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22683APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY Building Project Identification ntification PIX.TNO. w -g Address o �,� *(PrWW p2 22683 Owner's arras: one. q A CITY OF CUPERTINO- BUILDING DIVISION APPLICATION / PERMIT Cant Lic.No- CATEGORY CONTROL. BUILDING PERMIT INFO BUILDING-ELECTRICM PLUMRING-MDCfIAMCAL ArcMtect/Enginmr. k. Na QTY ELECTRIC PERMIT FEE Address: PERMITISSUANCE ❑ ❑ ❑ LICENSED that EO CONTRACTOR'S DECLARATION I hereby I am under pessand of Cssiona9de,and c AI'PLIANCI'SRFSIDENTfAL ]OB DESCRIITION PANELS cctIonrtn(BofDwg Ingwlth5cct1on7000)of Division 3o(theBminesaand Pro(essLroCode,and my on3ofthe license is In B(orm and effect. Li.& I Lk.N 1 1�T 1 6r Date_ Contractor UP TO 2QUAMPS 201 -IOW AMPS _ ARCHITECTS DECLARATION I understand my plans shall be used as public records. OVER IOW AMPS SQ. FT. FLOOR AREA $/SQ. FF. SIGNSELECTRICAL Licensed Professional SPECIALCIRCUIT/MISC OWNER -BUILDER DECLARATION I hereby affirmthat I am exempt fourths Contractor's Limns law for the foilowingreasen.(SMIon7031S, Businessand Professions Code:Anycityor cwntywhichrequimsaperMttommtmd,alteglmpmve,der ldh,orrepair A L E D t a� [pppfi\/nn, {6aa�i IV, TEMP. MEEK OR POLE INSI. anystructure pdorto its usuance,alsorequirestheappIlcant for such permitto file a signed statement that he Is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9(comnnncing with Section 7000) of Divi- ,an3 ofthe Business and Professiom Code) orthat he la exempt therefromand POWER DEVICES SWIMwNG POOL ELECTRIC the basis for the alleged exemption. Any violation of Section 7031.5 by any appfionl fora permit subjects the applicant to a civil penalty of not mom than OUTLETSSWITCHESFD(TURES five hundred dollars ($SM. ❑ I, as owner of the property, or my employees with wages as their sole compensation, wllldothe work andthe structure isnot Intended or offered for NEW RESIDENTIALELECTR SQ.FT. STORIES TYPE CONf,TRlKT10N sale (Sm. 7044, Business and Professions Code: The Contractor's License law does not apply to an owner of property who Wilds or improves thereon, and whodoessuchworkhlmmif orthrough hlsownemployees, provided that such OCGGROUP RES. UNITS TOTAL: improver nlsarenot Intendedoroffemdforsale. If,however,thebuildingor Improverrcntismld withinaneyearofcompletlon, tMowner-bullderwlll have tle�iuI,rden of proving that he did not Wild or improve for purpose of We.). Lf ate owner of the property, am exclusively contracting with licensed contractors to constn ct the project (Sec. 7014, Business and Professions Code: QTY, PLUMBING PERMIT FEE FLOOD ZONE APN PERMIT ISSUANCE 1 a The Contractor's License Law does not apply to an owner of property who Wilds or Imp. thereon, and who contracts for such plajects with a actor(s) licensed pursuant to the Contractor's License Law. l�OUTI am exempt under Sec. B & P C for this reason ALTER -DRAIN & VENT - WATER (EM FEE SUMMARY BAIX FLOW PROTECT. DEVICE SIDE I III DRAINS FLOOR ROOF, AREA, COND. SANITARY RECF– NP Owner Date WORKMAN COMPENSATION DECLARATIONFO(TlIRFS ❑I hereby affirm that I have a mrtlfkate of consent to self -insure, or a certBicateofWorken Compensation lnsunncem. mrtBled copy th..