12080305 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10522 CYPRESS DR C0N'7'RACPOR:Y'B5-TMBE PERMIT NO: 12080305
QGFF_Rf.ftMf?D
OWNER'S NAME: 'rAO YING YAU 0 'L DATE ISSUED:08292012
O�,�WNNER'S PHONE: 408725250 '� PHONE NO:
CI LICENSED CO\MACfOR'S DECLARATION JOR DESCRIPTION: RESIDE\PIAL COMMERCIAL
11
License Class Lic.N G RE-ROOF 26 SQ- ROOF OVERLAY OF EXISTING
/ _ MULTIFAMILY DWELLING
Contmdo Date
I hereby a m Ih 1 am ' nsed unJ the provisions of Chapter 9
(commencing with Section 7000)of Division 3 of the Business&Professions
Code and that my license is in full force and effect.
hereby affirm under penally of perjury one of the following two deelarations:
I have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$70000
1 have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for die performance of the work for which this
APN Number:31630051.00 Occupancy Type:
permit is issued.
APPLICANTCERTIFICATION
I certify than have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 180 DA ' , OM LAST CALLED INSPE TI N.
indemnify and keep harmless the City of Cupertino against liabilities,judgments, -
costs,and expenses which may accrue against said City in consequence of the � ) ! /
granting of this permit. Additionally,the applicant understands and will comply Issued by: Date: til
with all non-pointsot cc regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature Date Q(r All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection,I agree to remove all new materials for
inspection.
❑ OWNER-RUILDER DF,CLARA'rION
Signature of Applicant: Date:
1 hereby affirm that 1 nm exempt from the Contractor's License Law for one of
the lnllowing two rensons: ALI,ROOF COVERINGS' O RE CUASS"A"OR BETTER
I,as owner of property,or my employees with wages as their sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&•Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to IIA%ARDOIIS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
California Ilealth&Safety Code,Sections 25505,25533,and 25534. I will
1 hereby'affirm under penally of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: Ilealth&Safety Code,Section 25532(x)should Istore or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should 1 use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the flay Area Air Quality Management District
performance of the work for which this permit is issued e'ill maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Ilealth&Safety Code.Sections'S505,25533,and 2 534.
Section 3700 of the Labor Code,for the performance of the work for which this
ized agent
Owner or authorUote:
permit is issued.
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 Worker's
Compensation laws of California. If,after making this certificate of exemption,I CONST'RUCT'ION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,I must 1 hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked w'ork's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
,\I'['LICAN'I'CER'1'IFIGVI'ION Lender's Address
I certify that I have read this applicatiodmid state that the above inromation is
correct. I agree to comply with all city and county ordinances and state laws relating
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes.(We)agree to save ,\RCIII'rF.CI"S DECLARATION
and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may occrue against said City in consequence of the I understand my plans shall be used as public records.
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O.. BUILDING OFFICIAL
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUPERTINO
(408)777-3228• FAX(408)777-3333•building(Dkuoertino.org
PROTECT ADDRESS APNa
O Sd"t- eJ I'_
OWNER NAME P NE — l E-MAIL
DO au L
STREET ADDRESS CITY. STATE ZIP V FAX
CONTRACTOR NAMELICENSE NUMBER LICENSE TYPE BUS.LIC.a
r e G
COMPANY AME E-MAIL FAX
(,o tr cold / ✓vl n- dw CSI o Lf X 7_ /
STREET AD RESS CI .STATE.ZIP ONE
/Ss Geneva tla T°/S H PH77 -33��
I UNDERSTAND AND AGREE TO THE FOLLOWING:
I. The re-roof project shall comply with all applicable provisions of the 2010 California Codes.
2. An inspection request can be scheduled up to the day before the inspection date. Please call (408)777-
3228 from 7:30 - 3:30pm (Mon-Thurs) or 7:30 - 2:30pm (Friday) to schedule the next day inspection.
For Tear-Off and Nailing Inspections, you must also call on the day of the inspection only after that
phase of the work is completed. The building inspector will be available within one hour. Progress
and Final Inspections will be given a two hour window.
