may in any way accrue against said City
SWIMMING POOL ELECTRIC
Q
❑ I, as owner of the property, or my employees with wages as their sole compensation,
AIR HANDLING UNIT (TO 10,000 CFM)
a, o
will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business
rte.
W 3 coo
and Professions Code: The Contractor's License Law does not apply to an owner of
AIR HANDLING UNIT (OVER 10,000 CFM)
OUTLETS - SWITCHES - FIXTURES
• •
I pp n ontra or Da
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
HAZAR US MATERIALS DISCLOSURE
NEW RESIDENTIAL ELECTR SQ FT.
sale. If, however, the building or improvement is sold within one year of completion, the
1 the applicant or future building occupant store or handle hazardou aterial
HEATING UNIT (TO 100,000 BTU)
owner- builder will have the burden of proving that he did not build or improve for pur-
as by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety
Section 25532(a)?
HEATING UNIT (OVER 100,000 BTU)
pose of sale.).
L) Yes ❑No
❑ I, as owner of the property, am exclusively contracting with licensed contractors to TOTAL:
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 QTY, PLUMBING PERMIT
who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's
License Law. PERMIT ISSUANCE
❑ I am exempt under Sec. , B & P C for this reason
ALTER DRAIN & VENT WATER (EA)
'wner Date
RESIDENTIAL:
❑ SFDWL
BACK FLOW PROTECT. DEVICE
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
❑ MULTI -UNIT
❑ STRUCTURAL
I have and will maintain a Certificate of Consent to self - insure for Worker's Compen-
MODIFICATION
DRAINS - FLOOR, ROOF, AREA, COND.
sation, as provided for by Section 3700 of the Labor Code, for me performance of the
IMPROVEMENT
❑ SWIMMING POOLS
work for which this permit is issued.
❑ OTHER
FIXTURES - PER TRAP
❑ I have and will maintain Worki;w 'I n quired by Section
3700 of the Labor Code, for th erw rch this permit is issued.
GAS -EA. SYSTEM -1 INC. 4 OUTLETS
My Worke ' S t' I-c
y No.:
GAS - EA. SYSTEM -OVER 4 (EA)
CERTIFICATE OF EXEMPTION FROM WORKS S'
COMPENSATION INSURANCE
GREASE/INDUSTRL WASTE INTERCEPTOR
GREASE TRAP
(This section need not be completed if the permit is for one hundred dollars ($100)
or less.)
SEWER - SANITARY - STORM EA. 200 FT.
I certify that in the performance of the work for which this permit is issued, I shall
Znot employ any person in any manner so as to become subject to the Workers' Compen-
sation Laws of California. Date
Z 0 Applicant
WATER HEATER W/VENT/ELECTR
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NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should
become subject to the Workers Compensation provisions of the Labor Code, you must
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
WATER SYSTEMITREATING
WATER SERVICE
NEW RESIDENTIAL PLMB. SQ. FT.
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the work for which this permit is issued (Sec. 3097, Civ. C.)
Lender's Name
Lender's Address
TOTAL:
I certify that I have read this application and state that the above information is
correct. I agree to comply with all city and county ordinances and state laws relating to
QTY MECHANICAL PERMIT
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building construction, and hereby authorize re esentatives of this city to enter upon the
PERMIT ISSUANCE
0-4
above - mentioned property for inspection I S.
(We) agree to save, Ind ify a harmless the City of Cupertino against
ALTER OR ADD TO MECH.
liabilities, judgments, costs e s . h may in any way accrue against said City
in consequence of the ng s It.
AIR HANDLING UNIT (TO 10,000 CFM)
APP NT UN A ILL COMPLY WITH ALL NON -POINT
RC REGU . N
AIR HANDLING UNIT (OVER 10,000 CFM)
• •
I pp n ontra or Da
EXHAUST HOOD (W/DUCT)
HAZAR US MATERIALS DISCLOSURE
1 the applicant or future building occupant store or handle hazardou aterial
HEATING UNIT (TO 100,000 BTU)
as by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety
Section 25532(a)?
