23696 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
Building Project idemificainn PERMIT NO.
BuOding AddmO LAJ 23696
woe's arra: one: -
GL4pyS ( I,Jo S—1/6, CITY OF CUPERTINO-BUILDING DIVISION
contncror's Nams: Lic.No APPLICATION /PERMIT '
'
1-1qJeRr Kc10A/Z BUILDING-ELECTRICALPLUMBING-MECHANICAL CATEGORY CONTROLp
Architect/Engineer,_ Ltc,Na.
t.;
ELECTRICPERMIT, ' FEE BUILDING PERMIT INFO.
Address: PERMITISSUANCE '
LICENSED CONTRACTOR'S DECIARATION, o
I hereby affirm that larn licensed underprovbionsdf Chapter's(commAPPUANCESRESIDEMIAL JOB DESCRIPTION
'
In ease 1 Section 721.and
a(theBmineseand Pro(essionsCode,and
license le In fuB'force and e!!M. PANELS
LicenseC6m Lk.N "
Date Contractor" _
ARCHITECPS DECLARATION - 201-1000 AMPS
0 I understand my plans shall be used as public records. OVER 1000 AMPS SQ.FT.FLOOR AREA 5/SQ.ET.
Fi od(Cj Licensed Profesaioml SIGNS ELECTRICAL ,
OWNER-BUILDER DECLARATION.
Z H�4 I herebyaffirmthat l am exempt from the Contractor's License taw forthe SPECIALCBiCUIT/MLSC
09-p following reason.(Section 7031.5,Business and Professions Code:Any city or TEMP.METER OR POLE INST.
p� .a countywhich requiresa permittoconatruct,alter,inprove,demcliah,orespalr
anystmeture priorwits Issuance,also requirmthe applicantfor such permitto POWER DEVICES
fG file a signed statement that he is Licensed pursuant to the provisions of the - '
3 O Contractor's License Law(Chapter 9(commencing with Section 7000)of Owl- SWIMMING POOL ELECTRIC
sion 3oflhe Busrnessand ProfeuloruCode orthat heisexempt therefromand VALUATION
'g the basis for the alleged exemption. Any violation of Section 7031.5 by any ,
q applicant for a permit subjects the applicant to a civil penalty of not more than - OUTLETS-SWITCHESHXTURES
five hundred dollars 5500). , NEW RESIDENTIAL ELECTR
(y I,as owner of the ro SQ.Fr. .STORIES TYPE CONSTRUCTION
❑ p party,or my employes with wages r[herr sole
k51<
compensation,0K will do the Business and k and mf..ihe e[mcture Is he Coot cbsexdcd oioff law
C p d for
sale(Sec.apply
to Business and pmFminy Code:The or improves
threrun law
$ does not apply to an owner of property who build,or Improves thereon,and OCC.GROUP ' RES UNITS
who dnessuch worktinten intended
hisownemIf,how,providedthatwch
improvements are not Intended oroHer¢d(oreale.](,however,thebulldingor TOTAL;
' Improvementbaold withinoneyearo(coinpletbgtheowner-buBderwilHuve
den otproving that he did nmt build orimprove for purpose ofnk.)., QTY, PLUMBING PERMIT ' FEE FLOOD ZONE APN
as mune'o(lhe property,em exclusively rontratling with licensed PERMIT ISSUANCE
tractors to corutmct the project(Sec.7044,Business and Professions Cade:
The ContnctoYs License Law does oat apply to an owner at property who ALTER-DRAINk VENT-WATER(FA)
bu0de or Improves thereory and who contracts for such p�ojem wah a
c¢Gt'actoKa)uanaed punuantrothe Contractor9Lkense Law. :FEE SUMMARY
IJ I am exempt under Sac. 'B&P C (or this reason BACKFLOW PROTECT.DEVICE _
Owner DRAINS FLOOR ROOF,AREA,COND. SANITARY � Y_ N
• Date RECEIPT'R
WO it MAN COMPENSATION DECLARATION FIXTURES.PER TRAP SCHOOL TAX Y" N
❑I hereby affirm that I have o lexu a c of consent ro elf-insam,ora RECEIPT X
certificate of Workers Compnaatlonlwurance oracertifled ropythereof(Sec. GAS EA.SYSTEM-1 INC.4 OUTLETS PARK FEE' Y N
3800,lab C.)
Pollry p RECEIPT R
Com any "' GAS EA.SYSTEM-OVER 4(EA) t. BUILDING DIVISION FEES
[P Certified copy b herebyfurnished.the city GREASE/INDUSTRL WASTE INTERCEPTOR PLANCHECK FEE
❑Certified copy bfiled with the airy Inspection division. - '
CERTIFICATE OF EXEMPTION FROM WORKERS' GR PAID
COMPENSATION INSURANCE _ ARY-STORM
"IT �� Date. Recei t#
(0)crim ) need not be completed if the permit b(Drone hundred dollars
(81I camleea.) - HEATER W/VENT/M FCTR ENERGY FEE Y N '
I ll not that o the person nce of in any he numnrkso as to become
permitisIssued,
I shall not employ any person in any manner so as to became subject to the WATER SYSTEM/TREATING
Worlicn'Compensatlon Lawsof Calitomla.Data PAID
O Z Applicant on,you NEW RESIDENTIAL PLMIL SQ,FE Date - Recei t#
Z O NOTICE beOAPPLICANT:e aorkem'ftcr making this Coon provisions
oft eLabo
Code, becorn forth to the Work it Comp onsialn ,orchis permit shall
Labor TOTAL:
f/)
Code,you mkeHorthwlth comply with such provisloru or this permit shall be DING
� deemed revoked. FEE
CL _ CONSTRUCTION LENDING AGENCY SEISMIC FEE
I herebya((irmthat there b a construction lending agency forthe perfomF
Z - ance of the work for which this permit b issued(See.3097,Civ.G.) !�^j ELECTRIC FEE
(,) O Lender's Name _ y�Y PLUMBING FEE
LL � Eandar's Address QTYI MECHANICAL PERMIT FEE MECHANGFEEICAT FEE
O W Irertifythatl havereadthbapplinHonand statethattheabove information
b comact.I agree to comply with all city and county ordinances and nate laws PERMIT ISSUANCE FEES PAID:
}
N W relating to building construction,and hereby authorize representatives of this ,
city to enter upon the shave-mentioned property for inspection purposes. . ALTER OR ADD TO MECH.
