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B-2016-1538CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PEI RMIT NO: B-2016-1538 22343 MCCLELLAN RD CUPERTINO, CA 95014-2768 (357 03 004) DIANLI CHEN CONSTRUCTION CUPERTINO, CA 95014 OWNER'S NAME. HSUEH PO-JEN AND KONG PO I JDATE ISSUED: 03116!2016 1 OWNER'S PHONE: 650-303-9394 1 1PHONE NO: (408) 888-2898 � LICENSED CONTRACTOR'S DECLARATION Class 8 Lic. #a5_6154 for DIANLI CHEN CONSTRUCTION Date 03/31/2017 I hereby affirm that I am licensed under 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. BUILDING PERMIT ES O: X BLDG —ELECT —PLUMB MECH X RESIDENTIAL — COMMERCIAL hereby affirm under penalty of perjury one of the following two declarations: S.F.) L 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. z. 1 have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of -the Labor Code, forth-, performance of the work for which this permit is issued, APPLICANT CF.RTIFICATi0N 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 building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for Inspection purposes. (We) agree to save 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 with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date 03/16/16 OWNER -Il ALDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: L I, as owner of the property, or my employees with wages as thoir solo compensation, will do the work, and the structure is not intended or offered for sale (Scc.7044, Business & Professions Code) z I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (See,7044, Business & Professions Coda). I hereby affirm under penalty of perjury one of the following throe declarations: t.. 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 perrnit is issued, z I have and will maintain Worker's Compensation Insurance, as provided for by Section3700 of the Labor Code, for the performance of the work for which this permit is issued. s. 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any mapner so as to become subject to the Worker's Compensation laws ofCaiifornia. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shalt be deemed revoked. APPLICANT CERTIFICATION I certify that ( 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 building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 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 with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date 03t16/16 DESCRIPTION: 0 (E) 1 STORY SFD (1344 S.F.) AND DETACHED GARAGE (680 Ft Floor Area: I Valuation:.$12000.00 AP 05004 Number., jOccupancy Type. 357 1 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT :ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued 1 ABI3YAYE DE 0 1 9AAa,;tk Date: 03!3/16/l ( R&ROOFS: All roofs shall be inspected prior to any rooting matet'ial being installed, Ir a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signahtre of Al Date: 03116!16 HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the Califarnia Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which enilt hazardous air contaminants as defined by the Bay Aron Air Quality Management District I will maintain compliance with the Cupertino Municipal Cotte, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. Owner or authorized agent: Date: 03116116 CONSTRUCdON LENDINGAGE NCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. DEMOLITION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 FAX (408) 777-3333 • building@cuoertino.nra -ao1�c •153:3 PROJECT ADDRESS FSS APN# '3'1,s' OWNERNAME a"4 PHONE � �j f� EMAIL STREET ADDRESS -2_3d/ a+� CITY, STATE, ZIP eup.,__e_� ?Pt FAX CONTACT NAME �C)U�,�(��s'"vU STREET ADDRESS �+h CITY, STATE, ZIP .- CA FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNNRAGENT X CONTRACTOR El CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER l l DEVELOPER TENANT CONTRACTORNAME D LICENSE 13 BUS. LIC# •� COMPANYNAMElq,4j-1 f'^%¢•'�i `LICENSETPE -MAI FAX I. i ip`[,-1/i i�t�( STREET ADDRESS tr� ! CITY, STATE, ZIP }R ' e PHONE DESCRIPTION OF WORK/ Ym•+cR/U, t/(.f , ��/{ Ems/ �`' /���p t�,� t f �,� (±C (_stn f ve, W RESIDENTIAL f``'.r # DWELLING OFFICE USE ONLY USE •OCC, TYPE •S .:P'C VALUATION FLOOR AREA y ,,r UNIT$. COMMERCIAL FLOOR AREA TYPB OF CONSTRUCTION #STORIES AQMD JOB NUMBER j kp} RECE1VEp BY; TOTAL VALUATION: By my signature below, I certify to each of the following: I atn the property owner or authorized agent to act on the property owner's behalf. I have read tdLs application and the information I have provided is correct. I 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 building construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of ApplicantJAgent: —Date:.;; hx7lAl SUPPLEMENTAL INI:ORMATION RfQUIRED PRIOR TO ISSUANCE OF DEMOLI'T'ION PERMIT oFEZICE uss aN�x -PLAN CHECK TYPE Provide Job Number from Bay Area Air Quality Management District www.baagmd.org Q.41S-749-4762. I] -EXPRESS Provide three copies of a site plan showing protection for any trees Win diameter or more at 3' above grade. 'f Provideletter fiom PG&E (408-725-3325) stating all gas and electric has been disconnected. El STANDARD : Provide a letter of inspection, tests, and abatement of any Hazardous Materials. Letter to be initiated by person(s) E LARGE, certified in asbestos, mercury and/or hazardous material examination, El .MAJOR B f Planning Dept clearance to verify building is not considered an historical landmark. Allow 10.business days. kkt'e Provide letter of clearance of all vermin from a licensed pest control contractor. shall call the Public Works Department at 408-777-3104 and schedule a "habitable dwelling" inspection. VANie /Applicant �I Provide signed Debris Bin and Recyclable Materials form. 3 �� _ Commercial Buildings Only: Provide Fire Dept clearance for fire suppression / alarm system review, DemoApp_ 011.doc revised 03116111 M Old City of Cupertino Public works Department Eirvirornnental Programs Division 1A, 10300 Torre Ave CUPERIIINO,anr! 31 - Cupertino, CA 95014 Program (408) 777-3354 Construction and Demolition Recycling Diversion Requirements and Instructions Covered projects, or all construction, demolition and renovation Projects that are 3:000 square feet or more are required.. to complete a Waste 1vlanagement flan .for the City of Cupertino demonstrating that 60% of the: material generated is recycled, in compliance with ordinance CMC 16.72.050. At the conclusion of the project a Construction Recycling Report must be filed with the Public Works Department/Envi.roiunental Division showing the tons recycled and disposed by material type. Use tonnage information. from weight tags provided by facilities to quantify total estimated, waste and percentages for materials. Weight Tags of all material recycled and disposed must be submitted with the final report in order to receive a Final. Building Inspection, service. Debris from. a project 3,004 square feet or more in Cupertino can be collected and disposed. by using: Please check all that apply: I: am not using a Recology debris. bin, however, the project is less than 3,000 s.f., e.g. buildings., patios, sidewalks, .driveways. Ct I will use a Recology debris bin. Ey Agreement with the City, Recology will prepare my required Waste Management Plan & Recycling