HEATING UNIT (OVER 100,000 BTU)
L) Yes ❑No
VENTILATION FAN (SINGLE RESID)
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
BOILER - COMP (3HP OR 100,000 BTU)
BOILER - COMP (OVER 100,000 BTU)
District?
L] Yes ❑ No
AIR CONDITIONER
I have read the hazardous materials requirements under Chapter 6.95 of the Cali-
NEW RESIDENTIAL MECH. SQ. FT.
fomia Health & Safety Code, Sections 25505, 25533 and 25534. 1 understand that if the
building does not currently have a tenant, that it is my responsibility to notify the occupant
of the requirements which must be met prior to issuance of a Certificate of Occupancy.
TOTAL:
Owner or authorized agent Date
OFFICE
BUILDING PERMIT INFO
JOB DESCRIPTION
RESIDENTIAL:
❑ SFDWL
❑ KITCHEN REMODEL
❑ ADDITION
❑ PLUMBING RE -PIPE
❑ MULTI -UNIT
❑ STRUCTURAL
MODIFICATION
❑ INTERIOR
❑ CHIMNEY REPAIR
IMPROVEMENT
❑ SWIMMING POOLS
❑ BATH REMODEUREPAIR ❑ DEMOLITION
❑ OTHER
❑ DEMOLITION
❑ FOOD SERVICE
❑ OTHER
SQ. FT. FLOOR AREA I $ /SQ. FT.
FEE li A' )
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{,
VALUP
TYPE CONSTRUCTIOD
GROUP II APN
BUILDING DIVISION FEES
PLANCHECK FEE
ENERGY FEE
GRADING FEE
SOILS FEE
PAID
Date Receipt #
BUILDING FEE
FEE SEISMIC FEE
ELECTRIC FEE
PLUMBING FEE
MECHANICAL FEE
CONSTRUCTION TAX
HOUSING MrnGATION FEE
PAID
r Dale Receipt #
I TOTAL:
ISSUED BY:
ISSUANCE
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C17Y ld& ASBESTOS SURVEY
CpCU��'q %NRT "'Biiljilain "B
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19620 Stevens Creek Boulevard
Cupertino, California
Prepared for:
Wells Fargo Bank
394 Pacific Avenue, 4th Floor
San Francisco, California
Prepared by:
ACC Environmental Consultants, inc.
September 9, 1993
Prepared by: •-��
Larry Eve on
EPA Certi icate Number 1320
Reviewed by
Ja s W. Wilson
A Certificate Number 967
r
1000 Atlantic Avenue. Suite 110 • Alameaa. CA 94501 • (510) 522 -8188 • FAX. (510) 865 -5731
TABLE OF CONTENTS
1.0 INTRODUCTION
2.0 EXECUTIVE SUMMARY
3.0 TYPE, LOCATION, QUANTITY AND ASSESSMENT OF ACBM
4.0 GENERAL BUILDING CONSTRUCTION AND SYSTEMS DESCRIPTION
5.0 OPERATIONS AND MAINTENANCE PROGRAM
6.0 REMOVAL COST ESTIMATES
APPENDICES:
A SUMMARY OF RESULTS AND ASSESSMENTS
3 :ABCRATORY REPORTS
C ASSESSMENT AND HAZARD RANKING CRITERIA
D BULK SAMPLING PROTOCOL
E FLOOR PLANS WITH ACBM LOCATIONS
J
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1.0 INTRODUCTION
The intent of this report is to identify the locations and content of
accessible friable and non - friable asbestos containing building materials
(ACBM), to assess the condition of the friable ACBM, to access its hazard
potential and provide removal cost estimates for the ACBM at the Building
"B ", 19620 Stevens Creek Boulevard, Cupertino.
This survey address6s accessible friable and non - friable suspect materials.
=riable materials include materials that can be crumbled, pulverized, or
reduced to powder, when dry, by hand pressure. Non - friable materials can
become friable by being rendered to a crumbled, pulverized, or powdered
state, when dry, by crushing, sanding, sawing or shot - blasting, severe
weathering or other mechanically induced means.