((Sec. 3800, Lab C.) PER TRAPSCHOOLTA% Y_ N_ RECEIPT y GAS FA.SYSTEM-1 WC.60VTI.ETS PARK FEE Y N T N Policy p Com any GAS E.A. SYSTEM -OVER 6 (FA)RECEI BUILDING DIVISION FEE �CertlRed copy is hereby fumished. Certified copy Is filed with the city Imps U.o division. ❑ GREASE/WDUSTRL WASTE INTERCEPTOR PLANCI'IECK FEE GREASE TRAP CERTIFICATE OF E'%EM PTION FROM WOR KERS' PAID y'E}yp-R SAM7•gRY-SNRM EA pOF-p I l COMPENSATION INSURANCEDd (This section need not be completed if the permit isfmna ohundred dollars (sIW)orless') I camlythat lathe performance of thework for which this permit Is Issued, tC Recei t# WATER [gFATER W/VENT/ELGCTIR ENERGY FEE Y_ N_ WATER SYSTEM/TREATING I shall not employ any person N any manner an as to become subject to the Worked Compensation laws of Cahfmma. Date Applicant NOTICE TO APPLICANT: If, after maWrg this Certificate of Exemption, you should become subject to the Workers' Compensation provisions of the Labor PAID Date Recei t# NEW RESIDENTIAL PLMB. _SOFT. TOTAL: BUILDING FEE Code, you =at forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY SEISMIC FEE - TOTAL: ELECTRIC FEE Iherebyaffirm that there is a construction leading agency for the perform ance of the work for which this permit b Issued (Sec. 3097, Civ. C.) Lender's Name Lerdcr'sAddreaa PLUMBING FEE QTY. MECHANICAL PERMIT FEE MECHANICALFEE I mdifythat l have read thisapplicationand statethattheabove information iscomoct. l agree to comply with all city and county ordinances and state laws PERMRISSUANCE FEES PAID: relating to building construction, and hereby authorim representatives of this city to enter upon the above-memiored property fou Inspection purposes. (We) agree to save, indemnify an d keep harmless the City of Cupertino against llabill dg ts, mets and eapFna awhic rmyinanywayamme ALTERORADDTOMECH. Date Receipt# MR HANDLING UNIT (TO 10,00D CFM) SUBTOTAL: AIR HANDLING UNIT (OVER 10,WO CFM) CONSTRUCTION TAX against• it nron uenm of the gr i ng. t pe G� sig atumo tor Applicant/ContracData IXHAUSTHOOD(W/DUCT) CONSTRUCTION TAX PAID: HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT (TO 100,000 OTU) Date Recel t# Will the applicant or future Wilding occupant stare or handle hazardous material as defined by the Cupertino Municipal Code, Chapter 9.1 2, and the Health and Safety Code Section 25532(.)7 F-11Yes M No Will the applicant or mom, building occupant use equipment or devices HEATING UNIT (OVER 100,000 BTU) TOTAL: VENTILATION FAN (SINGLE RESID) ISSUANCE DATE which emit hazardous air contanname s as defined by the Bay Area Air Quality Management District? Yes [ No Ihave read the h m%uamaterialsrequirementsunderChapter6.95of BOILER -COMP (3HP OR 100,000 BTU) BOILER-COMP(OVER 10 lIDBTU) the Gllf.mU Health & SafetyCode, Sections 25505, 25533 and 25534. 1 understand that if the building does not currently have a tenant, that B la my responsibility to notify the..pant of the requirements which must be met prior to Issuance of a Certificate of Occupancy. OCP 4 '9N r ISSUED BY: C NEW RESIDENTIAL MECH. SQ.FT Owner or authorlud agent Date TOTAL: OFFICE COPY W .i CUPERTINO SANITARY DISTRICT 20065 Stevens Creek Blvd. Building C Cupertino, California 95014 Phone (408) 253-7071 SERIAL P N 7 5 9 8 5 SEWER CONNECTION PERMIT NO. R.O.S./P.M./Tract No. ./A #7....C. Lot No..� /...... A.P.N. Bk. f..I. ... Pg X 5...... Par n Z 0 .... Date. V eA....y............. 199!.. The undersigned, being the owner (or owner's agent) of the jproperty located at ........................................................ 16.6105-....IX.7n?7 Pr..�...��0-it � h D ........................................................... 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. J. ` 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 .. ! `7....0 y � '� /T /'t O . 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 Name. ................... ......................... Telephone.................. ...................... Mailing address if different from above ..... 50.n!In.C................................................ ..................... .......... By. ...C,iGfiY �.... . ...................... . ❑A standard backflow protective device shall be installed, to the satisfaction of the Building Department, for the above property. (Note — See Detail /) a FEES: Connection Permit Fee .......... Sewer Service charges to June 30, 199.7., $ ... A2 rG.../mo. X,/e. MO. ��.�.. .. Inspection Fee for backflow protection device TOTAL $ 12 4 ' OO � lVeceipt of $ . �.21% `� .... 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 mcintolned by Property Owner. Overflow point of least twelve inches(12'') below lowest finished floor containing plumbing. Kelly Valve installed at Property Line to be readily removable for Lateral Sewer maintenance, Figure I Fqure 2 Figure 3 Kelly Valve -Below Surface Backwater Valve - Normally Kelly Valve - Above Ground Installation- Shown at required finish Floor Level Installation -Slaws Installed - along House Sewer between close to building. Kelly VaIvO Finish Floor Level E Finish Grade— Nelly Valva g T s Valve Access B s —� ,gI._ E with Veined C or ` IB Valve Awes. as Backwater Valve ' Figure I Fqure 2 Figure 3 Kelly Valve -Below Surface Backwater Valve - Normally Kelly Valve - Above Ground Installation- Shown at required installed at shallowest point Installation -Slaws Installed Property Line Cleauoul. along House Sewer between close to building. Properly Line and building. STANDARD BACKFLOW PROTECTIVE DEVICE INSTALLATION I DETAIL I Disfonce Irom 0- to be as close as arocticabl e. Removable Cleanout Plug A. Fini.h Grade Wye for Riser,µ• Sewer Cleanout Bos with Lid to be accessible 'hu"Ie ngtM1� and moinlained DY property owner. Riser Pipe' Adaptor coupllnq� 1/8 Bend 'r-- FLOW yr minim m mope determined by Building Department. Lateral SewerCleanout to be some size as Lateral Sower. k' �. DETAIL STANDARD CLEANOUT FOR, LATERAL SEWER J 0,; 0 IE� APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY Building Project Identification ntification PIX.TNO. w -g Address o �,� *(PrWW p2 22683 Owner's arras: one. q A CITY OF CUPERTINO- BUILDING DIVISION APPLICATION / PERMIT Cant Lic.No- CATEGORY CONTROL. BUILDING PERMIT INFO BUILDING-ELECTRICM PLUMRING-MDCfIAMCAL ArcMtect/Enginmr. k. Na QTY ELECTRIC PERMIT FEE Address: PERMITISSUANCE ❑ ❑ ❑ LICENSED that EO CONTRACTOR'S DECLARATION I hereby I am under pessand of Cssiona9de,and c AI'PLIANCI'SRFSIDENTfAL ]OB DESCRIITION PANELS cctIonrtn(BofDwg Ingwlth5cct1on7000)of Division 3o(theBminesaand Pro(essLroCode,and my on3ofthe license is In B(orm and effect. Li.& I Lk.N 1 1�T 1 6r Date_ Contractor UP TO 2QUAMPS 201 -IOW AMPS _ ARCHITECTS DECLARATION I understand my plans shall be used as public records. OVER IOW AMPS SQ. FT. FLOOR AREA $/SQ. FF. SIGNSELECTRICAL Licensed Professional SPECIALCIRCUIT/MISC OWNER -BUILDER DECLARATION I hereby affirmthat I am exempt fourths Contractor's Limns law for the foilowingreasen.(SMIon7031S, Businessand Professions Code:Anycityor cwntywhichrequimsaperMttommtmd,alteglmpmve,der ldh,orrepair A L E D t a� [pppfi\/nn, {6aa�i IV, TEMP. MEEK OR POLE INSI. anystructure pdorto its usuance,alsorequirestheappIlcant for such permitto file a signed statement that he Is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9(comnnncing with Section 7000) of Divi- ,an3 ofthe Business and Professiom Code) orthat he la exempt therefromand POWER DEVICES SWIMwNG POOL ELECTRIC the basis for the alleged exemption. Any violation of Section 7031.5 by any appfionl fora permit subjects the applicant to a civil penalty of not mom than OUTLETSSWITCHESFD(TURES five hundred dollars ($SM. ❑ I, as owner of the property, or my employees with wages as their sole