03010112 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS. ABLE SEPTI.' PERMIT NO.
10560 CHACE DR 03010112
• OWNI[R'S NAME. 520 REED ST. APPLICATION SUB DATE
STAUB DONALD M AND CORNEILA V1 01/22/2003
ZONE: (408) 377-9990 SANITARY NO. CONTROL NO.
ARCUITECr/ENGINEER. BUILDING PERMIT INFO
BLDG ELECT PLUMB MUCH
0 0 0 0
uMi00 LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I are hemsed under provisions of Chaplcf 9(commend., Job Description
N¢� with Section 7000)of Division 3 of be Busm sand probes,on,Code,and my her..is
infuul roe ndeffrot SEPTIC SEWER HOOK UP FINALE[7►
z o q Lieegrc�+r�asa /-�z Leif�7 7'�'T5 e
i2Z—CD _Zi — OS G laic 5elTT
f'�'1-'s �t.�—j ARCHITECT'SWARATION
� �a �undcrusurdmyplanssha)Muaedispablicmcmds JAN 2 7 2003
Foaldo
ce 't-t Licensed Professional
=tea OWNER-BUILDER DECLARATION
1 hereby affirm that l am exempt from the Contractor's License Law Int the BUILDING
00 following reason,(Section 7031,5,Business said Professions Code:Any city of county
n X S� which regmles a permit ro construct.alley'Improve,demolish,or repair any structure
so—O, prier le its issuance.also mquirci the applicant]or such permit to file a signedstatement
that he is licensed pursuant to the provisions of the Contractor's License Low tChapter9 SCI. FI. Floor Arca y$°7��t(hh0❑
e, (cam mcnctng with Section 7000 of Division 3nfthe Business and Pr..msumuo Code)ur
i $ Nal he is exempt therefrom and the basis for me alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subecu the applicant to a civil penally of
not more man live hundred dollars 1S51p). �CCUpaDCy Type
E]1,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the directors,is not imended or offered for safe(See 7044,Business —
and Professions Code:The Convector's Leon.law does not apply m an owner of 2 02 - UNDEREN"F e fIY`1�G
property who builds or improves thereon.and who doessuch work himself ur through his
own employees,provided that such improvements are not intended or offered forsale.If, 301 — ROUGH PLUMBING
however,me building or improvement is sold within one year of completion,the owner-
builder will have me burden of proving that he did not Wild or improve for purpose of 3 02 - TUB & OR SHOWER
side.)- 502 - FINAL PLUMBING ENERGY
❑ I,as owner of the property,am exclusively contracting with licensed contractors to 5 06 - GAS TEST
Ourtmet the project(Sec.7044.Business and Professions Code:)The Contractor's Li-
se taw does not pply to an Owner of property who Wilda or improves menton,and 507 - FINAL PLUMBING
who contracts for such projects with a convactons)licensed pursuant to the Convamor'a
License Law.
E] l am exempt under Sec .B&P C for this reason
Owner Date __
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penally of perjury one of the following dechroamas'.
❑1 have and will maintain a Certificate of Conserv to self Insure for Worker's Compere
cation,as provided for by Section 37 W Of me labor Code,for the performance of me
work for which this permit is issued.
❑ 1 have and will maintain Worker's Compensation Insurance,as required by Section
3701of me labor Code,for the Performance of me work for which this peri it is issued.
My Worker'ssCCompensau Insurance came,and Palm n her are'
Carter.S2esTC FOOT L{ Policy
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(ITis se,con need not be completed if me,e mil is forme hundred dollars($100)
or loss.)
I eenily that in the scrum arm,of the work for which this Permit is round.I shall not
employ any Person In any mannerso as to become subject IOlhe WorkersCompensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:II:alter making this Cer ilicam of Exempting you should
become subject to the Worker's Compensntion provisions of the"her Code,you must
� Z forthwith comply with such provisions or this Permit shall be deemed revoked.
Z O CONSTRUQION LENDING AGENCY
(-I I hereby notion that there is a construction lending agency lot Performance of
(X the work for which this permit Is issued(Sec.3097,Civ.C)
Was Q Lender's Name —
z Lcndcr's Address
U Q 1 rectify rent I have read this application and state that the above lnformatinn to
V. P correct 1 agree to comply with all city and county ordinances and&tale laws relating in
�U building construction,and hereby audios representatives of this city to enter upon the
r D.I ahovementiuned properly for inspection purposes.
