26993 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO Istj1I:1) '-iI,EC I RICA L PT:RMTr NO'
APPLICATION/PERMIT PLUMBING-MECHANICAL 26993
BUILDING DIVISION BUILDING PROJECT IDENTIFICATION'
BUILDING
GAADDRESS
/:`� /� 6&E"
�` �) SANITARY NO. APPLICATION SUBMITTAL DATE
•/c.Q/ >3 g /GG " �Y+- UNITY LOTH
OWNS SNAME: r$ PHONE: CONTRACTOR'S NAME: LIC NO: -` I
R S L !C/u 1 V I , f N/C CONTROL,
AR ITECT/ENGINEER: I LIC NO: DRESS: ❑
ec+USTRVt,i-I0,j I e(!r l/ -W . lo7la(o l�
CONTACT: PHONE:
1p p - QTY. ELECTRIC PERMIT FEE BUILDING PERMIT INFO
6,466 Si-Aa-a— WO'S-5q_0`,71f3 PERMIT ISSUANCE LOG ELECT PLUMB MECH
❑ ❑ ❑
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL N
M=Z I hereby affirm that l am licensed underpmvisionsofaapmr9(commencing with
"00 Section 7")ol Division 3 ofthe Business and Professions Code,andmylicense is in PANELS
yV F full force and effect. �/��//�,�-�I JJr�..-tea
IQ„Zµ1 Date CE^% Contractor
UP T02(IO AMPS
m Q'y Date Y Contramor - 201-1000 AMPS SQ PI'.FLOOR AREA $/SQ.FT.
z0o,s Z' ARCHITECTS DECLARATION OVER 1000 AMPS
O Z_q I understand my pmr,shall be used as public records.
SIGNS ELECTRICAL
Licenred Note esional
K attrdr�'�Q OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MISC.
XOwU 1 hereby alfno that 1 am exempt Gam the Contractors License Law for the
W34y ollowingreaorn.(Seelion01131.5,Bueincssand Professions Code:Aa,va,orcounty TEMP.METER OR POLE DIST
E' 0-L which reyuircv n Rrmit m canstmn,elmq improve,demolish,or repair any strveturc
C,}� or to its issuance,alsorc then licam forsuch t fileasi ed statement POWER DEVICES
tri 4uircs tp Rtmi gn
W Kip that he is licensed.........heprevisions ofine Cmurnior's License Low(Chapter SWIMMING POOL ELECTRIC
wXo4 9(commencing with Section 701R)of Division 3 ofthe Business and Professions Code) VALUATION
orthat he is exempt thefefrom and the basis for the alleged exemption.Any violation of
F Z< Section 7031.5 by any applicant for a ROUTLETS-
rmen subjects the applicant to a civil Penalty of SWITCHES-
FIXTURES
�Zp
not more than five hundred dollars($500). NEW RESIDENTIALELECIR _SQ.FT. STORIES TYPE CONSTRUCTION
=t. ❑ hvownendNetrnRrtY.ormyemploYeswith wagesas NeirsolecomRrssaimi,
a3O° will do the work,and the stmcmreisnot intended oroffered for sale(See.]014,Business / -•rf 'I
and Professions Code:The Contractor's License Law does nm apply to an owner of
property whobuildsorimproves Nemon,andwhodoe_isuch work lamselfor Juough his
cmployes,providedthatsuch improsoldwi arenot intendedoroffered forsale.1f,
OCC GROUP RFS.UNITS
however,the have
the
b r improvement rs sold a didn one yearefesurnpletiorn,
or rhe owner- TOTAL:
builder will have the burden of proving than he did not build m improve for poryose of �_3
sale.).
❑ Las ownerofthe tropcny,am exelusivdycontractingwiNliamed<ontractorsm QTY. PLUMBING PERMIT FEE F1.00D LOMi nPN
construct the project(Sec.TIN.Business and Professions Code:)The Contractor's
License Lawdoeanot apply loan owneroEmpeny who bu iclimimproves thereon,and PERMIT ISSUANCE
who conuacrsforsuch umbers with a conuecmr(s)licensed pursuant rothe Contractor's ALTER-DRAIN&VfiNT-WATER
License Law. CA
(' ) FEE SUMMARY
❑ 1 am exempt under Sec. ,B&PC for this reason BACK FLOW PROTECT,DEVICE O I'SIDI!FEES
SANITARY Y N
Owner Date RECEirr p
DRAINS-FLOOR,ROOF,AREA,COND.
WORKMAN COMPENSATION DECLARATION SCHOOL TAX Y N
(hereby uffimUhotl have occnifcmwfconsenunself-insure,oracenificate of FIXTURES-PER TRAP RIiCC:IFI'p
ors.1 Compensmion Insurance oraccnifiedcopy thereof(Sec 3800,Lab CJ which PARK FEE Y N
w ullcmpinyccy rA� pcFmj{• GAS-EA.SYSTEM-1 INC.4 OUTLETS R[IVISIOp
Pnlicyq ! /'rte BUILDING DIVISION(LES
Counter, GAS-IA.SYSTEM-OVEiR 4(IiA) PLANCHEICK FEE
❑ CenifieJ copy is hmreby famished.