Z (We)agree to save,Indemnify an d keep barrel.the City of Cupertino Date R2COIPt#
V. against liabilities,udgments,cosmand expenses which may in anywayaccrus AIR HANDLING UNIT ITO 10,000 CFM) SUBTOTAL'
against said City in consequence of the granting of this permit.
- AIR HANDLING UNIT(OVER 10,000 CFM) CONSTRUCTION TAX
Signature of Applicant/Contractor - Data EXHAUST HOOD(W/DUCT) _ CONSTRUCTION TAX PA ID:
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle haeardous HEATING UNIT(TO 100,000 BTU) .. Date Recei [#
material as defined by the Cupertino Municipal Code,Chapter 9.12,and the
Healthand SafetyCode Section 25532(.)7 HEATING UNIT(OVER 100,000 BTU) - TOTAL.
❑Yea No �¢ ie a'E
Will the applicant or r lure building occupant use equipment or devices VENTILATION FAN RESID)'. - Sr(.0Pa (17 DATE
which emit hazardous air contaminants as defined by the Bay Area Air - 17
• a lily Management District? BOILERLOMP OHP OR 100,000 BTU)
�Yn NNo
have read the hazaHealth
& Tet Code,materi
tions 25505,255 3 and 25534.1 of BOILER-COMP(OVER 1(10,000 BTU) - MAY 1 8 1992
the California Health building
Code,not
sntly have a tenant,
that
n
understandthat lithe building does not currently haveatenanp that itbmy NEW RESIDENTIAL MECH. SQ.Ff.
responsibility to notify the occupant of the requirements which must be met C/aITY 1
prior to bsuarq of.Certificate ofO/mpanry,�/�/ p p UC laUt'CT31
Owner or authorized ag t - - Date—f—= -
TOTAL:. ISSUED BY:
OFFICE COPY
SEWER CONNECTION PERMIT SERIALNO. P 5239
11,93�/
CUPERTINO SANITARY DISTRICT R.O.S./P.M./Tract No..5 3. .... Lot No.7�........
20065 Stevens Creek Blvd. A.P.N. Bk...5.5. ?..... Pg..�O>..... Par.�.�. ....
Building C
Cupertino, California 95014
Phone(408) 253-7071 Date...�����..... ...................... 19/.p
z.
The undersigned, being the owner(or owner's agent)of the property located at ........................................................
/4� 46 I o4n4 ) GnPt_'O ei' 40O
....................................................>........ .P. .....................................................................,
consisting of the following TYPE OF BUILDING:
Residential: Single family....x..... Multiple............ No. Units............
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 ..4/! 9 -(.... 6_1 a r- -b n.0............................ Building Depart-
ment and obtain inspection and approJal 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.
-t1,.
Property Owner's Name J,.P. ..C.:.. .. .(AQ. .S..}'.r�•...&O.Telephone.....Z.::5. .......................
Mailing address if 2 -7 4�
differentfrom above....................... .`..............................�.......�.......�....�...............................
By...... .........I .
G !r-: C !C t i
( .................
❑ A standard backflow protective device shall be installed, to the satisfaction of the Building Department, for the above
property.(Note—See Detail I)
FEES:
Connection Permit Fee o 0
Sewer Service charges to June 30, 19., -7.$.... ..../MO. x.Z..mo. ...
Inspection Fee for backflow protection device
`� Oo
TOTAL $ �!
60
Oeceipt of ...... acknowledged and permit granted. MARK THOMAS &CO. INC., District Manager-Engineer
By % ..................
NOTE.See Details on other side of this permit.
CUPERT/NO SANITARY DISTRICT
NOTES: all valves to be accessible and mamlamed by Property Owner.
Overflow point at least twelve mchee(12") below lowest finished
floor containing plumbing.
Kelly Valve Installed at Properly Line to be readily removable
for Lateral Sewer maintenance.
F
J
— 5
o m h Flo r el
i Finish Floor Level_
d u Kelly Valve
E Finish Grades u.
go Kelly Valve _-41E g
Valve Access B r j ink
with Vented C ver Valva access Sox -
Backwater Valve
Figure I Figure 2 Figure 7
Kelly Valve- Below Surface Bockwalm Volvo-Normally Kelly Volvo-Above Ground
Imlallolion Shown al reputed Installed or shallowest point Inslallalmm Shown installed
Property Line Cleanout. along Haus. $ewe, between close to building.
Property Line and Wilding.
DETAIL
STANDARD BACKFLOW PROTECTIVE DEVICE INSTALLATION I
r Distance from R to be as
I corse as proctitobi•
J
Removable Cleanout Plug
1 Finish Grade
Wye for Riser —
--Sewer Cleanout Box with Lid to be accessible
and maintained by property owner
Shari length- - Rlssr Pipe
Adaptor coupling I/B Bend
1 cruse Sewer
lalaml Sewer .µ-) - h]DTE nimum slope determined by Building Department.
TII
-Lateral Sewer Cleonoul to be same
size at Latero) Sewe,
DETAIL
STANDARD CLEANOUT FOR LATERAL SEWER J