3. Tear-Off Inspection is required. Any and all dry-rotted wood shall be replaced prior to this inspection.
Unless new plywood roof sheathing is proposed throughout, all the nails/fasteners shall be either
completely knocked-down or removed prior to this inspection.
4. if plywood is installed, a plywood Nailing Inspection is required.
5. Roofing shall not be applied without first obtaining all prior inspection and written approvals from the
building inspector. Any roofing which is applied without first obtaining an approved inspection will
require the removal of all new material down to the sheathing so a proper inspection can be performed.
6. Progress Inspection is required when approximately 50%of roof covering is installed.
7. A Final Inspection and approval shall be obtained from the building inspector when the re-roofing is
completed. To receive a final sign-off, the following items will be verified:
a. Flat roofs shall have a minimum of/" per foot of slope and demonstrate there is no ponding.
b. Listings from approved testing agencies for all pre-manufactured products used shall be
available on-site to review at the time of the inspection.
c. Proper spark arrestor installation, vents painted, gutter/downspouts installed, debris removed.
8. NOTE: .If you call for a tear-off or plywood nailing inspection and the work is not complete, you will be
charged a re-inspection fee of$126.00. The re-inspection fee shall be paid before another inspection
can be scheduled.
By my signing below, 1 certify each of the following is true: I am the property owner or authorized agent to act on the
property owner's behalf. 1 understand and agree to comply with the re-roof policy stated above. I also understand that
smoke detectors and carbon monoxide etectors are required to be installed in accordance with Sections R314 and R315 of
the 2010 California Residential C
Signature of Applicant/Agent: Date:_005� ze
ReroofPolicv_201 l.doc revised 02116/11
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 10522 cypress dr. DATE: 08129/2012 REVIEWED BY: bobs.
APN: BP#: 'VALUATION: $7,000
*PERMIT TYPE: Building Permit PLAN CIIECK•TYPE: Alteration / Repair
PRIMARY SFD or Duplex PENTAn1ATION 1SFDWLROOF
USE: PERMIT TYPE: .41
WORK 1 roof overlay of existing mult)(family dwelling.
SCOPE
Atech. Plait Check Plumb. Plan Check Elec.Plan Check
Mech. Permit Fee: Plumb. Permit Fee: Elec.Permit Fee:
Other Adech.Insp. Othr,r Plumb 1ne11. Other Elce.Insp. Ej
,llech.Insp.Fee: Plumb. hasp. Fre: Elec.Insp. Fee:
NOTE: This estimate does not include fees due to other Departments(i.e. Planting, Public Works, Fire,Sanitary Sewer District,School
District, etc). These fees are baser/on the prelintinan information available and are onh•air estimate Contact floe De r or arddri7 info.
FEE ITEMS (Fee Resolution 11-053 Elf 71111/) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 2,600 s.f. Re roof
Suppl. PC Fee: Q Reg. 0 OT0,0 hrs $0.00 $390.001 IREROOFRES
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Fee D Reg. 0 OT 0.0 1 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Construction Tax:
Adminictratire Fee:
Work Without Permit? 0 Yes Q No $0.00 G
Advanced Planning Fee: $0.00 Select Non-Residential E)
Travel Documentation Building or Structure 0unentatian Fuer: �
Strong Motion Fee: IBSEISnOCR $0.70 Select an Administrative Item
Bldg St ds Commission Fee: IBCBSC $1.00
SUBTOTALS: 1 $1.701 $390.001 TOTAL FEE: $391.70
Revised: 07/01/2012
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION O�
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 O� `
CUPERTINO (408)777-3228• FAX(408)777-3333•buildino(ocunertino.org 1�
PROJECT ADDRESS OS rc C ^ r- APNY I / O 2 o5-/
OWNERNANffi (n IJ U PHONE s_ �SO` E-AUJIL -J
STP.EE'r ADDRESS CITY, STATE,ZIP I FAX
CONTACT NAME PHONE E-MAIL
STREET ADDRESS CITY,STATE,ZIP FAX
❑ OWNER ❑ O\\'NEIt aun.GIt ❑ OWNERAGfM 110 fMICrOR ❑CONntACrORAGFM ❑ ARCHITECT' Cl ENGINFER ❑ DEVELOPER ❑TENANT
CONT11,47NAME LICENSE NUMBER LICENSE T\'PE BUS.LIC.0
r
COMPANY NAME E-MAIL FAX
L0 Sm 000 e°Z13 misn-Cai" Sta -/ 7_?
