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22580 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY ^ - Building Project Identification PF3IMITNO. Jo Building Address: n C O O /orale ,y N .e• G /!J lj-- ,77173 CITY OF CUPERTINO-BUILDING DIVISION A co o' Lie.No: APPLICATION p /PERMIT 6 �OV BUILII NIELECTRICAL PLUMBING.MECFIAMCAL CATEGORY CONTROL N A iter/Engineer. Lic.No: QTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO Address vI ��O gfan„ef�a PERMITISSUANCE ❑ ❑ ® ❑ LICENSED CONTRACTOR'S DECLARATION I hercbyaffirmthat l amldcensed anderpronedonsof Chapter9(..c APPLIANCES-RESIDENTIAL JOB DESCRB�ION Ingwlth Sectlon70000)of DiWsion 3o4the Businessand Pmfessdon.Code,and my hunsee pCls.V-sf�ndLicN IDP PANELS Licens �a � � 1 -.4 � 1 Date_�(Z+�Contrudar 1.- file^ ARCHITECTS DECLARATION 201-IOW AMPS ON Z I understand my plana shall be used as public records. OVER IOW AMPS SQ.17.F10DA ARTA $/`�'FT. O �j Licensed Pnafessionsl SIGNS ELECTRICAL p ¢' OWNER-BUILDER DECLARATION iI I�' In SPFCIALCIRCUIT/MISC L'�+ fff i„ Z raving yaf@mthatlam eaemptfromthe Contractor's License Law(or the y IN ].9,., (ogowing reason.(Seddon 70115,Business and Professions Code:Any city or TEMP METER OR POLE INS. II 1 countywhi&rcqu4 apermdttommtmd,alter,dmpmwdemolLh,ormpalr 1� 1 g at anystrudure prior to its issuance,alsonequirestheappllant forsuch permit to POWER DEVICES EE file a signed statement that he b licensed pursuant to the provbbv of the Contractor's License Law(Chapter 9(commencing with Section 70000 of Divi- 4123 gWP4hDNG IDOL ELECTRICUATfON O sion3ofthe Busdnemand Profemlons Codr)orthathebexempHherefmmand — EL ATE the basis for the alleged exemption. Any violation of Section 70]15 by any OUTLETS—SWITCHES-FIXTURES �05 applicent fora permit subjecosthe applicant to a civil penalty a neat moethan five hundred dollars(500). NEWRESIDFNHALELECTR F1 1,as owner of the property,or my employees with wages as their sole �Ff. STORIES TYPE CONSTRUCTION s, compensatlon,will dothe work and thestructure is nor ntended or offered for g 0 sale(Sec.7044,Businen.rd Professdom Code:The Contractors License Law does not apply to an owner of property who Wilda or dmprovo thereon,and �$^ whodoessuchworkhimselforthrough hd.ownemployees,provided that such OCC.GROUT' RFS.UNITS Improvements are not intended oroffered forsale.If,however,thebuilding or TOTAL: improvement bsold withinoneyearofcompleiogtheowner-budiderwdll have t"relen of proving that he did nmbuildorbnproveforpurposeofsale.). QTY. PLUMBING PERMIT FEE FLOOD ZONE APN "L as owner of the property,am exclusively contracting with licensed ^� contractors to construd the project(Sec.7044,Bu.iness and Professions Cade: pFRMIT ISSUANCE I y The Contractor's License law does net apply to an oner of property who w Wilds or Improves thereon,and who contracts(oe such p(ojecb with a ALTER -WATER(EN yJLtIactor(9Bcensedpmaumtothe Contractors Limn.Law. BACK FLOW PROTECT.DEVICE FEE SUMMARY LJ I am exempt under Sec. B& P C for this reason OUTSIDt� DRAINS-FLOOR ROOF,AREA,COND. SANITARY Y_ N ' Owner Date RECEIPT N J WORKMAN COMPENSATION DECLARATION �.IUR�I�.�P SCHOOL TAX Y_ N— relay hereby affirm that I have a cortifiate of consent m self-Insure,ora RECEIPT N artiflate ofWorkere Compensatlonlnsurance cora certified copy thercof(5ec. GAS FA.SYSTEM-1 INCA OUTLETS PARK FTE Y_ N Policy Y Z S NM Cm GAFA.SYSI'F7N-0VER4(EA) BUILDIDINGG DIVISION VISION FIiES oQCertlfie copy b heed with the GREASE/INDUSIRL WASTE INTERCEPTOR PLANCHECK FEE �frdl0ed copy Is filed with ted city inspection division. CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE TRAP PAID COMPENSATION INSURANCE SEWER-SANITARY-STORM EA.200117. Date Rccei tN (Thei.eddon need not be completed If the permit is for one hundred dollars (51W)orless.) WATER HEATER W/VEM'/F].ECTR ENERGYFEE Y_ N_ I certify that In the perf..rra of the work fuewhdeh this permit Is board, I shall not employ any person in any manner an a to become stabled to the WATER SYSTEM/T'REATINC Workers Compensation Laws of California.Date PAID O Z Applicant NEW RESIDENTIAL PLMB. SQFT. Dale Recei tN Z O NOTICETO APPLICANT:If,after raking this Certificate of Exemption,you should becomesubject to the Workersmrovro 'Compeatlon plaloofthe Labor TOTAL: r N Code,you most forthwith comply with such provisions or this permit shall be A 4 J x LM j deemed revoked. BU FEE • . W — CONSTRUCTION LENDING AGENCY SEISMIC FEE d I hereby affirm that there Is a constmddon lending agency for the perform a� ELECTRIC FEE 7 Z ani of the work for which that permit Is Issued(Sm.3097,Civ.C.) TOTAL: ` PLUMBING FEE O O Lender.Name LL 1— lender.Add QTY. MECHANICAL PERMIT FEE MECHANICAL FEE W I ceddfythat l have madthb applicatbnand statethatthe above information O 11 bcoallrect.l agree to comply with acity and county ordinances and state laws PERMIT ISSUANCE FEES PAID: >- CIL tobulldLegconstrudlon,and hereby authorim rcpresentativesof this F N city to enterupen the above-mentioned Property for Inspection purposes. ALTER OR ADDTO MECH. z Date Receipt# (We)agree to ave,indemnify and keep harmles which the City of Cupertino AIR HANDLING UNIT CFO 10,000 CFM) V against liab�itie.,ydgmems,co&sand expenses which may In anyway accroe SUBTOTAL: gainst City In matj an.of the granting of this permit. !