25828 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO B ILIA G-EL.U'RI AL PF.RMITNO.
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL /� r/N /� /�
T1� t �t`IHnpmr,9'ROJECTIDENTIFICA'T'ION; L 5 VX L VX
BI TNG
O1Ra5 �G.YOlt. e ✓` SAN)'T'ARY No. APPIlCAnONSUBMIITALDATfi
DNIT# LOT# •�/��
O�I yE'R AI�Oy, p . M CON�AC It'$NAMI;: �/9 LIC NO:
(,I\aYt\L)geVIVI�f� NC CONTROLp
ARCHITBCT/ENGINEFR: LIC NO: ADDRESS: ❑
.ONTALT: PHONE:
QTY, .ELECTRIC PERMIT • FEE BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
PERMIT ISSUANCE ❑
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL
I hereby affirm drat l am licensel under fClet itcommenedn BDESCRIPTION
L 0 Ya pro Professions
per ( eis in
00 Senion 9000)of Division]of the Business and Professions Cade,and my license is in PANELS 1
0p; ful l force and ell'aet.
F2m 'cense Class Lie# UPT0200AMPS
F= ate COrbecmr 201-10010 AMPS 11 177 r .S
z bONz ARCHITECT'S DECLARATION OVER IM AMPS - - Q a;, ARF $/SQ.Fr.
O{—q Iundcmt.nd my,Itemshall be usedas publicrecoils f-�
" SIGNS ELECTRICAL �V I..✓ U T E: R
$eco"
Licensed d Professional Il
"`• 0'6 OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MISC.
iWyp((O y UU I hereby affirm but I um exempt from the Concis,.License Law for the
413 WOm Ibllowingreason.(Section 9131.5,Business and Professions Cole:Any city or county TEMP.METER OR POLE INST.
1= m J which requires a Permit to cnnstmed,almr,improve,demolish,or repair any stoemm
pension i¢iseuance.elsorev drestheapplicantforsuchpertniuoNe.silpm dommem POWER DEVICES
<C) that he is licensed Immortal o the provision of the Connivance License Law(Chapter
4 0�' 9(commencing with Section]000).(Dr,i....3 of the Rusinessund Professions Code) SWIMMING POOL ELECTRIC VALUATIO
fZ,_co Sectio M1ei31.5 exempt
any appoint f the permit subjects
thedexemptt to civiny l
Of OUTLETS-SWITCHES-FIXTURES /As vr^ •�
CPO
EZY Section om than v eundredidollrs($50mtiuobjcemaM1e applicenlmecivil penalty of ll/ ''_% (
� O 1,asown rafthedodrty,ormyem). NEWRESIDENTIALELECfR _SQ.FT.
cull opo n❑ Ldou wt,mfthepropuny,orm.Iirlmdolmthwugcsasalei(sole 044.Build., STORK TYPECONSTRUC110N
n
will rdmwons andlha he Corulsmoas Licem or offerrd dmfor notl apply to an owner of and Professions Code:The Contrecmcs license Law des not apply to an owner of
property who builds or improves thereon,and who does such wok hi msec f or Nmugh his
howeerloyecs,pingor ilhatsuerrmis sold within not earoedmoffered finscathea der. OCC.GROUP NIS.UNITS
however,will
have the bra i brander,
of pmem is that
he within et build ofcompl a for t propose
f TOTAL:
builJm will have the burden o(proving that he did not build or improve for puBxrse of
of'he emulusivelyconmming with licensed I,nsowner QTYa.r_zPLUMINGERvIT '
I1.00DZONEcmi
APN
construct the project(Sec.7(W ,Business and Professions Coded The Convector'.
Licence Law doesimt apply man ownerafpropeny who huildsorimmov thereon,and PERMIT ISSUANCE
who contracts forsuchprojects with aconwnar(s)licensed pursuant mthe Contractors ALTER x . (FEE SUMMARY '
License Law. WATER(EA)
❑ I em exempt under Sec. ,B&P C for this reason BACK FLOW PROTECT.DEVICE. SID. .S
SANITARY YN
Owner -Date DRAINS-FLOOR,ROfIF,ARFA,GOND. RECEIPT,
WORKMAN COMPENSATION DECLARATION SCHOOLTAX YN
❑ Iherebyuf mthaolhaveacenificateofconswttoself-insum,oracenirLeateof FIXTURES-PER TRAP RECFIP 0
Worken'Compensation Insurance or a certified copy thereof(Sec.3g(Q Lab C.)which PARK FEE Y_N1cov _
em all employee's under his permit. GAS-EA.SYSTEM-1 INC.4 OUTLETS RECEII'1'#
Polity# BUILDING DIVISION FEES
Company GAS.EA.SYSTEM-OVER 4(EA) PLANCHECK FEE
El Certified copy is hereby famished.
