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03040052CITY OF CUPERTINO=sn. `A�" "` '' '�• "' - �F C©]Y PRCTM INFORMATION BUILDING DIVISION PERMIT BUILDING ADDRESS: PERMIT NO. 21890 MEADOWVIEW LA ABLE SEPTIC 03040052 OWNER'S NAME:. PERMIT ISSUE DATE - GARLAND RAYMOND L AND MARILEE520 REED ST. 04/09/2003 E: SANITARY NO. CONTROL NO. (408)377-9990 CHITEC (ENGINEER: BUILDING PERMIT INFO BLDO EO PLO . 0 LICENSED CONTRACTOR'S DECLARATION Ib Description DDSCTIp 1 hemby,fRlm Nal l em licensed under provisions of Chapter 9 (commencing with Smdm 7=) of Divtsion J of thC Bear. aM Profexalom Code.and my liccnsvis - Infullfoo:eoadeDaL — License Class �'-.+z Lk.a ®y SEWER CLEAN OUT ��^�^aED . Dam Contractor C ARCHITECTS DELLA A N I understand my plans shall lm used As public records APR 1 APR 'I 0 2003 . Licensed Professional OWNER-BUILDER DECLARATION ' I hereby affirm that I em exempt from the Conlractals License Lew for the BUILDING following reason. (Sudan 7101.5, Business and Pmm fessioCeara: Any city or cranny which requires a Permit to cmo;nmL alter. Improw, demolW, or report any anactum poor to its issuance. also requlrea.he applicant for such Permit o ole a signed Ntemenl that he is licensed Forward to the powisiana of the Comment's Law (chapter 9 Sq. Ft. Floor Area Valuation (commencing with Section 7000) or Division 3 of the Business and Professions Code) or _ $1000 that he I, exempt therefrom and the buts for the alleged exemption, Any violation of r Occupancy Type Semon 7031.5 by any applicant for a permit subjects the applicant to a civil penalty ofAqp not mare than nw hundred dollars (5500). 3 G 64 J U L 0 0 . ❑ 1, as owner of the property, m my employees with wages as their wk compensation, Rtq* will do the work, and the suuaum Is not intended or offered for sale (Sec. 7044. Business and Profession, Code: The Contractor's Liam Law doom not apply to an owner of 106 - SEWER AdjlBjpections property who build, or Barrows thereon, and who doesamh weak hlmselfor through his ZOZ — UNDERFLOOR PLUMBING own employru, p raidad than such Improvements art oat Intended oronered feassla if. however, the building of Improvement is sum within am year ofaomplemm. tic owner. - 301 — ROUGH PLUMBING builder will have the burden of proving that he did not Is ild or imptow for purpose of 507 - FINAL PLUMBING ❑ 1, As owner of the property am exclusively contracting with licensed eootnctors to mnatNCl the project (See. 7044, Business and Professions Cade:) The ConmCmYe Li- , cense law don not apply to an owner of property who Wilds or imp caws Osmon, and, who contracts rat such project with acandru or(q licensed pursuant to the Comnechoes License Law. ❑ 1 am exempt under Sec. . B At P C for this meson - Owner Data ' WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty, of perjury om of the following declarations: have and will maintain a CmM..ta ofConsem IC xlGlnxum for Walker-Campm- on, as provided for by Section 7700 of the Labor Cade, for tic performance of the work for which this permit is issued.. ❑ i have and will maintain Wmkefs Compeosad.. Insurance, ss required by Section ' 3700 of the Labor Cade, far Ne performance of the work for which this permit is Issued. My Worker. Compensation Insurance carrier and Policy number art: S'fAT� Ff9tM'dPolk tie CERTIFIC T73r�P170N M WORK RS' COMPENSATION INS RANCE Gala seetlmmed nothecompmleJ firth: pemolt is fmane hundred dollar (SIM) or leas.) ., ... 1 comfy that In the performance of the work for which Nis petmlt Is issued, l shall not employ any person in any manner an as m become subject to the Worhrs'Compensation . Laws of C.1if ,mix. Data Applicant ' NOTICE TO APPLICANT: If. after making this Certificate of Exemption, you should become subject to the Worker's Compensation provisions of the Leben Code, you mut forthwith comply with such priwtsinm or this Permit mall he deemed revoked. - - CONSTRUCTION LENDING AGENCY 1 hereby affirm Nat then Is a eorutmctun lending agency for the perfomance of the work for which m4 Permit Is issued (Sr,. 3097, Civ. C.) Lend.e. Name _ Lenders Address 1 anify that 1 have read this application aM state Nn the above Information is correct. I agree to comply with all city and county ordinances nd we Ism reining to building construction, and hereby amhodm representatives of this city at inter upon the .have-menthened property for Impaction purposes. (We) agree to saw, indemnify end keep han niess the City of Cupertino agaimt Ilabilites,judgments, costs and expense, which may in any my am= against said City ) In consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. Re-roofs -Type of Roof � /9 :u 5 eYi - '// ��-�j" i P&blure of AppHe HAZARDOUS MATERIALS DISCLOSURE tor ate Will the applicant or future building occupant pore er Mndle havrdoos mamril as defined by the Cupertino Municipal Cade. Chapter 9.11, and the Health and Safety Code. saran 25532(a)? ❑YesNo All roofs shall be inspected prior to any roofing material, being installed. If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future building occupant use equipment or devices which I havrdous air mntvminanat As ok finca by Ute Bay Arta Air Quality Management all new materials for inspection. tncT7 ❑Yea &No, I hrvemet Na 533a n5N.I rChsPmr d.95of Health &t Slaty Coda. Sectors5505,2 d uMe dNulllhv building es N an, - tecdomhat it my razlJ25534.1 does no Jas not anenlly have a teMn6 Net it u my rtmlwoslhility