+ d e_ A I Z-q/ AIR HANDLINGR T OVER I0,000C T) CONSTRUCTION TAX SI aW sof Applicant/ContractorDate EXHAUST HOOD(W/DICT) CONSTRUCTION TAX PAID: HAZARDOUS MATERIALS DISCLOSURE Will the appEant orfatum building occupantstore or handle hazardous HEATING UNIT(70100,W0 BTU) Date Recej tit material as defined by the Cupertino Municipal Code,Chapter 9.12,and the - Flcalth xnd Safely Code Secidon 2S532(a)7 HEATING UNIT(OVER 100,000 BTU) TOTAL: Yes t]No Will the applies rat orfulum build ing occupant use equipment or d evices VENTILATION FAN(SINGLE RESID) ISS %(aE DATE which emit hazardous air contaminants as defined by the Bay Area Air Quality Management DblTictl BORER-COMP QHP OR 100,009 BTU) aI 4Yes No (� �• 7 have read the h.9 us materials requarcmenb under Chapter 6.95 of BOILER-COMP(OVER 1W,OW BTU) the Califomla Health&Safety Code,Sections 75505,75533 and 25534.1 understand that if the building does not currently have a tenant,that it is my NEW RFSIDEFITIAL MECH. SQ.Fr responsibility notifythe occupant ofthe requirements which must be met poor to IssuanceceofaCertifiate ofOavpanry. Owner or authorized agent Date TOTAL: ISSUEDBY: OFFICE COPY SEWER CONNECTION PERMIT SERIALNO. P 15148 CUPERTINO SANITARY DISTRICT 14 ) R.O.S./P.M./Tract No.............. Lot No.............. 20065 Stevens Creek Blvd. A.P.N. Bk... .2.�...:.. Pg.��.... Par T��..... Building C Cupertino, California 95014 / Phone (408) 253-7071 Date.V.v.Iy......1.-.7...................... 1991. The undersigned,being the owner(or owner's agent)of the property located at ........................................................ e.....'/l..i..r�.....D... ...... ..w .....-........................................................... 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: l) 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 ..�..7:..�....R.J fD. .......................................... 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. btv { L /mar E. ! e7r✓trn �✓lTele hone... .2... 870 3 Property Owner's Name�P..........'.........Y..................y... p 7 S....................................... Mailing address if differentfrom above...........m.... ........................................M............................�../.�.........,.................... ❑ A standard backflow protective device shall be installed, to the satisfaction of the Building Department, for the above property.(Note—See Detail/) FEES: Connection Permit Fee $...V6!.."�. e Sewer Service charges to June 30, 19.9 2., $.... ��...../mo. x/2.mo. p«4 o �� ........... Inspection Fee for backflow protection device ev TOTAL $ 06 O D receipt of$.Z G-7 .... acknowledged and permit granted. MARK THOMAS&CO. INC., District Manager-Engineer ............... NOTE.See Details on other side of this permit. CUPERT/NO SANITARY DISTRICT NOTES: All valves to be accessible and maintained by Property Owner. Overflow point at least twelve inches112°I below lowest finished floor containing plumbing. Kelly Valve installed of Property Line to be readily removable for Lateral Sewer maintenance. J� Finish Floor Level w G NeIIY valve Finish Floor Level Finish GradeI+a exxx - LL �( Kelly Vulva— Volvo alve—Valve Access B�x —/ E in m with Varied Czar— I Valve Access Bac ♦' Backwater Valve - 3' Figure I Figure 2 Figure 3 Kelly Valve- Below Surface Backwater Volve-Normally Kelly Valve-Above Ground Installot ion-Shown at required installed of shallowest point Installation-Shawn inslalled • Property Lina Cleamul. along House Sewer between close to building. Property Line and building. DETAIL STANDARD BACKFLOW PROTECTIVE DEVICE INSTALLATION I Distance from R m be as close as practicable. J Removable Cleanout Plug a. Finish Grade Wye for Riser Sewer Cnaul Box weft Lid to be a¢essible Short length and maintaitained by property owner. Riser Pipe Adaptor coupling 1/8 Bend FLOW Laleral Sewer House Sewer �i T��J�'��nimum slope determined by Building Department. -Lateral Sewer Cleanout to be same silly as Loteral Sewer. • DETAIL STANDARD CLEANOUT FOR LATERAL SEWER J