Or. September 3, 1993, Larry Everton, an Environmental Protection Agency (EPIC)
Certified Building Inspector /Management Planner from ACC Environmental
Consultants, Inc. (ACC), performed a survey of Building "B".
The suspect materials identified and sampled consisted of:
Surfacing Materials
none
Thermal Systems Insulation
none
Miscellaneous Materials
roof tar
roofing felt
transite shingles
joint mudding compound
floor tile and adhesive
glue -or. ceiling tile
sheet vinyl flooring
2.0 EXECTJTIVE SUMMARY
No friable asbestos containing materials were found in this building.
The non - friable ACBM found at Building "B" includes roof tar, transite shingles,
roofing felt, and 9" x 91, w.^ite floor tile and adhesive. Actual descripticns,
locations, and quantities of these materials are detailed in Section 3.2 of this
report. A summary of estimated removal costs is listed in Section 6.0. ACC
does not recommend removal of any of these materials unless demolition or
renovation activities will disturb them.
Page 1
As long as asbestos containing materials remain at this building, an Operations
and Maintenance (O&M) Program should be instituted to alert maintenance,
custodial workers and outside vendors of the existence and location of these
materials and to set policy for the maintenance of these materials.
This report is based upon conditions and practices observed and information
made available to ACC Environmental Consultants, Inc. This report does not
purport to identify all hazards or unsafe practices nor to indicate that
other hazards or unsafe practices do not exist. No responsibility is
assumed for the control or correction of conditions or practices existing
at the premises.
2.1 SUMMARY OF ANALYSIS
BUILDING "B"
FIRST FLOOR
Asbestos detected:
9" x 9" white floor tile and adhesive
Joint mudding compound
Asbestos not detected:
white fissured glue -on ceiling tile
brown pattern sheet vinyl flooring
a.6• a
Asbestos detected:
roof tar
transite shingles
roofing felt
Asbestos not detected:
roofing felt
3.0 TYPE, LOCA'T'ION AND QUANTITY OF ASBESTOS CONTAINING BUILDING MATERIALS
This survey addresses friable and non - friable suspect materials. Examples
of friable materials include, but are not limited to, spray applied
fireproofing on structural steel members, spray aDpliad acoustical ceiling
material, acoustical ceiling tile and thermal systems insulation. Examples
of non - friable materials include, but are not limited to, roofing material,
floor tile, linoleum and adhesives used to glue them in place, fabric,
caulking compounds, wall and ceiling plaster, exterior stucco, wallboard
board joint compound and cement " transite" products.
ACC shall not be responsible for identifying asbestos - containing materials
located behind walls and /or columns, beneath flooring, under carpeting, above
solid ceilings, underground or any other inaccessible areas. Roof samples were
obtained during the inspection.
Page 2
J
3.1 FRIABLE MATER_ALS
No friable asbestos containing materials were found in Building "B".
3.2 NON- FRIABLE MATERIALS
There is approximately 1000 square feet of asbestos containing roof tar on the
roof in Building "B". This material, identified as sample '1, is reported to
contain 12% Chrysotile asbestos. ACC estimates the removal cost for this
material is $2,000. -
There is approximately 1300 square feet of asbestos containing transite s:_ino__es
on the roof in Building "B ". This material, identified as sample #3, is
reported to contain 15% Chrysotile asbestos. ACC estimates the removal cost for
this material is $5,200.
There is approximately 320 square feet of asbestos containing roofing felt on
the parapet wall in Building "B ". This material, identified as sample I4, is
reported to contain 451k Chrysotile asbestos. ACC estimates the removal cost fz:_
this material is $640.
There is approximately 160 lineal fee*_ of asbestos containing roofing felt cr.
the top of the parapet wall in Building "B ". This material, identified as
sample #5, is reported to contair. 55: Chrysotile asbestos. ACC estimates the
removal cost for this material is $500.
There is approximately 2000 square feet of asbestos containing joint mudding
compound throughout all areas on the first floor in Building "B ". This
material, identified as sample #7, is reported to contain 2t Chrysotile
asbestos. ACC estimates the removal cost for this material is $6,OCO.
