B 0609 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
JIER
OF CUPF,RTINO - RUILDING-ELECTRICAL PERMIT NO.
BUIL(DING DIVISION APPLICATION/PF,RMIT PLUMB NG MRCIIANICAI, �ppppL QO' �f y,�.Ly.y,pJyL
r"'{ra r' ''<pU1LDIN1:'PItOJIrC'h IDI!MI'IFICATIOry';r fj,j/ �OO VwI)vV�I r�'V g Lv�TL
G ADDRESS; G -// SANITARY NO. APPLICATION SSUUHMITITL DATI
9 gbo St�UGn S /SCLk DUN Q7'2�a
NAME: PHONE: C N'I RACTOIfN F:: LIC NO:
NIC CONTROL k
CH�EGT/I!NGIN R' LIC N(1: Dltl?Sti: '
�ullso, ,As>a4 0 41,4o-ti.: st
',NTAC'In PHONE: b RUII:DINGPERMIT INFO,
-
❑.Consultant Fees Paid by Applicant(Initial) 131 DO IiLECT PLUME - MECH
LICENSED CONTRACTORS DECLARATION t yPERMIT!,.r
QTY.. ry, f)I ELECTRIC , C64
C 1 herchy alum,hal 1 am licensee under provisions of Chapter 9(commencing c lire / _e _ . i _ c_ , lir,- JOB DF,SCRLPTION
Z 3 s. �.s ane ilio anam beamed. .. )P TI
wi1.11 m..( Divisil n.of the Ru'n Y RESIT I. AI:
uIp - PERMIT ISSUANCE
H in lull lbrca u,�. ❑SFDWI. El KITCHEN REMODEL
ce
ase Clnsl Co
Crdrvcmr ES
Z APPLIANC -RESIDENTIAL ❑ ❑
ADDITION PLUMBING RI PIPE
E m Da - ..m
'n4L ❑MUI:I)d1Nl'T - ❑MODE STRUCTURAL
As shall
DEO blit c ON
Z O r4 z I nndersmnd my plans sM1nll M..red as public records PANTO.$ + CHIMNEY
REP
O Z'3Q UP TO 20()AMPS ❑IMPOVE ❑S IMMINGP OL
f r3�W Licenred Prefirsorml - 201-1000AMPS IMPROVEMENT SWIMMING POOLS
as1�� OWNIiR-PUILDER DECLARA'T'ION OVER IIXro AMT'S ❑BATH RF,MODEUREPAIR ❑DEMOLITION
,Y C G 1 hereby amen that Iwm exempt from the Cann xuas License Law for the
5Z a U following mama(Spain.](131.5,Business,md Profusions Code:Any city or enuety SIGNS ELECTRICAL El TO HER
W 3 LL which mclarms a permit to construct,alter,improve,deardo ,or repair any structure
mono its issuance,also requires the applicant linsuch permit to file a signed smtemem SPECIAI:cptcu r/mp;c.
that be is llcemredpnrsuant mlhr On"vioe,of,he Canlfaclue,Licemc Law(Contain
yjCd'7e,m,ncndngwva
ith Sc0110m),sf Division 3ofthe Business and Profe)o
eiaions Col , TEMPMETER OR POLE INST COMMERCIAL:
M aIV that he is exempt therefrom and the basis for the alleged exemption.Any violation of [INEW BLDG/AUDITION C1DEMOLITION
.w�y•Sedion]031.5 by any andicam for a pefmilsubjec,a the mplican m,l civil Pahl,el POWER DEVICES ❑TI:NAM C)FOOD SERVICE
Fnm n om,hon list,hundred dollars(SSW). IMPROVEMENT C ❑
1.le,owner of the property,or my enployces with wages re,theirsole compensation, SWIMMINEj&9lLEcpRIC
will dmhe work.andmi,opa om is no,owmlml omffemd for sale(See.]044.Business ❑0'fHE12
a
0. and Professions Cede:The Contractor's License Law does not apply m an rnvner of OUTLETS-SWI' �/
IX' RES V+��J
property who builds or improves thereon,and who does such xmrk himself lin through
' his own employees,provided that such improvemenrs are not Emended m ol1'emol for NEW RESIDENTIAL ELECT SQ Cr
side.11,Imwevem,he b..ilm.,ou t mormert in,old withinone yearaf compiation,'ha /+..PT.FLOOR AREA $/&Q.Fr.