(We)agree m save,Indemnify and keep harmless the City of Cupertino against
FF-t q liabilities,]idgmears,costs and expenses which may to any way accrue against said City
U Z in consequence of the granting of this permit.
F-r APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON POINT Issued by: Date
SOURCE REGULATIONS
jz-t '3rM �/ e-yycy— / - 2 Z-r 2 Re-roofs
rgnamre of AppllcaH ZARDOUS MATERIALS DISCLOSURE Dale Type of Roof
Will the applicantor future building Occupant store or handle harcerdouc maenal
as defined by the Cupertino Municipal Code,Chapter 912.and the Health and Safdy
Code,Section 25532(a)1 All roofs shall be inspected prior to an roofing material bei. installed.
400 i ❑Yee 7Nn P P Y g g
Will thea applicant m future building Occupant use equipment or deice.which If a roof is installed without first obtaining an inspection,I agree to remove
pp g P gmpmen
emit hmamnus air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
Doctor
El Y's No
1 have read the haiardolo materials mquimmenm under Chapter 6-95 ofthe Calimr-
non Heald&Sa(cty Cale,Sections 25505,25533 and 25534.1 undefsland mat if dw building
does not currently haw a tenant that it is my resptmsmody to noddy the eacupanl of me
mquiremeaswhichmustbemetpoortoissuanceofaCemfi,meofOcouparey- Signature of Applicant Date
r,r3�0 la J-2z-�3
owner ,,aitmmiAol agent Dam All roof coverings to be Class "B" or better
CUPERTINO SANITARY DISTRICT
20065 Stevens Creek Blvd.,Bldg. C `I'l/17ER:
Cupertino,California 95014 V CHB: _
(408)253-7071 CV: P�
File:
"ON-SITE REQUIREMENTS-OVER THE COUNTERRE� F'P 2Z 03
Date:
File: CuSD P
Building Dept-Cupertino
Community Development Department-Building
City of Cupertino
10300 Torre Ave. o ���DQ�1 CJ��
Cupertino,CA 95014-3202 -� S..�
a Re: Subject: y�� h eo���T TO 5{IAIfXJ
Approved For Issuing Name: DoN 5TAVD �iYYUL�
Building/ Plumbing Permits
Address: 21060
Control/Plan
Permit No: -tnGj�.
The Cupertino Sanitary District has reviewed the plans for the subject project: 16601
❑ No additional conditions/requirements by the District.
❑ Sanitary sewer is available and the existing building is connected to sanitary sewer,see conditions/requirements listed
below.
❑ Sanitary sewer is(not)available,see conditions/requirements listed below.
❑ Sanitary sewer is not provided by the District,please contact the City of Sunnyvale(408)730-7510.
The following Conditions/Requirements are made:
❑ Install new Property Line cleanout or locate and mise to grade an existing property line cleanout. Cleanout .shall be
the same diameter as the street portion of the service lateral(Minimum gravity lateral is 4"diameter).
W Video Inspection of the existing Cleanout, Point of Connection and Street Lateral is required prior to passing The City of
Cupertino Final Plumbing. Owner to call District 48 hours prior to video inspection to schedule a District Inspector.
❑ Inspection of Street Portion of Sanitary Sewer Lateral by the District,Please Do Not Inspect any onsite construction prior
to clearance in writing by the District.
❑ Owner to have a Civil Engineer fix the lowest finished Boor elevation, with plumbing,to the rim of the next upstream
manhole. If the lowest floor with plumbing is less than one(1')foot above the rim a Sewage Pump may be required.
❑ Cupertino Sanitary District Fees or Permits are required for the subject improvements please do not
issue any building permits.
❑ Plans shall be reviewed by the Industrial Waste Division of the San lose/Santa Clam Water.Pollution Control Plant,
Phone 945-5121 for questions and to schedule a plan review appointment. Please Do Not Issue permits until
pretreatment recommendations have been forwarded to you by the District.
VVerify existence and serviceability of an existing backflow protective device.
❑ Break areas authorized minor electrical
appliances
only.(No commercial
disposal or commercial dishwasher installations.)
Other: .IrAR... r. ..`o.l..IA.tM'C.•1.✓••/....M.f. . •' .... .11..... .� .. ....:...........