:here is approximately 850 square feet
floor tile and adhesive throughout room
This material, identified as samples #8
Chrysotile asbestos in the tile and 15k
ACC estimates the removal cost for this
Df asbestos containing 9" x 9" white
u 230 on the first rst floor in Building "n"
..
and :9, is reported to contair. 2 0
Chrysotile asbestos in the adhes_•re.
material is $1,700.
4.0 GENERAL BUILDING CONSTRUCTION AND SYSTEMS DESCRIPTION
Building "B" located at 19260 Stevens creek Boulevard in Cupertino is part cf a
three building complex owned by the Wells Fargo Bank Corporation. it is di n ded
into 3 or 4 commercial office spaces under one roof. '
The building exterior consists of painted stucco and glazing. The flooring is
wood framed and finished with floor tile, sheet vinyl and carpet over plywocc.
The'roof is a wood framed system that supports a manzard facade around the
building perimeter with a flat section in the center supporting HVaC Em:ipre
This flat section is built up rolled roofing over plywood.
The interior partitions are wood framed and finished with painted gypsum
wallboard and ceramic the in the restrooms. The ceiling is wood framed and
finished with 12" x 12" glue -on ceiling tiles and painted gypsum wallboard in
the restrooms.
Page 3
Heating, ventilation and air is supplied from forced air heating and chiller
units located on the roof and connected to each space by ducting throughout the
attic space. Hot water is provided by copper lines from the water heating tank
in the mechanical room.
5.0 OPERATIONS AND MAINTENANCE PROGRAM
The lack of_ a known, _safe level of asbestos exposure is the reason for
implementation of an Operations and Maintenance Program. Research and physical
evidence have proven conclusively that asbestos damages the human lung tissue.
Asbestos related lung diseases are debilitating and almost always fatal.
Studies over the past 30 years have documented thousands of such ases among
insulation workers, and even persons indirectly exposed to asbestos fibers. The
question of how much asbestos can be inhaled without causing damage to the lungs
in unclear.
The purpose of an O&M program is to minimize building user exposure to airborne
asbestos fibers. The O&M program is designed to train maintenance and custodial
workers in the proper procedures to be used when working in and around asbestos
containing building materials and to continually monitor the condition of these
materials.
The first step of an O&M is to alert those workers who may come in contact with
the ACBM as part of their maintenance or routine duties that the material
contains asbestos. Only when the location of the material is known, can the O &M
program work effectively to prevent disturbance of the material which in turn
prevents fiber release.
Whenever ACBM is found to be damaged, the O&M training provides the techniques
and use of specialized equipment safely and properly repair the damage as well
as decontamination of the surrounding vicinity where asbestos fibers may be
present. The 0&M training must include the proper use and fit testing of each
person who wears a respirator.
Asbestos management is a dynamic process. Since there are no guarantees that
the condition'of the asbestos will go unchanged over time, that workers will not
disturb the materials, or that outside vendors-or other service personnel will
always know the proper safety precautions, ACC recommends an 0&M program as long
as friable or potentially friable asbestos remains in these buildings.
Page 4
6.0 REMOVAL COST ESTIMATES
The following cost estimates for the ACBM identified at Building "B" are
based on prices recently obtained from projects at locations with similar
materials. Prices may vary markedly from those listed depending on
industry conditions, contractor work loads, removal control methods and
other factors. Lower prices may be obtained by combining one or more of
the materials in a single project. Prices do not include demolition,
replacement, reconstruction, project design, management or sample analysis
costs.
MateriallLocation /Building
-------------------- - - - - --
Quantity
-- - - - - --
Removal Cost
- - - - - -- - - --
ArP
6.0 REMOVAL COST ESTIMATES
The following cost estimates for the ACBM identified at Building "B" are
based on prices recently obtained from projects at locations with similar
materials. Prices may vary markedly from those listed depending on
industry conditions, contractor work loads, removal control methods and
other factors. Lower prices may be obtained by combining one or more of
the materials in a single project. Prices do not include demolition,
replacement, reconstruction, project design, management or sample analysis
costs.
