11040095 (2)COVERSHEET
11040095-D/P
10750 JOHNSON AVE
PERAM #
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ADDRESS )0 S-0 1070AE450
DATE
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SCHOOL FEES (Y)
HOUSING NMG (Y)
HEART OF THE CITY (Y)
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CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10750 JOHNSON AVE
CONTRACTOR: PAULSON LEE
PERMIT NO: 11040095
OWNER'S NAME: PAULSON LEE
10700 JOHNSON AVE
DATE ISSUED: 05/03/2011
OWNER'S PHONE: 4086917735
CUPERTINO, CA 95014
PHONE NO:
11 LICENSED CONTRACTOR'S DECLARATION
T_ f—
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic. #
MECH F RESIDENTIAL F COMMERCIAL
Contractor Date
I hereby affirm that I am licensed under the provisions of Chapter 9
JOB DESCRIPTION: SFDWL DEMO 1140 SQ FT
(commencing with Section 7000) of Division 3 of the Business & Professions
Code and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations:
I have an d 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: $5000
I have and wi I I maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APN Number: 37531006.00
Occupancy Type:
APPLICANT CERTIFICATION
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
PERMIT EXPIRES IF WORK IS NOT STARTED
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments;
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs, and expenses which may accrue against said City in consequence of the
180 DAYS FROM LAST CALLED INSPECTION.
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.
Issued Date: J—
Signature Date
OWNER -BUILDER DECLARATION
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
I hereby affirm that I am exempt from the Contractor's License Law for one of
installed without first obtaining an inspection, I agree to remove all new materials for
the following two reasons:
inspection.
1, as owner of the property, or my employees with wages as their sole compensation,
wil I do the work, and the structure is not intended or offered for sale (Sec.7044,
Signature of Applicant: Date:
Business & Professions Code)
1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
I hereby affirm under penalty of perjury one of the following three
declarations:
HAZARDOUS MATERIALS DISCLOSURE
I have and will maintain a Certificate of Consent to self -insure for Worker's
I have read the hazardous materials requirements under Chapter 6.95 of the
Compensation, as provided for by Section 3700 of the Labor Code, for the
California Health & Safety Code, Sections 25505,25533, and 25534. 1 will maintain
performance of the work for which this permit is issued.
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
I have and will maintain Worker's Compensation Insurance, as provided for by
Safety Code, Section 25532(a) should I store or handle hazardous material.
Section 3700 of the Labor Code, for the performance of the work for which this
Additionally, should I use equipment or devices which emit hazardous air
permit is issued.
contaminants as defined by the Bay Area Air Quality Management District I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
I certify that in the performance of the work for which this permit is issued, I shall
Health & Safety Code, Sections 25505,25533, and 25534.
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
w
Own a
become subject to the Worker's Compensation provisions of the Labor Code, I must:
Date:
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION
I hereby affirm that there is a construction lending agency for the performance of work's
I certify that I have read this application and state that the above information is
for which this permit is issued (Sec. 3097, Civ C.)
correct. I agree to comply with all city and county ordinances and state laws relating
Lender's Name
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
Lender's Address
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. dditionally, the applicant understands and will comply
ARCHITECT'S DECLARATION
with all non -p int s rce eg9loons per the Cupertino Municipal Code, Section
I understand my plans shall be used as public records.
9.18..
Licensed Professional
Signature Date
CUPERTINO
DEMOLITION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 - FAX (408) 777-3333 - buildingecupertino-org
116�40 /D
PROJECT ADDRESS lo 9,00 7o [l
APN #
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OWNER NAME
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PHONE aojp-�q 7
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STREET ADDRESS
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CITY, STATE, zip
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CONTACT NAME
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STREET ADDRESS
ZIP
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WI�ER 0 OWNEit-BUTLDER OWNER AGENT CON7RACTOK El CONTPLACTOIk AaENT ARCHITECT ENarNEER El DEvELOPER TENANT
CONTRACTOR NAME
LICENSE NUMBER
ICENSE TYPE
BUS. LIC 9
COM[PANY NAME
E-MAIL
FAX
STREETADDRFSS
CnY, STATE, ZIP
PHONE
DFSCRI1MON OF WORK
RFSIDENTIAL
-7
DWELLING
FLOOR AREA
UNITS
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0 RCIAL
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FLOOR AREA
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TYPE OF CONSTRUCTION 0 STORIES
rg.