Report, Contact Recology: (408) 725-4020. Ci Iain not using .a Recology debris bin. T will provide the following submittals to the City's Public Works Department, showing that f have -recycled at least 60% Of. all construction demolition material: Ask for the Construction & Demolition Recycling Packet from the Building ]Department and complete the following ✓ Submit a Construct m cand Denzollf-ion if'caste Managent:ent Plan with your budding perrnit alaplication, M fee_ for this -plan. Forms are available at the Building/Paiblic Works counter and online at iviviv. otiperti72o.oiglc, 47. )iro72i7'aeiital. Report the tonnage recycled Lw_d disposed, by material type. .Recycling facilities inust be selected fro77a. the City's appro.ved list of Recycling Reso-urces. ✓ Saibn7.it ct Constrarctiora Recyclirxg.Repor'tforill. Tile -report is rcgtiired befoi-e tl7.e Bitilcling Deparhnent will schedule a(anal inspection. The report fora: is available at the Bu ldinblPttblic PVorks Counter and onlii-le www.cupertirrn orglenvirorirnental. Signature: Name: (printed) v l t( 'ritie: Phone: Project 7'liis-form to rernahi in the -project's buildi.jig petm'it file for.the duration of the project. Reirised 317112 1 auftwe .AN 4 s10ES ITYP} IV Yde��B�E K£AT .c 410" EXISTItia GR011Tfap1 ° re 2+0� lilt ROCK OR EC.UA, 12" IIIA. 7Y� POST LL A4 rloN I. THE MV£LOPER SHALL INSTALL THE "TREE PROTECTION" DEVICES PRIOR TO THE. START OF GRADING OR CLEA#ING WORK. 2.. THE CITY A:ESERVES THE RIGH` iO ISSUE A "STOP WORK" NOTICE IF THE "TREE PROTECTION" DEVICES ARE NOT INSTALLED OR IS THE DEVICE$ ARE NOT MAINTAINED PROPERLY. 3. SEE THIE. PROJECT GRADING ALAN rOR SPECIFIC TREES THAT REQUIRE PROTECTION, ALL SPECIMEN TREES REQUIRE PROTECTION UNLESS OTHERWISE NOTED. 4. NO. EXCAVATIONS WITHIN THE "TREE PROTECTION AREA." ARE ALLOWED UNLESS TINDER THE SUPERMION OF A nE-GISTERED TREE SERVICE COA?PANY, 5. ANY FILLING WITHIN THE. "TREE PROTECTION AREA" SHALL BE DOME FN ACCORDANCE WITH A DETAILED IMPROVEMENT' PLAN APPROVED BY THE CITY, G. NO TRIMMING, CUTTING,OR PRUNING, GO DESIGNATED TREES CAN OCCUR W17HOUT A REGISTERED TREE SERVICE CORBPAIM T. C0MSULT ORDINANCE 778 OF THE CITY OF CUPERTINO FOR PERMIT REQUIR9MENTS AND EXCEPTIONS, 8, TEMPORARY CHAIN LINK FENCING iS AN ACCEPTABLE SUBSTITUTE TO THE WOOD CONSTRUCTION. TREE PROTECTION- -j `a_,_ x. WAS ., MI- SIX Regulation 11, Rule 2 COMPLIANCE & ENFORCEMENT Acknowledgement of B: YEAR EA DIVISION Notification and, At a"��'�' Payment of Fees MANAGI-MENT D I S 'Y' R Y c 'r RHC LLC 10181 Empire Ave Cupertino, CA 95014 J#: 4RO53 Invoice No: 3RQ04 The Bay .Area .Air Quality Management District (BAAQMD) acknowledges receipt of your payment and your Asbestos Removal or Demolition Plan described as: Demolition Site address 22343 McClellan Rd Cupertino, CA 95014 Start Date November 10, 2015 Completion Date November 17, 2015 Removal amount's of friable ACM 0 linear feet 0 square feet 0 cubic feet Should it become necessary to revise this plan, please do so in the spaces provided below and immediately copy the District by fax or by mail REGULATION 11-2 REVISION BAAQMD J# 48053 REVISION # START DATE COMPLETION DATE 1 ! 1 J 2 r i 3. i 4 i 5 t NOTA': This form is not intended as a verification of either the completeness of your original notification or of its compliance with BAAQMD Regulation 11-2. If you have any questions about this acknowledgment, please call our office at (415) 749-4762. Pacific Gas and Electric Company' DATE: 31. I�(f10 CITY OF CUPERTINO 10300 TORRE AVE CUPERTIN© CA 95014 14900 No. Blaney Avenue Cupertino, CA 95014 SUBJECT: REMOVAL OF GAS SERVICES (CUT @ MAIN IN THE STREET) ON: 14,2,3L -f3 kL C j e(f et -j W LGc Ke, r5 - SUBJECT: ELECTRIC SERVICES WAS CUT If you have any further questions, please contact me at (408) 725-3325 Sing ly, �2 Pacific Gas & Electric Company DeAnza Service Planning 408/725-3325 SAFE Am FAIST TESTING AND CQNSULTmr, SErmc.ES Limited. Asbestos Inspection RepqrLt InSDeetion Results ACM - Asbestos Containing Materials were DETECTED (>I%) ALCM Asbestos Containing Construction Materials were DETECTED See Section. 2.1 •► Subject Proer 22343 McClellan Rd. Cupertino CA 95014 Inspection date: September 3, 2315 Report date: September 4, ZOO 15 - Client: Dianli Chen SIGNATORY Safe Air Fast Environmental Benicia CA 94510/Rocklin CA 95677 Q f ce Ph6ne: 415.813.4144 / U face Fox: 888.979.6417 Email: admin a,safeahfiast.com Report Produced By: Abe Barocio Field Consultant Report Reviewed By: Ignatius Rioliorido, CAC DOSH 14-5257 Sr. ]Field Consultant Safe ,yin• Fgsf 1-n0mu'-fui, 111, C nnlact morznadw I'mail: a<taiin.daai'relrfnsl.nnI" " Fnl: hu?.9'4.S47 :.: PUuue:'41':"Bq_:_^' St•t,jdng rfclU nftirex: Ro; IAin GL'6nukia C -A Ptea<.e tefir to rq m•i tft€e pgf for ser'lmug Mike information Page 12 1.0 - GENERAL BACKGROUND Safe Air Fast Environmental, LLC (SAFE) performed a Limited Asbestos Inspection (Inspection) at 22343 McClellan Rd., Cupertino CA 45014 (Subject Property). The Inspection was performed in accordance to the agreed upon Limited Asbestos Inspection Report Reliance and Warranty Statement as published within this document APPENDIX B. The Inspection was performed on September 3, 2415 by our Field Consultant, Abe Barocio. 1.2 Inspection Oblectiv SAFE's Inspection and this published work product are designed to provide information to assist the Client solely with the determination that inspected areas (Section 1.3) at the Subject Property and as observed and sampled by SAFE may likely support friable or non -friable asbestos containing materials (ACM) or friable or non -friable asbestos containing construction materials (ALCM) within sampled products. A material is considered to be ACM if at least one sample collected from an defined homogeneous product type shows asbestos present in an amount greater than one percent (>I%) or as defined by state law- Amaterial can also be determined asbestos containing construction materials (ALCM) when sample product analysis presents asbestos content at less than one percent (<1%0) or as defined by state law- Both ACID and ALCM product disturbances require adherence to multiple regulatory requirements as pro sided by federal, state and local laws. Sampled products that do not present detectable asbestos through sampling analysis are considered not detected (ND) and do not fall tinder federal, state or other local asbestos regulatory requirements. 