DIR-2008-26b
CITY OF CUPERTINO
10300 Torre Avenue, Cupertino, California 95014 (408) 777-3308
To: Mayor and City Council Members
Chairperson and Planning Commissioners
From: Steve Piasecki, Director of Community Developme~
Prepared by: Colin Jung, Senior Planner
Date: August 11, 2008
Subject: Director's Minor Modification, DIR-2008-26, to erect a state-mandated, above-
ground, phase II vapor recovery system for an underground storage tank at an
existing gasoline station located at 20999 Stevens Creek Blvd.
Chapter 19.132 of the Cupertino Municipal Code allows for administrative
approval of minor changes in a project. The Director reports his decision
to the City Council and Planning Commission in time to allow an appeal
of the decision within fourteen calendar days.
DISCUSSION:
The applicant, Gavin Kirk of Stantec Consulting, representing Shell Oil Products, is
required by the California Air Resources Board (CARB) to install vapor recovery
systems to filter gasoline vapors that emanate when refueling vehicle fuel tanks (Exhibit
A). Presently, CARB has certified only a couple of systems that comply with its current
air quality regulations, such as the Healy System, Inc. Phase II Enhanced Vapor
Recovery System (Exhibit B). Its appearance, height (about 8.5 feet tall), and above-
ground installation are governed by the CARB's rule making and are not subject to City
regulation. This is a statewide mandate and eventually all gasoline stations in
California will be retrofitted with this system.
Staff has been working with the applicant to minimize the visual impact of this vapor
recovery system to the extent possible. The system will be mounted sideways on a
concrete pad in a landscape bed along a side property line. The equipment will be
enclosed and screened by a 5' 2" tall galvanized metal enclosure, which will be blocked
from views to the north by a wood slant chain link fence. Views from other directions
will be screened by the existing shrubs and proposed new shrubs. The approval is
further conditioned to paint the enclosure a forest green color to blend it with the
surrounding shrubs. Two 24" box trees are being required to screen the existing, tall
vent risers.
ACTION:
The Director of Community Development deems the modification minor and approves
the change as described in the plan set exhibit entitled: "CC # 135215! 20999 Stevens
Creek Boulevard! Cupertino, CA! Enhanced Vapor Recovery Upgrade"
DIR-2008-26
Page 2
August 11, 2008
dated 7/09/08, and consisting of three sheets labeled EVR1, EVR2 and TK2-3, and with
the following conditions of approval:
1. The Healy System enclosure shall be painted a forest green color to blend with
the existing and proposed shrubs.
2. The applicant shall plant two 24" box trees - one to the west side and the other to
the east side to screen views of the vent risers.
The approval is effective August 11,2008. The fourteen calendar day appeal period
expires on August 25,2008.
Enclosures:
Exhibit A: CARB Vapor Recovery Certification Procedure, CP-201
Exhibit B: CARB Executive Order VR-201-A: Healy Systems, Inc. Phase II EVR
System
Plan Set
G: Planning/ PDREPORTS / DIRreports /2008/ DIR-2008-26.doc
1:\(\.\\ b'I 1-; A
California Environmental Protection Agency
Air Resources Board
Vapor Recovery Certification Procedure
CP-201
Certification Procedure for
Vapor Recovery Systems at
Gasoline Dispensing Facilities
A set of definitions common to all Certification and Test Procedures are in:
0-200 Definitions for Vapor Recovery Procedures
For the purpose of this procedure, the term "CARB" refers to the California Air Resources
Board, and the term "Executive Officer" refers to the CARB Executive Officer, or his or her
authorized representative or designate.
1. GENERAL INFORMATION AND APPLICABILITY
This document describes the procedure for evaluating and certifying Phase I and Phase II
vapor recovery systems, and components, used at Gasoline Dispensing Facilities (GO F).
A CARB Executive Order certifying the system shall be issued only after all of the
applicable certification requirements have been successfully completed.
This Certification Procedure, CP-201, is adopted pursuant to Section 41954 of the
California Health and Safety Code (CH&SC) and is applicable to vapor recovery systems
installed at gasoline dispensing facilities for controlling gasoline vapors emitted during the
fueling of storage tanks (Phase I) and the refueling of vehicle fuel tanks (Phase II). Vapor
recovery systems are complete systems and shall include all associated dispensers,
piping, nozzles, couplers, processing units, underground tanks and any other equipment
or components necessary for the control of gasoline vapors during Phase I or Phase II
refueling operations at GDF.