AQMD JOB NUMBER
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TMAX; VAJL.jATION-.
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By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf I have read this
application and the information 1 have provided is correct. I have read the Description ofWork and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building construction. I authorize representatives ofCupertino to enter the above- identified property for inspection purposes.
Signature of Applicant/Agent: Date: ........ . ... .
SUPPLEMENTAL INFORMATION REQUIRED PRIOR TO ISSUANCE OF DEMOLITION PERMIT
Provide Job Number from Bay Area Air Quality Management District wyny.bagamd.ora @ 415-749-4762.
e three copies of a site plan showing protection for any trees I Y' in diameter or more at 3' above grade.
�Z
122
e letter from PG&E (408-725-3325) stating all gas and electric has been disconnected.
e a letter of inspection, tests, and abatement of any Hazardous Materials. Letter to be initiated by person(s)
NX� M, tJzf1
ified in asbestos, mercury and/or hazardous material examination.
jol- ?P-
TL
historical landmark.
P anni 9 Dept clearance to verify building is not considered an
I Allow 10 business days.
e letter of clearance of all vermin from a licensed pest control contractor.
e
N
Applicant shall call the Public Works Department at 408-777-3104 and schedule a "habitable dwelling" inspection.
till
lo,�v$e signed Debris Bin and Recyclable Materials form.
.......
Commercial Buildings Only: Provide Fire Dept clearance for fire suppression alarm system review.
b� g, �v
DemoApp_201 1. doc revised 03116111
CUPERTINO
OWNER -BUILDER DISCLOSURE FORM
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 - FAX (408) 777-3333 - buildinga-gugertino.org
Dear Property Owner(s):
An application for a building permit has been submitted in your name listing yourself as the builder of the property
improvements specified at:
SITE ADDRESS 17�v
APN B P
OWNER NAME OWNER ADDRESS 7-U
_e Ma AV tA
I_S50,� Lz-�_ I A
DESCRIPTION OF WORK: a
I t;07
We are providing you with an Owner -Builder Acknowledgment and Information Verification Form to make you aware of
your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner -Builder. We
will not issue a building permit until you have read, initialed your understanding of each provision, signed, and
returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless
you, the property owner, obtain the prior approval of the permitting authority.
OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION
(DIRECTIONS: Please read and initial each statement below to signify you understand or venly this information.)
0 Il. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-
Ui7il—der" building permit that erroneously implies that the property owner is providing his or her own labor and material
personally. 1, as an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by
an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not
provide coverage for those injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my
insurance coverage for injuries to workers on my property.
�h_e2- 1 understand building permits are not required to be signed by property owners unless they are responsible for
t co
nstruction and are not hiring a licensed Contractor to assume this responsibility.
�3
C, I understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may
ro2te myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her
name instead of my own.
I understand Contractors are required by law to be licensed and bonded in California and to list their license
rs; on permits and contracts.
I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the
Ktotal value of my construction is at least five hundred dollars ($500), including labor and materials, I may be
considered an "employer" under state and federal law.
t/6 - I understand if I am considered an "employer" under state and federal law, I must register with the state and
1deral government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to
unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject
me to serious financial risk.
_t��7. I understand under California Contractors' State License Law, an Owner -Builder who builds single-family
idential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by
licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work
is performed under contract with a licensed general building Contractor.
�368. I understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for
f
I nancial or personal injuries sustained by any subsequent owner(s) that result from any latent construction
defects in the workmanship or materials.