1.3 G'li:ent Defined inspection Areas SAFE's survey was limited to include only the following readily observable and accessible areas (survey area): • Property Interior_ SAFE was engaged by Client to inspect interior areas of the Subiect Property only as deemed readily accessible and readily visible by SAFE. SAFE does not move content or appliance items. Interior Client Deterred Areas include the Living Room, Kitchen, South Bedroom, Hallway Bathroom, Master Bathroom, Master Bedroom Closet, Hallway Closet and Master Bedroom. • Property Exterior: Exterior Client Defined Areas include the Main Roof Shingles, 2°s Part of Roof and Cove. 1.4 Limited Inspection Methodolo6y SAFE's Inspection, in general, consists of: a walk-through visual inspection within Client Refined Inspection. Areas to classify readily visible and accessible suspect ACMIACCM for bulk sample collection using Asbestos Hazard Emergency Response Act (AHERA) Protocols or SAFE methodology. Suspect materials include the following building material types: • Surfacing Materials - including spray -applied or troweled -on wall/ceiling coatings; • Thermal System Insulation (TSI) including pipe insulation, duct insulation, boiler lagging, and/or; • Miscellaneous materials - including ceiling tile, floor the and mastics, gaskets (if accessible), fire doors, and Nvallboard/spackling compound. , • Tile is only sampled when requested in -tvriting. If client is aware that tile will be removed please call SAFE and submit written request to have tile samples taken. Suspect asbestos containing materials and asbestos containing construction materials are then evaluated for homogeneous nature (i.e-, uniform in color, texture, date of application, area function, etc.), touched to determine friability and when appropriate one or more samples are collected. Unless specifically referenced materials not considered under AHERA rules as suspect asbestos containing building materialswere not addressed by SAFE during this Inspection. Suspect ACM/ACCM when readily visible and identified by SAFE w=ithin Client Defined Inspection Areas is recommended to be sampled in accordance with AHERA. Any sample deviations from AHERA were at Client request and when such requested deviations occur bulk sample collection usually occurs at SAFE investigator discretion in accordance with National Emission Standards for Hazardous Air Pollutants (NESHAP). In either case (AHERA or NESHAP) SAFE's sampling strategy is established in accordance to Client limitations, including potential cost restraints, or at Client directive. SAFE makes every attempt to identify and sample all suspect ACM/ACCM however all inspection areas include "inaccessible" areas which are not evaluated, not considered for sampling and not included within this report. SAFE does not, absent noted engagement within this report, review conditions associated with the requested bulk sample collection nor does SAFE provide asbestos planning or design actions. Parties are advised areas of potential AC.M/ACCM disturbance and as such associated bulk sample collection were directed by Client or Client representative. 1.5 Inspection General Inforrnatfon General Subject Property or Inspection information is as follows: s The Subject Property is a single family building constructed in or about 1473. • Samples are being collected for regulatory requirements associated with renovation or demolition actions. Sai�•.1fr Fast F.mirnumantsl, I�r.t. (il7ftflfl Fnfurnrutuu: Lrttak: gdmitx;n safes€r[st.rent FnAfa3,919.641" r lmrw 41-813-4144 S—IcTlt-,nold 011,es: roddhi CA41enfeto (-A 1'If'xsv i re r m ivport iille I'— F. Y,�viqg offl- hif"o31 d R f'au`n {3 If additional information related to the Subject Property, or tate completed inspection, should be considered by SAFE or if additional site actions, including that of additional product sampling, should be considered within this work product or is required for site actions or should any additional site information not presented in this report be available by any party please contact SAFE as such additional information may alter Sul ect Property findings, conclusions and when provided limited site action plan. 2.0 - CONCLUSIONS 2.1 Conclusion Statement SAFE collected 15 bulk sample(s) for analysis. Based on the sample analysis, SAFE opines the=following: ACM - Asbestos Containing Materials (>I%) are present within Client Defined Inspections Areas ALCM — Asbestos Containing Construction Materials (<I%) are present within Client Defined Inspections Areas In general identified ACM was noted within the below listed areas based on engagement, collected site samples and collected site inforimation: (ABA'I FAIENT REQUIRED IF DISTURBED) Sample lD# Material Location Results 1311-091514742-0013 Floor Tile/Tan-White Hallway Closet 4% Chrysotile 1311-091514742-0013A Mastic Hallway Closet 2% Chrysotile 19-091514742-0015B Floor Tile 2 -White Kitchen 4% Chrysotile 15J -091514742-0015C Mastic 2 Kitchen 3%u Chrysotile In general identified ACCM was noted within the below listed areas based an engagement, collected site samples and collected site information: (ABATEMENT REQUIRED IF DISTURBED) SampleID# Material Location Results 2A-091514742-0002 Skim Coat Kitchen/East Wall <1% Chrysotile 3A-091514742-0003 Skint Coat South Bedroom/East Wall <1% Chrysotile 4A-091514742-0004 Skim Coat Hallway Bathroom/West Wall <1% Chrysotile 7B-091514742-0007 Composite-SheetrockdJoint Compound Kitchert/Northeast Corner <1% Chrysotile 7B -091514742-0007A Skim Coat Kitchen/Northeast Comer <1% Chrysotile In the event suspect or potential non -sampled ACM/ACGM products are uncovered durin Subject Property actions, suspected not- san1pled material is not to be disturbed and SAFE is to be innnnediately contacted to perforru additional asbestos brllk sample collection or non-sanmpled and suspect materials are to be considered Presumed Asbestos Containing Materials (PALM) and accordingly addressed as ACM. SAFE requires after the Client has contacted a professional asbestos abatement company and abatement activities have been completed, SAFE returns to the Subject Property to perform a Post Abatement Asbestos Inspectioan and Clearance Testing in an effort to determine the success of the abatement efforts. This is required by federal, state and local governing agencies. 2.2 Additional inspection Conclusion Statements Additionally, SAFE opines the following with respect to the completed survey and the Subject Property findings: s Some analyzed bulk samples were noted to possess greater than 1% asbestos (>l%) and as such are considered asbestos containing material (ACM). ACM is subject all asbestos related federal, state and local regulatory requirements. Client is advised regulatory requirements require tie use of a licensed and properly certified asbestos contractor. • Some analyzed bulk samples were noted to possess less than I % asbestos (<I %) and as such are considered asbestos containing construction materials (ACCM). ALCM is subject to various asbestos related federal, state and local regulatory Saf'c.alr Past 1ullm- m-1-1 LLC C.MRrl Ci3C6n11:CL0tf: Elmii: IF`=SOS 'P -r.417 MWM -{{{.813-11.14 set kht ' VIM affires: Rorldin C s T ,tflchi CA Pl— 3'frn-1311'f'[3n3i Olk il'(;p Ful' FI.1'3'king O£rtF {3[!LI'ii31{{Ol[ P a a e 14 requirements. Client is advised regulatory requirements require the use of a licensed and properly certified asbestos contractor. If any questions exist about areas sampled or sampling methodology or if questions or clarification is required regarding any federal, state or local regulatory requirement please contact SAFE prior to the onset of any site action and prior to any product disturbance. Adherence to regulatory requirements is the responsibility of Client, site contractors and site parties and failure to appropriately comply with all requirements is at the sole peril, risk and liability of the breaching site party. SAFE was not engaged to provide regulatory compliance information, establish regulatory site actions or provide site recommendations. 