ACertified copy is BIed with the city inspection division. GREASIVINDUS'1'RE,WASTE INTERCE OR GRADING FEES
CERTIFICATE OF EXEMPTION FROM WORKERS' GRFASE'IRAPSOILS FEF.
COMPENSATION INSURANCE
(This section need not he completed iftheRman is furore hundred dollars($100) SEWER-SANITARY-STOR A. ERGY ItiE
or less.)
I cenifythar in Else ofmormmen ofthe work for which this permit is issued,I shall WATER III: N ECTR e
not employ any.erten in any manner as to become subject ro Nm Workers' PAID
Z Compensaionlrwsaf Cnliromia. Dom so WATER sY EATING t Dole Receipt,
QApplicant
C) NOTICE TO APPLICANT:IL after making this Certifiwm of Exemption,you should NEW RESIDE. AL PLMIL Q.PT. TOTAL:
^ became subject to the Workees ComRnsaion Provisions arm,Labor Cade,you must
> foMwirh comply wiN such Provisions or this permit shall be dcemed revoked. BUILDING FEE.
CT7 SEISMIC FEE
D (�
CONSTRUCTION LENDING AGENCY
1 hereby affirm is p Nem is a sued(See lending agency for the performance of
U 0 the work for which this RtMt is issued(gee.3097,Civ.CJ TOTAL: ELECTRIC LLE
lender's Name
0 F Lender's Address QTY. MECHANICAL PERMIT FEE PLUMBING FEE
U'• 1 ccnify that 1 have read this application and state that the above inf rrou6on is MECHANICAL Mr.W Correct.l agree m comply with WE city and county ordinances and state laws relating to PERMIT ISSUANCE
F" p" building construction,and hereby summit representatives ofthiscity to enterupon the
CONSTRUCTION TAX
U uhnve-Vr) 'rcard propen forint iif dkeep hes. ALTER OR ADD TO MECO.
(ies gree nt save, ode ify d keep headman the City of Cupeni is against
liabilities. Igmcnls,cls. x ewhich may many way accreagainat said City AIR HANDLING UNIT(10 I11,IKK1 CFM)
s eeof Neg tin of i.vsRrmit. AIR HANDLING UNIT(OVER B,IXg)CFM)
Sign ur A lien / mnmmr Dam EXIIAUS'I'HOOD(W/DUCq PAID
HAZARDOUS MATERIALS DISCLOSURE HEA'ONG UNIT'CYO 100,000 B'I'U) Dam R_Pt Y
Will thl Plicate or future building occupant store or handle hazardous material
as dcfinal by the CuRnlno MunicitalCode,Chapter 9.12,and The Health and Safety HEATING UNIT(OVER HIP0I0 BT'U)
Cade.Section 25532m)".4 VENTILATION PAN(SINGLE BESIDE
❑Yes
BOILER-COMP(311POR igTWBTU) ISSUANCE DATE
Willrheappliwm aforum building occupant useeyuipmenr ordevices which emit
haeardous air conmminantts.es defined by the Bay Arca Air Quality Management BOILER-COMP(OVER 100,tXp BTU) p
.District? 44
Cl Ya NEW RESIDENTIAL MEC11. SQ.FT. 'r
1 haven tea the h�dors emrm uirtmmnta no&'Chapter 6.95 of the SEp 12
Califomialieal &$afolyCute ec nx2 5,255]1 and 25534.IundersEamdNet 19x�
ifthe building m not cuncoil term .0aitismyarkamsibilitymnody Ne
occupant ofPoe Pv at met Prior to issuance of Cenifiwte of
Occupanc' u
Owner ar a cot Date TOTAL: ISSUED BY:
OFFICE
I
Env4rvnmenta4Englneer/ng Consultants
September 9, 1994
Job No. 5380200
Construction and Development Services
950 East Campbell Avenue
.Campbell, CA 95008
ATTN: Mr. John.Anderson
SUBJECT: ASBESTOS SAMPLING AND ANALYSIS REPORT
20630 Valley Green Drive
Cupertino, California
Dear Mr. Anderson:
At your request, EzC, Inc. performed asbestos sampling at the above-mentioned site
on September 7, 1994. The sampling was performed in response to requirements by
the city of Cupertino for asbestos clearance prior to the demolition of specific building
materials. Based on our understanding of areas that will be demolished or upgraded
during planned tenant improvements, EZC, Inc. inspected specific areas of the building .
• for the presence of suspect Asbestos Containing Materials (ACMs). These building
areas included the interior walls of the main assembly area and the kitchen and an
area at the.center of the roof.