STREET ADD s CITY,STATE,ZIP / PHONE
s eu K wt 1�d 7 -33Ua-
ARCHITEC,ENGINEER NAME LICENSE NUN®ER BUS.LIC.k
CONVANY NAN(E E-NIAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑ SFD or Duplex "ultl-Fainly, ROOF AREA: VALUATION:
STRUCTURE: ❑ Commercial �� 6 S73 - ;970 "- a O
EXISTINGROOFTYPE: ❑BUILT-UPROOF P-ASPHALTSHWGLES ❑W'OODSHAKES 13 WOOD SHINGLES ❑OTHER(SPECIFY)
REMOVE mtEPLACE ❑YES IF NO. PLY'W'OOD ❑ w ❑ PLY'WD ❑ OSB PITCH: �// ROOF
IIYo 9LA RS• -� ❑ Ha" NV' ❑CD. -- LZ CLASS A
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF t7.ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT a
DESCRIPTIO IJF'wORK; C r l Osl 4,&Pn 1 e r
C4,7 GW
em Ft /a h Y
By my signature below,I certiiv to each of the following: Iran the property owner or authorized agent to act on the proper•owner's behalf. t have read this
application and the information 1 have provi ed is correct. [have read the Description of Work,and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to build' construction. 1 authoraz ep rives of Cupertino to enter the above-id stifled p per'for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTALINFOIZKATI00UIRED - OFFICEUSEONLY -
_If building is associated with a Home Owners Association,provide letter PLANCUECK TYPE ROIUTIFG SLIP-
of approval from HOA. 6-1-111-THE-COUNTER �1 B o�RC PLAN REVIEW
_Provide Planning approval to verify if there any restrictions. ❑ r1pRLss ❑ PLaN9lnCreiN Rn tsw
_Provide copy of Manufacturer's Installation Specifications. C] STANDARD El naE DE"
Psigned copy of Cupetvno•s Tear-Off Policy. ❑ OTHERv .
Reroofdpp_201 Ldoc revised 03/16/11
t
O ® o a
2603 Camino Ramon,Suite 200
San Ramon,CS 94583
877 285 8450 877 285 1445 in,
August 8, 2012
Vulcan Construction
1685 Russell Ave. Suite H
Santa Clara, CA 95054
Limited Asbestos Survey
RE: 1001 N. De Anza Blvd. Cupertino, CA 95014
Claim No. Lab No. 12A36008
Introduction
This letter report presents the results of the limited asbestos-containing material (ACM) survey
conducted by Protera Inc. for the potential abatement at the above referenced site.
Methods
The asbestos survey was restricted to the materials to be disturbed by the demolition of the residence
and/or at the direction of claims adjuster and/or contractor. The following materials were sampled:
1. 3rd floor area 1 -drywall/joint compound composite
2. 3`d floor area 2-drywall/joint compound composite
3. 3rd floor area 3-drywall/joint compound composite
4. 3'd floor area 4-drywall/joint compound composite
5. 3d floor arca 5-skim coat
6. 3'd floor area 6 -skim coat
7. 3`d floor area 7-skim coat
8. 3rd floor area 8-skim coat
9. 3rd floor area 9-acoustic ceiling tile
10. 3'd floor area 10-acoustic ceiling tile
11. 3`d floor area I 1 -acoustic ceiling tile
12. 3'd floor area 12 -acoustic ceiling the
13. 3'd floor attic-lay in insulation
14. 3`d floor area 14-vinyl the flooring/mastic, 1 layer
15. 3rd floor area 15-vinyl the flouring/mastic, 1 layer
16. tad floor area 16-drywall/joint compound composite
17 2nd floor arca 17-drywall/joint compound composite
18. 2"d floor area 18-drywall/joint compound composite
19. tad floor area 19-skim coat
20. 2"d floor area 20-skim coat
21 tad floor area 21 -skim coat
1
22 2"d floor area 22-acoustic ceiling the
23. 2"d floor area 23-acoustic ceiling tile
24. 2nd floor area 24-acoustic ceiling tile
25. 2"d floor area 25-vinyl tile flooring, I layer
26. 2nd fl000r area 26-vinyl tile flooring, 1 layer
Other areas or materials at the site were not surveyed.
