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03020106 CITY OF CUPERTINO 'n - ' tt'Yyyzhn'' BUILDING DIVISION PERMIT pop" Btlllig`aTnDlbRs:DE ANZA BLVD PERMIT NO.03020106 UAt,"IC RICHFIELD/ARCO GAS P°Nd'rLsUr7A 9/2003 PHONE: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BIAG ELECT PLUMB MECH MOO LICENSED CONTRACTOR'S DECLARATION Job Description inFF 1 hereby affirm that I am limned under provisions of Chapter 9(commencing nz`uj with Section 7000)af Division 3 of thc Business end Pirfessioas Code,and myliccnu is rnmeanyret. 780 TI--REPLACE TANK TOPEQUIP/PRODUCT & �gz License C-liy/DC.ZI Lie.N Z;:, °a 1 20aRcxlrncrso o` AnoN VAPOR LINES/DISPENSER/ISLANDS/LEAK MONITOR SYST a, dersmndmyplaushallheuscaesPuldiciamids CONTRACTOR: SLUNAKER CONSTRUCTION . ;O Limned Pmfcssionel OW NEmBUILDER DECLARATION 2I 1 masa affirm that 1 1. ,sumps from the Cnniacm o License city O for the \ o O r0lowing mason.(Smit t 9x13 L5, t.Mon. and rte.dernu Code:Any city or county \� O m which requires a permit rc convrvct.eller,imports.demolish, fie.sig any-Imetine cement v Z PA.,b its issuan.,alto requite theviso.o for such permit W file. statement ts3s< (that Com purstiant cpuvislain the of nmrmataWccnuLaw(Chep 9 Sq.FL Floor Area Valuation (Comm inning with Section 7W0)nf Division 3nf the Buzinut and Professions Cmfe)or c that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant W a civil penalty of APN Number $ Type not mom Nan Eve hundred dollars(8500). I,uowrer of the property.or my cmplvym with wguastiseir sole compcmtien, willdo tiework,and thestmctom isnot Initiated oroRcmd forsale(Sec.]DCA,Busitm 3 2 6 10 0 2 8 . 0 O .and professions Co . Code:The ConumU.r.utaw does not apply W an owner or Required Inspections prapenywho builds or Improvezthemon,and who dmssuch workhimtelfm fortnight his own employees,provided thatneh improvements are not intended oro@red formic.It. 101 — FOUNDATION however,the building or improvement is sold within one year of compledon,Ne owner. wader will have the wmen of proving that he did not nand or Improv for i n roe,of 102 — PIERS sale')' 103 — UFER ❑1.as owner of the pmWny.am exclusively contracting with licenud rnnuacr na 10 construct the pmJect(see.7WA,Business and Pmtcssioo Code:)The CobaCteri Lb 104 — REBAR .nse Law dots not apply W an owner of property who wilds or improve thereon.and lOS — ANCHOR BOLTS who convects for such pmjeeu with a contractor(s)Emitted pursuant W the Convaetofs License Law. 106 - SEWER & WATER C1 rt I aexempt under See .B B P C for this mason 202 - UNDERFLOOR PLUMBING Dita203 - UNDERFLOOR MECHANICAL WORKER'S COMPENSATION DECLARATION I hereby elfrm under penalty of perjury one of to following declaration. 