22579 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
tlulldin Pra'ect Identification PO"TNO.
~- No11Z d eass:T _ 29575
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nems sine: one:
A A
5� n/pJ ULI/e 7
'/ (-' CITY OF CUPERTINO-BUILDING DIVISION
c r LIe
No: APPLICATION /PERMIT
e co-'s (7 6 I /O. BLULDING-ELECTWCALPLUMBING-MECFIAMCAL CATEGORY CONTROL 1I
rchkect/Engineer. Lk.No:
QTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO
Addrcss: _ p e, B��a— PERMITISSUANCE ❑ 1-1 ® ElLICENSED CONTRACTOR'S DECLARATION
I hereby affirm that l am licensed under provisions of Chapter 9(mmmenc APPLIANCESRIESIDENTIAL JOB DESCRIPTION
ingwith Section7000)of Divlslon3 ofthe Businessand PmfesslonsCode,and my
license is I. fo j, 'd effect. / PANELS e'-.
Lim C 1_LCo N or l� r t�l�V-{N�
Dat �_Contractor 'q��C� f 701-1000 AMPS
LIP TO 200AH�5
ARCNITECPS ECLARATION OVERi000AMPS SQ.Fr.FLOOR AREA $/SQ.FT.
K'CZC Iundentand retry plans shall be used upublic remrds
c� U 00
Licensed Professional SIGNSELECTWCAL E D IN
h a w OWNER-BUILDER DECLARATI r'. E p . E
�n Fefi SPECIALCIRCIAT/M15C ON
AV, R
Iherebyafrirm thatlamexempt(romthe Contrattar'e License law lm the
Z o following reason.(ttdtil 7llD.$Buslnese and Professions Code:Any city or TEMP.MEI'ER ORPOLE INST.
Kmuntywhlchrequlresapermlttomrutrucl,atter,impmve,demolhhormpalr �N�♦as
�Q.a� any structure prior to Its Issuance,also requires the applicant for such permit to POW1R DMC'ES DATE !��
+ U file a signed statement that he Is licensed pursuant to the provisions of the 1
Contractor's License Law(Chapter 9(commencing with Section 7000)of Divi- SWIMMING POOL ELECTRICVALUATION
O cion1ofthelu,let,,"Illrofessio,Cl,)orthathebexempttherefromand
XP 5 the basis for the alleged exemption. Any Violation of Section 70315 by any
v�a OUTLETSSWITCFiESF7%TUAES
E'
applicant fora permit aubjensthe applicant toacivil penalty of not more than
c. rive hundred dollars($SM. NEW RESIDENTIAL ELECIR
7 ❑I,as owner of the property,or my employees with wages as their sole �'�' STORIES TYPE CONSTRUCTION
rompcnsation,wllldothe work andthestmmm V not intended or offend for
OIn(Sec.7064,Business and Professions Code:The Contractor's License Law
does not apply to an owner of property who Wilds or Improves thereon,and OCC.CROUP RES.I1NlTS
F- who dmswch work himselforthrwgh hisownemployeas,provided thatsuch
Improvements am not Intended oroffered forsale.If,however,thebullding or TOTAL:
improvement uwldwlthinoneyearofcomplation,the owner-builderwlll have
mrIiirden of proving that he did nm build or improve for purpose ofsale.1, QTY. PLUMBING PERMIT FEE FOOD ZONE APN
LI L as owner of the property,am exclusively contracting with licensed PERMIT ISSUANCE
contractors to construct the project(Sec.70K Business and Preafewlons Code: fj ex7
The Contractor's License Lew docs not apply to an owner of property who
Wilds or Improves thereon,and who nvrnraRs for such piojem with a ALTER-DRAIN&VENT-WATER CEA)
cur(s)licensed pursuant to the Contractor's License Law. FEE SUMMARY
c am exempt under Sec. ve
B&P C for this man BACK FLOW PROTECT.DEVICE
751 �`
DRAINS FLOOR ROOF,AREA,COND. SANITARY Y_ N (J I�$
Owner Date RECEIPT N _
WORKMAN COMPENSATION DECLARATION FIXTURES PER TRAP SCHOOLTAX Y N
❑I hereby affirm that I have a certllcate of consent to self-Inwre,ora RECEIPT N
cenifiate of Workean'Compensatlon Wurance oraartifkd mpythereof(Sec. GAS EA.SYSTEM-1 WCAOUT.ETS PARK FEE Y N
3800,Lab C) _
Polig# /2ii 7F CAS EA.SYSCFMAVER4(EA) RECEPTN
Com env G ,Lsn C BUILDING DIVISION FEES
L_j� inspection
le hereby fumiahed. PLANCHECK FEE
�copy6 filed with the city pection division. CREASE/WDUS132L WASTE INTERCEIPIOft
CERTIFICATE OF EXEMPTION FROM WORKERS' GRFASETRAP PAID
COMPENSATION INSURANCE SEWER.SANTARY-STORM EA.2(X)FT. Date Recef t#
(This section need not be completed if the permit is for one Fund rN dollars
($10))orless.I WATER HEATER W/VENT/D FCTR ENERGY FEE Y_ N_
I certify that In the performance of the work for which this permit is Janice,
I shall not employ any person In any manner w m to become subject to the WATER SYSTEM/TREATING
Workerti Compensation Lawsof California.Data
PAID
O Z Applicant NEW RESIDENTIAL PLMB. SQ.FT. Date Recel t#
Z O subject NOTICE TO APPLICANT:If,after ma king this Certificate of Exemption,you
Hshould become, bject to the Workers'Compensation provisions ofthe Labor .� .� �. TOTAL:
CC N Code,you must forthwith comply with such provision or this permit shall a BUILDING
W ] datmed rcvokcd.