1.1 Legislative and Regulatory Requirements of Other State Agencies
As required pursuant to Sections 41955 and 41957 of the CH&SC, the Executive
Officer shall coordinate this certification procedure with:
1.1.1 Department of Food and Agriculture,
Division of Measurement Standards (OMS)
1.1.2 Department of Forestry and Fire Protection,
Office of the State Fire Marshall (SFM)
1.1.3 Department of Industrial Relations,
Division of Occupational Safety and Health (DOSH)
California Air Resources Board
CP-201, Page 1
October 8, 2003
Prior to certification of the vapor recovery system by the Executive Officer, the
applicant shall submit plans and specifications for the system to each of these
agencies. Certification testing by these agencies may be conducted concurrently with
CARB certification testing; however, the approval of the SFM, OMS and DOSH shall
be a precondition to certification by CARB. The applicant is responsible for providing
documentation of these approvals to CARB.
1.2 Requirement to Comply with All Other Applicable Codes and Regulations
Certification of a system by the Executive Officer does not exempt the system from
compliance witnotner applica5le- codes anaregulations sucn as state-fire-coaes, ___n___
weights and measures regulations, and safety codes and regulations.
2. GENERAL PERFORMANCE STANDARDS AND SPECIFICATIONS
2.1 Performance Standards
A performance standard defines the minimum performance requirements for
certification of any system, including associated components. Ongoing compliance
with all applicable performance standards shall be demonstrated throughout
certification testing. Systems and components shall comply, throughout the warranty
period, with the applicable performance standards.
2.2 Performance Specifications
A performance specification is an engineering requirement that relates to the proper
operation of a specific system or component thereof. Performance specifications
shall be identified in the application for certification. Ongoing compliance with the
minimum level of performance specifications identified herein shall be demonstrated
throughout certification testing and specified in the certification Executive Orders.
Any applicant may request certification to a performance specification that is more
stringent than the minimum performance standard or specification. The performance
specification to which a system or component is certified shall be the minimum
allowable level of performance the component is required to meet throughout the
warranty period. Typical performance specifications include, but are not limited to,
pressure drop and pressure integrity.
2.3 Innovative System
The innovative system concept provides flexibility in the design of vapor recovery
systems. A vapor recovery system that fails to comply with an -identified
performance standard or specification may qualify for consideration as an innovative
system, provided that the system meets the primary emission factor/efficiency,
complies with all other applicable requirements of certification, and the Executive
Officer determines that the emission benefits of the innovation are greater than the
consequences of failing to meet the identified standard or specification.
California Air Resources Board
October 8, 2003
CP-201, Page 2
f~\,~'6 d-: b
State of California
AIRRESOURCES BOARD
EXECUTIVE ORDER VR-201-A
Healy Systems, I nc. Phase II
Enhanced Vapor Recovery (EVR) System
Not Including ISO
WHEREAS, the California Air Resources Board (ARB) has established, pursuant
to 'California Health and Safety Code sections 25290.1.2, 39600, 39601 and
41954, certification procedures for systems designed for the control of gasoline
vapor emissions during motor vehicle fueling operations (Phase II EVR vapor
recovery systems) in its CP-201, Certification Procedure for Vapor Recovery
Systems at Gasoline Dispensing Facilities (Certification Procedure) as last
amended July 22,2004, incorporated by reference in title 17, California Code of
Regulations. section 94011;
WHEREAS, ARB has established, pursuant to California Health and Safety Code
sections 39600,39601, 39607, and 41954, test procedures for determining the
compliance of Phase II vapor recovery systems with emission standards;
WHEREAS, Healy Systems, Inc. (Healy) requested certification of the Healy
Systems, Inc. Phase" Enhanced Vapor Recovery (EVR) System (Healy Phase II