OwnerBuilderForm_2010.doc revised 04114110
N�2 — 9. 1 understand I may obtain more information regarding my obligations as an "employer" from the Internal
�Zevenue Service, the United States Small Business Administration, the California Department of Benefit Payments,
and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State
License Board (CSLB) at 1-800-321 -CSLB (2752) or www.csib.ca.gov for more information about licensed
contractors.
"1 0. 1 am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I
am the party legally and financially responsible for proposed construction activity at the site address listed above.
11. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide
by all applicable laws and requirements that govern Owner -Builders as well as employers.
�_, 2 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the
informat-ion I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If
you contract with someone who does not have a license, the Contractors' State License Board may be unable to
assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed
Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or
employee of that individual or firm is injured while working on your property, you may be held liable for damages. If
you obtain a permit as Owner -Builder and wish to hire Contractors, you will be responsible for verifying whether or not
those Contractors are properly licensed and the status of their workers' compensation insurance coverage.
CONSTRUCTION LENDING AGENCY
(DIRECTIONS: Please complete the following consttuction lending agency inforination.)
I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued
(Sec 3097 Civ.)
Lender Name:
Lender Address:
Before a building permit can be issued, this form must be completed and signed by the property owner an
Is
returned to the agency responsible for issuing the permit. Note: A copy of the property owner's driver's ficer ,e,
forin notarization, or other verification acceptable to the city may be required to be presented when the pennit is issued
to verify the Property owner's siwlziture.
I Property Owner's Sign Date: b C- ---v, 21=:l / I
- yk6tif:- - �h e-- ?&1i6 w --in g-- Xwti�6 hia- ii6wi�6 rin- -is- -r-e-q- u -i -re --d- -to- -b- e-- -66 m-- p--l-e-t-e- d-- b --y- -th--e --- p-rop- ei-rit y-- o-- w --n- e --r- 6 -nil -y- -w- -h-e- -n- -d-e- -s-ig--n- ai-fi n -g-- -a- n ----
agent of the property owner to apply for a construction permit for the Owner -Builder).
AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF
Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby
authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an
Owner -Builder Permit for my project.
Scope of Construction Project (or Description of Work):
Project Location or Address:
Name of Authorized Agent: Tel No
Address of Authorized Agent:
I declare under penalty of pedury that I am the property owner for the address listed above and I personally filled out the
above information and certify its accuracy. Note: A copy of the property owner's driver's license, forin notarization, or other
verification acceptable to the city may be required to be presented when the pennit is issued to ve* the property owner's
signature.
Property Owner's Signature:
Date:
OwnerBuilderForm_2010.doc revised 04114110
.. . .. .... . . . .
V
�-e: L
Debris Bins
— ----- . .. . ....... ........ .
City of Cupertino
Public Works Department
10300 Torre Ave.
Cupertino CA 95014
(408) 777-3354
Debris from a project in Cupertino can be collected and disposed of in either:
1. a Los Altos Garbage Co. bin (call 725-4020 to order), OR
2. a bin owned by the project's general contractor or demolition contractor, and hauled by a vehicle
owned and registered to that contractor (contractor should be prepared to prove ownership), OR
I a private truck with a bed, but no bin
The Los Altos Garbage Company is the only debris bin service provider
franchised to do business in Cupertino.
Bins from other leasing companies may not be used in Cupertino.
Please check all that apply:
El I will use a Los Altos Garbage Company bin
0 1 will use a bin and truck owned by the general contractor or the demolition contractor.
E3 I will use a private truck, and not drop a bin.
Recyclable Materials
Recyclable materials may be collected in private debris bins or containers leased
from ANY company, as long as the materials are both:
1. separated by type of material into separate containers, AND
2. are not contaminated by garbage.
Separated recyclable materials are materials that are separated into individual containers, each
containing just one type of recyclable material. Typical examples of recyclable materials
include: metal, wood, concrete, steel -reinforced concrete, asphalt, tree trimmings, white goods,
toilets (hardware removed), rocks and clean U dirt. Separated recyclables must ultimately be
recycled or otherwise reused, and not disposed of in a landfLI1.