CONSTRUCTION LENDING AGENCY SEISMIC FEE
CL Z I herebyaffirm that there is a construction lendingagency forthe perform TOTAL: CZ) ELECTRICFEE
arm of the work for which this permit Is Jsaod(Sec.3097,Civ.Q L
U O Lender's Name PLUMBING FEE
LL f Lender'.Add rcss QTY.I MECHANICAL PERMIT FEE MECHANICAL FEE
OW Icertifythat l havemeadthu application and tatethatthe above information
III. Is cornet.I agree to comply with all city and county ordinances and state laws PERMIT ISSUANCE FEES PAID:
>. W relating to building construction,and hereby authorize repreaentativn of this
F Z city to enter upon the above-mentioned property for inspection purposes. ALTERORADDTOMECH.
(We)agree to save,IndemDate Receipt#nify and keep harmless the City of Cupertino V AIR HANDLING UNIT(TO 10,000CFM)agalnstllabllitles,jrdgments,mstsand expenses which may In anyway accrue SUBTOTAL:
/�against say{ City in con ence of the granting of this permit.
O_/Z AlRrfnNDLIIVG UNIT roVERlo,000cFM) CONSTRUCTION TAX
SI / of Appllcmt/Contractor O Date EXHAUST HOOD(W/DUCTI CONSTRUCTION TAX PAID:
HAZARDOUS MATERIALS DISCLOSURE
Will the appica cat or future building occupant atom or handle hazardous HEATING UNIT CM 100,000 BTU) Date RCCCI I#
material as defined by the Cupertino Municipal Code,Chapter 9.1 7,and the
I With and Safety Code Section 75537(a)? HEATING UNIT(OVER 100,000 BTU) TOTAL: s-
❑ Yes No
Wllltheapplkant or tum building occupant use equipment ordeviocs VENTILATION FAN;SINGLE RESID) ISSUANCE DATE
which emit hazardous air mntaminsnts as defined by the Bay Area Air
Qua lily Ma nsgement Dist rid? BOILER-COMP(31 IF OR 100.0(*BTU)
4YtI''�'J No P
M1avers read the hazaiJuun materlaln requirements under Chapter 6.95 of BOILER-COMP(OVER100,WOBN) Ryt3�
the California Health&Safety Code,Sections 25505,25S33 and 75534. I
understand that if the building does not currently have a tenant,that it is my NEW RESIDENTIAL MECH. SQ.FT AUG 12 19,11
reaponsibility m entity the occupant of the requirements which must be real ) �
prior to Issuance of a Certificate of Occupancy.
Owner or authorized agent Data )ggOp f
TOTAL:
OFFICE COPY
`err 1-. U"—v yi7�n� � �•J .. _..
5'79 -
SEWER CONNECTION PERMIT SERIAL NO. P 15158
ISUPERTINO SANITARY DISTRICT R.O.S./P.M./Tract No...�lP Lot NoA��.....
20065 Stevens Creek Blvd. A.P.N. Bk... Pg.... ,� Par. z.Q..
Building C
Cupertino, California 95014 /
Phone (408) 253-7071 Date.. a4e.......2��................ 19 Q�.
The undersigned,being the owner(or owner's agent)of the property located at .ICJ
......... ..-rte P� 7 -e........................................................................................................
V
consisting of the following TYPE OF BUILDING:
Residential: Single family....^..... 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
/D_is_tfiict easement. (Note—Detail J)
j3) To acquire a permit from the ...C..�1; ...C?Z....... -- ....-?��?`'T! �...................... 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.,,I"J.Xixw...��/.��!�� RAiUl!�/Telephone...C?'.).. zl �...........
Mailing address if
differentfrom above........ ................................. ...f�..................b..................................
1�
❑ A standard backflow protective device shall be installed, to the satisfaction of the Building Department, for the above
property. (Note—See Detail/)
FEES:
m
Connection Permit Fee $ '
`b
Sewer Service charges to June 30, 19 9�.,$,M ......./mo. x.42..mo. ................
Inspection Fee for backflow protection devicet,
TOTAL
n/ GYJ
Receipt of$fes. ' ..... acknowledged and permit granted. MARK THOMAS&CO. INC., District Manager-Engineer
I `
By.,1,e�4. . /. .... i.....................
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 inches02") below lowest finished
floor containing plumbing.
Kelly Valve installed at Property Line to be readily removable
for Lateral Sewer maintenance,
Jv
Finish Floor Level
ru [ Kelly Valva Finish Floor Llval
E Finish Grace —IIe o
Kelly Valve �yTB g
{ s
Valve Access IS •r A E in k m
with Vented G e ` Valve Access Boa
Backwater Valve
FLOW �
Figure I Figure 2 Figure 3
Kelly Valve-Below Surface Backwater Valve—Normally Kelly Valve-Above Ground
Installation-Shown or required installed of shallowest point Installation-Shawn installed
Property line Cleanout z ProHouse Sewer between close to building,
Property Line dna building.
OE TAIL
STANDARD BACKFLOW PROTECTIVE DEVICE INSTALLATION I
Distance from R tD be as
close as Practicable.
J
Removable Cleanout Plug
a Finish Grade
Wye for Riser y
Sewer Cleanout Boa with Lid to be accessible
Short le egth and maintained by property owner.
Riser Pipe
Adaptor coupling I/B Bend
FLOW m
Lateral Sewer House Sewer
N T�4inimum slope determined by Building Department.
Lateral Sewer Cleanout to be same
size as Lateral Sewe,
DETAIL
STANDARD CLEANOUT FOR LATERAL SEWER J