204 - UNDERFLOOR FRAME ❑I have end will maintain a C.Ofieam ofconxnt to self-.sum for Wotrch Compcn- 205 — UNDERFLOOR INSULATION moon,as provided for by Section 3700 of the I<wr Code,for the po formance of the 3 01 - ROUGH PLUMBING W for which this permhisias.e. 302 - TUB & OR SHOWER ❑1 have and will maintain Worker's Compensation luunnce.u tequirW by Seniors 3700 oflhe labor Code.for tow perform...of the work for which this permit is iuuW. 303 — ROUGH MECHANICAL MyW.fte,Compermtkin I....candor and Policy numbers.: 304 — ROUGH ELECTRICAL carver: 5iJ+TE FuND PnBry N99.: 22E`i3-Lao3 FRAME ;% CERTIFICATEOFE%EMPf10N_FRYIM WORKERS' 3O6 — HOEDOWNS )U COMPENSATION IN$bbKKANCE or 4as)(This ucdmr recd not w completed lithe Permit is for one hand.-0dollars(SIM) 307 - INSULATION I certify that in the perfoonanct,of the work for which this permit is Witted.I shall not 308 SHEE TROC K employ any person in any ma.neranas to become subject to tis Workers'Compensation 309 — EXTERIOR LATH Laws of California.Da.Applint 310 - INTERIOR LATH NOTICE NOTICE TO APP LICANT:IL afarmaking n p Croons.of Exemption,es youthoulJ 311 - SCRATCH COAT become subjectrep.the Woher'a Compensation previsions of tow Labor Code,you must .JZ forthwith camplywith such pmtisionsprthis permit shall wd.mcdinvoked. 313 — ROOF NAIL ZO - CONSI'RUCTIONLENDING AGENCY 501 — FINAL ELECTRICAL ENERGY F I hereby affirm that Vert is a eansvuction lending agency for the Performance or 502 - FINAL PLUMBING ENERGY G' the work for which this permit is issued(S..3097,Civ.C.) Wry q Leader's Name 503 - FINAL MECHANICAL ENERGY PZ <naeriAaams 504 - FINAL BUILDING ENERGY U O 1 certify that I have mad this epplicad..and mule thn the above information ts 505 - FINAL ELECTRICAL F commit.1 agree to comply with all city and county ordinances and sec¢laws misting W p U ImMing construction.and hereby auffiorin nepmrionstives or this city to enter upon the OGASSTW ehovc-mentioned to artysave fon emnifyan pump ha. (Wc)agree a arty,indemnify dna keep hmmless Ne City of Cupertino against 0 7 ' 7i liabiliOeAjudgment,costsandarena..whichmayinanywayacmeagainstacidCity 5 ICAL UZ Inconsequence of the granting of this Permit. APPLI�GAv NT UNDE�R¢STANDS AND33a��III�QQL COMPLY WITH ALL NON-POINT Issued by:5 Date Rd'RRB�ULzIn1'IpN�Ss�`C 9/03Re-roofs PLANNINGr acanUConumbor 'Date 51.4 PUBLIC WORKS v HAZARDOUS MATERIALS DISCLOSURE Type of Roo Will the applicant or future building occupant store or handle ha mous material defined by the Cupertino Municipal Code,Chapler 9.12,and the Health and Safety .Sado.25532(07 All roofs shall be inspected prior to any roofing material being installed. ❑Y. a1Na Will the applicant or future building occupant esu equipment.devices which If a roof is installed without first obtaining an inspection,I agree to remove emit harardnus air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? � ❑Yes uird I have mad the havaMnwsma.rlels.quirementa under ChePlyr 6.95 of the Celifor- .ia Hmlth&SafctyCode,S=Nou255U5,25533 mdn5M.1 end. Om if the Wilding doer oat eine9,Wd m an Nes It it mf uihilhy tar notify tM scxvPant.f the mgaimmc wm metpdormi.m r.ccrdrmleorae ancy. Signature ofApplican[ Date A. G.�l+.. Ow r p(.am .gent Date All roof coverings to be Class "B"or better • e ® CITY OF CUPERTINO Item 1 of 1 PERMIT RECEIPT OPERATOR: conniew COPY # 3 Sec : Twp : Rng : Sub: Blk: Lot : APN . . . . . . . . : 32610028 . 