Materials suspected of containing asbestos and scheduled to be disturbed by possible
demolition/abatement appear in the attached Limited Asbestos Survey Summary Table. Since the
asbestos survey was restricted based upon the possible abatement, if revisions to the anticipated
abatement are made that impact additional materials or areas, it is important that Protera Inc. be
contacted to review the changes and/or conduct additional asbestos survey work to address potential
impacts to untested materials. No previous asbestos survey reports were provided for review.
No as-built construction records were provided for review.
Materials to be disturbed by possible repairs and suspected of containing asbestos were sampled in
accordance with the federal EPA AHERA protocols. Suspect materials were grouped and classified
as homogeneous materials based on their color. texture and time of construction (i.e., similar
appearing materials in different construction phases of a building are classified as separate materials)
and samples representative of the materials were collected. Materials determined by the inspector to
be non-suspect, such as wood, metal, glass, and fiberglass insulation, were not sampled. Because
destructive investigation was not conducted, additional untested materials may be present behind
walls,column enclosures or similar areas, or in inaccessible areas such as locked rooms.
Samples were collected in such a manner as to minimize release of the material into the
surroundings. Material type, sample number, sample location and other pertinent information were
recorded at the time of sampling. Each sample was placed in an airtight polyethylene bag labeled
with a unique sample number and submitted to an accredited laboratory for analysis. Samples were
analyzed in accordance with EPA Method 600/R-93-116, using polarized light microscopy (PLM)
with dispersion staining and using visual area estimation to determine percent asbestos content. This
method allows for the identification of the primary types of asbestos used in building materials. The
lower limit of detection for this method is one percent. Samples containing less than one percent
asbestos by PLM with visual area estimation are reported as Trace.
Findines
Asbestos was identified in the following materials and/or areas:
• None Detected
Approximate measurements only,not for bidding purposes. Laboratory reports are attached
Conclusions
Materials for which sample analysis by PLM resulted in greater than one percent asbestos (for any
one sample collected from a homogeneous material) are classified as ACM under regulations
promulgated by (but not limited to) the following agencies: federal EPA, Bay Area Air Quality
Management District (BAAQMD) California EPA (Cal-EPA), federal OSHA and Cal/OSHA.
These materials are also classified as asbestos-containing construction material (ACCM) under
Cal/OSHA and California Contractor Licensing Board(CCLB)regulations.
Limited Asbestos Survey
The agencies use the following definitions:
Federal EPA: materials containment greater that one percent asbestos are ACM
BAAQMD: materials containing greater than one percent asbestos are ACM
Cal/OSHA: materials containing greater than 0.1%asbestos by weight are ACCM
CCLB: materials containing greater than 0.1%asbestos by weight are ACCM
Materials shown in the table as containing more than one percent asbestos are regulated materials
under the Bay Area Air Quality Management District (BAAQMD) District Regulation 11-2,
Cal/OSHA regulations, and numerous additional regulations. Some of the regulatory requirements
with significant logistical impacts on building owners and contractors include, but are certainly not
limited to, those appearing below. Materials containing more than one-tenth of one percent asbestos
also require licensing for asbestos with the CCLB and registration with Cal/OSHA. Certain
Cal/OSHA requirements apply to materials containing any level of asbestos. including exposure
assessments and wet work methods.
BAAQMD District Regulation 11-2-401.3 requires that for every demolition or for every renovation
involving the removal of 100 sq ft/lin ft or greater of Regulated Asbestos Containing Material
(RACM), a notification must be made to the BAAQMD at least 10 working days prior to
commencement of demolition/renovation. For residential buildings of four or fewer dwelling units,
72 hour prior notification is acceptable with the payment of an additional fee. These materials
should not be disturbed, except by a licensed asbestos abatement contractor who complies with all
applicable regulations.