EVR System Not Including In-Station Diagnostics (ISO));
WHEREAS, the Certification Procedure provides that the ARB Executive Officer
shall issue an Executive Order if he or she determines that the vapor recovery
system conforms to all of the applicable requirements set forth in the Certification
Procedure;
WHEREAS, I, Catherine Witherspoon, California Air Resources Board Executive
Officer, find that the Healy Phase II EVR System Not Including ISO conforms w[th
all requirements set forth in the Certification Procedure, including compatibility
when fueling vehicles equipped with onboard refueling vapor recovery systems,
and results in a vapor recovery system which is at least 95.0 percent efficient and
shall not exceed 0.38 pounds of hydrocarbons per 1,000 gallon of gasoline #
transferred when tested pursuant to TP-201.2, Efficiency and Emission Factor
for Phase (J Systems (October 8, 2003);
NOW, THEREFORE, IT IS HEREBY ORDERED that the Healy Phase It EVR
System Not Including ISO is certified to be at least 95 percent efficient and does
not exceed 0,38 pounds of hydrocarbon per 1,000 gaflons of gasoline transferred
in attended and/or self-service mode when used with an ARB-certified Phase I
vapor recovery system and installed, operated, and maintained as specified herein
and in the foHowlng exhibits. . Exhibit 1 contains a list oUhe equipment certified for
use with the Healy Phase II EVR System Not Including ISO. Exhibit 2 contains the
performance standards, specifications, typical installation drawings and
maintenance intervals applicable to the Healy Phase II EVR System Not lnciuding
ISO as installed in a gasoline dispensing facility (GDF). Exhibit 3 contains the
manufacturing specifications. Exhibit 4 is the test procedure for verifying
performance ofthe Healy Clean Air Separator. Exhibit 5 is the vapor to liquid ratio
-------~.1esLpfQcedm.eJor--Y:eriMng performance of the Healy 900 Nozzle. Exhibit 6 is the
Healy Phase II EVR System limited Warranty. Exhibit 7 is the nozzle bag test
procedure. Exhibit 8 is items to consider in conducting TP-201.3.
IT IS FURTHER ORDERED that compliance with the applicable certification
requirements, rules and regulations of the Division of Measurement Standards of
the Department of Food and Agriculture, the Office of the State Fire Marshal of the
Department of Forestry and Fire Protection, the Division of Occupational Safety
arid Health of the Department of Industrial Relations, and the Division of Water
Quality of the State Water Resources Control Board is made a condition of this
certification.
IT IS FURTHER ORDERED that Healy shall provide a warranty for the vapor
recovery system and components to the initial purchaser and each subsequent
purchaser within the warranty period. The manufacturer of components listed in
Exhibit t not manufactured by Healy Systems, Inc. shall provide a warranty to
each of their components certified herein. The warranty shall include the ongoing
compliance with all applicable performance standards and specifications and shall
comply with all warranty requirements in Section 9.2 of the Certification Procedure.
Healy or other manufacturers may specify that the warranty is contingent upon the
use of trained installers. Copies of the warranty for the system and components
shall be made available to the gasoline dispensing facility owner/operator.
IT IS FURTHER ORDERED that the certified components manufactured by Healy
Systems, Inc. shall be 100% performance tested by the manufacturer using the
applicable procedures listed in Exhibit 3.
IT IS FURTHER ORDERED that the certified Healy Phase /I EVR System Not
Including ISO shall be installed, operated, and maintained in accordance with the
ARB Approved Installation, Operation, and Maintenance Manual for the
Healy Phase 1/ EVR System Not Including ISD. A copy of this Executive Order
and the ARB Approved Installation, Operation and Maintenance Manual for
the Healy Phase If EVR System Not Including ISD shall be maintained at each
GDF where a certified Healy Phase II EVR System Not Including ISO is installed.
HEALY PHASE II EVR SYSTEM - VR-201-A
IT IS FURTHER ORDERED that equipment listed rn ExhibIt 1, unless exempted in
writing by ARB, shall be clearly ldentified by permanent identification number
showing the manufacturer's name and model number.