> Storm water from surface or roof drains,other general surface runoff water or condensate from any residential HVAC equipment shall not
be discharged to the sanitary sewer.
NOTE: Contact C SD for "0 �MENTS"
File Building Letter-OTC f '/� e
AAA
1R r PERMIT P-16601
CUPERTINO SANITARY DISTRICT
• Santa Clara County
20065 Stevens Creek Boulevard, Building C
Cupertino, California 95014
Telephone 408-253-7071
1� '}CO/NNECTION PERMIT /
Date ��}�,d( � ! t/�U APN: Book i.Z(r Page Parcel JQZ (.
Property Owner:
NA �'.{� t f I9 ROS/PM/Tract No. Lot No.
I I
Mailing Address: /t r.1r) (`VAtr, (1. 1'
I .
(UWe),be in die/owner(s)(owner's agent),hereby make application for connection of the at:
AA C-C oz . consisting of the following Type of Buildings:
Residential: Single Family Dwelling X ; Multi Family Dwelling_; No. Units 11
Commercial ; Industrial ; Other No. Units
• Do hereby request a permit to connect the sewer system of the Cupertino Sanitary District.
IN CONSIDERATION OF THE GRANTING THIS PERMIT,THE OWNER AGREES:
1.To comply with all existing Ordinances,Rules and Regulations of the Cupertino Sanitary District as now or hereafter amended.
2.To maintain the House Sewer(that portion of the sewer within private property)which includes a serviceable cleanout to grade
and accessible located within five feet (5')of the point of connection with the Lateral Sewer(that portion of the sewer in the
street right-of-way of District easement. - rt
3.To acquire a Plumbing Permit from the e.I � 7tom of CQ(,1 I( N d ,Building Department and obtain the required
Building Department inspections and approval prior to use.
4.To expose and inspect for serviceability the Lateral Sewer prior to starting construction of the House Sewer.
5.That this permit does not constitute a request for the issuance of an encroachment permit for sewer construction in the
street/public right-of-way of the agency having jurisdiction thereover.
6.To connect to sewer within one(1)calendar year from the date of issuance of this permit.
7.To call UNDERGROUND SERVICE ALERT(USA) 1-800-IA2�,27--2260000,at least 48 hours prior to starting construction.
yy
8.SPECIAL PERMIT CONDITIONS: Vty-A(n( Ur9V % ftNow,
A BACKFLOW PROTECTIVE DEVICE shall be installed to protect the above property by the owner. Type of device
and installation shall comply with the Plumbing Code Requirements of the jurisdiction shown in 3 above.
Fees: /I
Screr Service qharges to June 30,��G
No.Units J.a Sig rimo n—thT6 no. months I U . 4 y (31010)
Backflow Protection Device Inspection Fee I r �0 (31020)
Connection Permit Fee: I' (31 o2o)
• Additional Connection Fees
Total: ) 7,7.0� )
Considerations and Considerations of this Sanitary Sewer Connection Permit with attached Exhibits,are hereby agreed to
and acknowledged by the undersigned Owner(or Owner's Agent). Failure to comply may result in termination of permit.
Acknowledgement:
Owner's Agent: _ :. t � •s. ✓/ 1
(If Signing for Owner Please Print Your Name)
Receipt ofl I� / acknowledged and permit granted.
MARK THOMAS & CO.,INC.,district Manager-Engineer
By: \ 1/L{i,{/✓��i�l
Revised s/oo NOTE: See Details on other side of this permit
TYPICAL CLEANOUT FOR LATERAL SEWER •
Distance from Property Line
to be as close as practicable,
c
not to exceed five(5�) feet.
J
Removable Cleonout Plug
6
O
a. Finish Grade
Wye for Riser
Sewer Cleanout Box with Lid to be accessible
and maintained by property owner.
Short length Riser Pipe
Adaptor coupling 1/8 Bend
FLOW m
Lateral Sewer House Sewer
LateralSewer slope House Sewer elope
determined by District e' determined by building department
— CLEANOUT TO BE SAME SIZE AS LATERAL SEWER—
Notes: •
1. Distance from the property line not to exceed five (5')feet.
2. Property Line Cleanout, Lateral Sewer Cleanout,to be same size as Lateral.
3. The maintenance of the Lateral Sewer Cleanout is the responsibility of the Property Owner.
4. House sewer minimum slope determined by local Building Department plumbing code requirements of the
agency having jurisdiction thereover.
