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APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
CITY OF CUPERTINO
1. BUILDING DIVISION APPLICATION/PERMIT
BUILDING -ELECTRICAL
PLUMBINf;-MECHANICAL
BUILDING PROJECT IDENTIFICATION
PMMITNO.
n O O A
28209
BUILDINGADDRESS: LOS
A/ P-5.1 CA
UNIT# LOT#
SANITARY NO.
APPI.ICAIIONSUBMITTALDATE
Gr�
OWNERg AME: r HONE:
IfLE/'
CONTRACfOR'SNAME: LIC NO:
NAC
❑
CONTROL#
ARC In C (ENGINEER: LIC NO: ADDRESS:
CONTACT: PHONE:
QTY ELECTRIC PERMIT
FEE
BUILDING PERMIT INFO
BLDG P.ECT PLUMB MECH
PERMIT ISSUANCE
❑ ❑
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm thin l sin licensed under prov i si ons of Chaps 9 (commencing wi th
APPLIANCES - RESIDENIAL
B N
Section](100) of Division 3 of the Business and Professions Code, and my license is in PANELS
mu farce and effect,
License Class Lic.0
UPT02MAMPS
Dale Co tramm
201 - 1000 AMPS
ARCHITECTS DECLARATION
1 understand my plans shell M used as public records.
OVER I" AMPS
-SQ. FT. FLOOR AREA
E/SQ, FT.
SIGNS ELECTRICAL
Licensed Professional
OWNER-BUILDERDECLARATIONthe
SPECIAL CIRCUIT/MISC.
CRATION
1 affirm thin 1 am exempt from the Convector's License Law for the
following
gmas Business and Professions Code:r Anypai city or county
TEMP. METER OR PoIJ; (NST.
whowingreasan.ermit to
which requires issuance, Permit re conswn, aIle imfor su demolish, or rcpaig any swaurc
requires thevisio
he s
POWER DEVICES
far. lomlpalsu
sof the C.pennitmfilease Law
License Law (es Coder
that he is ncingM pursuant m Nc provisions of the lie Business
9(commencing with Stttion]MO)al Division 3of the Business and Professions Code)
SWIMMING PoOL ELECTRIC
VALUATION
or that he is a um pnherefrom and the basis for the alleged exemption. Any violation of
Section 7031.5 by any applicant far a Permit subjects the applicant to s civil pcom,of
OUTLETS - SWITCHES- FIXTURES
not mom thanfve hundred dollars ($500).
❑
NEW RESIDENTIALFLECTR_SQ. 14.
STORIES
TYPE CONSTRUCDON
will do
othewrk, anhepmpenpofmyemplayealmofred for orei(Set, 7ompename,,
Rosiness
the she
and Pm helot sand
Cale: The Contrec.ra lndwhe Law does not apply tort owner of
Contractors License Lms does or p,ly 1. son
whonx
ownerywhubuildsorimproves Nemproverwhodaesauchworkhimsecaral (rough his
employees,p that suchemrntsa. ne dnroffercd foe sale. If,
OCC. GROUP
RES. UNITS
how issoldFewithin ofcompletion,turposehe r-
angor improvement is s yearof
ot
boweer
builderwill have @e burden of proving that he did not build or improve for purpose of
will avetie buresof ibuild
❑ huaowneroftbepropeny,emexclusivelycontracting with licensed contmctomo
QTY. PLUMBING PERMITFF.E
FLOOD ZONE
APN
container due project (Sec. 70im, Business and professions Code:) The Cantneutr'a
License Law does not apply to an owner of property who builds m i mpmves themon, end
PERMIT ISSUANCE
whocontracts forsuchpbjecis with aconvr'tor(a) licensed pumumtto the Contractor's
License Law.
ALTER - DRAIN & VENT -WATER (EA)
FEE SUMMARY
❑ I am exempt under Sec. , B & P C for this reason
BACK FLOW PROTECT. DEVICE
. ID FEES
NITARY YN
RECEIPT #
Owner Date
WORKMAN COMPENSATION DECLARATION
DRAINS- FLOOR, ROOF, AREA, CONO.
HOOL TAX YN
-❑ I hereby affirm that l have acerificarsofcommrnoself-insure,ora marificme of
copy ihemof(S. 3800, Lab CJ which
Workers' Compensation Insurance or o cenifed ec
covers all employee's under this permit.
Policy #
FIXTURES -PER TRAP
GAS - EA. SYSTEM -1 INC. 4 OUTLIITS
RECEIPT#
RK FEE Y N
RECEIPT p
BUILDING DIVISION FEES
Company
❑ Cmifiedcopyiaherchyfumished.
GAS - HA. SYSTEM -OVER 4EA)
PLANCI IECK FEE
GRADING FEE
❑ Certified copy is filed with the city inspection division. GREiSFJINDUSTRL WASTE INTERCEPTOR
CERTIFICATE OF EXEMPTION FROM WORKERS'
GREASETRAP
SOILS FEE
COMPENSATION INSURANCE
ENERGY PEE
(This section need nut he camplimd ifthe permit is forone hummuldollars(SIM) SEWER - SANITARY - STORM PA. 200FT.
or leas.)