00 DATE ISSUED. . . . . . . : 04/29/2003 RECEIPT # • . . . . . . . . : 21713 REFERENCE ID # . . . : 03020106 SITE ADDRESS . . . . . : 10625 N DE ANZA BLVD SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : ATLANTIC RICHFIELD/ARCO GAS ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . . , RECEIVED FROM . . . . : TAIT & ASSOCIATES CONTRACTOR . . . . . . . : LIC # COMPANY . . . . . . . . . . : ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : , TELEPHONE . . . . . . . . : FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL - - - - --- - --- ---- - - - - -- ------- - - - ---------- - - - - - ----- - - - - - - ---- BPERMFEE VALUATION 160, 000 . 00 1028 . 00 0 . 00 1028 . 00 0 . 00 BPLANCHK PERMIT FEE 1, 028 . 00 873 . 80 873 . 80 0 . 00 0 . 00 BENERGY PERMIT FEE 1, 028 . 00 308 . 40 308 . 40 0 . 00 0 . 00 13SEISMICOM VALUATION 160 , 000 . 00 33 . 60 0 . 00 33 . 60 0 . 00 PPERMITFEE FLAT RATE 1 . 00 35 . 52 0 . 00 35 . 52 0 . 00 EPERMITFEE FLAT RATE 1 . 00 35 . 52 0 . 00 35 . 52 0 . 00 MPERMITFEE FLAT RATE 1 . 00 35 . 52 0 . 00 35 . 52 0 . 00 - - - ------- ---------- ----- - - - -- ----- - - - -- TOTAL PERMIT 2350 . 36 1182 . 20 1168 . 16 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER -------- - ------- - ----------- - ---- - - ------------ CHECK 1168 . 16 14031 TOTAL RECEIPT 1168 . 16 s 03/13/03 16:11 $4087773333 _ CITY CUPERTINO 0002/008 SANTA CLARA COUNTY BOARD OF DIRECTORS DISTRICT MANADER.ENBINEER 20065 STEVENS CREEK BOULEVARD, BLDG. C J"M-OATTO,PRESIDENT MARK THOMAS&COMPANY,INC. CUPERTINO, CA 95011.2350 DA JOSEPH P.BROWN,SECRETARY DISTRICT COUNSEL PHONE (400) 253.7071 • FAX (408) 253-5173 WILLIAM A•BOSWORTH WENDFLLH.HERR,JR ATKINSON•FARASYN, LLP CLAMS B.14 R'uSON March 7,2003 File: CuSD—MOP Building Dept.—Cupertino Community Development Department—Building City of Cupertino 10300 Torre Ave. R�i CF..TV rFD Cupertino,CA 95014-3202 �� 9t n3 Subject: Gas Station Upgrade 13Y- Name: Arco Address: 10625 N. De Anza Blvd APN: 326-10-028 Control/Plan Ck No. 11980 Permit No. 03020106 ® The Cupertino Sanitary District has reviewed the plans for the subject project: • Sanitary sewer is available and the existing building is connected to sanitary sewer, see conditions/requirements listed below. The following Conditions/Requirements are made: ® Videotape Inspection of the existing New Cleanout,Point of Connection and Street - Lateral is required prior to passing The City of Cupertino Final Inspection. Owner to call - District 48 hours prior to video inspection to schedule a District Inspector, H Plans shall be reviewed by the Industrial Waste Division of the San Jose/Santa Clara Water Pollution Control Plant. Phone 408-945-5121 for questions and to schedule a plan appointment. Please Do Not Issue permits until pretreatment recommendations have been forwarded to you by the District. m Verify existence and serviceability of an existing backflow protective