owner-milder will have the burden of proving that he did not build or impmvc for pur-
pareof al
pp I,m awnur of We pmpcn,at,,csclmivcly wnnuning with Iiccn.eJ commc,nrs to TOTAL:
lin tat t the nemeo(Sec.VDaJ Businessit Profess em C d )BT C t woo ss L' - --{
can W J trpplyt fproperty whobuflds 'mp :lute ad QTY. ft f1pLUMHINC-f ERMIq' F ��
wb(contractsf eh pnjecm with ac ations)I cunedpursuant t theContractor's - - Jnr
21
License Law, 1999
PERMIT ISSUANCE
C1 am cxampt undc,See. ,B&P C for tMsrenar. 47
AMIt-DRAIN&VENT-WA HA) VA - )N
Owner Dae '-
WORKER:S COMPENSATION DECLARATION BACK FLOW PROILC'I'.DIiVIC13
1here]y will
mai an am Ctrimeofperjuryencn elf-instar,
lfinst ,fee Worker's
Camilla-an,]dwie forbyetion TOM of me Labor Cod.for the Worker'sce of the DRAINS-PLOOR,ROOP,ARI3A.CONU. 'TYPECONS'IRUCTIOD
Sq'OR S
ation, r provided for by Section 3]11(1 of IsMr Cada for the perfisrmnnce of the -
Fl I farwhich Thispermitis Issued FIX'TUHF.S-PER'IAAI'
I have and will mcimuin Workers Compensation Insurance,as required by Section -
3700ofthe labor Code,for the performaomm'the work for shich,hi,permit is issued. GAS-IIA.SYSTEM-I INC.4 OUT'UlS OCC GROl1P APN
MYet:Work gt `.pcnNinSkti t�tpicrrfi,,No.,_ ler1rig39 369oSov�
!!�� '4 Polioyolic: 7ff WF GAS-1?A.SYSTEM-0VER4(IiAI
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASF/INDUSTRI.WAS'TF,INTERCEPTOR COMPENSNOON INSURANCE _ RUILDING DIVISION FI?ILS
(1'1hisse,lin 0 need not be completeddlhapermd its forme hundred dollars($10d GRI?ASI3TRAP
,or lest IT ANCHECK PER
I certify that in me performance at the work fur which WEsprnait i.....eOf.I,hall SEWER-SANITARY-STORM EA.200 FT.
not employ any person in aB ntamner so nm s become%object,o the Workers'Compcn ENERGY PEE
Z Indoor laws of CaGfomia Dae WATER HEATER WNEIGUELECTR - GRADING PEE '
0 Applicant
M NOI ICI:TO APPLICANT:If,after making this Cerlifiam of Exemption,you should WATER SYSTEMIGRENPING -
a , become suhiect to the Workers Compensation provisions of the Labor Code you mast SOILS IEE
forthwith comply with such provisions or this .it shall be Acemedrevoked. WAT17R S13RVICE
a' CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLMIi. SQ.IT. PAID
5) I hereby affirm that hen is a construction lending agency for the performance of Date Re np
the Werk for.rich this pumtit is ismcd(See.30)],Civ.C.)
OLander'.Name _ _ TOTAL:
0 4 Lender',Address .'TOTAL:
•� 1 certify that 1 habe read this application and state that the above infomwtion is n .. BUILDING FEE
F U7J anrem.last=?o comply withull city Emit county ordinances and state laws rdadngm QTY , MECHANICAL PERMIT 1.�' 1 FEC' "fs
'U 7- building construction,and hereby authorize representatives of this city m eater upon me . +'' t'• SEISMIC FLEE
shove-m'almard property for ardr ctiun purposes. PERMIT ISSUANCE
(We)agree to save,inm
denify and keep tradition,the Cry of Cupertino against ISL EC1'RIC IEE
liabilities,judgments,costs and expenses which may in any way accrue against said City ALTER OR ADD I,MECH. PLUMBING FEE
in asequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIP(TO I(LI CFM) MECHANICAL PER
SOURCE REGULATIONS.