I certify that in the performance of the walk for which this permit is ismed. I shall WATER HEATER W/VENT/F.LECTR
not employ any person In any rammer so as tin became subject to the Worker'
Compensation Lawsof Califomia. Date
WATER SYSTEMnREATING
Det Re i #
Applicant
NO]ICE TO APPLICANT: IL after making this Conificlic of Exemption, you should
NEW RESIDENTIAL PLMEU SQ. FT.
TOTAL:
manse subject to the Workers Compensation provisions of the Labor Code, you must
forthwith comply with such provisions or this permit shall be deeme revoked.
L
SMI
CONSTRUCTION LENDING AGENCY
IPAD
I hereby affirm that there is a construction lending agency for Ne performance ofthe work for which this permit is issued (Sec. 309], Civ. C.)
TOTAL:CTR
FEE
Lende/s Name
UMBING FEE
Lender's Address QTY. MECHANICAL PERMIT
I certify that 1 have road this apdand. and stn.that the aove information is
correct. l agree to comply with all city and county ordinances andstate laws relining m
PERMIT ISSUANCENSTRUC
CHANICAL FE
above-mentioned property for inspection purposes.
ALTER OR ADD TO MECIU
IO
(We) agree to save, indemnify and keep harmless the City of Captain. against
liabiliucajudgmena, costs and expenses which may in anywayaccrue agamilludid City
AIR HANDLING UNIT (TO ill." CFM)
in con qts a of the granting of Ilii it.
AIR HANDLING UNIT (OVER IO,IXIO CFM)
(`
PAID ClIi ISP 1#UrCt11I V11
Signaturenf ApP'an Cnnrvnnr are FXHAUSI'HOOD (W/DUCT)
HAZARDOUS MATERIA(. ISCLOSURE '
HEATING UNIT (TO 101" BTU)
at Receipt#
Wilt the applicant m future building occupant store or handle hazardous ma.dul
as defined by the Caperton Municipal Cade, Chapter 9.12, and the Health and Safety HEATING UNIT (OVER 100.0k)11 BTU)
Cada Section 25532(a)]
❑ Yes ❑ No
VENTILA'T'ION PAN (SINGLE RESID)
QQ�1 ' UA
Will tM1e apPliwntmluwrcbuildingmcupant use equipnrcnt ordcvicea whichemit
BOILER- COW(1HP OR IMAM BTU)
WG/
t artrskon air contaminants as defined by the Bay Arse Air Quality Management
BOILER -COW (OVER 100,000 BTU)
Vlr` ASV
IT 0ID
lstrict'l
s
❑ Yes ❑ No
NEW RE•SIDENI'IAL MECII. SQ. FT.
® gb,
0
I have mad the hazardous requirements under requiremenunder Chapter 6.95 of the
�E
yr -
Califomia Health & Safety Code, Sections 25505, 25533 and 25534. I understand that
film building drys unicameral, have a tenant that it is an, responsibility to rarefy the
i
occupant of tM requlrcmenu which must be met prior to issuance of a Chrifica. of
Occupancy.
ISSUED BY:
Owner or authorized agent Date TOTAL:
OFFICE
;0
GATE of: YjE"Cm cEmETCRY
22555 CRISTO REY ORTVE, LOS ALTOS, CALtIZORMIA 94024
JUNE 22, 1995
Joe Antonucci
Building Official
CITY OF CUPERTINO
Community Development
10300 Torre Avenue
Cupertino, CA 95014
Dear Joe:
BLDG:
'IPA
R1MENT
The attached map is marked where Gate of Heaven Cemetery is located in the
:. foothills of Cupertino with the industrial giant, Kaiser Permanente plant to the
south-west of us, and Rancho San Antonio Park, Open Space to the north-west
of us. Also on the map you can see the marked location of Deep Cliff Golf
Course where you have informed me of an above ground fuel tank that has
already been approved and installed. If Deep Cliff Golf Course meets the criteria
for installation of an above -ground fuel tank in a industrial area, I would hope our
tank proposal would meet the intent of your city ordinance.
Gate of Heaven Cemetery is located on 58 acres, not counting the many acres
of open space that surrounds it. We have proposed locating the new 1,000
gallon above -ground gasoline fuel tank in our corporation yard not more than 75
ft. from where our old underground fuel tank was located before it's removal.
The steel fuel tank we have selected is the latest in construction technology and
safety.
I would think our proposal for locating a tank on our property would not pose any
greater threat or danger level then Deep Cliff Golf Courses fuel tank, because we
are both in remote fringe areas of the City of Cupertino.
Gate of Heaven Cemetery has always placed a high degree of importance on fire
suppression and safety . We have allowed our irrigation lakes to be used for
firefighting and have a long tradition of working together with local Fire
Departments.
• 1 sincerely hope we can proceed with the fuel tank installation as soon as
possible, so our cemetery operations can get back to normal.
TELEpbome (408)738-2121 • rXX (408)738-2729
•
Please contact me at Gate of Heaven Cemetery ( 415-428-3733 ) for any additional
information.
Sincerely,
Larry E. Sharkey
Field Superintendent
10
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