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22655 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY Build]. Prom lden1iflratlon ,PERMIT NO. Budding Address: . 2Igoo 6 vJetirvie,,/ 22655 n amc: O e/ Ms4 CITY OF CUPERTINO-BUILDING DIVISION c n a Lk.No APPLICATION / PERMIT 4810 Y BUILD ELFCIIDCALPLUMBINC- F HANICAL CATEGORY CONTROL It Nen/li�gioer. lk No: / QTY ELECIRICPERMIT FEE BUILDING PERMITINFO Addrcas O p Q/ C�.j�.../y.�� PERMTISSUANCE ❑ ❑ ❑ LICENSE DCONTRAR R5 DECLARATION Ingwith Sen n7DDD)ofDivt m3ofthe BuMland PmfwlCode,and I hereby affirredat l alicensed under pmWmno/Chapter9(cormnme M APPLIANCES-ITMEiAL BDESC ON m v lice.bin full fo and effect. r PANELS Llmnae Gla» yLbY; y�C.'pf y:N Li-t. or V.1��+-+`�'A•� "I:HTIECTS CIARATION X11-1000 q�up�p11 Q2 lurdennnd my plan ehal be uxd n pubheremNa OVERIOMAMP13 f/SQ.Fr. G♦:'j Liaised Prfesbrul SIGNS ELECTRICAL ' «<<<bLn1 OWNER-BUILDER DECLARATION SPFEULCIRCNT/MLSC NI P U T a 7 5 Iherebyamrmtlutlamexemptfrythe CoMradora Llnm Lwfmthe 6rs folbwing reaeon.C:�en1on 70315,Buslnema�Pmfubru Code:Mydtyor TEMP METERORPOLE INST. 1 P4�.. muntywhkhmqul aperndttommtmMalter,Impmve,demo h,ornpalr anyw =mpr tolbla.>van<,ml requl theappbantfwwNper tto POWER DEVICES c Ob•aigned statement that he b lioemed pursuant to the provisions of the Contnlorb License Law r9 commens with Snrion 7000)d Divi- VALUATION Og kon3&the Bupneaa and Profra.bns dCode)or"he b exempt thenfmmand SWIMMING POOL ELECTRIC Ser" the beats for the alleged exemptlm. Any violation of Section 7M%S by any <��] appU.t fora permit abjeeta the appBcant to a ehdl penalty d not more than OUTLETSSWHCFiFSFIJCIIJR6 o. Ili flve�undreddclI;usMM. NEW RESIDENTIAL ELECIR I,n owner of the pmNrty,or my empbym with wagn as tits wle SQ STORIES TYPECONSTRUCTION P^ cmnPensalun,w0ldot1,ewok andtheetrueturcbmt band dim.ffered for OBale Oec 70N,Buairras ami Profembm Cade:Tia Coed do/.Lienee I w _$ dm wiappty to an ownerdpropertywb bnikl.orimprovn thraan,and c, who doeasuchwork hlmslforthmugh Msawoemplcym,provided that such OCG GROUT' RES UNITS improve enc Intendedoroffendfmsale.If,however,thebulUirgor TOTAL: Improvement bedd wghlnoneyeero(completbrt,tMowrsr-buBderwW have try urdenarpmving thrt lie dw notwudorlmproverWparpeaeoraale.). QTY, PLUMBING PERMIT FEE LrI L aa owner of the property,am elusiwty contracting with IkM eruFLOOD ZONE APN PERMIT ISSUANCE euntraeton to mmtruet the project(See 70K 13.1m.and Prdmians Code: The CoMndor'a Lucus Uw does not apply to an owner of property who ,��-DRAIN&VFM-WATER(EA) builds or imp. thereon, and who contracts for weh PSoFry wW a optfator(a)Ikrnard pursuant w the Cmtranors Lloerue Law. BACK FLOW PROTECT.DEVICE FEE SUMMARY i_J 1 am exempt under Sec B k P C for this rcuonOUTS1 DF FE—ES Avner Data DRAINS FLOOR ROOF,ARFA,COND. SANITARY Y_ N WORKMAN COMPFNSATIONDECIARATII RECEITY J OJ ❑1 hereby affirm that I have a artlrirate of ecoarm to:losure,or FZXNRES PER TRAP SCHOOL TAX Y - N_ aNBeate or Workers'Cnmpematfon Inwrwce ora artBied mpy thereof Lies. RECEIPT N 3800.Iub CJ p GAS FA.SYSTEM-]INCH OUTLETS PARK FEE Y_ N_ Pdky Y 17,77(-�z 1 �i GIs- Glr FA' M -0VER�(EA) LN - BUILDING DIVISION FEESCa�+CrtedpSpy,� L f. 1zCrtNedcopy