3.0 — COLLECTED & PROCESSED SAMPLE RESULTS I 3.1 Laboratory Sample A,nalvsis The results of the collected and laboratory sample analysis (Laboratory PLM report) are attached to the end of Report. 3.2 Laborator} Analysis Following sample collection, samples are logged to the project and either hand -delivered to EMSL Analytical Inc, in San Leandro, CA or shipped overnight (or held in locker and then shipped) to the appropriate office associated laboratory under SAFE chain -of -custody procedures. Asbestos samples collected within the Subject Property and submitted to the laboratory undergo analysis by polarized light microscopy (PLM) witlf Dispersion Staining Technique. The recognized EPA method for this analysis is EPA 600/R-93/116 and analysis data is summarized per EPA Method 60DA44-82-020. Asbestos fiber content is estimated by optically comparing the quantity of non -asbestos material to asbestos fibers. The lower limit of reliable detection using PLM is l %. Samples that contain snore than I % asbestos are reported in percent ranges and are considered AaL Samples that contain asbestos in a concentration lower than the limit of reliable detection (<I%) are reported as "trace" or "<l%" and are considered TAM. Samples in which no asbestos is observed are reported as "None Detected" (ND). 14.0 — DISCLABIER STATEMENT i The results, findings, conclusions and recommendations expressed in this report are based only on conditions noted during the inspection within the listed Client Defined Inspection Areas and sampling was completed per agreed engagement. SAFE sample locations and sample frequency were based on SAFE's observations and the assumption that like materials in the salve area are homogeneous in content. This report is designed to aid the building of{liter or Client in locating ACM or ACCM within the Subject Property and sampling analysis can present false negatives, false positives, be under reported or over reported. SAFE recommends all suspect ACM is collected per established guidelines and when sampling: is not collected accordingly (AHERA 3-5-7) sampling errors can increase and such potential errors are accepted by Client and all associated site parties in full that rely on the completed inspection or this report and all such parties accept such increased liability is at their own peril and risk. Awry conditions or materials that could not be visually identified on the surface were not inspected and may differ from those conditions or materials noted. It was not within the scope of the inspection to remove surface materials to investigate portions of the structure or materials that lay beneath the surface. SAFE, in some instances, may be asked to render expert opinion, suggestions or recommendations based out invalid statistical data, incomplete information or intentionally misleading information. Client is advised such opinions, suggestions or recommendations carry extreme limitations in use and reliance and may at times exacerbate Subject Property conditions, create false or inaccurate Subject Property assumptions and reliance or may result in breaches in federal, state and/or local regulations. The professional services provided and judgments rendered on this project meet current professional standards and do not carry any other guarantee. SAFE is not responsible for any property devaluation based on identified issues, completed work or public perception. In no event will SAFE be liable for damages= of any kind, including though riot limited to, special, indirect, incidental, punitive or consequential regardless of the form or type, including though not limited to, contractual, tort or product liability related to or arising from the an SAFE survey, SATE work product or actions undertaken by site parties or any third party arising from this SAFE surveys or work product in any form or manner except as expressly provided herein or within a written engagement agreement_ SAFE disclaims any and all representations and warranties of any kind or nature related to the completed survey, site findings, published work product or the accuracy of collected site data, analysis or information provided when such. information is provided by any third party and is considered inaccurate, incomplete or fraudulent. Engagements or contracts not stipulated in writing, such as vernal agreements, are.not considered valid and do not supersede any written document or ", rk product limitation or statement. The Client is solely responsible for the use of, and any determinations tirade froin SAFE work product, SAFE recommendations or SAFE conclusions, SAFE shall not have any liability with respect to Client's decisions or recommendations made or actions taken by the Client, it subsidiaries, contractors or any other related or affiliated third Sao .itr r not Ln irrmenrnSrzl, r-r.C. CnnEnri luim7xmiinjr. $mai3; xtim[n.a�s. e•a' jysf.rmu- Fns: 889.09.6417, Ph nne 435.813-4144 Srrriciug FiodnFf we Roetdfu C".d:4cafeis Ca Pura• refer IU 3Tpm t {ttte pale for xerlidu nWf in€Annie"our file 15 party, leased on the findings of any SAFE published work product outside that stated within the Nvork product or in Mace written agreements or written contracts. If questions arise about any survey, any work product or the engagement agreements - contracts, contact SAFE immediately, I hereby certify that I am responsible for the services described in this document. The services described in this document have been Provided in a tanner consistent with the current standards of the profession and to the best of my knowledge comply with all applicable federal, state and local stahites, regulations and ordinances. Respectfully submitted, 144+4 RaWC14 Abiu Barocio Certified Site Surveillance Technician CSST CSST Cert. # 145266 Safe Air Fast EnvironrnetitaI, LLC Office: 415.813.4144 rlyxaduce �rs�t'osiito Ignatius Riullorido CAC (Certified Asbestos Consultant) DOSH 14-5267 Safe Air Fast Environmental, LLC Cell: 415,757.7711 Office Prone: 415.813.4144 APP.El NDIX A: Subject Prntierty Diagrams and Pictures Diq;nnars andlor•picnrres are only alleiched when produced and requested. 1f dfagrarns andlor pioures are not attached and are mquireel, then can be.obtcrfrled bt' coJltactirrg S.1IC n'herr pinrduced. APPRNDLX B. Limited Asbestos Insuection Ret}ort Reliance and Warrantt Statement Upon report delivery, Client accepts Safe Air Fast Environmental (.SAFE)'s surtrey and all work products ire limited by the teens and conditions stated within this report; this statement and other SAFE published work product. Further, Client acknowle4ges SAFE made every reasonable attempt to locate istlestos contanting material (ACM) and asbestos comailung construction niateria[s (AC'ClA) in the Client Defiled Inspection Areas and Client accepts Subject Property may support not readily accessible or hidden AC'ivl or ACC\4 products not discoverable during the inspection or -within the inspection's scope may el,-isr and fall outside readily observable areas or areas included within the inspection, that latent or concealed defects and deficiencies are excluded from inspection and that the inspection was limited by time, budget and other applied constraints. Listing of such constraints can be provided at