device. • SUPPLYING SANITARY SEWERAGE SERVICES FOR; CRv OF CVPERYINO.PORTIONS OY TNF CITIES OP SARATOGA,SUNNYVALE AND LD]ALTOS AND SURROUNDING UNINCORPORATED AREAS 09/19/09 18:11 '$4087779999 CITY CUPERTINO 2009/008 "Y SANTA CLARA COUNTY BOARD OF DIRECTORS DISTRICT MANAGER-ENOINEER 20066 STEVENS CREEK BOULEVARD, SLOG. C .IOHNN.OATTO,FRESIDENT MARK THOMAS&CO.INC. CUPERTINO, CA 06014-2660 DR.JOSEPH F.BROWN,SECRETARY PHONE (400)269.7071 • FAX (406) 263.6173 MALIAN A.S05WORTH DISTRICT COUNSEL WENDELL N.KER1L JR- ATKINSON•FARABYN, LLP CURTIS S.HAPJMN Page 2 March 7,2003 File: CuSD—MOP Building Dept. —Cupertino Subject: Oras Station Upgrade Name: Arco Address: 10625 N- De Anza Blvd APN: 326-10-028, Control/Plan Ck No. 11980 Permit No. 03020106 Storm water from surface or roof drains, other general Surface runoff water or condensate from . , r any residential HVAC equipment shall not be discharged to the sanitary sewer. NOTE: Contact CuSD for"OFF-SITE REQUIREMENTS" OYours very truly, MARK THOMAS &COMPANY,INC. District Manager-Engineer k4P By Carl H. Beckham CHB:va cc: BP West Coast Products, LLC Retaining Marketing Division Jason Chou,Assistant Civil Engineer,City of Cupertino-Public Works e 3 II I'I'I.T I NG v,�N I'l AI;Y R`1,k Ari F. SI'It C I CI',1 1'701?: rn'Y nr t'I I'Y.lrglp:n.I',AU Ins INTI 11.VI Ill's wv s.kif,I'I?XiA m C.'-Vv.%)l: %;qI I.r iS.u;(r S .l'�11J.11i KI(WPO)@di I^:ICPutt It 1,,11G1 nIUL.\6 Mr.David E. Ross Cupertino Sanitary District 20065 Stevens Creek Blvd. . Cupertino, CA 95014 Subject: XXXX 000 rod w-p 06/// xxxx /O&zs N. DF 41074 �3c_tJO . XXXX Plans submitted to this office show the following sources of wastewater to the sanitary sewer: e 12r SC�lr�P6t TD Tim C/l�Ll�ril P[ 0411 . The following shall be required: Na v/2eNeu-rS Comments: If you have any questions, please call meat(408) 945, X49 S3 3 Sincerely, XXXX • Source Control Inspector • PLAN CHECK SAN JOSE/SANTA CLARA WATER WASTEWATER DIS CHARGE QUESOT ONONAOL PLANT All users which discharge to the San Jose/Santa Clara Water Pollution Control Plant are required to complete a wastewater discharge questionnaire. Use current operating data, if available, or you best estimate based on similar types of businesses. Answer all questions to the best of your ability. 1. Facility Name: C' 0 E 2. Address: /061-.5 N Mlk �E z� .3. Name of Manager/Owner: P {� a D '�i/ 7F,1 '0 4. Building Owner and Telephone C� G C y2 —C� 06006 .5. What is the nature of business conducted at this address: DUEL 5o,L&S NLVro mDBtLf, .t1SPA iZ 6. List any products that are manufactured at this facility: S7. Do you use any water in your process(es)? ❑ Yes [4 No -If yes, list the process(es) which will produce a wastestream discharge to 1. The sanitary sewer Loo 7 —<s , 2;- Th'6:8torm sewer IY14-7 8. Estimated amount of water disgharged to the sanitary sewer from your processes) in gallons per day: /1110Cya / CS �O, SLZ 1 7./ A�✓� 9. Wastewater generating activities/points of discharge: (Check all that apply) Sanitary