b fliedwith the ey Wpectlon division. CREASE/MWSTRL WASIE INTERCEPTOR PLANCHECK FEE CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE TRAP PAID COMPENSATION INS"ANCESETVQ45AM1'ARY STORM EA.ZODF[' Date Remi t# ffhls aetion need not be completed lithe permit b fm one hundred do0an r Ob Rteal®J WATER HEATER W/VENT/EI.ECIR ENERGY FEE Y N IartOy that In the pen(omano of thework(orwNch W.permit is baued, I shag not employ any person In any manna w as to become aaby ei to the WAM SYSTEM/TREATING Wacker:compenvbon Law.M C.Nonla.Dam PAID Applicant Bans Z � [NICE TO APPLICANT.If,after ouldrig ted.Certlfiate ofEumptbn,you NEWRESIDENTIALPLMB. SQFr. Dale Recei t# sPh ' culd become wbfeet to the Workers'Compeniatlmn provisions of the Labor TOTAL Ln Code,y..Ofathwhhcomply wihwchpmvbbnsorthbpemdts)ullbe - W j dermed revoksd. I BUILDING FEE CL c CONSTRUCTION LENDING AGENCY SEISMIC FEE I hereby amrm that then b a mmtmman lerdbg agency for the pedornr ELECTRIC FEED Z aneu of the work!or which this permit bblued bee 3097,CW.C) TOTAL; Q.[p Q0 lerder.Name PLUMBING FEE 3000 LL ~ Lender.AddQTY. MECHANICAL PERMIT FEE MECHANICAL FEE O W IortifythNlFuve read thbappBatbnaM aatethat lheabovelnfor ion fl bmrnt.Iagrermcomply whhalnryand moray ordbunm wdStam law. PERMIT ISSUANCE FEES PAID: } N relating to building comtruedo,ard henbyauthorlu repRsenmtive of this F Z dry to enter upon the above-mendand property for Wpenbn purpura. ALTFRORADDTOMECFL Date - Reeei [# _ (We)agm to save,IMmrms erdfy an d keep halethe City of Cupertmo .,.Inst lbbWties,/rdgmenb,".and npemes which may lnanywayaeeue AIR HANDLING UNIT flu 10,0DO CFM) SUBTOTAL: aga dClly In era of the,rami oftMa p<�R. AIRHANDLINGUNrT(OVER IO,DDOCM CONSTRUCTION TAX roof Appilant/Cmrcranor Date EXHAUSTHOOD(W/DUCII CONSTRUCTION TAX PAID: HAZARDOUS MATERALS DISCLOSURE Wllltheapplkant or futunbulldingoaopant3mreorhardieh...rdms HEATING UMT(TO IOD,ODOBTU) nmeriDate Recei t# Ikahh and Safety by the Cupertino 2552(x)? !code,Chapter 9.12,and the - EleahhandSafaty Cade Seniors 75537G)7 }IEATING UMT(OVERIW,OOD BTU) TOTAL: O•015 1� yesMN. —FY III the appVnnt or futon building ooipant use cqulpment or dev{m VENTILATION FAN MNGLE RESID) ISSUANCE DATE which emit hazardous air mnumiro Ms as defined by the Bay Area Ab Quality Marogement Dbtrict7 BOILER-COMP PHP OR IK"BTU) F1yea ❑No o mr t ]have ad the ha>udmu material rrqulremont,under Chapter E95 o1 BOI.ER-COMP(OVER 100,000 BTU) A- II theC.Bfomia Ileahh h Safety Cade,Setbns 75505,75533 and Z .I 1 'I��} ® 1 undrntaidthat if the building does not currently have a tenant,that it b my NEW RESIDENTIAL MECH. SQFT - s�l .PonafbBBy,to notify the ocmp.d of the requirement,which crust be n t " prier to(mu..da crtif tcofoceipaoey. CAvnerowthodvedagent Date I� "I(fp TOTAL: 1$UED BY: OFFICE COPY SERIAL Pry;, 15183 SEWER CONNECTION PERMIT No. OCUPERTINO SANITARY DISTRICT R.O.S./P.M./Tract No./P.74.... Lot No..L.7....... 20065 Stevens Creek Blvd. A.P.N. Bk.. ...... Pg....�. ... Building C Cupertino, California 95014 Phone (408) 253-7071 Date... , 2 (Z................ . ..... ... ..f .. The undersigned,being the owner(or owner's agent)of the property located at ........................................................ /I Y1 0 ........................................... consisting of the following TYPE OF BUILDING: Residential: Single family...,X..... Multiple............ No. Units.....I....... Commercial............ Industrial............ Other............ No. Units............ does hereby request a permit to connect to the sewer system of the Cupertino Sanitary District. In consideration of the granting of this permit, the undersigned agrees: 1) To comply with all existing regulations and Ordinances of Cupertino Sanitary District and all future regulations and Ordinances which may be adopted. 2) To maintain the house sewer(that portion of the sewer within private property)and to provide access to the lateral sewer through a cleanout raised to grade at the property line or at the limits of any existing District easement. (Note—Detail J) • 3) To acquire a permit from the ..�J'...7.....q.4....r-S?.P.X'! :�?.Y1.0........ ............. Building Depart- ment and obtain inspection and approval by said Building Department prior to covering of the work or use of the sewer. 4) To first expose and inspect for serviceability the lateral sewer prior to starting construction of the house sewer. Property Owner's hame. h �X ��...t . .... ............... Telephone...../ .? ....Ig.......................... Mailing address if ja Yn i. i different from above......................................................By./ ..��..................................... ................................................. ❑ A standard backflow protective device shall be installed, to the satisfaction of the Budding Department, for the above property.(Note—See Detail/) FEES: D O Connection Permit Fee r U r U Sewer Service charges to June 30, I<)7.,$.../�......./mo. X. mo. Inspection Fee for backflow protection device ee TOTAL $ �3 e, 'teceipt of$.!3.�f' -.. acknowledged and permit granted. MARK THOMAS &CO. INC., District,Manager-Engineer �i Bye.lxz ?............................. NOTE.See Details on other side of this permit. CUPERT/NO SANITARY DISTRICT NOTES: All verves Ito be accessible and maintained by Property Owner. Overflew palm at least twelve Inahe1(12") below ION4t finished floor containing plumbing, Kelly Valve Installed W Property Line to be readily removable for Lateral Sewer maintenance. J 'mah FI Level p5 d 8 Nally Valve Flnlsn Flo�m:1 Le—vel O Finish Grade L4 Kelly Valve wove AccessBos — in wilh Vented C6vo Valve Access Bm - Backwater Valve FLOW F�qure I Figure 2 Figure 3 Kelly Valve-Below Surface Backwater Valve—Normally Kelly Volve-Above GIou1M Imlallation-Shown o1 required installed al shallowest point ottl011Wlon-Shown installed • Property Line Clemmut. aI.N House Sewer between close to bullding. Property Line and building, 77 DETAIL STANDARD BACKFLOW PROTECTIVE DEVICE INSTALLATION I Dlsbnce from 11 tp be as close os macllcable. J tRlois Cleanout Plug o. rade Wye for Riser Cleanout Bos with Lid to be acueelEHolntuined by property owner. Short lengthipe Adaptor coupling 1/ FIDW it Lmerol SewerHowe Sewer t7tjfF'-'WInmum elope determined by Building Department. Lateral Sewer Cleanout to be same size as Lateral Sew., DETAIL STANDARD CLEANOUT FOR LATERAL SEWER J