request. SAFE represents to the Client that it has used a degree of care and skill ordinarily exercised by like qualified independent environmental professionals (IFP) given Client or inspection limitations and known Subject Property conditions in the preparation of SAFE work product, the ctmipletion of SAFE inspections and ill the assembling of data Gild information related thereto. No warranty or guarantee concerning the findings or conclusions beyond that stated -wherein this "Statement" is intended or offeied. SAFE makes no watlanly, nor can any company, that the Subject Property or any property is free from asbestos (ACvI or AC'CM) or that all ACM and ACC'A4 products -were identified or sampled. S.A) E is not responsible for ch'ulaes in state of industry. SAFE hereby eh-prressly disclaims any and all representations and warranties of any kind or sante, weather expressed, implied or statutory, related to the findings of this report, Additionally, this report does not snake any express or implied warranty or mtai-aince regarding the inspection or methodology used by Elie inspector perfnrining the inspection repotted herein, or the accuracy of any information provided. With respect to SAFE's inspection, Client trust niiderstand the completed iinspecti0 o is not considered sufficient in detail and scope to serve as all all-inclusive and eompleliensIve Subject Property suivey to identify all areas of potential AC N14 or AC'CR4 inside or at the Subject Property. Stich a comprehensive survey regnires nuresit.ilri intrusive and destructive investigation ofall Sutsject property b€iiidnlg products and areas, hich idklg opening of all building cavities., coupled with non- restricted Soicel Properly sampling and data collection which SAFE opines is not practical under the ctilrerit engagements such actions would result ill the destruction ofihe Subiect Property itself and given most inspeetion engagements is cost prohibitive. SAFE's inspection is not technically exhaustive and the fee charged is substiartially less Than that of a teelmically exhaustive inspection or surrey. Likewise, the inspection is not intender] to reduce the tisk that potential asbestos or the disturbance of potential ACINI or AC'C'M may pose to the Subject Property or its occupants. SAFE's inspection and this 1Lpolt are for the eXCbLSive Ilse of Clletll and %vas designed to provide information to assist the Client solely With the 'determination that Client Defined inspection Areas as observed and sampled by SAFE likely do or likely do not contain ACM or TA -M. Client is solely responsible for the use of, and any liability with respect to decisions or recommendations made from this report and VX -E shall not have ally liability with respect to decisions or recommendations made or actions taken by Client, their subsidiaries, suppliers, employees, agents, contractors, affi€imes or attomgs, lased oil tine findings of this report. Client is advised the deterinilnation the Snllject Property or Client Defined Inspected Areas do not support ACM or AC CM is neither feasible nor practical and as Stich no company call make such a statement based oil the completed inspection on• ally type of ltrtnited inspection, Client is advised that neither SAFE nor any company call guilrantee all potential ACM or AMM was identified or sampled at the Stibjcct Property during Elie conipleted inspection, It is also possible identified potential contaminated areas may not be noted in this report or may fall outside SAFE's engagement or Client Defined hlspection Areas. Any conditions or materials that could not be visually identified on the surface were not inspected and may differ from those conditions or materials noted. It was not withni the scope of the inspection to reinove surface materials to investigate portions of the slluclule or materials that lay beneath the surth". Sat,• Mr Fait Eara•„nrmmt:d. TJ E r nettari Furus•mai inn:u:arr: a<rnur• :[ ,nrr�irfm?,rut. 1 ns; 483.9•''J.6t i- Funur 215 8134144 4t:['�l: nt:i F[eLl arfire�: nucl:lil: i .l4leaicJa f -t t%ea+r 1a rri:rsri her paer rot irr ring crib, ut,h on14,n 1gC 16 The above noted areas considered inaccessible or impractical to inspect may contain ACM or ALCM that may not ]nave been identified, sampled or that may present an exposure issue within ling space areas during site actions. Such aI'eas,, at a inininium, are: interiors of walls and ceilings and inaccessible areas below: areas concealed by any floor product or floor covering:: areas to which there is no access without defacing or teirin2 oil( lumber, masonry, roofing or other finished ivorlamanship: any attic and basement areas unless Specifically engaged to evaluate and separated listed as a Client dcflllefl &1'ea or when engaged attic or basement areas concealed or trade inaccessible by insulation, Construction, ducting, belongings, or equipment. areas where locks or contents prevented access: areas concealed by appliances, contents or .other like items including stored materials, and areas concealed by any vegeiation, soil, roc. seape or oilier landscape items, areas within mechanical equipment; within HVAC duct systems: inside drainage or sanitary pipes-, and areas deemed hazardous for entry as dactiltined by SAFE personnel, SAFE-- is not responsible for consequences. or conditions that were intentionally or unintentionally concealed or withheld from WE, overlooked or not evaluated by SAFE or not fully disclosers to SAFE at any time prior to, during or after the conducted inspection. Further, SAF[ snakes no warranty whatsoever with respect to any -, condition, asbestos, lead, microbial or other, for areas outside die limited inspection area(s) or for any area(s) SAFE opines were not readily obse-i-able or assessable whether within the limited assessment arca(s) or not. All non -inspection listed areas or areas outside SAFE opined. readily accessible or observab]e areas were not considered in the production of SAFE work product. Reference to such Iintited areas may not be so directly noted in this report though are available at request. SAFE considers information provided by Client and third parties truthful and accurate for work product purposes. SAFE is not responsible to independently verify any information provided and finny rely on information absent actual knowledge to the contrary and to the extent that the information appears reasonable to SAFE personnel. SAFE understands accuracy and completeness of information may vary among sources and as such information not provided within this report was not considered in pori: product npinions; conclusions and site actions plans. If site parties believe additional hifontration should be considered or if provided. information may be inaccurate or incomplete SAFE is to be contacted prior to any report reliance as work- product opinions, conclusions and site action plans may alter or become iiivali(I Based oil engagement some potential: polls nuts (i.e. lead, mold, bacteria, oilier microbial impact issues, etc.) may not have been characterizedand additional investigation may be needed to determine if such other pollutants are present at the Subject Property or to align to potentia] applicable federal, state or local regulatory