Facilities ❑ Photographic Process ❑ Automotive Repair Machine Shop ❑ Printing . ❑ Parts Cleaning F1Steam Cleaning Vehicle Maint./Washing ❑ Floor Drains ❑ Sign Painting E] Fumiture/Paint Stripping ❑ Painting ❑ Boilers El Chemical Formulations Silk Screening ❑ Solder Leveling ❑ Wave Soldering ❑ Board Washing ❑ Laboratory Drains ❑ Electro-Polishing ❑ Pharmaceutical Manufacturing ❑ Compressor Condensate ❑ Groundwater Remediation ❑ Cooling Tower Blow Down ❑ Other (explain below) • �'IPiA)Cs 406 ��• �0 K EPL�i� ELII{ '. REV. 6114196 C�el1(60EL� MAR-18-2003 TUE 0925 AM WATERSHED PROTECTION FAX NO. 4089453000 P. 03 • 10. Do you currently have any type of treatment for your process waste stream. Such as clarifier, filters, pH neutralization? ❑Yes, ,fig No. If yes explain: 11. Are any solvents used at you facility? p Yes, No. If yes state how are they disposed. 12. Are any solid wastes other than standard refuse generated at your facility (such as solid hazardous waste etc.)? ❑Yes, IA No. If yes how are they disposed? 13. GAS STATION: If you plan to upgrade your station... A. Are there any floor drains from the work areas? p Yes, R No. B. For car wash: Is there a grease interceptor or other grease removal device already installed? p Yes, ❑ No. No GA2Wr,&v\ C. Will any steam cleaning of engines be performed on site? D Yes, ®,No. ® If yes, will any water flow to the sanitary or storm drain? ❑ Yes, No. CERTIFICATION STATEMENT I certify that to the best of my knowledge, all the above are true and correct. understand that any permit issued or plan stamped and cleared by this department on the basis of a falsification on this form will be revoked or considered invalid upon discovery of such falsification. FULL NAME SIGNATURE. DATE EGRITY TESTS , TANK SYSTEM • • ENDED PURPOSE 300NING DRAWING LIST T1-1 — PROJECT TITLE SHEET AS SHOWN -ON TK1—D — TANK DEMOLITION / REMOVAL F rRUCTION 71-1 — STORAGE TANK & PIPING SITEf F )T INTENDED TO TK3-1 — SUMP AND PIPING INSTALLATION :RAL CONTRACTOR TK3-2 — PIPING ARRANGEMENT & INSTAL CONSISTENT SHALL PREPARE TK3-3 — PIPING INSTALLATION .DETAILS A' MULTI—PRODUCT DISPENSERS S FOR PUMPS TK3-4 — TYPICAL MUL11—PRODUCT DISPEP INGS. ALL TK3-5 — TANK SLAB, IDENTIFICATION MAF \LED PER N.E.C. TK3-8 WASTE OIL SUMP INSTALLATION TK4-3. — "MATERIAL UST, ABBREVIATIONS, STING. TANK ORIENTATIONS AND GENER ;TING. San lose/Santa Clara ES1-1 — ELECTRICAL SITE PLAN NG• water Pollution Control Plant ES1-2 — CONDUIT AND PANEL SCHEDULE Industrial waste seq� E2-2 — FUEL SYSTEM ELECTRICAL. �— Api roved :. REMOVE By SCHEMATIC DIAGRAM >CE. R� Sc Comments Below: E2-3 . — LEAK DETECTION AND NOTED AV ELECTRICAL DETAILS E2-4 — TANK MONITORING SCHEMATIC No REGULATIONS. AND GROUNDING DETAILS E2-5 — ELECTRICAL MATERIAL J.) IN ALL NEW LIST MP SHALL JDUCTORS PER 4TAL EFFORTS. NO. BP WEST COAST PRODUCTS MASTER REVISI NO. DATE REVISIONS BY • CITY OF CUPERTINO Item 1 of 1 PERMIT RECEIPT OPERATOR: conniew COPY # 3 Sec : Twp : Rng : Sub: Blk: Lot : APN . . . . . . . . : 32610028 . 