BLD-2024-0358_Sanitary ApprovalHITS.g�,
CUPERTINO SANITARY DIS /fin ,,/
20863 Stevens Creek Blvd #100, C Approved -
Tel (408) 253-7071 . Fax (408) 253 By fmartlnez at 1:40 prep use 6, 202 Eg+��� CUPERTINO
SANITARY DISTRICT PERMIT LETTER
Cupertino Sanitary District has adopted Resolution No. 1263 and Ordinance No. 123
Building Permit Request
(Over -the -Counter)
Single Family Project ❑ Multi -Family Project ❑ Commercial Project
Project Address: ( , t,j f �A-' APN: 356-14-053
City Permit Number:
Scope of Work:
Owner/Applicant Name:
District Permit Number: 24-511 i (
il/k i) 6.11 Phone:
Address: E
Date:
Prepared By:
1, as property owner or authorized agent, acknowledge
will be met, and all required fees will be paid prior to th
t
Date: i< f /2-1 Signature:
f
City Authorized Representative
Cupertino Sanitary District requirements
a/ of fiaaf spe®ction for proposed project.
Owner / Authorized Agent
CUPERTINO SANITARY DISTRICT OFFICE USE ONLY
❑ Pre -inspection Required
Date Scheduled:
Conditional Approval By:
® Final Inspection Required
Authorized Representative
Cupertino Sanitary District
Date:
District will notify owner of the required fee within 5 business days after Pre -Inspection has been
completed and cc City of Cupertino. All fees are non-refundable and payable by check or cash only.
Inspection Fees:
EX $400/unit - Single Family Residential already connected, but ne:w cleanout is required
C7 $300/unit - Single Family Residential already connected with existing cleanout in working order
CI $800/unit— New Lateral Installation with CCTV Included
[� $300/unit — Grease Trap Inspection _CuSD Comments:
CI $600/unit — Grease Interceptor/Oil Separator Inspection
$250/each — Disconnect and/or abandon lateral service
Plan Check Fees:
0 $300 — Lateral Plan Check
$800 — Grease Control Device Plan Check
Change in Use Fees. Actual Amount:
® Fee Paid Date Paid: 02/06/2024
A backflow preventer is
required for this property.
Final Approval By: Date: 02/06/2024
Authorized Representative
Cupertino Sanitary District