or compliance requirements. Subject Property work completed absent such other pollutant evaluation, regardless ofpttoperlyage or SAYE knowledge of stick patential contaminants, is done so at contractor or Client's sole peril and liability. SAFE is not required to make other such potential pollutant survey recommendations. All regulatory standards .vldindustry standards or guidelines referenced or commented to in SAFE work- product are based on SAFE's knowledge of applicable documents in effect at the time work was perforated and per SAFE personnel's understanding of such documents. SAFE cannot anticipate potential fittmre changes or interpretation adjustments to regolntory standards. SAFE- is not licensed as a medical professional nor are any of SAFE's personnel. Neither SAFE performed inspections nor any SAFE work product is meant to be a health evaluation, a health assessment, any form of medical opinion or any type of a health risk analysis. SAFE or those representing SAFE bear no responsibility, regardless of cause, for the actual condition of the structure or safety of a site pertaining to indoor Air Quality (IAQ) contamiivation reg.irdtess of the actions taken by the Client. A licensed Medical Doctor should be consulted[ for medical opinions regarding die information collected during the assessment or presented within this report_ SAFE will make no comment with regards to, nor is SAFE responsible to provide commneitt with regards to SubJect Property or surrounding property's, air quality or conditions with regards to occupancy or Habitability. In no event hill SAFE lie liable for special, indirect, iucidentai, punitive, or consequential damages of any kind regardless of the form of action whether in contract, tort, (including negligglice). strict product liability or otherwise: arisin? from. or related to the inspection. ar this report. The aggregate of liability of SAFE arising from this report,. whether under contract law, tort Iaw= ivan-ant), or officm ise, shall be limited to direct damages not to exceed the fees actually received by SAFE fmm Client for this report. Bah the inspection trod this report are designed to aid the Client or Client representative in locating ACRO or .ACCM. Under no circumstances is the report to be utilized as a bidding dominent OrRS a project specification document since it does not have all the components required to serve as an asbestos project design document or an abatement work plain. Tile quantilies of ACMs identified in this report are only estimates Mid should notate used for bidding or developing costs for abatement. It should be the responsibility of the asbestos abatement contmetor to calculate actual quantifies and develop relmaval costs accordingly. Die invalidity or unenforceability, in nidnole or in pant, of any provision, slntement, fern or condition herein lhis statement or this report shall not invalidate m otherwise afTeet the cili'orceability o€tate remainder of these prol]sidnis, stateitneints, terns and cmnditirnts. 51:11, kir Y -i rm"riamrrntst. Ut. C attrltIt [t[rarw.itruu: 4.mnil::ed:ninlr ssfono fn+t xam sat: sSA.9 J -t tl' Fh,l tr di:L 51d 11:1.1 ire+�irhbnnlrtdnran•.: uncfiiEiF d .ti�Rrutrttt [ a i'tea;e rrfr, w r'p,10 till, I—V fur u- 1-t'j..- "MI, i1J'nTns14f.9 III k, tj Its. .x r7l TZ - p r 7—v 0000 rRr rA is s 000 T�W- 55001 'C' 7z oowv F21 Ll III k, tj .x r7l TZ - p r III I OF! EMSL Analytical, Inc 464 McCormick Street, San Leandro, CA 94577 Phone/Fax: (510)895-36751(510)895-3680 hite;llx nv.EMSL.con sanfeandroiab@emsi.com Attn: Safe Air Fast Environmental 6519 Hearthstone Circle #323 Rocklin, CA 65677 Phone: (925) 998.6£ Fax: There is an insufficient amount of malertal for analysis. Recelvod: 09/03/15 10. Analysis Date: 9/312015 Collected: 3/3/2015 Project: CHEM/ RH CONSTRUCTION/ 22343 MCCLELLAN RD. CUPERTINO, CA��T -� EMSL Order 091514742 CustomerlD: SAFE42 CUstQmerPO: ProjectlD: Teen Report: Asbestos Analysis of Bulk Materials aria EPA 600/R-931116 Method using Polarized Light Microscopy Pion -Asbestos Asbestos Sample Oestri ion Appearance % Fibrous % Non -Fibrous % Type — 1A LIV RM E. Insufficient Material 091514742 -OMI WALL - SC 4A HALL BATH W. White There is an insufficient amount of malertal for analysis. 2A KITCHEN E. White 800% Ca Carbonate 41% Chrysotfle 091514742-0004 WALL- SC Non -Fibrous 20% Non-fibrous (other) D91514742-0002 - LIV. RM N.W. Homogeneous 601(o Gypsum None Detected 3A S. BEDROOM White 80% Ca Carbonate <,°lo chrysotile 0915147424005 (REAR Non -Fibrous 20% Non-fibrous (other) 091514742.0003 BEDROOM) E. Homogeneous Homogeneous 27°Jo Non-fibrous (other) WALL - SC e 613=Skim Coat M. BED N -W. 4A HALL BATH W. White 80% Ca Carbonate c1% Chrysotile None Detected WALL -80 Non-FEbrous 20% Non-fibrous (other) 091514742-0004 Homogeneous SC/JC/SR 56 -Composite - LIV. RM N.W. BrownAi0ite 8% Cellulose 601(o Gypsum None Detected SRIJG CORNER- Fibrous 20% Ca Carbonate 0915147424005 SC/JClSR Homogeneous 123'0 Non-fibrous (other) 5B -Skim Coat LEU. RM N.W. White 80% Ca Carbonate None Detected CORNE=R - .Non. -Fibrous 20% Non-fibrous (other) 0915!4742-0005.4 SC/JC/SR Homogeneous $B -Composite M. BED N.W. Brown/White 8% Cellulose 50% Gypsum Mone Detected SR/JC CORNER- Fibrous 15% Ca Carbonate 491614742.0005 SC/JC/SR , Homogeneous 27°Jo Non-fibrous (other) e 613=Skim Coat M. BED N -W. White 80% Ca Carbonate None Detected CORNER- Nan-Flbrous 20% Mon -fibrous (other) 091514742.0006A SC/JC18R Homogeneous U Analyst(s) Matthew Satongbacal (34) Chris Dojlidko, Laboratory Manager or other approved signatory .---- [MSL maintains Yabgily libiltsd to casinfanalysis. This report teretes airy to the samples roportedand may net be reproduced, eXcepfin fuD..:tithaut wrttren approval by EMSL. EMSL bears no responsibility for sample collection activities or analytical method limitations, interpretation and use of test results are the responsiblltty, of the client: This report must not be used by Ilia client to claim product certification, approval, orendarsementby WLAP.. NIST or any agency of thefederal government. Non-frlable organically bound materials present a problem matrix and therefore ENISL rewmmeiidsgravinietrie reduefion prior to analysis. Samples received in good condition unless otherwise noted. Estimated accuracy, precision and uncertairuy data availableupon request. Unless requested by the client, building materials manufactured with multiple layers (i.e. linoleum, wallboard, etc.) are reported as a single sample. Reporting limit is 1% Samples. analyzed by EMSL Analytical, Inc San Leandro, CA NVLAP Lab Code 1D1048-3, WA C884 Initial report from 09103/2015 12;32:39 Test Report PLM -7.28.9 Printed: 913/2015 12:32:39 PM EIVI$L- Analytical, Inc 464 McCormick Street, San Leandro, CA 94577 Phone/Fax: (510) 895-3675!(510)895-3680 iittn:lMrivve EMSL.com sanleandrolab�emsl.com Attn: Safe Air Fast Environmental 6511 Hearthstone Circle #323 Rocklin, CA 95577 Project: CHEM/ RH CONSTRUCTION/22343 MCCLELLAN RD. CUP EMSL Order: 091514742. CUStomerlD: SAFE42 CustornerPO: ProjectlD: Phone: (925)998-6957 Fax; % Non -Fibrous % T e Received: 0910311510:30 AM Analysis Date: 913/2015 Collected: 9/3/2015 CA Test Deport: Asbestos Analysis of Bulk Materials via EPA 600IR-931116 Method using Polarized Light Microscopy NQn-Asbestos Asbestos Sample Description Appearance % Fibrous % Non -Fibrous % T e 75 -Composite KITCHEN N.E. Browm/White 8% Cellulose 60%d Gypsum [1% Chrysotile SR1JC CORNER- Non -Fibrous 15% Ca Carbonate 091$14742.0007 SC/JC/SR Homogeneous - . 