�/ S'-z/-f AIR HANDLING Clod I'(OVE.R 10,010 CPM) CONSTRUCI'ION'I'AX
Neuronic id A•pplicunVConlmcmr Date EXHAUST HOOD(W/DUCT) HOUSING MITIGATION FEE
HAZARDOUS MATERIALS DISCLOSURE
Will th,,diend or hums building oreapw,amrc or handle hazardous mrmrial HEATING ON]'T(10100,000 IITU)
as defnee by the Cupertino Municipal Cole,Chapter 9.12,and the lfealth and Safety
Code,Section 25532(m? HI?KUNG UNIT(OVER 100,000 ETU)
YO, 0 No
VENT]LA'1']ON PAN(SING1,13 RES ID) PAID Dale Receipt
Will the...icsmorfuture building+v .,.I ase equipment or devices which p01LER-COMI'(311P OR IW,OW ETU)
mil haeardeu,air contamdefined
contaminants a, by the[toy Area Air Quality Management TOTAL,.
Benin^ ❑OILER-COMP(OVER 1X),000 BTU)
❑Yes Fl No
I lime real,bc humid.....mamrials mgnirememx under Chapter 695oftbe Ceti- AIR CONDITIONER ISSUANCE DATE
fomin Health&Safety Calc,Sections 25505,25533 and 25534.1 understand that dire NEW RE.ti1�13NT1AL MIiCI1. SQ.t1'.
building dies not currently have a tenant,that it is my mepeaslbllity turnout y em eccupmn
of the myuimmcntx which,nuM he n,ct prior m isawmce of a CamiOam of ouupmny.
S->_/—f o
OwnerarootharizN..gem Doe TC1TA1^ ISSUED BY,
OFFICE
May-/1'2-99 06: 3 P P . 03.
S1 All: Or (:Al II'QRNIA
SKATE BOARD OF EQUALIZATION WILHAMM BENNE71
10711 R S I RFE I,SAC RAM FNtO,CA LIPORN I A
Po BOX 942870,SACRAMCNI[i,IIAOFURNIA 94279 0001 len ADS11COMAN
Telephone (916) 445-7393 ERNEST I DIRMLN8uluo, IN
1111.011111...I.S
"A I I I IF W N 10i4G
September 4, 1991 ......... 1114JR11 1,,,A g,,
GRAY JAVIS
E .HOFFMAN ENTERPRISES INC.
ATTN: STEVE HOFFMAN
1275 LINCOLN AVE . . #4-C cmnynAmno
SAN JOSE, CA 95125
Account No. : HA HQ 36-041314
Site Address: 19960 STEVENS CREEK BLVD.
CUPERTINO, CA 95014
EPA No. : CA0000634344
Dear Mr . Hoffman:
The Hazardous Waste Tax Account Number listed above has been assigned
Pursuant to your recent telephone call to this office, This account number
It used when completing Section B, "State Generators
10", on your California
Uniform Hazardous Waste Manifest and informs the disposal Facility that you
will be paying the disposal fees directly to the Board. If there are any
errors on the above account, Please make the necessary corrections and notify
us by copy of this letter .
Attached is an informational notice and applicable rates for the Hazardous
Substances Tax Program.
If you have any returns/schedules due or overdue, they are enclosed with this
letter . They should be completed and mailed back to this office within
Fifteen days. Otherwise, they will be sent to you according to the schedule
on the attached insert. These forms will Include further instructions which
will aid you in their completion. When you are no longer generating or
disposing of hazardous waste, please notify us so that your account can be
closed.
Please keep this letter for your records as confirmation of registration. If
you have any questions, Please contact us.