Contractor should be prepared to provide the name and phone number of any recycling companies being
used on the project. A list of local recycling companies can be found at: www.recyclestuff-org.
. . . . . . . . . . . . . . . .
Signature: Date: Y -
Name (printed): Llo!�i
Title:
Phone:
SV
-V q
Project address: -(C>2�v 10&4t, � X- rlb-er-1 rX,
This form tD remain in ffie pmJs building prnmit fila fb.r the duration of the projecL
Revised 1/03
2011-04-13 13:26 RIVERBANK 2098691800>> 1-209-593-0276 P 1/3
40
Rivep*ank Intedors
3131 AlUdbuii Shwt
Riverbank, CA. 95367
209-869-3684
209-869-18M
Contractors State License # 247684
CAL -OSHA F-008/507
4-12-2011
Attention: Paulson Lee
Riverbank Interiors performed removal of 900 sq ft. of asbestos floor tile
and removed asbestos window cocking throughout at 10750 Johnson Ave, Cupertino, CA.
Please note that mastic was not removed, the mastic Is non asbestos containing.
The project was performed on April 7th & P 2011.
'rho floor tile and cocking material were disposed of at Forward Landfill
1145 W. Charter Way, Stockton, CA. 95206
Thank You,
Steve Glenn
Riverbank Interiors
2011-04-13 13:26 RIVERBANK 2098691800 >> 1-209-593-0276
F.�
FA
TEMPORARY WORKSITE NOTIFICATION FOR ASBESTOSALEAD
And METHYLENDIANLINE-RELATED WORK
COMPANY/EMPLOYER NAME: Riverbank Interiors
HEADQUARTERS ADDRESS: 3131 Atchison Street Riverbank, CA 95367
(209)869-3684
CONTRACTORS STATE LICENSE BOARD LICENSE NUMBER: 247684
DOSH-ACRU` (CAIJOSHA) ASBESTOS REGISTRATION NUMBER: 507-FOO8
and/or "REPORT OF USE" REGESTRY NUMBER: -
ADDRESS OF TEMPORARY WORKSITE and PRECISE LOCATION:
10750 Johnson Ave --Cupertino, CA.
TYPE OF BUSINESS:
Vacant House
NAME OF CERTIFIED SUPERVISOR,
Ray Glenn and/or Steven Glenn and/or David Glenn.
NAME OF QUALIFIED PERSON IN CHARGE OF AIR MONITORING,
LABORATORY WORK AND RESPIRATORS:
No testing required—did not removed mastic. (non asbestos containing)
NAM[E OF CERTIFIED CONSULTANT:
None
PROJECTED STARTING DATE: 4-7-2011
PROJECTED COMPLETION DATE: 4-8-2011
DESCRIBE TYPE, SCOPE AND WORK PRATICES OF JOB:
Removal and disposal of asbestos floor tile, and asbestos window cocking throughout.
EVALUATION OF POTENTIAL FOR EXPOSURE:
None, material kept wet at all times with water.
ESTIMATED NUMBER OF EMPLOYEES ON THIS JOB: 3-5
ACCORDING TO TITLE 8CCR SECTIONS 341.9 AND 1529(r) for ASBESTOS
and MDA, PLEASE SEND THIS COMPLETED NOTICE TO THE NEAREST
DISTRICT COMPLIANCE OFFICE (SEE ATTACHED LISTING, NOT TO
WO/0-17 �70
P 2/3
20%04-13 13:27 RIVERBANK 2098691800 >> 1-209-593-0276 P 3/3
.4
f
DOSH HEADQUARTERS OR TO DOSH CONSULTATION, PRIOR TO
COMMENCEMENT OF ANY SUCH WORK ACTIVITY.