IT IS FURTHER ORDERED that any alteration in the equipment parts, design,
installation, or operation of the system certified hereby is prohibited and deemed
inconsistent with this certification, unless the alteration has been submitted in
writing and approved in writing by the Executive Officer or Executive Officer
-~-~ -_u-u--~elegat8:---
iT\lS FURTHER ORDERED that the following requirements are made a condition
of certification. The owner or operator of the Healy Phase II EVR System Not
Including ISO shall conduct and pass the following tests no later than 60 days after
startup and at least once in each twelve month period, using the following test
procedures: TP-201.3, Determination of 2 Inch we Static Pressure
Performance of Vapor Recovery Systems of Dispensing Facilities (March 17,
1999); Exhibit 4, Determination of Static Pressure Performance of the Healy
Clean Air Separator; and Exhibit 5, Vapor to Liquid Volume Ratio for Healy
Phase II EVR System. Shorter time periods may be specified in accordance with
local district requirements. Notification of testing, and submittal bf test results,
shall be done in accordance with local district requirements and pursuant to
policies established by that district. Alternative test procedures, including most
recent versions of the test procedures listed above, may be used if determined by
the ARB Executive Officer or Executive Officer delegate, in writing, to yiefd
equivalent results.
IT JS FURTHER ORDERED that the following requirements are made a conditfon
of certification. The owner or operator of the Healy Phase II EVR System Not
Including ISO shall conduct, and pass, the following tests no later than 60 days
after startup using Exhibit 7, Nozzle Bag Test Procedure. TP-201.4, Dynamic
Back Pressure (July 3,2002), shall be conducted in accordance with the
conditions Hsted in item 1 of the Vapor Recovery Piping Configurations section of
Exhibit 2. Local districts have the authority to require conducting of Exhibit 5,
Vapor to Liquid Volume Ratio for Healy Phase II EVR System, in lieu of
TP-20 1.4, Dynamic Back Pressure (July 3, 2002), provided that at least 2 gallons
of product are introduced into the system through each dispenser riser prior to
conducting the test. Notification of testing and submittal of test results shall be
done in accordance with local district requirements and pursuant to the policies
established by that district. Alternative test procedures, including most recent
versions of the test procedures listed above, may be used if determined by the
ARB Executive Officer or Executive Officer delegate, in writing, to yield equivalent
results.
IT IS FURTHER ORDERED that, except as provided above, local districts at their
option will specify the testing frequency of the nozzle vapor valves. If nozzle vapor
HEALY PHASE II EVR SYSTEM - VR-201-A
If
""""'1'-
valve tests are required by the district, the testshall be conducted in accordance
with Exhibit 7, Nozzle Bag Test Procedure.
iT IS FURTHER ORDERED that the Healy Phase II EVR System Not Including
ISO shall be compatible with fuels in common use in California at the time of
certification and any modifications to comply with future California fuel
requirements shall be approved in writing by the Executive Officer or Executive
Officer delegate.
IT is FURTHER ORDERED that the certification of the Healy Phase II EVR
. .
SY6tem Not including ISO is valid through August 1, 2009.
Executed at Sacramento, California, this 8~ day of April 2005.
C~ Z;;;;Zc2r-) .~
Catherine Witherspoon (/
Executive Officer
Attachments:
Exhibit 1 Equipment List
Exhibit 2 System Specifications
Exhibit 3 Healy Manufacturing Performance Standards and Specifications
Exhibit 4 Determination of Static Pressure Performance of the Healy Clean Air
Separator
Vapor to Liquid Volume Ratio for Healy Phase II EVR System
Healy Phase II EVR System Limited Warranty
Nozzle Bag Test Procedure
Items to Consider in Conducting TP-201.3
Exhibit 5
Exhibit 6
Exhibit 7
Exhibit 8
HEALY PHASE II EVR SYSTEM - VR-201-A
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MARK DATE REVISIONS INITIAL
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CC # 1 3521 5
20999 STEVENS CREEK BOULEVARD
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ENHANCED VAPOR RECOVERY UPGRADE
SITE PLAN AND KEY NOTES
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MARK DATE REVISIONS INITIAL
.--n5Icia ISsuED fOR PERMIT ZG
Ii 7/09/08 REVISED PER PLANNING COMt.lENTS ZG
CC H'35215
20999 STEVENS CREEK BOULEVARD
CUPERTINO, CA
ENHANCED VAPOR RECOVERY UPGRADE
~ ~p~u~~sD
~ ARCHITEcrURE. ENGINEERING. ENVIRONMENTAL SERVICES
llJ7 N. MoOO..a.L BLVD_ PETAl.lIIll.... C'" g49~4 (707) 76~-1660
~IMC. JOHNW.JOHNSON,A.RCHlItCT llICti"'EL9UAGESS,CIVlLENGlNEER
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StanteC
Transmittal
Stantec Consulting Inc.