Under the California Health and Safety Code Section 25915 et. seq., notification about asbestos
containing construction materials must be provided initially by the building owner within 15 days of
receipt of the infomaation to co-owners, tenants, employees, contract workers, or others who may
encounter the material, and the notification must be provided annually thereafter. Notification of
new asbestos information (such as any ACM or ACCM identified in this report) must be provided
within 15 days of the end of each 90-day period. Under Cal/OSI-IA regulation, this information must
also be provided to contractors, sub-contractors or others whose work may disturb ACM or ACCM,
prior to submission of bids and performance of work.
For detailed regulatory requirements in specific situations, Protera Inc. should be consulted, or the
applicable regulations should be examined.
Limitations
The survey was conducted by personnel accredited as an asbestos building inspector under the
federal Environmental Protection Agency (EPA) Asbestos Hazard Emergency Response Act and
work under the direction of a Certified Asbestos Consultant (CAC) certified by the California
Division of Industrial Relations, Department of Occupational Safety and Health Administration
(Cal/OSI-IA)
Protera Inc. did not disassemble building equipment; such as fans, ducts, and electrical equipment.
Consequently, equipment may contain untested gaskets, packings, internal components, overspmy of
building materials and the like. If the aforementioned materials or any other untested suspect
materials are encountered during abatement, they should be treated as ACM and not disturbed,
unless sampling and analysis of the materials proves otherwise. If revisions to the renovation
project are made that impact additional materials or areas, it is important that Protera Inc. be
Limited Asbestos Survey 3
contacted to review the changes and/or conduct additional asbestos survey work to address potential
impacts to untested materials.
Protera Inc. has performed this asbestos sampling in a substantial,and workmanlike manner, in
accordance with generally accepted methods and practices of the profession, and consistent with
that level of care and skill ordinarily exercised by reputable environmental consultants under
similar conditions and circumstances. No other representation, guarantee or warranty, express or
implied, is included or intended in the asbestos survey report.
If you have any questions please call at your earliest convenience.
Thank You,
Nefi Hernandez
Certified Asbestos Consultant #00-2858
Operations Manager
Limited Asbestos Survey 4
- {r
Uw /� B Contact: Date Sampled: 08/06/12
'v e Company: Protera Inc Date Received: 08/07/12
UMB ANALYTICAL INC. Address: 2603 Camino Ramon, Suite 200 Date Analyzed: 08/07/12
26010 Eden Landing Rd.Suite C
Hayward.CA.94545 San Ramon, CA 94583 UMBA ID k: 9708
510.786.0507 1 510.786.0509 N Phone: 877.285.8450
Fax: 877.285.1445
Project 12A36008
Comments: 1001 N De Anza Blvd
ASBESTOS PLM TEST REPORT: EPA METHOD 600R/-93-116
Sample Description Appearance Fibrous Non-Fibrous Asbestos Content
1 DW/JC Composite 3rd Floor Area 1 White Brown Cellulose 20% 80% None Detected
Fibrous Fiberglass <1%
9708-1 Heterogenous
2 DW/JC Composite 3rd Floor Area 2 White Brown Cellulose 20% 80% None Detected
Fibrous Fiberglass <1%
9708-2 Heterogenous
3 DW/JC Composite 3rd Floor Area 3 White Brown Cellulose 30% 70% None Detected
Fibrous
9708-3 Heterogenous
4 DW/JC Composite 3rd Floor Area 4 White Brown Cellulose 30% 70% None Detected
Fibrous Fiberglass <1%
9708-4 Heterogenous
5 Skim Coat 3rd Floor Area 5 White Cellulose 40% 60% None Detected
Fibrous
9708.5 Heterogenous
6 Skim Coat 3rd Floor Area 6 White Cellulose 40% 60% None Detected
Fibrous
9708.6 Heterogenous
7 Skim Coat 3rd Floor Area 7 White Cellulose 70% 30% None Detected
Fibrous
