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22529APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY Build]. Pru ed Identification Ba� Address: I'F7iwTI:O. l O G U: .r - 2 2 5 2 9 •.err p 1(,e -,wt S—oy CITY OFCUPERTINO- BUILDING .DIVISION APPLICATION I PERMIT N Wc.No - 18�� i M_ BUILDINC-ELEC7RICALPLUMBING-MECHANICAL CATEGORY CO a chNed/Englruer. Lie Na Q ELECTRICPERMrr FEE BUILDING.PERMIT INFO f r1 Address,i`"�8� O/ sl�f4,fp.h- PFRMITISSUANCE ❑ ❑ per( ❑ I`ll'L LICENSED CONTRACTOR'S DECLARATION I hereby a ffbmtlutlamlicenaedunderprovWl of Chapur9(commmc Ingwithsen70DD)ofDMMw3oflhe Busmand PmfeWCdde,nd APPHANCFSRESIDEN71AL JOB' DESC Lbul Date _ Camrador PANELSm UP TO 2DD ANTS Q 2QI.IOQOAMPS ARCr7ITECPS DECLARATION I underwed my plana)ull be used u publicremNa OVER1000AMPS SQ. Fr. FLOOR AREA S/SQ.FT. SIGNS E'LECTRIC'AL' - Livnsd Professional • - ALE IN OWNER -BUILDER DECLARATION I hereby affirenthat l amexemptfmntheCoNradoriLlrense Lswfor he S�LC>R�/MISG P U T TEMP. METER OR POLE INST. POWER DEVICES DATE fo0owing mason. l5edim 70715, Rusin® and Pmfebn Code: Any dtyor muntywhk requmapermittomrutmc"ter,impmve,demolbh,orrquur anyetmdun prior to Its Wrarce,atwrequimtheappuunt for such pemtlt to file a signed statement ttut k b licensed pursuant to the proMbra of the Contractor's License Law (Chapter9(mncing with Sedion 7000) of Divi- rerrc don3 ofthe Bu Wen and Profession Code) or that he is exempt reM ept therefroa E R 1 + 1 gy,.D,U,gNG IDOL ELECTRIC �- VALUATION the basis for the alleged exemption. Any vlolnbn a Section 7 015 byany017ILE'ISSlVI7CF3ESE7%Tl1RF5 applicant lora Ferrell vbjctsthe.ppleast too dWl penally dna rmnthan NEWRb1flENT[ALFLECR SUFI. Ilvel,.ttrdoddrofthepro or req employees want ween a thele mor L n �wner:(the property, STORIES TT'PECONSTRUC`ION a wllldothework andthes rotnmeor'rt intended o mle(S,, 0Ktra, i:Bored(or sale Cole:rch .roes and Pretensions Cole: The C the�eInw - not. ply to do<snot eurh torn owrcrdpmpertywhabnlldsoym,pvnthenoRand impro,es who does each work hMseB mthrough his own emplgms, prwldN that vd+ OCC.GROUP RER UNITS Improvemenh are wt Intended oroHered forsale. If, however, the buikRng or bnprovement Nmld wllhIn oneynrofcompldbri,the owrnr-W liderwlu Nve TOTAL; t Iden arpmWng that la ad wtbullao,brpmw<forpnrposenfsale.). L -J L as owner of the pmperty, am exchuWely cntracung with 11«ruM contract. to mrestrud the pm}ect(See 706/, Busmew and Pr Manion Code: TIW Contractor's License Law does not apply to ..owner d pmp<rty who Wilds or Ireprasv thereon, and who mntraeb for wH plo)tms with a �alT+�roRe)Bernard p..et to the Cmtradae. License Law. Lf I am eurept under Sec B A P C for this recon QTY. PLUMBING PERMIT FEE PERMIT ISSUANCE ALTER -DRAIN& VERA-WATER(EA) FLOOD ZONE AM BACK FLOW PROTECT. DEVICE FEE SUMMARY DRAINS FLOOR, RODE, AREA, CONED. FDCrURES. PER'IRNa SANITARY ' Y— N. �EIPT a Owner e Dat WORIQAAN COMP FS95ATION DECLARATION a c of <m.ent to o y the. « a ❑I hereby oHbm that I haw o Insurance nrtBRate of Workeri Competuximlvunn««a«rtBfed mpytherml6ec. 3800, # G I'a1ky l 2 L SCHOOL TAX Y_ N— RECEEP,T a GAS E.A. SYSTEM -L INCl OI17LEIS PARK FEE Y_. N AECII/ GAS EA. OVER4 MAECa O BUILDING DIVISION FFE9 rtIf5,d copy bhereby famished. e ed espybfRM with the dty traps Han dlWslon. GREASE/INDUSIRL WASTE rNITRCFPIOR PLANCHECK FEE GREA.SETRAP CERTIFICATE OF EXEMPPION FROM WORKERS COMPENSATION INSURANCE (edbn need na b<completed lithe permit b fmorc hundred dollars PAID Date Revel t# SEWER SANITARY STORM F.A.2(X)FT. WATFRHFATEt W/VENT/ELECIR