❑ Cenitial copy is filed with the city inspection division. GREASWINDUSTRL WASTE INTERCEPTOR GRADING WE
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE TRAP SOILS ME
COMPENSATION INSURANCE
(This section need not be completed Hine permit is for one hundred dollars($IN) SEWER-SANITARY-STORM EA.200FT. ENERGY FEE
or less.)
I certify that in the performance of the work for which this permit is issued,l shall WATER HEATER W/VENT/ELEC`pR
am employ any pcnan in tiny manner s r as m become subject am the Workers PAID
z Applicant Compensation Lawsof Califomia. Date WATER SYSTEMITRFATING - Date Receiplp
zO NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should NEW RESIDENTIAL PLMB. SQ.FI'. TOTAL:
(•-' .u. becomesubjmlto the Workeca Compameamn pmvisienof We Labor Core,yeu must
funhwiah comply with such provisions or this permit shall be deemed mocked. BUILDING IEE a�a
p, z CONSTRUCTION LENDING AGENCY SEISMIC FEE.
SI hereby affirm thin them is a construction lending agency for the perfoemence of
U O the work for which this permit is issued(Sec.3091,Civ.C.) TOTAL: ELECTRIC FEE
LI. tr Lenders Name 4 t� , c y 2 _ s n
L�
Lender's Adareva QTY,. i'i t,MECHANICAL PI,RMIT tit 'f+� F;EO f PLUMBING FEE
U 1 certify that I have mad this application and state that the above information ' " e X 3 f q Y r
correct.l agree to comply with all city and county ordinances and start laws celaing to PERMITISSUANCF. MF.CHANICALFEE
0 building construction,and hereby authorize representatives of this city to enter upon the CONSTRUCTION TAX
U z ahnve-mentioned properly for inspersion purposes. ALTER OR ADD TO MECH.
(We)agree w save,indemnify and keep hmor ens the City of Cupertino against
liabiliaies,judgments,cosm and expenses which may in any wayrommeagainst said City AIR HANDLING UNIT(TO 10,01)1 CFM)
co q ft Br ming of this permit. �-g�
(/ 1 'n ,/J a/Trs all AIR HANDLING UNIT(OVER IO,OWCFM)
IS'gname.f Applirmd/C.rIr nxr",a Dram/ EXHAUST HOOD(W/DUCT)
PAID
HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO 100,000 BTU) Date Receipt#
Will the applicant or future building occupant store or handle hazardous material
ns defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety HEATING UNIT(OVER 100,001 BTU) TOTAL:
Cade.Section 25532(a)?
C1 yes 0 N VENTILATION FAN(SINGLE REBID) to
BOILER-COMP LIMP OR 100,0X10 BTU ISSUANCE DA
Will the app...immune is building by the
Auipmir Quality as Maraichemlt ) A A ' '
hazardous yr comaminants es defined by Ire Bey Acte Air Quality Manogemrnt BOILER-COMP(OVER 100.000 BTU) r
'Distract?
❑Yee ❑No NEW RF.SIUENTIAL MECH. SQ.ET. DEC L ����
I have read the hazardous material. 505,25533 under Chapter enit of the Yc(� {J
if the building
Health s Safety Code,avea to 25505.t it is and 25534. 1 understand Wat C�)t
if of be res notcurrentlywhich
m st N met
is myssuanc responsibility Ce notify the V I of VVrL�/'(IIIV
occupant of the requirements which man he me[prior to issuance of a Certific;ne of ,I�rL)
Occupancy. V UW V 1
Owner or authorized agent Dam - TOTAL: ISSUED BY:
OFFICE
Simon Leong TEL N0 . 415 6379829 Dec 06 , 93 13 : 10 P .02
SEQUOIA 1111 Aladdin Ave.
San Leandro, CA 94577
�- (510)6141900
ENVIRONMENTAL (510)614.2923 FAX
Consulting Services
December S, 1993
TO WHO IT MAY CONCERN
On November 29, 1993, Sequola Environmental Registered Environmental
Assessor performed a Phase 1 Environmental Site Assessment of former Sizzler
restaurant. The street address of the site inspected is listed as 10126 Bandley
Drive In Cupertino, California. During the inspection the floors were observed to
be of ceramic tiles on concrete subfloor, The walls are glass or wallboard or
brick or aluminum In the kitchen. The ceilings are wood or wallboard or ceiling
tiles of 2' x 4'. Some pipes and all air duct insulation were of fiberglass, The
water heater was not Insulated. The roofing materials are tar and gravel. The
Joints between the roofing materials and the heating, ventilation, and air-
conditioning (HVAC) system units may be cemented with adhesive. These
materials were not friable and appeared to be in good condition.
Sincerely,
Sequoia Environmental Consulting Services
Chris 'WabuzoF r
Senior Geologist
REA 602842
Servioy people and the Environment ORary[Iou Fes,