NOTE: ANY CHANGE IN THE INFORMATION PROVIDED TO THE
DISTRICT OFFICE BY
THE WRITTEN NOTICE SHALL BE REPORTED TO THE
DISTRICT OFFICE
WITHIN 24 HOURS OF SUCH CHANGE
A*
V
0 t7m i I
En% inindiation
r f� c� h ri c3 I c3 0 i a as
AmeriSci Los Angeles
24416 S. Main Street, Ste 308
Carson, California 90745
TEL: (310) 834-4868 - FAX: (310) 834-4772
PLM Bulk Asbestos Report
Environmental Remediation Tech. Date Received 03/08/11 AmeriScl Job # 911031250
Attn: Mr. Fanelli Date Examined 03/09/11 P.O. #
6472 Camden Ave. Page 1 of 3
Ste. 102B RE: 1103-04; Paulson Lee; 10750 Johnson Ave. Cupertino,CA.
San Jose, CA 95120 95014
(408) 866-4141 www.ertinc.com info@ertinc.com
Client No. / HGA Lab No. Asbestos Present
Total % Asbestos
WP -01 911031250-01
Yes
2%
Location: Window Putty
(by CVES)
by Paola Ducoing
on 03/09/11
Analyst Description: Beige, Homogeneous, Non -Fibrous, Window Putty
Asbestos Types: Chrysotile 2.0 %
Other Material: Non-fibrous 98 %
KFT-02 911031250-02
No
NAD
Location: Kitchen Floor Tile
(by CVES)
by Paola Ducoing
on 03/09/11
Analyst Description: Tan, Homogeneous, Non -Fibrous, Floor Tile
Asbestos Types:
Other Material: Non-fibrous 100 %
M-03 911031250-03
Yes
5%
Location: Kitchen Floor Tile Black Mastic
(by CVES)
by Paola Ducoing
on 03/09/11
Analyst Description: Black, Homogeneous, Non -Fibrous, Mastic
Asbestos Types: Chrysotile 5.0 %
Other Material: Non-fibrous 95 %
FT -04 911031250-04
Yes
4%
Location: Floor Tile Under Carpet Area's
(by CVES)
by Paola Ducoing
on 03/09/11
Analyst Description: Grey, Homogeneous, Non -Fibrous, Floor Tile
Asbestos Types: Chrysotile 4.0 %
Other Material: Non-fibrous 96 %
M-05 911031250-05 No NAD
Location: Floor Tile Under Carpet Area's Black Mastic (by CVES)
by Paola Ducoing
on 03/09/11
Analyst Description: Black, Homogeneous, Non -Fibrous, Mastic
Asbestos Types:
Other Material: Non-fibrous 100 %
See Reporting notes on last page
AmeriSci Job#: 911031250
Page 2 of 3
Client Name: Environmental Remediation Tech.
PLIVI Bulk Asbestos Report
1103-04; Paulson Lee; 10750 Johnson Ave. Cupertino,CA.
95014
Client No. / HGA Lab No. Asbestos Present
Total % Asbestos
LF -06 911031250-06 No
NAD
Location: Bathroom Linoleum Flooring - Backing Only
(by CVES)
by Paola Ducoing
on 03/09/11
Analyst Description: Grey, Homogeneous, Fibrous, Backing
Asbestos Types:
Other Material: Cellulose 65 %, Fibrous glass 5 %, Non-fibrous 30 %
FC -07 911031250-07 No
NAD
Location: Kitchen Formica Counter Tops
(by CVES)
by Paola Ducoing
on 03/09/11
Analyst Description: Beige/Brown, Homogeneous, Non -Fibrous, Counter Top
Asbestos Types:
Other Material: Non-fibrous 100 %
CSR -08 911031250-08 Yes
Trace (<1 %)
Location: Composite Sheet Rock, Tape & Joint Compound - Comp. Sampling
(by CVES)
by Paola Ducoing
on 03/09/11
Analyst Description: White/Brown/Beige, Heterogeneous, Fibrous, Composite
Asbestos Types: Chrysotile <1. %
Other Material: Cellulose 15 %, Non-fibrous 85 %
CSR -09 911031250-09 Yes
Trace (<1 %)
Location: Composite Sheet Rock, Tape & Joint Compound - Comp. Sampling
(by CVES)
by Paola Ducoing
on 03/09/11
Analyst Description: White/Brown/Beige, Heterogeneous, Fibrous, Composite
Asbestos Types: Chrysotile <1. %
Other Material: Cellulose 15 %, Non-fibrous 85 %
CSR -10 911031250-10 Yes
Trace (<1 %)
Location: Composite Sheet Rock, Tape & Joint Compound - Comp. Sampling
(by CVES)
by Paola Ducoing
on 03/09/11
Analyst Description: White/Brown/Beige, Heterogeneous, Fibrous, Composite
Asbestos Types: Chrysotile <1. %
Other Material: Cellulose 15 %, Non-fibrous 85 %
CSR -1 1 911031250-11 No
NAD
Location: Tar& Gravel Roofing
(by CVES)
by Paola Ducoing
on 03/09/11
Analyst Description: Black, Homogeneous, Fibrous, Roofing
Asbestos Types:
Other Material: Fibrous glass 15 %, Non-fibrous 85 %
See Reporting notes on last page
AmeriSci Job#: 911031250
Client Name: Environmental Remediation Tech.