ENERGYFEE Y N — alarEor l«Bu.) In for Ill.. erpiey,hat aepedar in tobechich rperedtlelmud, 1 oriu not empby, any person In any manse m n to become abject to the W«kers'CompuwtbnLaws of Glifomla. Data WATER SYSTEM/TREATING PAID ' Appuont NOTICE TO APPLICANT: IL after inking this CertiNate of Exemption, you Date Recei t# NEW RF�EN]IAL I'LMB. SQFT. TOTAL: should bemrrc mb)M to the Workers' Cnmpenaatton provision of the labor Code, you trust forthwith comply th such provisions or this pemJt shall be deemed revoked. -BUILDING SEISMIC FEE ' CONSTRIICEION LENDING AGENCY I hereby affirm that then b a contrudlm lend Ing agency for the perform ance of the work for which this permit is laved(Sec-3097, Civ. CO TOTAL: �Q2 ELECTRIC FEE QTY.j MECHANICAL PERMIT FEE PLUMBING FEE 00 'eder.Narm, lendee.Addnn 1eaWiry thx lhawreadtwappB tbnaMvatethattheabavetnformatim bmrred. l agomtoreseplywehall ckyaM muntyordirunms and date laws: MECHANICAL FEE PERMIT ISSUANCE FEES PAID: relating to butHIng construction, and hereby autheeUm mq msenrsttvn of this city to enter upon the abov rnentbtud prsperty for Wpedbn purposes. (We) agree to aaw, Ind<rerdfy an d keep hatndess the City of Cupertino ALTERORADDTOMFCJI. .Date Receipt# SUBTOTAL: against babllhics, jnd nmeta,mata and expenewhieh mayin anywayamue .g2 Id ChyI na of the granting a/ this PemtL AIR HANDLING UNIT(TO 10,000 CFM) AIR DANDLING UNIT (OVER 10,000CF:MI CONSTRUCTION TAX g no AFp ant/Contract« Date EXHAUST HOOD(W/DUCT) CONSTRUCTION TAX PAID: HAZARDOUS MATERIALS DISCLOSURE HEATu�GUMTCTOI00,000" Will the applicant or futurebulldingoccupant atone or handle hazardous material as defiecd by the Cupertiro Municipal Code, Chapter 9.12, and the Date RCCCI t# HEATING UNTr OVER 10,000 Blip TOTAL: .Ov Health and Safety Cade SeHm 25532(.)2 ❑ Yea No WWthe applimed:Mature building occupant use equlprrcN or devious which endt hanrdoua ab contarebuas as defined by the Bay Ana Air VINTILAMN FAN (SINGLE RESID) ISSUANCE DATE BOI1XR-CAMP OHP OR 1WM BTU) v Quality Magereent Dlsvid? I� YeaNo I hoe Wad thehva[ons materials requlmrrcnn under Clupter 6.95 of BOILER-COMP(OVER 100,000 BT(p the California Health k Safety Cad, Sections 25505, 25533 and 25536. I NEW RESIDENTIAL MECH. SQFT understand that If the building does not currently h,,.. meant, that It is rey nm spommrbe uky to rally the occupant of the requirements which trust tort A �� ���� prim to tauanee d a Certificate of Occupancy. • Ot ISSUE BY: �-jrrr�• Owner m authottred agent - Date TOTAL: OFFICE COPY SEWER CONNECTION PERMIT SERIALNO. P 0.1 15173 •CUPERTINO'SANITARY DISTRICT R.O.S./P.M./Tract No...�6.' 0.. Lot No...-�; � ...... 20065 Stevens Creek Blvd. A.P.N. Bk.. 3?. U ...... Pg ...1.9 ... Par?. `! .... Building C Cupertino, California 95014 Phone (408) 253-7071 'Date.......'v .. The undersigned, being the owner (or owner's agent) of the property located at ........................................................ %.).n�.1......��a ✓ci.w�j, e�.).... .C.!`.. 1....0 ./tP!!.ic!•.4............................................. consisting of the following TYPE OF BUILDING: Residential: Single family......... 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 easemenL-(Note — Detail J) 3). To acquire a permit from the........................................................... '............. Building Depart- ment and obtain inspection and approval by said Building Department pnof-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 Name.. �:�` �`.....✓� J. e ............ Telephone ....... ,!..5...