1137 North McDowell Boulevard
Petaluma CA 94954
Tel: (707) 765-1660
Fax: (707) 765-9908
To:
Colin J
Company:
For Your Information
Address:
COMMUNITY
Q
DEVELOPMENT DEPT.
Q
10300 TORRE AVE.
CUPERTINO, CA. 95014
Phone:
(408)777-3308
Date:
August ,11 2008
File:
CUPERTINO
Delivery:
CALIFORNIA OVERNIGHT
From:
Gavin G. Kirk
❑
For Your Information
❑
For Your Approval
Q
For Your Review
Q
As Requested
Reference: 08040194 -SHELL EVR
20999 STEVENS CREEK BLVD.
CUPERTINO, CA
Attachment:
Copies Doc Date Pages Description
1 Fee increase of $43.00
Hello Colin,
Per your Receipt, here is an additional $43.00 in Planning fees.
Thank you,
STANTEC CONSULTING INC.
Gavin G. Kirk
Job Captain
Tel: (707) 765-1660
Fax: (707) 765-9908
gavin.kirk@stantec.com
c. [Click here and type a cc list]
One Team. Infinite Solutions,
gk f:\project\q-r-s-t\tpx\tpx08l27.0\docs\tm_cuper ino_pinning_2.doc
Shell Oil Produces Us
2.8 April 2.008
Dear Sir or Madam:
Shell Qil Products US authorizes the following company to act as agent for permitting requirements:
Stantec'(formerly RHL Design Group, Inc.)
1137 N. McDowell Boulevard
Petaluma, CA 94954
707=765-1660
This agent authorization will last for a period of time not to exceed one year from this date.
If you have any questionsregarding'this authorization, please call me. at 403-691'-3894.
`Regards,
Pierre -Carl Dion
Project Manager
Retail Network Development
stantec
Transmittal
Stantec Consulting Inc.
1137 North McDowell Boulevard
Petaluma CA 94954
Tel: (707) 765-1660
Fax: (707) 765-9908
To:
Colin
Company:
Description
Address:
COMMUNITY
2
DEVELOPMENT DEPT.
1
10300 TORRE AVE.
CUPERTINO, CA. 95014
Phone:
(408)777-3308
Date:
July 28, 2008
File:
CUPERTINO
Delivery:
CALIFORNIA OVERNIGHT
From: Gavin G. Kirk
❑ For Your Information
❑ For Your Approval
Q For Your Review
Q As Requested
Reference: 08040194 -SHELL EVR
20999 STEVENS CREEK BLVD.
CUPERTINO, CA
Attachment:
Copies
Doc Date
Pages
Description
2
2
11 X17 Drawing set
1
Directors Minor Modification Review
Application and $1,297.00 Fee check
Hello Colin,
Per your 4/29/08 Comments here is our resubmittal with an application for a Directors
Minor Modification. We have also submitted this to the Building Dept. to address
comments from the other departments. Please let me know when we can expect
approval from your dept.
Thank you,
STANTEC CONSULTING INC.
Gavin G. Kirk
Job Captain
Tel: (707) 765-1660
One Team. Infinite Solutions.
gk cAdocuments and settings\gkirk\desktop\tm_cupertino_pinning.doc
County of Santa Clara �GOU/VT
Office of the County Clerk -Recorder
Business Division * 1
County Government Center
70 West Hedding Street, E. Wing, V' Floor
San Jose, California 95110 (408) 299-5665
CEQA DOCUMENT DECLARATION
ENVIRONMENTAL FILING FEE RECEIPT
PLEASE COMPLETE THE FOLLOWING:
1. LEAD AGENCY: City of Cupertino
Santa Clara County Clerk- Recorder's Office
State of California
REGINA ALCOMENDRAS, County Clerk -Recorder
by Veronica Aguirre, Deputy Clerk -Recorder,
2. PROJECT TITLE: DIR-2008-26
3. APPLICANT NAME: Gavin Kirk (Shell Oil Products) PHONE: 408.777.3308
4. APPLICANT ADDRESS: 20999 Stevens Creek Boulevard
5. PROJECT APPLICANT IS A: ❑ Local Public Agency ❑ School District ❑ Other Special District ❑State Agency ElPrivate Entity
