S 1691 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
C.TY OF CUPERTINO BUILDING-F.LECITACAL PEµ`p1I']'NO.
— BUILDING DIVISION APPLICATIONIPIERMIT PLUMBING-MECHANICAL. J 1691
• I BUILDING PROJ?C'IIDEPR IFICATION
BUILDING ADDRESS: SANITARY NO, APPLICATION SUBMITTAL DAT
O4 Q�
OW ER'SNAM!affimthat
PHONE: NTRACIOR'NAME; LIC No
rye 'Q SO _22�� AJC.
�O �.(_/ NIL COMI'ItOI.N
ChlETF.CTIEK LIC NO: RES C TA7 ❑
L
CONTACT: PHow?: BUILDING PERMITINFO
❑ Consultant Fetes Paid by Applicant(Initial) IILDG ELECT PLUMB MECH
❑ ❑ ❑
D CONTRACTOR'S DECLARATION QPY - IiLECTRIC PER MIT FEE
1 herebyam licensed under previsions of Chapter 9(commencing .. _ JOB DESCRIPTION
Aon count Swim,7JIIG)of Di....on 3 o�f�u;Bu�sint"tual PmfessdomCuree,and my hetero is RESIDENTIAL:
Won,= PERMIT ISSUANCE
H� mfull faucet J [ F'f/f'7i ❑SIDWL ❑KI'I'CfIP,N RI!MODfiI.
azu Limn.ne Cl coal S APPLIANCES—RESIDENT AL ❑ADDITION ❑PLUMBING RE.PIPE
vEi<W Dae Commcnx
ARCHITECTS DE A DON ❑MULTIANIT ❑STRUCTURAL
Z O A Z 1 unrs
deumd Iny pLne .hall be e,,d as pinia.0J
lu rrx PANELS MODIFICATION
OZ�-M UPTONIOAMPS ❑IN'I'1?RIOR El CHIMNEY REPAIR
W Licensed Prokssion.I 2II-10CRAMPS IMPROVEMENT []SWIMMING POOLS
OWNER-BUILDER DECLARATION OVER I"AMPS ❑HATHRIiM11ODEUREPAIR ❑DEMOLITION
�^C Q 1 hereby affirm that me exmnpt from the Contractor's license Law for Thu
QxC kU Billowing mason.(Section]y w (131.5,Business and l'mtessions Code,Any city orromay SIGNS ELEC'1'ItICAI. ❑CHER
which means a perms In ram mo ct cher,improve,derimled1,on repair any arvcmrc
prior to its issuance,also requires the applicant far such perarinn file aligned statement SPECIAL CIRCUIT/MISC.
Ihul he is licensed pursuunnn the provisions afthe Contractor x License Law(Chapter 9
W 00 (Oonmencingwith Semina 7000)of Di,kia 13 of l Lc Business and Pmfscninns Connors- THMP.ME TER OR POLE INN'L COMMERCIAL:
a 1 c C that he is exempt therefrom and the basis for me alleged exemption.Any violmine of ❑NI"W BLDG/ADDITION ❑DEMOLI'NON
W^vi Section 7031.5 by any applicant lernpemri.subjest,the applicant ma civil penalty of POWER DEVICES [I TENANT ❑FOOD SERVICE
not nam than live hundred Jolles($500),
F_Z i' IMPROVEMENT
x6 � Las nwnund n,prop..ly,or mY...i inyeeswhhwepa hassle ISce, 1144,8 sines, SWIMMING PUOI.IILF.CTItIC OTHER
WFO will do lhe11ion,an,
arummcisnot,Livens m olfetedrnrmii,pb,1.an,msec,as
L 3 m and Professions Codon imp Commmuls License do has nm apply s an owner of OVl'LITS—SWITCHES—FIXTURES
property who builds m waled that
therms,and who arcs meth work himself or through
itssal own however,
the
building Thal such dmpms sold within thin oat intended nr shared for NIiW RESIDHNIAL ELECI'R SQ tn'.
sale.ILbowuvoill have the bur inlpf proven is at hdd i one earel...untq,lction,the _� SQ,I .la nit.n SISQ.FI'.