<�3 2 .................. Mailing address if different from above ... I75... ......i ................................................... By%J.</ v,.! .......................................... FEES A standard backflow protective device shall be installed, to the satisfaction of the Building Department, for the above property. (Note —See Detail I) Connection Permit Fee 60 Sewer Service charges to June 30, 19-)7..,s .... f U. G.... /mo. x.. (t . mo. J � ........... Inspection Fee for backflow protection device TOTAL $ &,ceipt of $ . -3 G...... acknowledged and permit granted. MARK THOMAS & CO. INC., District Manager -Engineer .......................... NOTE: See Details on other side of this permit Valve Access with Vented CUPERT/NO SANITARY DISTRICT NOTES: All valves to be accessible and maintained by Property Owner, Overflow point at least trelve inCh.s(12p) below lowest finished floor conlainlnp plumbing. Kelly Valve Installed of Property Line to be readily removable for Lateral Sewer maintenance. Kelly Valve Valve Access Boa Backwater Valve FIOW_r Kelly Valve Figure t Figure 2 Figure B Kelly Valve- Below Surface Backwater Valve—Normally Kelly VWve -Abov. Ground Imlallatlon-Sh.. al re,ui,.d Installed rt etlall... It point Insinlludon-Shown Installed Property Line Cleonoul. along Mouse Sewer hilt.... clow to building, Property Line and building. I STANDARD BACKFLOW PROTECTIVE DEVICE INSTALLATION I DETAIL Olsmnce from 4 to be as dose as practicable. Removable Cleanest Plug Finish Glade Wye far Riser Sewer Cleanout Bos with Lod to be accessible Shur! lengta� alq maintained DY property owner. Riser Pipe Adopter coupling—�"1/B Bend FLOW ,>r MiWmum slope determined by Building Deparrmenl. L.I .,.I Suer Cleanout to be wme six. as Lateral Sewer. DETAIL STANDARD CLEANOUT FOR LATERAL SEWER J 0I • El APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY Build]. Pru ed Identification Ba� Address: I'F7iwTI:O. l O G U: .r - 2 2 5 2 9 •.err p 1(,e -,wt S—oy CITY OFCUPERTINO- BUILDING .DIVISION APPLICATION I PERMIT N Wc.No - 18�� i M_ BUILDINC-ELEC7RICALPLUMBING-MECHANICAL CATEGORY CO a chNed/Englruer. Lie Na Q ELECTRICPERMrr FEE BUILDING.PERMIT INFO f r1 Address,i`"�8� O/ sl�f4,fp.h- PFRMITISSUANCE ❑ ❑ per( ❑ I`ll'L LICENSED CONTRACTOR'S DECLARATION I hereby a ffbmtlutlamlicenaedunderprovWl of Chapur9(commmc Ingwithsen70DD)ofDMMw3oflhe Busmand PmfeWCdde,nd APPHANCFSRESIDEN71AL JOB' DESC Lbul Date _ Camrador PANELSm UP TO 2DD ANTS Q 2QI.IOQOAMPS ARCr7ITECPS DECLARATION I underwed my plana)ull be used u publicremNa OVER1000AMPS SQ. Fr. FLOOR AREA S/SQ.FT. SIGNS E'LECTRIC'AL' - Livnsd Professional • - ALE IN OWNER -BUILDER DECLARATION I hereby affirenthat l amexemptfmntheCoNradoriLlrense Lswfor he S�LC>R�/MISG P U T TEMP. METER OR POLE INST. POWER DEVICES DATE fo0owing mason. l5edim 70715, Rusin® and Pmfebn Code: Any dtyor muntywhk requmapermittomrutmc"ter,impmve,demolbh,orrquur anyetmdun prior to Its Wrarce,atwrequimtheappuunt for such pemtlt to file a signed statement ttut k b licensed pursuant to the proMbra of the Contractor's License Law (Chapter9(mncing with Sedion 7000) of Divi- rerrc don3 ofthe Bu Wen and Profession Code) or that he is exempt reM ept therefroa E R 1 + 1 gy,.D,U,gNG IDOL ELECTRIC �- VALUATION the basis for the alleged exemption. Any vlolnbn a Section 7 015 byany017ILE'ISSlVI7CF3ESE7%Tl1RF5 applicant lora Ferrell vbjctsthe.ppleast too dWl penally dna rmnthan NEWRb1flENT[ALFLECR SUFI. Ilvel,.ttrdoddrofthepro or req employees want ween a thele mor L n �wner:(the property, STORIES TT'PECONSTRUC`ION