Sincerely,
Nichole Hansen
Program Technician
Environmental Fees Section
Special Taxes Division
nl
Enclosure
\W� '
7659
May- 12-99 06 : 34P P _ 02
Plno Inlnt or 1YDw. Farm deelpnad for Uee on ellla(12.pifcn rypnw,ller). �_
UNIFORM HAZARDOUS Denerslol'e US EPA 10 No softest 2, P,ge I Inform,noa to the shaded areas
WASTE MANIFEST '� 3 Y/' ODJ�7 i I/ a y
eI
Is not required h Fednnl Isw.
3. n rani a Name e d M&HIA9 Addle ,� A. &lata Maall DOou"S1/ yy.,
/t"IeAo'O" �.ev !l" .:� r, : 1� s/aS 711�1GZJJ
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1. Generetoi s Phone(Pole) -2113- 37V,7 ra. sten era '0 � I Y
6. Transporter 1 Company Nem. a. UP EPA to Number 0. &tete IaMPb1M'e q „i.
BATIORAL >ZNTI RO NTAL COTraneWse.11shIMI 922_9184
uJ f. Temnspeder 2 Company Name 6. US EPA ID Number E. Stale Tf4NpMar'e ID
'SYQgl' F. Tra sporter'e licharke
g. Designated Feclllly Nome and Silo Address 10. Us FPA In Number G. Slate Faallil ID
5011 SOLID WASTE, INC. �'�' 4. f s
(4j 1670) CA"RIPGE RD. H. Facwte'o Phos.
LANDRAGON, CA. 95007 (916) 347-3136
�.kO 12. cmdalnen 13. Total Il 1.
tya Iw 11. IIS DOT Doncelpllon(Including Proper Shipping Name,Natard Cross,and ID Number) Ousalty Unll Waste N0.
..,e.1 No. Typo Wt/vol
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CV" o (ASBESTOS) 1
e R Q SAZARDOUS SUBSTANCE, SOLID, 1108, ORN—E NA9133 7 EPA/ M
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aP IS Sitocial Heading Instructions and Additional Information
2
€ OMVED RESPLILATORY EQUIPMENT AND PRUTSCTIVN CLOTHINC.P,H6RQHHCI( CONTACTI 1-300-533-5053
J
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GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name
J
and are classified,pecked.marked,and labeled,And are In all raepecla in proper condition for transport by highway according to sooficable Inlemallonal and
0. national government regulations.
II I em a large quantity gen.r.loc Ica"that I hoyp a program In place In reduce the volume and toxicity of walla generated Io the degree I have determined
To be economically practicable and that I hers selected the pn Clleeble method of Irearment,&lenge,or disposal currently available to me whI h minlmtr•, he
present end future Ihn•1 to human health and the environment;OR,11 I am a smell greatly generelw,1 have made a goon lath ellen to minimize my weal.
U
> gensragon end select the Deer waste management method Thal le evnllabte to m"and nn1 I can afford.
uZi Priniedliypad Nnme &Ipnelure
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w /r?a..y 4-1(' C a k I !'.. �_---� _/� 0 9lot9 9 /
WT 17. Trensponer I Acknewladoement of Reeeipt of Mnlenab
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N PykaealTYPed NameI i ylgr,ilure l ' %, Mrnlfln DeY Year
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w O 19. Transporter 2 Acknowledgement of R.celpl of Materiels
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1 20. Feollily Owner or Operator Certification of raeelpl e1 hazardous mltmi.la r—m,d by this m,nlfoel except is noted In hem 19.
T
lad/TYPed Name _ naive& OetIn V•ar
aoxz A Do Not Write Below This Line
EPA 6701-22
(Rev.6.65)Prsyteus editions ere obsolete.
Yellow; TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS
May- 12-99 06: 34P P . 03
(�� .v— r4 I I'tp c) Cl1 r"L .r IE MAnileel L 2. Now I Inmrmnllon In the ehn4nd ergine
/ Document No.,
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No. Type wl/vol
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And nra clu.lnn. pnakad.mnregd,and Iwhnleg,and qre In All rnaPAPIA In p,nnar cnndidnn for fir...nnd by Nnhwny aeemdop ro 0101/0611 lm�•nminngr And
N nAllnngl pevmnmanl rn Pnla11o1A.