00 DATE ISSUED. . . . . . . : 02/25/2003 RECEIPT # . . . . . . . . . : 21197 REFERENCE ID # . . . : 03020106 SITE ADDRESS . . . . . : 10625 N DE ANZA BLVD SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : ATLANTIC RICHFIELD/ARCO GAS ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . . , RECEIVED FROM . . . . : TAIT & ASSOCIATES CONTRACTOR . . . . . . . : LIC # COMPANY . . . . . . . . . . : ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . . , TELEPHONE . . . . . . . . : FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL - - - - ------------- - - - ------- - - - ---- ---- -- BPERMFEE VALUATION 160 , 000 . 00 1028 . 00 0 . 00 0 . 00 1028 . 00 BPLANCHK PERMIT FEE 1, 028 . 00 873 . 80 0 . 00 873 . 80 0 . 00 BENERGY PERMIT FEE 1 , 028 . 00 308 . 40 0 . 00 308 . 40 0 . 00 BSEISMICOM VALUATION 160 , 000 . 00 33 . 60 0 . 00 0 . 00 33 . 60 PPERMITFEE FLAT RATE 1 . 00 35 . 52 0 . 00 0 . 00 35 .52 EPERMITFEE FLAT RATE 1 . 00 35 . 52 0 . 00 0 . 00 3�55 . 52 MPERMITFEE FLAT RATE 1 . 00 35 . 52 0 . 00 0 . 00 35'�-52 TOTAL PERMIT 2350 . 36 0 . 00 1182 . 20 1168 . 16 METHOD OF PAYMENT AMOUNT NUMBER a ----------------- ------- - - --- -- -------- - ------- CHECK 1182 . 20 13976 TOTAL RECEIPT 1182 . 20 • A.S.E. CONSULTING ENGINEERING, INC. 255 N. Market St . , Suite #220 San Jose, Ca. 95110 (408) 999-7441 Fax (408) 999-6638 Permit # 03020106 Control # 11980 PLAN CHECK NUMBER: 03016 .CUP March 10, 2003 PROJECT: Dispense and Piping Modifications for an existing Gas Satation 10625 N. De Anza Engineer: Tait & Associates Stanley Iverson 714-560-8200 ------------------------------------ DOCUMENTS ATTACHED: VIA: 1 SETS OF DRAWINGS HAND DELIVERY 1 SET OF misc. Documents • ------------------------------------------------------------- Dear Sue: The attached document were reviewed and cleared by our office . • • i�3 -- 0421 City of Cupertino Plan Check Transmittal Permit# 03020106 Control# 11980 Project GAS STATION UPGRAD Plancheck# 1 Address 10625 N DE ANZA FileDate 2/25/03 Owner ARCO r Description 4 Plan Check Status (attach comments and return to Building with pian set) Plan Dept check#' Date Due Date staff Comment Date Approval? ASE 1 2/25/03 3/11/03 ❑ Planning 1 2/25/03 3/11/03 ❑ Public Works 1 2/25/03 3/11/03 ❑ Fire 1 2/25/03 3/11/03 u3 Sanitary 1 2/25/03 3/11/03 ❑ Assessor 1 2/25/03 3/11/03 ❑ 2% r,' t` o' RECEIVE CO�HEy 1�' p� SPN)AE1R DEPT. 'vr� Housing Mitigation Fee Amount Heart of the City Specific Plan Fee Amount �(DCity of Cupertino Plan Check Transmittal Permit# 03020106 Control# 11980 Project GAS STATION UPGRAD Plancheck# 1 Address 10625 N DE ANZA FileDate 2/25/03 Owner ARCO Description. Plan Check Status (attach comments and return to Building with pian set) Plan Dept check# Date Due Date Staff Comment Date Approval? ASE 1 2/25/03 3/11/03 ❑ Planning 1 2/25/03 3/11/03 ❑ Public Works 1 2/25/03 3/11/03 ❑ Fire 1 2/25/03 3/11/03 ❑ Sanitary 1 2/25/03 3/11/03 ❑ Assessor 1 2/25/03 3/11/03 ❑ Housing Mitigation Fee Amount Heart of the City Specific Plan Fee Amount