TYPICAL BACKFLOW PROTECTIVE
DEVICE INSTALLATION
TYPICAL BACKWATER VALVE TYPICAL KELLY VALVE INSTALLATIONS
INSTALLATION Jurisdictional Rnvicronr
Ataept.d By All Juriediclidne
FIGURE I FIGURE 2 FIGURE 3
howled Bala.Grade Installed Below Grade Installed Above Grade
shown Between SOuI Riph'.O.Way and building Shawn At Properly Line CManoul Shown Adjo shl To Building
Requires Regular Maintenance i Requires Minimum Mainteeann Requires Minimum Maintenance
Valve To Be Removable Valve Should Be Removable •
r VALVE ACCESS BOX FINISH FLOOR
w f
a KELLY VALVE
A. Irish
VALVE ACCESS BOKEFinish GradeFnieh Grade 5
BACKWATER ^
VALVE
FLOW A FLOW ll FLOWyl
Notes:
1. The Backflow protective device to be located on site in the house sewer.
2. The type, location and Installation of the Backflow Protective Device shall comply with the local Building
Department plumbing code requirements of the agency having jurisdiction thereover.
3. Device to be accessible and maintained by the Property Owner.
4. If a Kelly Valve is installed at Property Line, it is to be readily removable for Lateral Sewer Maintenance.
t C) PERMIT S-1209
CUPERTINO SANITARY DISTRICT
Santa Clara County
20065 Stevens Creek Blvd., Bldg C, Fax (408) 253-5173
• Cupertino, California 95014
Phone (408) 253.7071
LATERAL SEWER PERMIT
It shall be unlawful for any person to install or construct any sewer for connection to, or make connection to, the District sewer system in a street
within the District, who is not a master plumber or contractor, whichever is applicable, licensed under the State Contractor's License Law.All such
contractors must register with the District Manager prior to commencing or carrying out any such work within the District.
Sewer Connection Permit No. P— 1 G7 601
R.O.S./P.M./TractNc. Lot No.
A.P.N.: Book Page Parcel Date
Applicant P QZhll( I 'k
Address: 6Pi�
SonL% c' Nova �� g5o.,o
Phone: LIQ' S�� qgyC) '
Sirs: 6 Q
(I/We he eby make application for a permit to construct a lateral sewer to serve the property at: 1 l/10 r",
Said property is owned by: Owner's Address, if different:
IN CONSIDERATION OF THE GRANTING OF THIS PERMIT,THE APPLICANT AGREES:
• . 1. To comply with all existing.Ordinances, Rules and Re ul tions of the rt' ni r ' Irict, as now or hereafter amended.
2. To apply for an Encroachment Permit from the r; of Public Works Department, when
required by the District. An application therefore shall be attached to thi per it. All permit fees are responsibility of the applicant.
3. That all excavation and backfilling within the street right-of-way shall bedone in accordance with the requirements of the
Engineer of the public agency having jurisdiction thereover.
4. That all sanitary sewer laterals within the street right-of-way or within the District Easements shall be constructed in
accordance with the approved plans, materials and the Standard Specifications of the Cupertino Sanitary,District.
5.. To notify the District Engineer two(2)working days in advance of starting any of the work.
6. To guarantee this work for a period of one(1)year after installation.
7. To call Underground Service Alert (USA) 1.800-227-2600, at least forty eight (48) hours prior to starting grading or digging
operations. (Location of existing utilities shall be the responsibility of the permit applicant.)
ENCROACHMENT PERMIT APPLICATION ATTACHED(Lateral Sewer Permit Applicant responsible for ALL fees).
FEES:
Lateral Sewer Permit Fee: $ 01 /
Construction Charge: $
Other: $
TOTAL $
Considerations and Restrictions of this Lateral Sewer Permit are hereby agreed to and acknowledged by the undersigned
applicant. Failure to comply will void this permit.
Acknowledgment: //IU/ILL�
Receipt of$ acknowledged and permit granted.
MARK THOMMAS&C/O., INC., District Manager-Engineer
by
Description of Work: �`r
-WORK-TO BE PERPORME UNDER THIS.PERMIT 5 I
/ ) V V Z OnWI
n
Approximate Paving Cut: ^feet, " G2 main, deep
❑ NO WORK TO BE DONE, DISTRICT OWNED LATERAL#