ser-hildu will have the harden of paving that he did col huilJ or impmvc for pur-
❑El I,r,ratu JUL 14 A T
1,vs owner,of the property em axcluxively contracting with licensed contractors m
con Chao Ilse pre jet,(See.91144,Business and PmreWint,Cone:)'n,e Cunlnaurrn Li.
set Law Aces not apply to an owner of progeny who builds or improves flim-con,and Q'py. PLUMBING PERMIT FEE
who contracts for such projects with a cantmcmes)licensed pursuant to the Contractor's (;IVY Ur uurerluNU
Licemc Law. PERMIT ISSUANCE
❑ I amexmnplundeh Sue ,Bffi PCliil'Ihlsreannu
Owner Vete ACI'ER—DRAIN&VENT—WATER IIIA) VALUATION
WORKHR'S COM se following
ATION DECLANN BACK FLOW PROTECT.
al
Ihave and o will maintainbSection Grine of me Lalloself Code,stun for Workmance of the
DIRAINS—PhOOit,ROGV,AREA,GOND. $'fD12ICS '1'YI'Ii CONS'I'KUC'I'IOb
cation,as which
provided for by Section 3]INI of Net haMa Cade,Tasha performance of me
work fur which thin penton is issued. FIXTURES—PER TRAP
1hoveand will amount her Worker's C ni,cofmion Inmrunrc, lirequired.I Section
3]nn of the Libor Cndc,fonheITrfnml:mw ofthe wnrkfor which thio pennll ix dewed, ❑AS-5A.SYSTEM-I INC.000TLH'I'N OCC GROUP APN
y Wnr arsC 1 meanon insurance--cv$$ierand I'nlic ret ..
Carrier d�{}NGSPaIii No. GAS—EA.SYSTEM-OVER J(FA)
CERTIFICATE OF EXEMPTION PROM WORKERS' Gltl?ASFJINDIIS'fRL WASTE IN'I'EIICIiITOR
COMP12NSAI'[ON INSURANCE BUILDING DIVISION_PIES
(Thi ,ecenon need an,lace npdmaJ ifthe permit is marine hundreddeler,SINN GREASE"m RAP
or less.) PLANCHECK FEE
Icemy that in lire mr-fammucc arthe work forwhich his permit ixissued,Ishall SEWER—SAND'ARY—STrIRMEA,2NIFT.
nuI employ any person In:my murmur ma la IbComber, ENERGY as to becoe sahjee Workers'ComENERGY ITH
OZ mtinn Lows of ColHbrma.Dale WAFER HEA'I'In W/VI!N'DELECTR GRADING FEL:
Z. O Applicant
U1 NOTICE 10 APPLICANT:If,ager making this Certificate of Exemption,you should WATER SYSTI?MURESTIN . SOILS FEE
? became subject endue Worker's Compensation provisions of the Labor Code,you moa
Iimhwith comply with sorltpmvisinns is, permit shall fe Jeunmdmvnked WATER SERV ICI?
aQ
2
CONSTRUCTION LENDING AGENCY NEW'RESIDI?NTIAL i'LMIi. SQ.IT. PAID
rti Date Receipts
L) k o.hereby affirm lhatlherc i.nacun(Set.30 lending.gcncy for the perli:mlance rel
the work Lor which mus permit ix ismmJ(sec.304],Co.CJ
CT, ULeader's Name TOTAL:
W I LendefAJJress TOTAL:
certify that 1 have read this application unit sate that the above information in _ BUILDING Fiili
ycorrect I ayreu to comply with all"t"ad vomay ortllmnrus and slam lawn relating u' QTY. MECHANICAL PERMIT FEE
U z
building umclrvetion,and hereby vuthnrize mprescnmtivm nriLis city to cnmr upon the NHISMIC PHIL
.hove-mentioned property for inspection purpose, PERMIT ISSUANCE
(We)agree m aavc.indemnify ad keep hanaless the City of Cupenirio against ELECTRIC THE
Iiahilitivs,juAgmems,coos and expenses which may'm any way acemeagainasaid City AISERORADDTOMF.CII.