9708-7 Heterogenous
B Skim Coat 3rd Floor Area 8 White Cellulose 30% 70% none Detected
Fibrous Fiberglass <1%
9708-8 Heterogenous
9 Acoustical Tile Ceiling 3rd Floor Area 9 White Cellulose 50% 15% None Detected
Fibrous Mineral Wool 35%
9706-9 Heterogenous
10 Acoustical Tile Ceiling 3rd Floor Area 10 White Cellulose 50% 15% None Detected
Fibrous Mineral Wool 35%
9708-10 Heterogenous
11 Acoustical Tile Ceiling 3rd Floor Area 11 White Cellulose 50% 15% None Detected
Fibrous Mineral Wool 35%
9708.11 Heterogenous
12 Acoustical The Ceiling 3rd Floor Area 12 White Cellulose 50% 15% None Detected
Fibrous Mineral Wool 35% -
9708-12 Heterogenous
13 Lay-In Insulation 3rd Floor Attic Beige Mineral Wool 100% 0% None Detected
Fibrous Cellulose <1%
9708-13 Homogenous
14 Linoleum 3rd Floor Area 14 Cream 0% 100% None Detected
Tile Non-Fibrous
9708-14a Homogenous
^ 08/07/12
Authorized Signatory Date
due to magoinclum limitations Inherent In el albas os fibers In dimensions below,the resolution mpatllllty of PLM may not Ce intMtep. samples mpone0 as<1%or none deReiM may require additional
testing by TEM to termini esoeses quantities. The above test report relates only t0 the Items tested and may not be reproduceo In any to=without the erpress women ePpmval of UMB A,alydUl,interpretation
is left to the company and/or persons Who mMu6N the reld work. The test retort shall not be reproduced esttpt In hill,without written approval of the UMB Aner ball. The reason must not be used try the
otent to main proal cenl0patlon,appreval,or eMOrsement by NVLAP.NIST,of any agamey N the henral p wemmem. All samples were rtteivM in a¢ep[abie tool unless otherwise hotels. UMB Arannital
monewas me right to dispose of all samples after a penal of thirty(30)days,aG mems;to all state am Inial guloolnes,houses otherwise saammed.
1 of 2
U �/� Contact: Date Sampled: 08/06/12
M i Company: Protera Inc Date Received: 08/07/12
UMB ANALYTICAL INC. Address: 2603 Camino Ramon, Suite 200 Date Analyzed: 08/07/12
26010 Eden Lending Rd.Suite C San Ramon, CA 94583 .
Hayward.CA.94545 UMBA ID #: 9708
510.786.0507 1 510.786.0509 fx Phone: 877.285.8450
Fax: 877.285.1445
Project: 12A36008
Comments: 1001 N De Anza Blvd
ASBESTOS PLM TEST REPORT: EPA METHOD 600R/-93-116
Sample Description Appearance Fibrous Non-Fibrous Asbestos Content
14 Linoleum 3rd Floor Area 14 Tan Cellulose <1% 100%
Mastic Non-Fibrous None Detected
9708-14b Homogenous
15 Linoleum 3rd Floor Area 15 Cream 0% 100
Tile Non-Fibrous None Detected
9708-15a Homogenous
15 Linoleum 3rd Floor Area 15 Tan Cellulose <1% 100% None Detected
Mastic Non-Fibrous
9708-15b Homogenous
16 DW/JC Composite 2nd Floor Area 16 Gray White Brown Cellulose 30% 70%
Fibrous Fiberglass <1% None Detected
9708-16 Heterogenous
17 DW/JC Composite 2nd Floor Area 17 White Cellulose 40% 60%
None Detected
9708-17 Heterogenous
18 DW/JC Composite 2nd Floor Area 18 White Cellulose 30% 70%
Fibrous None Detected
9708.16 Heterogenous
19 Skim Coat 2nd Floor Area 19 White Cellulose 40% 60%
None Detected
9708-19 Heterogenous
20 Skim Coat 2nd Floor Area 20 Gray Cellulose 30% 70% None Detected
Fibrous Fiberglass <1%
9708-20 Heterogenous
21 Skim Coat 2nd Floor Area 21 White Cellulose 50% 50%
None Detected
Fibrous
9708-21 Heterogenous
22 Acoustical Tile Ceiling 2nd Floor Area 22 White Cellulose 50% 15%
Fibrous Fiberglass 35% None Detected
9708-22 Heterogenous
23 Acoustical Tile Ceiling 2nd Floor Area 23 White Cellulose 50% 15% None Detected
Fibrous Fiberglass 35%
9708-23 Heterogenous
24 Acoustical Tile Ceiling 2nd Floor Area 24 White Cellulose 50% 15%
Fibrous Fiberglass 35% None Detected
9708-24 Heterogenous
25 Linoleum 2nd Floor Area 25 Cream 0% 100%
None Detected
Non-Fibrous
9708-25 Homogenous
26 Linoleum 2nd Floor Area 26 Cream 0% 100% None Detected
Non-Fibrous
9708-26 Homogenous
6
08/07/12
Authorized Signatory Date