During sampling, four suspect building material samples were collected for laboratory
analysis to identify asbestos fibers. These materials included two samples of sheet-
rock from the ground-floor of the building, one sample of composition roofing material,
and one sample of roofing tar. Sampling locations and sample descriptions are shown
in Figure 1 and Table 1, respectively. Table 1 also indicates the results of sample
analyses, which was conducted at MACS Lab Inc. in Santa Clara, California using
Polarized Light Microscopy (PLM). A copy of the certified analytical report
documenting the findings of the sample analyses is attached to this report.
RESU i' , CRY
The results of sample analyses indicate that asbestos is not present within the four
building material samples collected during this study. Based on this finding, sheet-
rock within the building interior and roofing materials appear not to contain asbestos
fibers. Therefore, we do not recommend-any abatement actions or precautionary
actions related to asbestos during the performance of planned tenant improvements.
1220 Cms rnan Avenue. Sulte 200•Rrr uvale. Gafifb nla 94069•(4061 747-1414•FAX(4081745-1089 - -
,
• TABLE 1 - RESULTS OF SAMPLE ANALYSIS
SAMPLE BUILDING SAMPLING ASBESTOS %
NUMBER MATERIAL TYPE LOCATION PRESENT FOUND
1 Sheet-Rock Main Room No 0
2 Sheet-Rock Kitchen No 0
3 Composition Roofing Material Roof No 0
IL 4 Roofing Tar Roof No 0
Should you have any questions or require supplemental information, please do not
hesitate to contact us.
Sincere[ ,
Brenda D. McNabb, REA
Senior Pr 'ect Manager a
W.
Ken all W. Pnce, CEG/REA
President
F!° 00456
� _
E,C, Inc. September 9, 1994
APPENDIX A
LABORATORY REPORT
i
MACS Lab, Inc.
Bulk Asbestos Analysis
2070A Walsh Avenue
Santa Clara, CA 95050-2542
Report
(408) 727-9727
PLM
E2C, Inc.
1220 Crossman Ave. Suite 200 Person to contact: Brenda -
Contact phone: (408) 747-1414
Sunnyvale CA 94089
FAX phone: (408) 745-1089
Report prepared on: September 8, 1994 at:15:38
Corresponding invoice num 1773 /
Analyst: _ �� _ �� Laboratory manager:
sw (signature)
(signature)
Job Description: 9/07/94, 20630 Green Valley Drive, Cuperino, C
Lab Sample Client Sample Number (Asbestos present resent Remarks
Number and Description present?
L17731-1 #1 No 20% Cellulose Gray/brown/black sheetrock. Balance of
sheetrock sample is 50%gypsum, 10%carbonate,
.and 20% unspecified non-fibrous material.
7731-2 #2 No 20% Cellulose White/brown/green sheetrock. Balance of
heetrock sample is 40%gypsum, 10%carbonate,
and 30% unspecified non-fibrous material.
L17731-3 #3 No 10% Fiberglass Gray/black roofing aggregate. Balance of
roof material sample is 30%carbonate,55%organic
binders, and 5%unspecified non-fibrous
material.
L17731-4 #4 No 2% Cellulose Black roofing. Balance of sample is 3%
carbonate, 90%organic binders, and 5%
roof tar unspecified non-fibrous material.
End of report.
• ' Chrysotile, Amosite, Crocidolite, Tremolite, Actinolite, and Anthophyllite are asbestos fibers.
This report may not be reproduced except In full and with the Permission of MACS Lab,Inc.This report relates only to the Items tested.
Samples will be destroyed aher six months. Test per 40 Code of Federal Reg.Chap I i the >)Pert 763•Subpart F.Appendix r or ationcurrent
EPA method. P)and
is la are approximate.MACS Lab Is ct accredited tbcramry of the 7Nafionalgen Voluntary Laboratory ant may
be
Program s a result
and h laboratory number 1946. No product endorsement by hod Is o arty agency of the U.S.Government may be
chimed as i result of this analysis.Calif Dept of Health use . Date tion method is not to for analysis of rile or other materiels
when fiber size is less than t0µTEM analysis should be used. Detection Ibnit for asbestos is approx. tX
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city of
Cape bill.
10300 Torre Avenue
Cupertino, CA 95014
Building Division
(408)777-3228
Fax(408)777-3333
September 26, 1995
Carl Hays
20630 Valley Green Drive
Cupertino, CA 95014
Subject: 20630 Valley Green Drive, Permit# 26993
Dear Mr. Hays,
According to our records the above mentioned permit has never been finaled by a
City Building Inspector. A permit is considered to be valid only six months from its
last,inspection date. If your permit shows that the final inspection has been completed
please send a copy of the permit, along with this letter to 10300 Torre Avenue,
`upertino, CA., 95014, Attention Building Department.
If your permit has not been finaled, please contact the Building Department by
calling (408) 777-3228, so that we may arrange to extend your permit, and schedule a
final inspection.
In an effort to control the number of expired permits, the City of Cupertino
requires a response in ten working days from your day of receipt of this letter. If we do
not hear from you, the City of Cupertino's Building Department will have no
alternative but to resolve your permit as expired and discard the records.
Thank you for your assistance.
0lnic ,
Sincerely,
City of Cupertino
PPapni