22593 S
_ AINLICANTTO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
8"Ildlog Project Identification PERMIT NO.
Building Address: 2 2 5 9 3
/6s7 / M
Aoyd Rj v
ft,�s
Name: A A .
CITY OF CUPERTINO-BUILDING DIVISION
t � J jAe N APPLICATION / PERMIT
BUILDING-ELECTRCALaUMBING-MECHAMCAL CATEGORY CONTROL N
Art itect/Ensiruen Lk.No:
QTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO
Add.. PERMITIS5UANCE ❑ 1:1 1:1LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that l am licensed under provisions o(Chapter 9(comment APPLIANCES-RESIDENTIAL JOB DFSCRIPHON
ingwith5eetlon 7000).(Dtvl.lon3ofthe B..lnemand Pro(essi...Code,and my
license is in o deffeR. 39 PANELS _ SI�Kar�n
License Cl Lk.N �-i
Date ContractorUP TO 200AMPS
�r ARCHITECTS asps ATION OVER1000AMPS SQ.FT.FLOOR AREA S/SQ.FI'.
uz 7 I understand my platy slsll be used mpublic records. /� r
p Licensed Professional SIGNSELECTRCAL L• ® IN
< OWNER-BUILDER DECLARATION1hamSPECIAL ClRCU1T/ML9C ��—�B LL�»
L, owing rason.(hatTam31.5,Ba.empt fromthe Contractor's Llcenx Lawforth.the
OZI:. following reason.(Section 7011.5,Business and Pro(embna Code:Any dty or TEMP MEECR OR POLE INST.
F� county which requires a permit toconar uc%alter,improve,demoLLsh,orrepalr
,$mmQ anystmMmpdmtoisL ancgab requkestheappBnnlfmsuchperMtto POWER DEVICES DAT
O X V file a signed statement that heat licensed pursuant to the proWlons of the
Oq Contractor's License Law(Chapter 9(commencing with Section 7000)of Divi- SWIMMING POOL ELECTRIC
30� sion3aftheBuslnmsmdProfemlomCode)orthathelsexempttherefmmand VALUATION
<$ the beads for the alleged exemption. Any violation of Section 70315 by any OUTLEISSWITC}IESHXTURFS
Applicant fora perent subjects the applicant to a dvil penalty ofnot more than
live hundredsowner
hepr. NEW RESIDENTIAL ELECTR SQ.FC. STORES TYPECONSfRUCTION
7 m I,as owner of she property,or he employees with wages r[herr sofe
compensatlon,wW doth.work,endthe swcture at net Intended or offered for
Orule Sm 7046,Business and Profassmns Cade:The Conlractot's License law
does not apply to an owner of property who builds or Improves thereon,and OCC.GR011la RES.UNITS
who das suchwork himself or through his own employees,provided that such
improvements are not intended or offered for eek.If,however,the build Ing or TOTAL:
Improvement Is sold within one yearofcompiation,the owner-builderwill have
t rden of proving that he did not bu0d or improve for purpose of sale.). QTY. PLUMBING PERMIT FEE FLOOD ZONE APN
UL as owner of the property,am exclusively contracting with licensedPERMIT ISSUANCE
contractors to construct the project(Sec.7044,Business and Professions Code: _
The Contractor's License law does w
not apply to an owner of property who
Wilds or Improves thereon, and who contracts for such projects with a ALTER-DRAIN&VENT-WATER TAI
egn1(actor(s)licensed pursuant to the Contractor'.License Law. BACKFLOW PROTECT.DEVICE FEE SUMMARY
LJ I am exempt under Sec B& P C for this reason
DRAINS FLOOR ROOF,AREA,COND. SANITARY Y_ N_ I
• Owner Date RF-CERT p I
WOR KMAN COMPENSATION DECLARATION
I hereby affirm that I have a mkRcale of consent �.N��.�s SCHOOLTAX Y_ N_to vel(-Insure,or RECEIPT N
mrtifiateo(Warken'Compematton Insurance ora mrtifled copy thereof(Sec. GAS EA.NSTEM-1 WCAOUTLETS PARK FTE Y_ N_
3800,Lab C.) RECEIPT N
Policy p GAS EA.SYSTEM-OVER 4(FA)
Com any BUILDING DIVISION FEES
Com
copy is hereby furnished. GREASE/INDUSTRL WASTE INTERCEPTOR PLANCHECK FEE
E3CekJed copy at filed with the city inspection division.
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE TRAP PAID
COMPENSATION INSURANCESEwER-SAMTAAY-STORM EA 200FT C` ) Date Reoci t#
(ThIssekion need not becomplated dithe permit Is forone hundred dollen J lY
(9100)or less.) WATER HEATER W/VENT/EL[CIR ENERGY FEE Y_ N_
I comlythat in the performance of the work(orwhich this permit Is Issued,
I shall not employ any person in any manner so As to become subject to the WATER SYSTEM/TREATING
Workers'Crmpensation Lwsof Califmnk. Date PAID
O Z Applicant NEW RESIDENTIAL PLMB. SQFT. Date Recei t#
Z O NOTICE TO APPLICANT:ILaNer making this Certificate of Exemption,you
ns
should become subject la the Workers'Compensation provisions of the Labor TOTAL:
CC fA Code,you most forthwith comply with such provisions or this permit shall be BUILDING ,
EE
CC ] deemed revoked.