6. NOTICE TO BE POSTED FOR 30 DAYS.
7. CLASSIFICATION OF ENVIRONMENTAL DOCUMENT
a. PROJECT THAT IS SUBJECT TO DFG FEES
❑ 1. ENVIRONMENTAL IMPACT REPORT (PUBLIC RESOURCES CODE §21152) $ 2,606.75 $ 0.00
❑ 2. NEGATIVE DECLARATION (PUBLIC RESOURCES CODE §21080(C) $ 1,876.75 $ 0.00
❑ 3. APPLICATION FEE WATER DIVERSION (STATE WATER RESOURCES CONTROL BOARD ONLY) $ 886.25 $ 0.00
❑ 4. PROJECTS SUBJECT TO CERTIFIED REGULATORY PROGRAMS $ 886.25 $ 0.00
❑ 5. COUNTY ADMINISTRATIVE FEE (REQUIRED FOR as=1 THROUGH as=4 ABOVE) $ 50.00 $ 0.00
Fish & Game Code §711.4(e)
b. PROJECT THAT IS EXEMPT FROM DFG FEES
511. NOTICE OF EXEMPTION ($50.00 COUNTY ADMINISTRATIVE FEE REQUIRED) $ 50.00 $ 50.00
❑ 2. A COMPLETED "CEQA FILING FEE NO EFFECT DETERMINATION FORM" FROM THE DEPARTMENT
OF FISH & GAME, DOCUMENTING THE DFG'S DETERMINATION THAT THE PROJECT WILL HAVE NO
EFFECT ON FISH, WILDLIFE AND HABITAT, OR AN OFFICIAL, DATED RECEIPT I PROOF OF PAYMENT
SHOWING PREVIOUS PAYMENT OF THE DFG FILING FEE FOR THE *SAME PROJECT IS ATTACHED
($50.00 COUNTY ADMINISTRATIVE FEE REQUIRED)
DOCUMENT TYPE: ❑ ENVIRONMENTAL IMPACT REPORT ❑ NEGATIVE DECLARATION $ 50.00 $ 0.00
c. FILING THAT IS NOT SUBJECT TO DFG OR COUNTY ADMINISTRATIVE FEES
• ❑ NOTICE OF PREPARATION
8. OTHER: FEE (IF APPLICABLE): $
9. TOTAL RECEIVED......................................................................................................................................... $ 50.00
*NOTE: "SAME PROJECT' MEANS NO CHANGES. IF THE DOCUMENT SUBMITTED IS NOT THE SAME (OTHER THAN DATES), A "NO EFFECT
DETERMINATION" LETTER FROM THE DEPARTMENT OF FISH AND GAME FOR THE SUBSEQUENT FILING OR THE APPROPRIATE FEES ARE
REQUIRED.
THIS FORM MUST BE COMPLETED AND ATTACHED TO THE FRONT OF ALL CEQA DOCUMENTS LISTED ABOVE (INCLUDING COPIES)
SUBMITTED FOR FILING. WE WILL NEED AN ORIGINAL (WET SIGNATURE) AND TWO COPIES. INCLUDE THIRD COPY IF YOU REQUIRE
AN ENDORSED COPY FOR YOUR RECORDS.
CHECKS FOR ALL FEES SHOULD BE MADE PAYABLE TO: SANTA CLARA COUNTY CLERK -RECORDER
PLEASE NOTE: FEES ARE ANNUALLY ADJUSTED (Fish & Game Code §711.4(b); PLEASE CHECK WITH THIS OFFICE AND THE DEPARTMENT
OF FISH AND GAME FOR THE LATEST FEE INFORMATION.