Due of ma9nlncetem Jlml-atime,Inherent In PIH,es4estos theme In chrobslpm skew ma resolution e4paelllty of PLM may not be a¢eaee. samples reported as<l%or none eeteeted may require aOEWonal
estLq by TEM to confirm asbestos ouandtlbe. TM above test report relates only to the Items tested and may not M reproduced In any forth without:he express wrimen approval of UMB Arelf thal.Interp2tatlon
Is left to tl¢rnmpany and/or persons who conducted the flew work. The test report shall not be monlauted except In full,without written approval of the UMB AW1,0 al. rhe rep]n must not be useo by the
diem to Wim pmdu6 denidation,approval,or endorsement by IMAP,NIST or any ageroy of the federal govcmment. All samples ward, N.In acttptable condl[lon unless oNerwlse roteo. UMB Analytical
reserves Ne right to blabbed,a all samples after a paned 0 be ty(30)days,shadowing to all state and federal puldel unless otherwise loodfied.
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2603 Camino Ramon.Suite 200
San Ramon,CA 94583
877 285 8450 877 285 1445 fax
August 6, 2012
Vulcan Construction
1695 Russell Ave Suite H
Santa Clara, CA 95054
RE: 1001 N. De Anza Blvd. Cupertino, CA 95014
Lab No. 12A36008
On August 6, 2012 a site technician used a Niton XLp X-ray fluorescence (XRF) lead
paint analyzer to sample paint for ]cad.
The lead based paint survey was conducted in order for the contractor to protect workers
from lead and comply with 8 CCR 1532.1 should lead be found in areas scheduled for
demo/renovations due to loss. This survey is intended to give representative information
regarding lead based paint. This survey is not being done as a Lead Hazard Evaluation as
defined by California Department of Public Health (CDPH) in CCR Title 17.
Location Component Substrate Color Condition Reading
mg/cm2
1 3rd floor area 1 wall drywall white Intact 0.0
2 3rd floor area 2 wall drywall white Intact 0.0
3 3rd floor area 3 wall drywall white Intact 0.0
4 3rd floor area 4 wall drywall white Intact 0.0
5 2nd floor area 16 wall drywall white Intact 0.0
6 2nd floor area 17 wall drywall white Intact 0.0
7 2nd floor area 18 wall drywall white Intact 0.0
Condition (I=Intact;F=Fair;P=Poor)
No Detectable lead was found. Samples were found to be below detection Iimit of the
instrument.
Protera Inc. has performed representative sampling of identified painted surfaces scheduled
for remodel/renovation.
Definition of Lead Based Paint
EPA/HUD/DHS: 1.0mg/cm2; 5000 PPM; .5%by weight
OSHA/CalOSHA: Any detectable lead
If you have any questions please call at your earliest convenience.
Thank You;
Nefi Hernandez
CDPH Inspector/Assessor#8754
Operations Manager
Limitations:
This report is not to be considered a Lead Ha=a•d Assessment. This report has been conducted per
request to allow onsite contractors to protect workers in compliance with 3 CCR 1532.1 Protera
bnc. has performed representative sampling of identified painted surfaces scheduled for remodel/
renovation. Should arty additional painted surfacesvnot covered or listed in this report, be identified
at the jobsite, said painted sur faces must be assumed to contain lead.
These recommendations/findings are based upon visual inspection and/or samples taken and are
limited to the tine, place aid roamer of the samples collected at the Property and are further
limited by the variability associated with the inspection methodology established by industry
guidelines. These results1report are not to be considered a guarantee as to health or habitability.
The results reported bi, Protera Inc. cannot be interpreted in airy way as an indication that the
Property is, or is not,free from conditions that could pose a risk to human health or safety. nor of
the suitability of the Property for any propose whaisoever: No other representation, guarantee or
warranty, express or implied.is included or intended in this report.