CONSTRUCTION LENDING AGENCY SEISMIC FEE
CL o 1herebyaf nothat there Isaconttrucdon kndingagency forthe performELECTRIC FEE
D Z ance ofthe work forwhkh that permit is toned(Sec.3097,Cie.C.) TOTAL: Ti-lou
00 Lender's Name PLUMBING FEE
LL ~ Lender.Address QTY. MECHANICAL PERMIT FEE MECHANICAL FEE
OW 1mllythat l have read thisapplicationand katethat theabove Information
4 atconnit.lagreeto comply with aB dtyand countyardrnanms and state laws PERMIT ISSUANCE FEES PAID:
>. relating to building construction,and hereby authorirn representatives ofthat
I'_ Zcity to enter upon the above-mentioned property for inspection purposes. ALTER OR ADD TO MECH.
_ (We)agree to save,,Indemnify an dan d keep harmless the City of Cuparmo Date Refeiptri
against liabilities.ju��Lt,�(, Jexpensn whichmaylnany aye AIR HANDLING UNIT(170 10,000 CFM) SUBTOTAL:
against In mosegoenm ming of thlspe
AIR HANDLING UNIT(OVER IO,000CFM) CONSTRUCTION TAX
or
SI atureo ppll m/Co tractor Nk DaTof EXFIAUST HOOD(W/DUCT) CONSTRUCTION TAX PAID:
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle haeardoos HEATING UNIT(TO 100,00 BTU) Date Recei IN
material as defined by the Cupertino Municipal Cade,Chapter 9.17,and the
Ptrahh and Safety Code Seddon 25532(a)7 HEATING UNIT(OVER RQ00)BTU) TOTAL:
M ye, I]No
Will the applicant on future building occupant use equipment or devices VENTILATION FAN(SINGLE RESID) ISSUANCE DATE
which emit hazardous at.contaminant.as defined by the Bay Arca Air �p"dy'►`1rE
'
Quality Management District?
p)IPDR 100,000 BTU)
4Yea ❑No
havemad the hazardousmaterials requirements under Chapter 6.95of BOILER-COMP(OVIR100,OW BTU)
the Uliandt Health&Safety Code,Sections currently
h ve a ternd7Jha4, i AUG 14 »�
understand that if the&Safety does not a ns 25y h,25533 n d 2SSt It Is my NEW RESIDENTIAL MECH. SQ.R
responsibility to notify the occupant of the requirements which most ben t
prim to issuance of a Cool eate of occupancy. City of CU
Owncrorauthoriznd agent Data TOTAL: ISSUED BY:
OFFICE COPY
SEWER CONNECTION`PERMIT SERIALNO. P I `' 15177
CUPERTINO SANITARY DISTRICT R.O.S./P.M./Tract No../(r ... Lot No..!2."I......
20065 Stevens Creek Blvd. A.P.N. Bk..;5Z(,?...... Pg..�q5.... Par C2
Building C
Cupertino, California 95014 f
Phone(408) 253-7071 Date......r IV u.tl$ .......1.`!••.••••..••••
The undersigned,being the owner(or owner's agent)of the property located at ........................................................
................. ..........................................................
consisting of the following TYPE OF BUILDING:
Residential: Single family...,K...... 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 ..l..: .c.-/, ...�?....(C A&!t.T.6.P................................ Building Depart-
ment and obtain inspection and approvkl by said Building Department prior to covering of the work or use of the sewer.
4) To first expose 'annd inspect for serviceability the lateral sewer prior to starting construction of the house sewer.
Property Owner's Name..K G? !'.I. �' v,...... I. /o �...... Telephd W J... .c6.. .. 2 n V
Mailing address if
(N �
/ 7 � - 9Sz�./>.....
different from above...52..m.t......................................................................... .......................
By....f�!..........
..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:
p O
Connection Permit Fee $.. .....
Sewer Service charges to June 30, 19.,7., $....1........../mo.X.�Lmo.
Inspection Fee for backflow protection device
ru
TOTAL $ ( �
/3� �'
Oeceipt of$.�. ....' .. acknowledged and permit granted. MARK
�THOMAS
S&&CO. INC..,,, District Manager-Engineer
By-4 C<L11, :�..........................
NOTE:See Details on other side of this permit
, .
CUPERT/NO SANITARY DISTRICT
NOTES: All valves to be occas Bible and maintained by Properly Owner.
Overflow point at least twelve inches(12") below lowest finished
floor containing poen
Kelly Valve installed at Property Line to be readily removable
for Lateral Sewer maintenance.
J
Finish Flo r Level
Kelly Valve Finish Floor Level 'a
E Finish Grade a o'
Kelly Valve E t`
g
Valve Access B
spa ` or
with Vented C Valve Access Box
dT' Backwater Valve
_FLOW
Figure I Figure 2 Figure 3
Kelly Valve-Below Surface Backwater Volvo—Normally Kelly Valve-Above Ground
Installation-Shown at required installed at shallowest point tnstallutian-Shawn installed
Property Line CleoueuL along House Sewer between close to building.
Property Line and building.
TA
STANDARD BACKFLOW PROTECTIVE DEVICE INSTALDEIL
LATION I
Distance from R to be as
close as practicable.
J
Removable Cleanout Pluq
Finish Grade
Wye far Riser
Sewer Cleanout Bos with Lid to be accessible
Share length \ and maintained by property owner.
Riser Pipe
Adaptor coupling 1/8 Bend
,FLOW v
Lateral Sewer I Hone Sewer
OTE Mnimum slope determined by Building Department.
-Lateral Sewer Cleanout to be same
size as Lateral Sewer. •
OE TAIL
STANDARD CLEANOUT FOR LATERAL SEWER J