MateriallLocation /Building
-------------------- - - - - --
Quantity
-- - - - - --
Removal Cost
- - - - - -- - - --
Roof tar or. the roof, Building "B"
1,000
SF
$21000
Transite shingles on the roof,
1,300
SF
$5,200
Building "B"
Roofing felt on the parapet
320
SF
$640
wall, Building "B"
Roofing felt on the top of the parapet
160
LF
$500
wall, Building "B"
Jcint mudding compound in all areas
2,000
SF
$6,000
of the first floor, Building "B"
9" x 9" white floor tile and adhesive
850
SF
$1,700
throuchcut room 1#230 on the first
floor, Building "B"
Page 5
APPENDIX A
"jr"A"WI, a-_
, -44.
:NDIX A
.DING "S ", CUPERTINO
PHOTO
TYPE OF %
IASSESTOSICONTENT
FRIA-
ASSESS-
REC
REMOVAL
MATERIAL DESCRIPTION
MATERIAL LOCATION
QUANTITY
NUMBER
BILITY
MENT
RESP
I COST
(joint compound
front entry
C 2%
I
(joint compound
restrooms
C 2%
'
i
joint compound
front entry
C 2%
joint compound
throughout _
2000 SF C 2% NF
NA
i
56,000
Building "B"
!white fissured
throughout
NO
IgLue-on ceiling the
I
9" x 9" white floor
throughout
850 SF Tile: C 2% NF
NA
S1,7OO
(tile and adhesive
room #2300
Adhe: C 15%
brown pattern
throughout
NO
i
sheet vinyl flooring
mens restroom
brown pattern
throughout
ND
sheet vinyl flooring
womens restroom
!
roof tar
throughout the roof
1000 SF C 12% NF NA
I
S2,OOO
roofing felt
throughout the roof
NO
I
roofing felt throughout the roof
NO
.nsite shingles manzard roof
1300 SF C 15% NF NA
I
S5,2O0
roofing felt parapet wall (top) 320 SF C 45% NF NA
$640
roofing felt parapet wall 160 LF C 55% NF NA
i
5320
Type of Asbestos:
Friability:
Assessment:
NO = None Detected
F = Friable
SD = Significantly Damaged
A = Amosite
J = TS1 Jacketed
OPSD = Damaged with the Potential
for significant Damage
AC = Actinolite
NF = Hon - Friable
OPO = Damaged with the Potential for
Damage
AN = Anthophyllite
D = Damaged
C = Chrysotile
PSD = Potential for Significant Damage
CR = Crocidolite
PD = Potential for Damage
T = Tremolite
NA = Hon - Friable /Not Assessed
APPENDIX B
APPENDIX B
BUILDING "B ", CUPERTINO
SAMPLE
I
I
SAMPLE
I
ITYPEOOS
X
!CONTENT
NUMBER
MATERIAL DESCRIPTION
I FLOOR
LOCATION
ASSEST
1
roof tar
Roof
roof
C
12%
!10
joint compound
First
room #250
C
2%
:11
joint compound
First
room #250
C
2%
i
12
joint compound
First
room #240
C
2%
i
13
white fissure
First
ceiling
ND
i
suspended ceiling tile
X14
brown pattern
First
mens restroom
ND
i
sheet vinyl flooring
'15
brown pattern
First
womens restroom
NO i
i
sheet vinyl flooring
I
2
roofing felt
Roof
roof
ND
i
13
transite shingles
Roof
roof
C
15% i
i
roo +ing felt
Roof
roof
C
45%
i
5
•
roofing felt
Roof
roof
C
55% I
I
f
i6
roofing felt
Roof
roof
NO
i
i7
joint compound
First
room #230
C
2%
i
$
9" x 9" white floor
First
room #230
Tile:
C
I
2% i
tile and adhesive
Adhe:
C
15%
9
9" x 9" white floor
First
room #230
Tile:
C
2% i
the and 'adhesive
Adhe:
C
7%
Type of Asbestos:
NO = None Detected
A = Amosite
AC = Actinolite
AN = Anthophyllite
C = Chrysotile
CR = Crocidolite
T = Tremolite
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