The URL can be used to link to this page

15162 SERIAL P `15162 ✓ SEWER CONNECTION PERMIT NO. ..UPERTINO SANITARY DISTRICT R.O.S./P.M./Tract No.,"Jr/�.. Lot No...-s.3..... 20065 Stevens Creek Blvd. A.P.N. Bk.�2- !+...... Pg.....?.... Par f'J '.s.... Building C Cupertino, California 95014 Phone (408) 253-7071l�A...... ..................... 19.9 . The undersigned,being the owner(or owner's agent)of the property located at ....� � �..... �/ ...�✓%L!F'J... ..................................................................................................... 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 thel�m+ its of any existing District easement. (Note—Detail J) • 3) To acquire a permit from the .....�1.�..�.? .... �� '.F %[!.C1..................... 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 s�e"wer prior to starting construction of the house sewer. Property Owner's Name.STC!/rte/..!!!/.,, 1!l.l/((.•.,,C/..... Telephone! .' O... 1?..- r ..... ........... Mailing address if differentfrom above........... ................................................../...jf.,l. .. ..........J......,�.............. �f ❑ 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 $" •�• vo Sewer Service charges to June 3Q 19`��.,$.��."'-......./mo. x..O..mo. ............. Inspection Fee for backflow protection device TOTAL $ t n permit ranted. MARK THOMAS &CO. INC. District Manager-Engineer •eceipt of$................ acknowledged and pe g f By. : ...... .................... NOTE:See Details on other side of this permit. APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY Building Project Identification PERMIT NO. BugAddmm- 702- 69 "� �� ! • o .w , . 22517 Owners ame: 49 V �.yl� AFFU�IION 111111 IM, - CITY OF CUPERTINa BUILDING DIVISION ontraccera Name: Lie.No: APPLICATION If PERMIT 7 -- cl L S&W BUILDINGELECTMCA PLUMBING-MECHAMCAL CATF-GORY CONTROL N Architect/Englneee Lic.No: ` �-r QTY ELECTRICPERMIT FEE BUILDING PERMIT INFO Addrcmf 6 , /Z�/, CU e4,&/ 1/V0 PERMIT ISSUANCE LICENSED CONTRACTOR'S DECLARATION D 11 I hereby sitlrm that l am licensed under provisions of Chapter9(mmmmc APPLIANCFSSRFSIDENHAL JOB RPHON Ingwilh Saction7000)of Dlvislon3 ofthe Buslnessand ProfesslonsCode,and my License Is in force and c.8 PANELSLice Data Clam ContrUP TO 2QQAMPSactor Date GHITE sur 20110DOAh1I5 ARCNITECTSDECLARATION OVERIODOAMPS FL AREA S/SQ.FT. 0O pO I understand my plans shall be used u public raeords. I�`j Licensed Professional SIGNS ELECTRICAL LED I Id Z 3 Ohat WNER-BUILDER DECLARATION SPECIAL CIRCN7/MLSC i., owing .. cefl..m 11.5,B(romthe Contractorsfsss CoclLimmse Law for Me N1 Z$j following ape QttommtmMm tProfessionsea le hnycityor TEMP METER OR POLE INST. !6J r � mantywhich mqulresa pemdt tomnstmct,alter,bnprove,demolish,orrepsir ry^ / 4 Q any structure prior to Its Issuance,also requires the applicant for such permit to POWER DEVICES L U file a signed statement that he ts licensed Pursuant to the provtsionss of the V V Cantranoes License law(Chapter 9(commencing with Session AX())of Divi- SWBNMINGIWLELECIRIC VALUATION O sI.n3.fthe B..ffi...d Pmdeesio.Code).rthat hetsemm therefrom ani F Ey O the bads for the alleged exemption. Any violation of Section 7WIS by any OUTLETS-SWITCHES,EXTURES applicant fora permit subjects the applicant to a civil penalty of not more than 5� 0. NEW RESIDENTIAL ELECTR mfive hundred dollars($50 SQ.FT. I,as owner of the property,or my employees with wages as their sok STORIES TYPE CONSTRUCTION �7a compSec.70 ,Buinessthe nd Prondthestmcia The red Intended offamd ❑ sale(Sec.70 W,Business and Prafessbre Cade:7M Contractors Llmrne law does not apply to an owner of property who Wilds or improves thereon,and OCC.CROUP RFS.UNITS whodoessuchwork hlmseBorthraugh hisown employees,provided that such Improvements are not intended oroffered forsale.If,however,thebuilding or TOTAL improvementtssoldwithinoneyearofcomplel Mtheowner-buBderwill have t"rdenofprovingthathedld nes build or improve for purpose ofsakJ. QTY, PLUMBING PERMIT FEE FLOOD ZONE APN u L as owner of the pmperty,am exclusively contracting with licensed PERMIT ISSUANCE Q contractors to construct the project(Sec.7014,Business and Prof.