compensation, wllldothe work andthe structure isnot Intended or offered for NEW RESIDENTIALELECTR SQ.FT. STORIES TYPE CONf,TRlKT10N sale (Sm. 7044, Business and Professions Code: The Contractor's License law does not apply to an owner of property who Wilds or improves thereon, and whodoessuchworkhlmmif orthrough hlsownemployees, provided that such OCGGROUP RES. UNITS TOTAL: improver nlsarenot Intendedoroffemdforsale. If,however,thebuildingor Improverrcntismld withinaneyearofcompletlon, tMowner-bullderwlll have tle�iuI,rden of proving that he did not Wild or improve for purpose of We.). Lf ate owner of the property, am exclusively contracting with licensed contractors to constn ct the project (Sec. 7014, Business and Professions Code: QTY, PLUMBING PERMIT FEE FLOOD ZONE APN PERMIT ISSUANCE 1 a The Contractor's License Law does not apply to an owner of property who Wilds or Imp. thereon, and who contracts for such plajects with a actor(s) licensed pursuant to the Contractor's License Law. l�OUTI am exempt under Sec. B & P C for this reason ALTER -DRAIN & VENT - WATER (EM FEE SUMMARY BAIX FLOW PROTECT. DEVICE SIDE I III DRAINS FLOOR ROOF, AREA, COND. SANITARY RECF– NP Owner Date WORKMAN COMPENSATION DECLARATIONFO(TlIRFS ❑I hereby affirm that I have a mrtlfkate of consent to self -insure, or a certBicateofWorken Compensation lnsunncem. mrtBled copy th..((Sec. 3800, Lab C.) PER TRAPSCHOOLTA% Y_ N_ RECEIPT y GAS FA.SYSTEM-1 WC.60VTI.ETS PARK FEE Y N T N Policy p Com any GAS E.A. SYSTEM -OVER 6 (FA)RECEI BUILDING DIVISION FEE �CertlRed copy is hereby fumished. Certified copy Is filed with the city Imps U.o division. ❑ GREASE/WDUSTRL WASTE INTERCEPTOR PLANCI'IECK FEE GREASE TRAP CERTIFICATE OF E'%EM PTION FROM WOR KERS' PAID y'E}yp-R SAM7•gRY-SNRM EA pOF-p I l COMPENSATION INSURANCEDd (This section need not be completed if the permit isfmna ohundred dollars (sIW)orless') I camlythat lathe performance of thework for which this permit Is Issued, tC Recei t# WATER [gFATER W/VENT/ELGCTIR ENERGY FEE Y_ N_ WATER SYSTEM/TREATING I shall not employ any person N any manner an as to become subject to the Worked Compensation laws of Cahfmma. Date Applicant NOTICE TO APPLICANT: If, after maWrg this Certificate of Exemption, you should become subject to the Workers' Compensation provisions of the Labor PAID Date Recei t# NEW RESIDENTIAL PLMB. _SOFT. TOTAL: BUILDING FEE Code, you =at forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY SEISMIC FEE - TOTAL: ELECTRIC FEE Iherebyaffirm that there is a construction leading agency for the perform ance of the work for which this permit b Issued (Sec. 3097, Civ. C.) Lender's Name Lerdcr'sAddreaa PLUMBING FEE QTY. MECHANICAL PERMIT FEE MECHANICALFEE I mdifythat l have read thisapplicationand statethattheabove information iscomoct. l agree to comply with all city and county ordinances and state laws PERMRISSUANCE FEES PAID: relating to building construction, and hereby authorim representatives of this city to enter upon the above-memiored property fou Inspection purposes. (We) agree to save, indemnify an d keep harmless the City of Cupertino against llabill dg ts, mets and eapFna awhic rmyinanywayamme ALTERORADDTOMECH. Date Receipt# MR HANDLING UNIT (TO 10,00D CFM) SUBTOTAL: AIR HANDLING UNIT (OVER 10,WO CFM) CONSTRUCTION TAX against• it nron uenm of the gr i ng. t pe G� sig atumo tor Applicant/ContracData IXHAUSTHOOD(W/DUCT) CONSTRUCTION TAX PAID: HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT (TO 100,000 OTU) Date Recel t# Will the applicant or future Wilding occupant stare or handle hazardous material as defined by the Cupertino Municipal Code, Chapter 9.1 2, and the Health and Safety Code Section 25532(.)7 F-11Yes M No Will the applicant or mom, building occupant use equipment or devices HEATING UNIT (OVER 100,000 BTU) TOTAL: VENTILATION FAN (SINGLE RESID) ISSUANCE DATE which emit hazardous air contanname s as defined by the Bay Area Air Quality Management District? Yes [ No Ihave read the h m%uamaterialsrequirementsunderChapter6.95of BOILER -COMP (3HP OR 100,000 BTU) BOILER-COMP(OVER 10 lIDBTU) the Gllf.mU Health & SafetyCode, Sections 25505, 25533 and 25534. 