17% Non-fibrous (other) 713 -Skins Coat KITCHEN N.E. White 80% Ca Carbonate <1% Chrysotile CORNER Non-Fibrouso 091514742-0007A SCIJC/SR 20 fo Non-fibrous (other) t{41T1ageneall5 8C -Shingle 1 MAIN ROOF - BrovmlBlack 20% Glass 50% Matrix None Detected SHINGLES/ TAR Fibrous 30% Non-fibrous (other) 091614742.0009 PAPER/ WHITE Homogeneous GLASS FIBER 80 -Mastic MAIN ROOF'- Black 80% Matrix None Detected SHINGLES/ TAR Non -Fibrous 20% Non-fibrous (other) 0915147420MA PAPER/ WHITE Homogeneous GLASS FIBER 80 -Shingle 2 MAIN ROOF - Grayll3lack 15% Glass 609 Matrix None Detected SHiNGLESI TAR Fibrous 25% Non-fibrous (other) 0015 14 74 2-00 088 PAPER! WHITE Homogeneous GLASS FIBER 8C -Tar Paper MAIN ROOF- Black 60% Cellulose 40% Matrix None Detected SHINGLES/TAR Fibrous 10% Non-fibrous (other) 0915t4742 -0003c PAPER! WHITE Homogeneous GLASS FIBER 8C -Fibrous Material MAIN ROOF - White/Silver 95% Synthetic 5% Non-fibrous (other) None Detected SHINGLES! TAR Fibrous 09151474200080 PAPER/ WHITE Homogeneous GLASS FIBER Analysts) Matthew 8afangbacal (34) Chris Dcjlidko, Laboratory Manager or other approved signatory 'EMSL maintains liability limited to cost ofanalysis. This report relates only to the samples reported and may not be reproduced, except in full:rvitirout written approval by EMSL. EMSL bears no responsibility for sample collection aclivikes or analytical metirod limitations. Interpretation and use of test results are Via responsibility of the client. This report must not be used by the merit to claim product certification, approval, or endorsement byNVLAP. NIST or any agency of the federal government. Non-frlable organically bound materials presents problemnattily, and therefore EMSL rarnmmends gravltnstdc reduction prior to analysis. Samples received in good condition unless othenvisa noted. Estimated accuracy, precision and uncertainty dataavailableupon request. Unless requested by the client, building materials rnanuracturad vAih multiple layers (I.e. linoleum. wallboard, etc.) are reported as a single sample. Reporting Milt Is 1% Samples analyzed by EMIL Analytical, Inc San Leandro. CA NVLAP Lab Code 101048.3, W A C894 Initial report from 09/03/2015 12;32:39 Test Report PLM -7.28.9 Printed: 9/312015 12:32:39 PM l EMSL Analytical, Inc — 454 McCormick Street, San Leandro, CA 94577 PltonelFax: (510) 895-36751(51 0) 695-3680 htt�1M w.EMSLeom santeandrolabOemsl.com Attn: Safe Air Fast Environmental Phone: 6591 Hearthstone Circle Fax: #323 Received: Rocklin, CA 95677' Analysis Date: Collected: Project: CHEN/ RH CONSTRt7CTIOW 22343 MCCLELLAN RD. CUPERTINO, CA, EMSL Order: 091514742 CustomerlD: SAFE42 CustornerPO: Project) D: i (925) 998-6957 0910311510:30 AM 9/312015 9/3120/5 Test Report: Asbestos Analysis of Bulk Materials via EPA 6001€x-931116 Method using Polarized sight Microscopy IDE -Compound 081514742-oOfOG - COVE MASTIC White Non -Fibrous Homogeneous Non -Asbestos Asbestos Sattlpte Description Appearance % Fibrous % Non -Fibrous %Twe 90 -Tar 2ND PART OF Black 80% Matrix None Detected 10% Non-fibrous (other) ROOF - TAR & Non -Fibrous 20% Non-fibrous (other) 80% Matrix None Detected 091514742-000 GRNVEL TYPE Homogeneous 20% Non-fibrous (other) " 091514742-O01IA 9D -Felt 2ND PART OF Black 15% Glass 70% Matrix None Detected ROOF - TAR & Fibrous 15% Non-fibrous (other) 091514742-000PA GRWEL TYPE Homogeneous 10E -Mastic I COVE MASTIC Tan 80%° Matrix None Detected Non -Fibrous 20% Non-fibrous (other) 091514742.00fO Homogeneous IDE -Mastic 2 - COVE MASTIC White 10% Ca Carbonate None Detected Non -Fibrous 80% Matrix 091510702-oOioA Homogeneous 14%d Non-fibrous (other) 10E -Cove Base COVE MASTIC Beige 20% Ca Carbonate None Detected Non -Fibrous 70% Matrix ogfsfaigz-00108 Homogeneous 10% Non-fibrous (other) IDE -Compound 081514742-oOfOG - COVE MASTIC White Non -Fibrous Homogeneous 80% Matrix None Detected 20°/a Non-fibrous (other) 11F-Unoleum M. BATH - LINO/ Tan 30% Cellulose 10% Ca Carbonate None Detected MASTIC Ftbrous 10% Glass 40% Matrix 091514742.0011 Homogeneous 10% Non-fibrous (other) 11F -Mastic M. BATH - LIN61 Tan 80% Matrix None Detected MASTIC Non -Fibrous 20% Non-fibrous (other) " 091514742-O01IA Homogeneous Analyst(s) Matfhew Batongbaoat (34) 1 1 Chris Dojlidlco, Laboratory Manager or other approved signatory EMSL maintains liability, limited to cost of analysis. This report relates only to the samples reported and may not be reproduced, except in full, Mthout written approval by EMSL. EMSL bears no • responsibility for sample collection activities or analytical method limitations. Interpretation and use of test resultsare the responsibilnyof the client. This report must not be used by lite diem to claim product certification, approval, or andorcement by NVLAP, NIST or anyaganey of the'federal government. Non-fiflabte organically bound materials present a problem matrix and therefore EPiSL recommends gravinratric reduction prior.to analysis. Samples received In good condition unless otherwise noted. Estimated accuracy, precision and uncertainty data availableupon request. Unless . regtfested by the client, building materials manufactured vAth multiple layers (.e. linoleum, wallboard. etc.) are reported as a single sample. Reporting limit is f Samples analyzed by EMSL Analytical, Inc San Leandro, GA NVLAPiab Cotte 101048-3, WA C884 Initial report from 09103/2015 12:32:39 Test Report PLM -7.28:9 Printed: 9/312015 12:32:39 PM EMSL Analytical, Inc !r EMSL Order, 091514742 Polarized Light Microscopy ilii CustomerlD: SAFE42 464 McCormick Street, San Leandro, CA 94577 Non -Asbestos PhohaTFax: (510) 895-36751(510) 895-3680 Asbestos CustomerPO: . httP7L/ W.EMSL:com sanleandro#ab4ftnsl.boln Appearance % Fibrous % ProjectlD: Attn: Safe Air Fast Environrr ental Phone: (925) 898-6957 6611 Hearthstone Circle Fax: None Detected #323 Received: 09103115 10:30 AM $0%e Matrix Analysis Date: 9/3/2015 Rocklin, CA 35677 Homogeneouso 10 to Non-fibrous (oilier) Collected: 9/3/2015 CHEN/ ''TION/ 22343 MCCLELLAH RD. Test Report: Asbestos Analysis of Bulb Materials via EPA 600111-X331116 Method € sing Polarized Light Microscopy Non -Asbestos Asbestos Sam le Description Appearance % Fibrous % Non -Fibrous °!o e 12G -Linoleum HALL BATH - Tan[White 40% Cellulose 10% Ca Carbonate None Detected LINO/ MASTIC Fibrous 10% Glass $0%e Matrix 091514742-0012 Homogeneouso 10 to Non-fibrous (oilier) 12G=141astic HALL BATH- Tan 80% Matrix None Detected LINO] MASTIC Non -Fibrous 20% tion -fibrous (other) 091514742-00f2A Homogeneous 12G -Leveling HALL BATH - White 70% Gypsum None Detected Compound LINO! MASTIC Non -Fibrous 30% Non-fibrous (other) 091514742-09129 .Homogeneous u 13H -Floor Tile HALL CLOSET - Tan/White 70% Ca Carbonate 40/a Chrysotile VINYL TILE & Nan -Fibrous 26°!o Non-fibrous, (other) 091514742-0013 MASTIC Homogeneous _ 131 -1 -Mastic HALL CLOSET- Black 10% Cellulose 80°!0 Matrix 2% Chrysotile VINYL TILE & Non -Fibrous 8% Non-fibrous (other) 091514742-0013A MASTIC Homogeneous 