[..Code: L o The Contractor's License Law does nes apply to an owner of property who ALTER-DRAIN&VENT-WATER(EA) Wild.or improves thereon,and who contracts fm such ptojects with a ,,ttHBffactm(s)Ilcensed pursuant to the ContraRoe's License Law. BACK FLOW PROTECT.DEVICE FEE SUMMARY IJ I am exempt under Sec. B& P C for this masonOUTSIDE FEES DRAINS FLOOR,ROOF,AREA,COND. SANITARY Y_ N_ Owner Date RECEPT N WORKMAN COMPENSATION DECLARATIONFIXSCHOOL TAX Y— N 7.URES PER — ❑I hereby affirm that I have a certificate of consent to self-insure,or a RECEIPT N certl0rate of Workers'Compensationlnsuranco ora certBhd copy thereo((Sec. GAS EA.SYSTEd-1 INCAOUTLETS PARK FEE Y N 3800,Lab C3 — RECEIT T N Policy N GAS EA.SY5FEM-OVER 4(PA) BUILDING DIVISION FEES cmm any Certlfled copy 6 hereby furnished. CREASE/INDUSIRL WASTE INTERCEPTOR PLANCHECKFEE Certified copy is filed with the city Inspection division. CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE TRAP PAID COMPENSATION INSURANCESEWER-SANITARY-STORM EA.2WFT. S U Date Rewipt# (This section need not he completed if the permit g foroa hundred dollars ($10(tmlev.) WATER HEATER W/VENT/ELECTR ENERGY FEE Y_ N_ I cortify that N the performance ofthe work forwhich this Permit is gourd, I shall not employ any person In any manner m as to become subject to the WATER SYSTEM/TREATING Workers'Compensation Laws of GBfomia.Data PAID O Z Applicant NEWRESIDENTLM.PLMB. SQ.FT. Date RccCi t# Z O NOTICETO APPLICANT:If,after making this Certificate of Exemption,you F N should become subject to the Workers'Compensation provisions ofthe Labor TOTAL: Code,ymmrstforthwlthmmplywithsuchpmv lomorthtspermitshallbe BUILDING FEE W j deemed revoked. CONSTRUCTION LENDING AGENCY SEISMIC FEE CL Z IhercbyafRrmthat there Is construction landingagency forthe perform, TOTAL: (750_u a U' ELECTRICFEE once of the work for which this permit b Issued(Sec.3097,Civ.C.) U O Laodara Name PLUMBING FEE 17, 1919 H Landers Addmss QTY. MECHANICAL PERMIT FEE LL U I cerHfythat l have read thisappBotlonand statethat theabove Information MECHANICAL FEE O W Is correct.I agree to comply with all city and county ordinances and state laws PERMIT ISSUANCE FEES PAID: } IL relating to building construction,and hereby authorise representatives ofthts _'/� �j�f��j,(� Zcity to enter upon the above-mentioned property for impession purposes. ALTER OR ADD TO MECH. Be t/ IPt# (We)agree to save,Indemnify and keep harmless the City of Cupertino AIR HANDLING UNIT((010,(00 CFM) V agalysdnbyltic;jrdgments,costsanit penia whlchmrylnanywayaceme SUBTOTAL: O aSaata cit mm�eryuenmo t gran, thl pe t. CONSTRUCTION TAX 6 Ad :2 /�� AIRI;ANDWNG UNIT(OVER 10,000CIM) sl tum of AppBram/Contractor Date( EXHAUST HOOD(W/DUCT) CONSTRUCTION TAX PAID: HAZARDOUS MATERIALS DISCLOSURE Will the a pplicant orfuturc building occupant store or hand In hazardous HEATING UNIT(TO 100,000 BTU) Date Recel t# material as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety Code SnHon25532(a)? CLEATING UNIT(OVER 100,000 BTU) TOTAL: _Q ❑Yea M No Will the applicant or future building occupant use equipment or devices VENTILATION FAN(SINGLE RESID) DATE which emit harardous air contaminants a.defined by the Bay Area Air P Qu Iay Management District? BOTLFR-COMP OFR.OR 100,000 BTU) ^n 4Yes ❑No � t haveres theh dOusmaterials requirmanunder Chapter G95of BOILER-COMP(OVER I 00,0W BTU) I�1In the California Health&Safety Code,Sections 25505,25533 and 25534. I AUG understand that if the building does not currently have a tenant,that it is my NEW RESIDENTIAL MECH. SQ.FT responsibility to notify the occupant of the re quirvinvels which must be met prior to Issuance of a Certificate of Ompanry. Owner or authorized agent Date ISSUED BY: TOTAL: OFFICE COPY