1 understand that if the building does not currently have a tenant, that B la my responsibility to notify the..pant of the requirements which must be met prior to Issuance of a Certificate of Occupancy. OCP 4 '9N r ISSUED BY: C NEW RESIDENTIAL MECH. SQ.FT Owner or authorlud agent Date TOTAL: OFFICE COPY W .i CUPERTINO SANITARY DISTRICT 20065 Stevens Creek Blvd. Building C Cupertino, California 95014 Phone (408) 253-7071 SERIAL P N 7 5 9 8 5 SEWER CONNECTION PERMIT NO. R.O.S./P.M./Tract No. ./A #7....C. Lot No..� /...... A.P.N. Bk. f..I. ... Pg X 5...... Par n Z 0 .... Date. V eA....y............. 199!.. The undersigned, being the owner (or owner's agent) of the jproperty located at ........................................................ 16.6105-....IX.7n?7 Pr..�...��0-it � h D ........................................................... 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. J. ` 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 .. ! `7....0 y � '� /T /'t O . 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 Name. ................... ......................... Telephone.................. ...................... Mailing address if different from above ..... 50.n!In.C................................................ ..................... .......... By. ...C,iGfiY �.... . ...................... . ❑A standard backflow protective device shall be installed, to the satisfaction of the Building Department, for the above property. (Note — See Detail /) a FEES: Connection Permit Fee .......... Sewer Service charges to June 30, 199.7., $ ... A2 rG.../mo. X,/e. MO. ��.�.. .. Inspection Fee for backflow protection device TOTAL $ 12 4 ' OO � lVeceipt of $ . �.21% `� .... 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 mcintolned by Property Owner. Overflow point of least twelve inches(12'') below lowest finished floor containing plumbing. Kelly Valve installed at Property Line to be readily removable for Lateral Sewer maintenance, Figure I Fqure 2 Figure 3 Kelly Valve -Below Surface Backwater Valve - Normally Kelly Valve - Above Ground Installation- Shown at required finish Floor Level Installation -Slaws Installed - along House Sewer between close to building. Kelly VaIvO Finish Floor Level E Finish Grade— Nelly Valva g T s Valve Access B s —� ,gI._ E with Veined C or ` IB Valve Awes. as Backwater Valve ' Figure I Fqure 2 Figure 3 Kelly Valve -Below Surface Backwater Valve - Normally Kelly Valve - Above Ground Installation- Shown at required installed at shallowest point Installation -Slaws Installed Property Line Cleauoul. along House Sewer between close to building. Properly Line and building. STANDARD BACKFLOW PROTECTIVE DEVICE INSTALLATION I DETAIL I Disfonce Irom 0- to be as close as arocticabl e. Removable Cleanout Plug A. Fini.h Grade Wye for Riser,µ• Sewer Cleanout Bos with Lid to be accessible 'hu"Ie ngtM1� and moinlained DY property owner. Riser Pipe' Adaptor coupllnq� 1/8 Bend 'r-- FLOW yr minim m mope determined by Building Department. Lateral SewerCleanout to be some size as Lateral Sower. k' �. DETAIL STANDARD CLEANOUT FOR, LATERAL SEWER J 0,; 0 IE