PLM Bulk Asbestos Report
1103-04; Paulson Lee; 10750 Johnson Ave. Cupertino,CA.
95014
Page 3 of 3
ERT performed asbestos inspection and testing on the date of 3/7/11. ERT obtained
samples from various building materials associated with the home suspected to
contain asbestos. Those samples were submitted to an accredited laboratory for
analysis and characterization service using PLM. Lab analysis of the home interior
sheet rock indicates less than <1% asbestos content. Bay Area Air Quality
Management District (BAAQMD) doesn't regulate asbestos at less than <1%, and
therefore will allow you to leave the material inside the residence during
renovation or demolition activity without requiring professional removal or
abatement. However, Cal -OSHA regulates occupational exposure to asbestos at less
than <1%. The contractor must protect his employees and abide by Cal -OSHA Asbestos
In Construction Standard 1529.1101 during the course of renovation or demolition.
All other materials documented in this report that contain greater than >1%
asbestos content must be removed from the residence prior to scheduled renovation
or demolition activity as required by BAAQMD. The handling, work practices, and
Wsposal of asbestos is regulated and restricted by certain governmental agencies.
il work involving asbestos should be performed by a licensed asbestos abatement
contractor. If you have any questions regarding the content of this report, please
contact ERT. Dominick Fanelli, CAC # 92-0067
Certified Asbestos Consultant/DOSH
3/9/11
Note: The inspection and testing performed maybe inherently limited in scope and
nature. No guarantee is expressed or implied that all asbestos associated with the
home or at the subject property has been identified in this report. PLM analysis
has been known to miss asbestos in a small percentage of samples analyzed.
Inaccessible areas of the home under floors, behind walls, and above ceilings were
not inspected for asbesto ubject to testing.
Reporting Notes:
Analyzed By: Paola Ducoing Date Analyzed: 3/9/2011
*NAD = no asbestos detected; Detection Limit <1%; Reporting Limits: CVES = 1%, 400 Pt Ct = 0.25%, 1000 Pt Ct = 0.1%; NA = not analyzed; NA/PS
= not analyzed / positive stop; NVA = No Visible Asbestos; PLIM (polarized light microscopy) Bulk Asbestos Analysis by EPA 600/M4-82-020 per 40
CFR 763 (NVLAP Lab #200346-0, CA ELAP lab #2322): Note: PLM is not consistently reliable in detecting asbestos in floor coverings and similar NOB
materials. TEM is currently the only method that can be used to determine If this material can be considered or treated as non -asbestos -containing in
New York State (als (lee EPA Advisory for floor tile, FIR 59, 146, 38970, 8/1/94). NIST Accreditation requirements mandate that this report must not be
reproduced except inWII with the app ov21 of the laboratory. This PLM report relates ONLY to the items tested.
Reviewed By: �� �110(1%lk
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