in cnmequcnen of the gnmong of thM permit PLUMBING FEE
APPLICANT UNDERSTANDS AND WILL COMPLY WITH AL1,NON-POINT AIR HANDLING UNIT(I.,IU.00BCFM)
SOU EREGULATIONS. MSCI IANICAL FEE
AIR HANDLING UNIT(OVE.R 10,000CFM) CONSTRUCT ION TAX
I : pphcanl/Cmlractnr ora EXHAUST HOOD WIDUCI') HOUSING MIGATION FI?E
HAZARDOUS MATERIALS DISCLOSURE
Win theappdicotn m future buildingcecupan,ore nr h.ndlebuzurdaus tvvterial HHA'I'ING ONL'f(TO IOII.Igp BTU)
m dcOnml by the Cupcnlnn Man eq,L]Code.Ch:gncr 0,12.and the Heubh and Safety
Code,Section 25532(t)P I IHA'I'ING UNIT(OVER I IIf1,tlI)b 11'I'0)
C]Yl, El No VENGULATION FAN(S INGLE RF.SID) PAID
.r Dare keceipl s
Will the oppErun or future bni their a'mtpanl use equirynent nr Aeviccn which
all mondous stir emumniumus as Jufincd by the clay Are.Air Quality Management B01LER—COMP(311POR (I0,000IT1I!)
O'IAL:
District^
E3 Yes E]No BOILER—COMP(OVER 100,0001311D
AIR CONDITIONER
Health
seta Thr lamNoo.tions 55 5,455 .1 and
cad e 4,5 of me folie ISSUANCE I I /
fnmia Hcelih ffi SafetyC:xle,Sections 255U5,2553)and 25534.I unJenamJ the,if the NEW RESIDENTIAL MIiC11. SQ.IT.
buildingdwx entswhich hove a Ien.npmalo ismyce ofa ern eanotifythepancy.m
of the requirements which must M n¢I prior to issuance olio Cenificaa nl Occupancy.
Ownermatimmized agent Ilam TOI'A L: ISSUED BY'.
OFFICE
JUN 18 1998
y'SPCLARA c�G� F E DEPARTMENT
ye7 FIRE a` S NTA CLARA COUNTY PERMIT ISSUED: 6/16/98
\+ 700 Winchester Blvd., Los Gatos, CA 95030-1818 PERMIT EXPIRES: 12/16/98
08) 378-4010 (phone) • (408) 378-9342 (fax) FEE PAID: $90.00
DATE PAID: 6/2/98
,cnsm,
20999 Stevens Creek Rd Cupertino
N.vro ar B,din�s
SHELL STATION
THE BUSINESS LISTED ABOVE, HAVING APPLIED PURSUANT TO
THE PROVISIONS OF Cupertino Municipal Code, Chapter 9.12NOTICE
IS AUTHORIZED TO COMMENCE WITH THE FOLLOWING PROJECT: =Tx+ RjawY nor i'<ti rnr.:.
ptocr g4nytico*e"gwcd yImo ,(
Piping only UG IlazMat Closure nnAunor rmnsJemblr Ang ehung
m rht ust oriircupnnry oJPrvmt�a,t°"'
s1w71 rc
SUBJECT TO COMPLIANCE WITH APPLICABLE CODES AND ORDINANCES
AND THE FOLLOWING CONDITIONS:
PR 98-1588
ANY"OLAnONOF',FIFSI.MOWSIONSMAYBEGROLT IORRR OCAMT OFt'1 ff
ERMIT
98- 1588 POST ON �„"„ Divisk"
PREMISES 1[ BAKER, RICHARD 133
Wayne Perry Inc.
Attn: Steve Nicholson
8281 Commonwealth Ave
Buena Park, CA 90621
DISTRICT PLANS SPECS NEW RMDL AS OCCUPANCY I CONST,TYPE PEflMnTEE DATE PAGE
CUP 0 ❑ 0 El El Wayne Perry Inc 06/16/98 1 DF 1
SECJFLOOR AREA LOAD - DESCRIPTION BY
UG HazMat Closure Baker, Richard
NAME OF PROJECT LOCATION
SHELL STATION 20999 Stevens Creek Rd
A California fire Protection District serving Santa Clara County and the communities of
Campbell, Cupertino, Los Altos, Los Altos Hills, Los Gatos, Monte Sereno, Morgan I-1111, and Saratoga