141-1-inoleum M. BED Tan 35% Cellulose 10% Ca Carbonate None Detected CLOSET - LINO1 Fibrous 15% Glass 30% Matrix 091514742.0014 MASTIC Homogeneous10 !a o Non-fibrous (other) - 141 -Mastic M. BED Tan 8D% Matrix None Detected CLOSET - LINO/ Non -Fibrous 20% Non-fibrous (other) 091514742.00/4A MASTIC Homogeneous 15J -Floor Tile 1 KITCHEN - LINO/ Tan/White 70% Ca Carbonate Norte Detected MASTIC 2 Non -Fibrous 30% Non-fibrous (other) 091514742-00.15 LAYERS Homogeneous V — Analyst(s) Maffhew Batongbacaf (34) Chris Dojlidko, Laboratory Manager or other approved signatory EMSL maintains liability limited to cost of analysis. This report relates only to the samples reported and may not be reproduced. except in tali, :rthout written approval by EMSL_ EMSL bears no responsibility for sample collection acGvifies or analytical method limitations. Interpretation and use of test results are the responslbility of the client. This report must not be used by the client to claim product certification, approval, crendorsementby NVLAP. NIST or any agency of the federal government. Non -friable organically bound materials present a problemmaidx and therefore EMSL recoinnends gravtmetrtc reduction prior to analysis. Samples received in good condition unless alhervrise noted. Eslimated accuracy. precision and uncertainty data available upon request. Unless requested W the client, building materials manufactured vAth..multiple layers (Le. linoleum, wallboard, etc,) are reported as a single sample. Repor€ing limit is 1% samples analyzed by EMSL Analytical, Inc Sell Leandro. CA NVLAP Lab Code 161048-3. WA C884 Initial report from 09/03/2015 12:32:39 — �T 4 -rest Report PLM -7.28.9 Printed:.913/2015 12:32:39 PM EMSL Analytical, Inc 464 McCormick Street, San Leandro, CA 94577 Phone/Fax: (510) 695-36751(510) 895-3680 hitt);1fww .E-MSL.com sanleandrolabodemsl.corn Attn: Safe Air Fast Environmental Phone: 6511 Hearthstone Circle Fax: #323 Received: Macklin, CA 95677 Analysis gate: Collected: Project: CHEN/ RH CONSTRUCTION/ 22343 MCCLELLAN RD. CUPERTINO, CA EMSL Order: 091514742 CustomeriD: SAFE42 CustomerPO: `ProjectlD: (925) 998-6957 09103115 10:30 AM 913/2015 9/3/2015 Test Report: asbestos Analysis of Bulk Materials via EPA 609111-93/116 Method using Polarized Light Microscopy Non -Asbestos Asbestos Sample Description, Appearance % Fibrous % Non -Fibrous - %, jXpe, 15J -Mastic 1 KITCHEN - LINO/ Clear 80% Matrix None Detected MASTIC 2 Non -Fibrous 20% Non-fibrous (other) 091514742.0015A LAYERS Homogeneous 15J -Floor Tile 2 KITCHEN + LINO/ White 70% Ca Carbonate 4% Chrysotile 09151`4742-001`513' MASTIC 2 Non -Fibrous 26% Non-fibrous (other) LAYERS Homogeneous 15J -Mastic 2 KITCHEN - LINO/ Black 80% Matrix 3!Q Chrysotile MASTIC 2 Non -Fibrous 17% Non-fibrous (other) 091514742-QQf5C LAYERS Homogeneous _ 15J -Compound KITCHEN - LINO/ White 00% Gypsum Nome Detected 2 Non -Fibrous 40% Non-fibrous (other) M514742-00150 LAYERS LAYERS Homogeneous Atlaiyst(s) Matthew Satongbacal (34) Chris Dojlidl o, Laboratory Manager or other approved signatory EtvtSL maln(ains liability limited to cost of analysis. This. report relates. only to the samples reported end may not be reproduced, except in fu€l, without written approval by EMSL EMSL Bears no respvnsiblity for sample collection aetivllles or analytical method limitations. Interpretation and use of test results are Ilse responsibility ofihe client This report must not be. used by the client toclaim. product certification, approval, or endorsement by 14VLAP. NIST or any agency of the faders[ government. Non-rriabfe organically bound materials present a problem meulxand therefore. EMSL - recommends gravimetric reduction prior to analysis. Samples received to good condition unless otherwise noted. Estimated accuracy, precision and uncertainty (late available upon request. Unless requested by the client.' building materials manufactured with multiple layers (.e. linoleum, wallboard, etc.) are reported as a single sample. Reporting. limit.. is 1% Samples analyWd by EMSL Analytical, Inc San Leandro, CA NVLAP Lab Code 101048-3, WA C884 report from 09/03/2015 12:32:39 Test Report PLM -7.28.9 Printed: 91312.01512:32:39 PM THIS IS THE LAST PAGE OF THE REPORT.. 5 SOS PEST CONTROL & TERMITES August 13, 2015 To Whom It May Concern: Inspection for vermin was done at 22343 Mc Clellan Rd, Cupertino, Ca. 95014 and no infestation was found. Sincerely, Mike Stadmiller, Licensed Field Representative SOS Pest Control 214 Cristich Lane ## 103 Campbell, CA 95008 214 Cristich Lane, Campbell, CA 95008 . Phone: (408) 866-6609 . Fax. (408) 371-2371 9 www.SOSPestControl.com ��g City of Cupeztino Public works Department Environmental Programs Division 10300 Torre Ave Cupertino, CA 95014 t (408) 777-3354 ctta6Rrogra Program Construction and Demolition Recycling Diversion Requirements and Instructions Covered projects, or all construction, demolition and renovation projects that are 3,000 scluay e feet or snore are required to complete a Waste Management flan for the City of Cupertino demonstrating that 6G% of the material generated is recycled, in compliance with ordinance CMC 16.72.050., At the conclusion of the project a Constr action Recycling Report must be filed with the Public Works Department(Environnnental Division showing the tons recycled and disposed by material type. Use tonnage information from weight tags provided by facilities to quantify total estimated waste and percentages for materials. Weight Tags of all material recycled and disposed must be submitted with the final report in order to receive a Final Building Inspection. ,__.._,.._ - -_._..,..M _.._.. :. � x Debris from a project 3,000 square feet or more in Cupertino can be collected.and. disposed by using; Ple�►s check all I anthat apply: -i not using a Recology debris. bin, however the project is less than 3,000 s.f., e.g. buildings., patios, sidewalks, driveways. O I will use a Recology debris. bila. By Agreement with the City, Recology will. prepare niy required Waste Management Plain & Recycling Report. Contact Recology: (409) 725-4020, D lain not using a Recology debris bin. I will provide -the following submittals to the City's Public Works Department, showing that J have recycled at least 60% of all construction demolition material: Ask for the Construction & Demolition. Recycling Packet from the Building Department and complete the folloNvin_g V Submit a Constructi&n and Demolidon Waste Management Phan with your build -I g permit application. No fee for• this plan. Forms are available at the.BuildIng/Public Works counter and'ora.line atwww. caapertirzo.o.rglenvironmentttl. Report the tonnage recycled and disposed, by material type. Recyclingfiacilitles must be selected from the Cfty's cipproved list of RecyclingResour•ces. Stabnii-t za Cottsfr•cactiorr Recycling Ii'epor t form. Yhe. report is required before the Building Departrnerat will seh,-(Tule aji'iaa-1 insl)ectiorz. The report forin is available at the BuildinglPtablic - J,Fonts Courtlier and online ivww.L':.li�er li.no.or- /er7.a�irorrnterttal. Signature: Nance: (printed)___:v fL Title: Phone: Project This -form to remain in the project's building permit file for the duration of the project. Revised 317112 1