NO PROJECT SHALL BE OPERATIVE, VESTED, OR FINAL, NOR SHALL LOCAL GOVERNMENT PERMITS FOR THE PROJECT BE VALID,
UNTIL THE FILING FEES REQUIRED PURSUANT TO THIS SECTION ARE PAID." Fish & Game Code §711.4(c)(3)
09-09-2008
Document No.:
15077
Numer of Pages:
band
1
Filed Posted On:
9/26/2008
AL 90647w
Through:
10/26/2008
CRO Order Number:
136454
Fee Total:
50.00
REGINA ALCOMENDRAS, County Clerk -Recorder
by Veronica Aguirre, Deputy Clerk -Recorder,
2. PROJECT TITLE: DIR-2008-26
3. APPLICANT NAME: Gavin Kirk (Shell Oil Products) PHONE: 408.777.3308
4. APPLICANT ADDRESS: 20999 Stevens Creek Boulevard
5. PROJECT APPLICANT IS A: ❑ Local Public Agency ❑ School District ❑ Other Special District ❑State Agency ElPrivate Entity
6. NOTICE TO BE POSTED FOR 30 DAYS.
7. CLASSIFICATION OF ENVIRONMENTAL DOCUMENT
a. PROJECT THAT IS SUBJECT TO DFG FEES
❑ 1. ENVIRONMENTAL IMPACT REPORT (PUBLIC RESOURCES CODE §21152) $ 2,606.75 $ 0.00
❑ 2. NEGATIVE DECLARATION (PUBLIC RESOURCES CODE §21080(C) $ 1,876.75 $ 0.00
❑ 3. APPLICATION FEE WATER DIVERSION (STATE WATER RESOURCES CONTROL BOARD ONLY) $ 886.25 $ 0.00
❑ 4. PROJECTS SUBJECT TO CERTIFIED REGULATORY PROGRAMS $ 886.25 $ 0.00
❑ 5. COUNTY ADMINISTRATIVE FEE (REQUIRED FOR as=1 THROUGH as=4 ABOVE) $ 50.00 $ 0.00
Fish & Game Code §711.4(e)
b. PROJECT THAT IS EXEMPT FROM DFG FEES
511. NOTICE OF EXEMPTION ($50.00 COUNTY ADMINISTRATIVE FEE REQUIRED) $ 50.00 $ 50.00
❑ 2. A COMPLETED "CEQA FILING FEE NO EFFECT DETERMINATION FORM" FROM THE DEPARTMENT
OF FISH & GAME, DOCUMENTING THE DFG'S DETERMINATION THAT THE PROJECT WILL HAVE NO
EFFECT ON FISH, WILDLIFE AND HABITAT, OR AN OFFICIAL, DATED RECEIPT I PROOF OF PAYMENT
SHOWING PREVIOUS PAYMENT OF THE DFG FILING FEE FOR THE *SAME PROJECT IS ATTACHED
($50.00 COUNTY ADMINISTRATIVE FEE REQUIRED)
DOCUMENT TYPE: ❑ ENVIRONMENTAL IMPACT REPORT ❑ NEGATIVE DECLARATION $ 50.00 $ 0.00
c. FILING THAT IS NOT SUBJECT TO DFG OR COUNTY ADMINISTRATIVE FEES
• ❑ NOTICE OF PREPARATION
8. OTHER: FEE (IF APPLICABLE): $
9. TOTAL RECEIVED......................................................................................................................................... $ 50.00
*NOTE: "SAME PROJECT' MEANS NO CHANGES. IF THE DOCUMENT SUBMITTED IS NOT THE SAME (OTHER THAN DATES), A "NO EFFECT
DETERMINATION" LETTER FROM THE DEPARTMENT OF FISH AND GAME FOR THE SUBSEQUENT FILING OR THE APPROPRIATE FEES ARE
REQUIRED.
THIS FORM MUST BE COMPLETED AND ATTACHED TO THE FRONT OF ALL CEQA DOCUMENTS LISTED ABOVE (INCLUDING COPIES)
SUBMITTED FOR FILING. WE WILL NEED AN ORIGINAL (WET SIGNATURE) AND TWO COPIES. INCLUDE THIRD COPY IF YOU REQUIRE
AN ENDORSED COPY FOR YOUR RECORDS.