a wllldothework andthes rotnmeor'rt intended o mle(S,, 0Ktra, i:Bored(or sale Cole:rch .roes and Pretensions Cole: The C the�eInw - not. ply to do<snot eurh torn owrcrdpmpertywhabnlldsoym,pvnthenoRand impro,es who does each work hMseB mthrough his own emplgms, prwldN that vd+ OCC.GROUP RER UNITS Improvemenh are wt Intended oroHered forsale. If, however, the buikRng or bnprovement Nmld wllhIn oneynrofcompldbri,the owrnr-W liderwlu Nve TOTAL; t Iden arpmWng that la ad wtbullao,brpmw<forpnrposenfsale.). L -J L as owner of the pmperty, am exchuWely cntracung with 11«ruM contract. to mrestrud the pm}ect(See 706/, Busmew and Pr Manion Code: TIW Contractor's License Law does not apply to ..owner d pmp<rty who Wilds or Ireprasv thereon, and who mntraeb for wH plo)tms with a �alT+�roRe)Bernard p..et to the Cmtradae. License Law. Lf I am eurept under Sec B A P C for this recon QTY. PLUMBING PERMIT FEE PERMIT ISSUANCE ALTER -DRAIN& VERA-WATER(EA) FLOOD ZONE AM BACK FLOW PROTECT. DEVICE FEE SUMMARY DRAINS FLOOR, RODE, AREA, CONED. FDCrURES. PER'IRNa SANITARY ' Y— N. �EIPT a Owner e Dat WORIQAAN COMP FS95ATION DECLARATION a c of <m.ent to o y the. « a ❑I hereby oHbm that I haw o Insurance nrtBRate of Workeri Competuximlvunn««a«rtBfed mpytherml6ec. 3800, # G I'a1ky l 2 L SCHOOL TAX Y_ N— RECEEP,T a GAS E.A. SYSTEM -L INCl OI17LEIS PARK FEE Y_. N AECII/ GAS EA. OVER4 MAECa O BUILDING DIVISION FFE9 rtIf5,d copy bhereby famished. e ed espybfRM with the dty traps Han dlWslon. GREASE/INDUSIRL WASTE rNITRCFPIOR PLANCHECK FEE GREA.SETRAP CERTIFICATE OF EXEMPPION FROM WORKERS COMPENSATION INSURANCE (edbn need na b<completed lithe permit b fmorc hundred dollars PAID Date Revel t# SEWER SANITARY STORM F.A.2(X)FT. WATFRHFATEt W/VENT/ELECIR ENERGYFEE Y N — alarEor l«Bu.) In for Ill.. erpiey,hat aepedar in tobechich rperedtlelmud, 1 oriu not empby, any person In any manse m n to become abject to the W«kers'CompuwtbnLaws of Glifomla. Data WATER SYSTEM/TREATING PAID ' Appuont NOTICE TO APPLICANT: IL after inking this CertiNate of Exemption, you Date Recei t# NEW RF�EN]IAL I'LMB. SQFT. TOTAL: should bemrrc mb)M to the Workers' Cnmpenaatton provision of the labor Code, you trust forthwith comply th such provisions or this pemJt shall be deemed revoked. -BUILDING SEISMIC FEE ' CONSTRIICEION LENDING AGENCY I hereby affirm that then b a contrudlm lend Ing agency for the perform ance of the work for which this permit is laved(Sec-3097, Civ. CO TOTAL: �Q2 ELECTRIC FEE QTY.j MECHANICAL PERMIT FEE PLUMBING FEE 00 'eder.Narm, lendee.Addnn 1eaWiry thx lhawreadtwappB tbnaMvatethattheabavetnformatim bmrred. l agomtoreseplywehall ckyaM muntyordirunms and date laws: MECHANICAL FEE PERMIT ISSUANCE FEES PAID: relating to butHIng construction, and hereby autheeUm mq msenrsttvn of this city to enter upon the abov rnentbtud prsperty for Wpedbn purposes. (We) agree to aaw, Ind<rerdfy an d keep hatndess the City of Cupertino ALTERORADDTOMFCJI. .Date Receipt# SUBTOTAL: against babllhics, jnd nmeta,mata and expenewhieh mayin anywayamue .g2 Id ChyI na of the granting a/ this PemtL AIR HANDLING UNIT(TO 10,000 CFM) AIR DANDLING UNIT (OVER 10,000CF:MI CONSTRUCTION TAX g no AFp ant/Contract« Date EXHAUST HOOD(W/DUCT) CONSTRUCTION TAX PAID: HAZARDOUS MATERIALS DISCLOSURE HEATu�GUMTCTOI00,000" Will the applicant or futurebulldingoccupant atone or handle hazardous material as defiecd by the Cupertiro Municipal Code, Chapter 9.12, and the Date RCCCI t# HEATING UNTr OVER 10,000 Blip TOTAL: .Ov Health and Safety Cade SeHm 25532(.)2 ❑ Yea No