If I am n Imp.duen0ty Paneralnr,I Cedlly that I have a prnprnm In plan
In rrduq•Ing vnlOm• n I
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TO O tlrahin m.lhoq nl hanrm.nt,!lnrwpP,A. di.nnanl mrrr.mty avAIINN•In m.wna6 mmhnb..1h.
prawns end lulus 1,l VI lO human hema ga Ibe nnvironmont;DR,II I Nn A Amall p.nnnriq......... I hnva madq p pond lalln ellnd 1n mlr�mtrg my wAA r
i V oennr.tlon end wwbcl Ino hang wentw menep.mwnl metnnd that le Aved.hla 11 Han and Ihn Iran allord.
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"a.S-RpI Previnuw ediCong ern dbenl.11.
YELLOW. GENERATOR RETAINS
May- 12-99 06: 34P P . 04
NATOINAL UNION FIRE INSURANCE COMPANY
Certificate of Liability Insurance
• Certificate Issued-AQ, Named Insured:
The Hoffman Revocable Trust. The Charles Schwab Corporation/
1275 Lincoln Avenue Charles Schwab & Co. ,Inc./
Suite 4b Schwab Holdings, Inc./
San Jose, CA 95125 Mayor & Sdrweitaer, Inc.
Office of the Corporate Counsel
101 Montgomery Street
San Fran-isco CA 94104
Re: Use of premises-19960 Stevens Creek Blvd..
'This is to certify that the below designated policy has been issued by the Companies
indicated and is in force an the date borne by this certificate. The policy indicated
herein applies with respect to the hazards and for the coverage and limits of liability
indicated by specific entry herein, subject to the terns and conditions of such policy.
This certificate is upt an irzsuranoe policy and does not amend or alter the coverage
afforded by the policy listed on this certificate
Coverage• Commercial General Liability ins�ame
Policy: National Union Fire Insurance Co. Poligy fRMGL 121-71..,E
Term: April 15, 1995 to April 15, 1996
Ldy t of Liability $1,000,000 Combined single Limit for bodily injury/property
damage each occ•urrenee, subject to policy aggregates where
applicable
• -Policy insures all operations, premises and activities of the Named Insured imx.:ludinq
liability assumed under written agreements;
-Under the policy, the insured includes: The Hoffman Revocable Trust
but only to the extent and in the amount for which the Named Insured has contracted to
procure insurance and in no event to exceed the limits of liability set forth in the
policy•
should the above mentioned policy.be cancelled, assigned, or materially changed during
the above named policy period in such a manner as to affect this certificate, the
W parry will endeavor to give thirty (30) days written notice to the holder of this
certificate. This rnstificate is issued as a matter of information only, and confers no
SL9iit4on the holder It imposes no liability upon the Company and does not amend,
• extend or alter in any way the coverage or the limits of liability afforded by the
Policy designated herein. Notwitl �tardij2g envreguiement, tegmm._Qr condition of env
contract or otherdocwar with respect to which this certificate is issued the
insurance afforded by the policy listed on this certificate is subject to all terms of
the policy. —__..__
The above insurance arranged through: Date of Issue:, 04/19/1995
Johnson & Higgins of California Cert. : 096
345 California Street
San Francisco, Ca. 94104
(415) 981-6700
(Underscored wording required by State of California)
•
l
i
May-12-99 06 : 34P P . 05
i
September 3, 1991
i
EPA #CAC000634344
State Waste Removal
Tax No. HA11Q96-041314
At the end of the year, they will send
a statement concerning the asbestos
removal . If theca is less than 500 pounds
II removed, no tax is due. Type on
statement the following:
I� "Please close account, less than
• 500 pounds."
If over 500 pounds, then a tax is due
and Charles Schwab will pay the tax.
iA letter should be sent to Mary at
Charles Schwab confirming the above.