CHECKS FOR ALL FEES SHOULD BE MADE PAYABLE TO: SANTA CLARA COUNTY CLERK -RECORDER
PLEASE NOTE: FEES ARE ANNUALLY ADJUSTED (Fish & Game Code §711.4(b); PLEASE CHECK WITH THIS OFFICE AND THE DEPARTMENT
OF FISH AND GAME FOR THE LATEST FEE INFORMATION.
NO PROJECT SHALL BE OPERATIVE, VESTED, OR FINAL, NOR SHALL LOCAL GOVERNMENT PERMITS FOR THE PROJECT BE VALID,
UNTIL THE FILING FEES REQUIRED PURSUANT TO THIS SECTION ARE PAID." Fish & Game Code §711.4(c)(3)
09-09-2008
Filek 15077
9/26/2008
City of Cupertino
10300 Torre Avenue
Cupertino, CA 95014
Notice of Exemption
To: County Clerk -Recorder
70 W. Hedding Street, Vt Floor
East Wing—Business Division
San Jose, CA 95110
Project Title: DIR-200&26
Project Location - (be specific): 20999 Stevens Creek Boulevard
Project Location - (City): Cupertino Project Location - (County): Santa. Clara
Description of Project: Director's Minor Modification for an air cleaner tank.for gasoline at an
existing service station.
Name of Public Agency approving proj
Name of Person or Agency carrying out project: Gavin Kirk (Shell Oil Products)
Exempt Status: (check one)
Ministerial (Sec. 21080(b)(1); 15268);
Declared Emergency (Sec. 21080(b)(3); 15269(a));
_ Emergency Project (Sec. 21080(b)(4); 15269(b)(c));
x Categorical Exemption. State type and section number: 15301– Existing Facilites
_Statutory Exemption. State code number:
Reasons why project is exempt: Project involves the erection of mechanical equipment to
meet California Air Resources Board regulations.
Lead Agency
Contact Person Colin Jung__
Signature:
Area code/telephone number (408) 777-3257
Date: September 9, 2008 Title: Senior Planner
G: IPlanninglEPClExemptl2008exemptl dir200826. doe
PLEASE NOTE:
A pre -application conference is required prior to submittal on all
applications. The purpose of the pre -application conference is to
determine if the application is ready for submittal.
Please call your project manager to schedule a time for the review of
your application materials. We suggest you allow enough time prior
to the application deadline to prepare additional information or make
changes in case any are needed.
Please bring this form to the pre -application meeting for a signature.
Include this form in your application submittal.
Application Request: �1'2�f�T(7I25 /�l'^fU'1- /LL(��01G11` l'olu
Comments:f!'�YLj or olIrL 1?7LDCy - PCS 6C'W'-f4 e S
Gn-G��� fyi�-viz• FEn_A4 -r -,irz o8 o KD 19,q - iq -4- e-ji t- Ly
GSigned (planner) Date
As a part of the application review process, City of Cupertino employees may visit your site in order to take
photographs, slides and/or videotape. These materials may be shown at a city meeting.
Sheet 1 of 10
PRE -APPLICATION FORM
Community Development Department
10300 Torre Avenue (408) 777-3308 / Fax (408) 777-3333
CUPERTINO
Cupertino, CA 95014 planning@cupertino.org
I http://www.cupertino.org/planning
PLEASE NOTE:
A pre -application conference is required prior to submittal on all
applications. The purpose of the pre -application conference is to
determine if the application is ready for submittal.
Please call your project manager to schedule a time for the review of
your application materials. We suggest you allow enough time prior
to the application deadline to prepare additional information or make
changes in case any are needed.
Please bring this form to the pre -application meeting for a signature.
Include this form in your application submittal.
Application Request: �1'2�f�T(7I25 /�l'^fU'1- /LL(��01G11` l'olu
Comments:f!'�YLj or olIrL 1?7LDCy - PCS 6C'W'-f4 e S
Gn-G��� fyi�-viz• FEn_A4 -r -,irz o8 o KD 19,q - iq -4- e-ji t- Ly
GSigned (planner) Date
As a part of the application review process, City of Cupertino employees may visit your site in order to take
photographs, slides and/or videotape. These materials may be shown at a city meeting.
Sheet 1 of 10