WWthe applimed:Mature building occupant use equlprrcN or devious which endt hanrdoua ab contarebuas as defined by the Bay Ana Air VINTILAMN FAN (SINGLE RESID) ISSUANCE DATE BOI1XR-CAMP OHP OR 1WM BTU) v Quality Magereent Dlsvid? I� YeaNo I hoe Wad thehva[ons materials requlmrrcnn under Clupter 6.95 of BOILER-COMP(OVER 100,000 BT(p the California Health k Safety Cad, Sections 25505, 25533 and 25536. I NEW RESIDENTIAL MECH. SQFT understand that If the building does not currently h,,.. meant, that It is rey nm spommrbe uky to rally the occupant of the requirements which trust tort A �� ���� prim to tauanee d a Certificate of Occupancy. • Ot ISSUE BY: �-jrrr�• Owner m authottred agent - Date TOTAL: OFFICE COPY SEWER CONNECTION PERMIT SERIALNO. P 0.1 15173 •CUPERTINO'SANITARY DISTRICT R.O.S./P.M./Tract No...�6.' 0.. Lot No...-�; � ...... 20065 Stevens Creek Blvd. A.P.N. Bk.. 3?. U ...... Pg ...1.9 ... Par?. `! .... Building C Cupertino, California 95014 Phone (408) 253-7071 'Date.......'v .. The undersigned, being the owner (or owner's agent) of the property located at ........................................................ %.).n�.1......��a ✓ci.w�j, e�.).... .C.!`.. 1....0 ./tP!!.ic!•.4............................................. consisting of the following TYPE OF BUILDING: Residential: Single family......... 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 easemenL-(Note — Detail J) 3). To acquire a permit from the........................................................... '............. Building Depart- ment and obtain inspection and approval by said Building Department pnof-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 Name.. �:�` �`.....✓� J. e ............ Telephone ....... ,!..5...<�3 2 .................. Mailing address if different from above ... I75... ......i ................................................... By%J.</ v,.! .......................................... FEES A standard backflow protective device shall be installed, to the satisfaction of the Building Department, for the above property. (Note —See Detail I) Connection Permit Fee 60 Sewer Service charges to June 30, 19-)7..,s .... f U. G.... /mo. x.. (t . mo. J � ........... Inspection Fee for backflow protection device TOTAL $ &,ceipt of $ . -3 G...... acknowledged and permit granted. MARK THOMAS & CO. INC., District Manager -Engineer .......................... NOTE: See Details on other side of this permit Valve Access with Vented CUPERT/NO SANITARY DISTRICT NOTES: All valves to be accessible and maintained by Property Owner, Overflow point at least trelve inCh.s(12p) below lowest finished floor conlainlnp plumbing. Kelly Valve Installed of Property Line to be readily removable for Lateral Sewer maintenance. Kelly Valve Valve Access Boa Backwater Valve FIOW_r Kelly Valve Figure t Figure 2 Figure B Kelly Valve- Below Surface Backwater Valve—Normally Kelly VWve -Abov. Ground Imlallatlon-Sh.. al re,ui,.d Installed rt etlall... It point Insinlludon-Shown Installed Property Line Cleonoul. along Mouse Sewer hilt.... clow to building, Property Line and building. I STANDARD BACKFLOW PROTECTIVE DEVICE INSTALLATION I DETAIL Olsmnce from 4 to be as dose as practicable. Removable Cleanest Plug Finish Glade Wye far Riser Sewer Cleanout Bos with Lod to be accessible Shur! lengta� alq maintained DY property owner. Riser Pipe Adopter coupling—�"1/B Bend FLOW ,>r MiWmum slope determined by Building Deparrmenl. L.I .,.I Suer Cleanout to be wme six. as Lateral Sewer. DETAIL STANDARD CLEANOUT FOR LATERAL SEWER J 0I • El