b no Jm upanl M Ne require case which most b: mCi prier to issuance of a Ccmfic,mar cu cy. Signature of Applicant Date All roof coverings to be Class "B" or better ncr or oWhorircd egcm Data CUPERTINO SANITARY DISTRICT 20065 Stevens Creek Blvd., Bldg. C DER: Cupertino, California 95014 CHB: File: Is "ON-SITE REQUII2EMENTS-OVER THE COUNTER REVIEV� ' Date: �tlt 12 12003 File: CuSD -MOP .. Building Dept -Cupertino Community Development Department - Building City of Cupertino 10300 Torre Ave. - Cupertino, CA 95014-3202 Re: Subject: Name:t`r 1I A VI Address: 2 ( p 0 M(-* 'k LICA_ APN: 37 (o -4-5`--O 2 5 Control/Plan Ck No: Permit No: I (o (p 2 The Cupertino Sanitary District has reviewed the plans for the subject project: No additional conditions/requirements by the District. I Approved For Issuing Building/ Plumbing Permits Sanitary sewer is available and the existing building is connected to sanitary sewer, see conditions/requirements listed below. Sanitary sewer is (nl)) available, see conditions/requimmenls listed below. • ❑ Sanitary sewer is not provided by the District, please contact the City of Sunnyvale (408) 730-7510. The following Conditions/Requirements are made: ❑ Install new Property Line cleanout or locate and raise to grade an existing property line cleanout. Cleanout , shall be the same diameter as the street portion of the service lateral (Minimum gravity lateral is 4" diameter). Video Inspection of the existing Cleanout, Point of Connection and Street Lateral is required prior to passing The City of Cupertino Firinti"tnitiag, Owner to call District 48 hours prior to video inspection to schedule a District Inspector. U4 PCC —()0N ❑ Inspection of Street Portion of Sanitary Sewer Lateral by the District Please Do Not Inspect any onsite construction prior to clearance in writing by the District. ❑ Owner to have a Civil Engineer Lx the lowest finished floor elevation, with plumbing, to the rim of the next upstream manhole. If the lowest floor with plumbing is less than one (F) foot above the rim a Sewage Pump may be required. ❑ Cupertino Sanitary District Fees or Permits are required for the subject improvements please do not issue any building permits. , ❑ Plans shall be reviewed by the Industrial Waste Division of the San Jose /Santa Clara Water Pollution Control Plant, Phone 945-5121 for_questions and to schedule a plan review appointment. Please Do Not Issue permits until pretreatment recommendations have been forwarded to you by the District. ❑ Verify existence and serviceability of an existing backflow protective device. ❑ Break areas authorized minor electrical appliances only. (No commercial disposal or commercial dishwasher installations.) ❑ Other: ............................................................................................:....:...................:........... Storm water from surface or roof drains, other general surface runoff water or condensate from any residential HVAC equipment shall not be discharged to the sanitary sewer. NOTE: Contact CuSD for "-SITER�IJIRFMENTS" File Buildina Letter -OTC T ..3v--F-:i+� �.T'+'-;a--'?.cam-r...=i....:,a-.,—;.,�Nh�,i -_3 �r �.�}.-...'.... J-..... C .,L -=-r'^•.-. Ty • •'` PERMIT PI 6627 . CUPERTINO SANITARY DISTRICT Santa Clara County 20065 Stevens Creek Boulevard, Building C Cupertino, California 95014 Telephone 408-253-7071 CONNECTION PERMIT Date A"Tl Z, PGCE 3 APN: Book (GP PageOkJ Parcell%l-5- Property Owner: Mailing Address: / ROS/PM/Tract No. Lot No. 64-V AX11 0 9 2003 being the owner(s) (owner's agent), hereby make application for coo tion of the at: t. / 19,L) O L/1 to or. N e -e fj V i�"Ge.J F.. Ld yf C- - Cc, sg6W f7 r7 46 consisting of the following Type of Buildings: Residential: Single Family Dwelling � ; Multi Family Dwelling_; No. Units Commercial ; Industrial ; Other ; No. Units •y Do hereby request a permit to connect the sewer system of the Cupertino Sanitary District. IN CONSIDERATION OF THE GRANTING THIS PERMIT, THE OWNER AGREES: 1. To comply with all existing Ordinances, Rules and Regulations of the Cupertino Sanitary District as now or hereafter amended. 2. To maintain the House Sewer (that portion of the sewer within private property) which includes a serviceable cleanout to grade and accessible located within five feet (5') of the point of connection with the Lateral Sewer (that portion of the sewer in the street right-of-way of District easement. / + 3. To acquire a Plumbing Permit from the t of &I4eieA 110 , Building Department and obtain the required Building Department inspections and approval p 'or to use. 4. To expose and inspect for serviceability the Lateral Sewer prior to starting construction of the House Sewer. 5. That this permit does not constitute a request for the issuance of an encroachment permit for sewer construction in the street/public right-of-way of the agency having jurisdiction thereover. 6. To connect to sewer within one (1) calendar year from the date of issuance of this permit. 7. To call UNDERGROUND SERVICE ALERT (USA) 1-800-227-2600, at least 48 hours prior to starting construction. 8. SPECIAL PERMIT CONDITIONS: A BACKFLOW PROTECTIVE DEVICE shall be installed to protect the above property by the owner. Type of device and installation shall comply with the Plumbing Code Requirements of the jurisdiction shown in 3 above. Fees: Serer Service Charges to June 30,a.41sn ?j No. Units I x SiIgLlmonTh x¢.. -Y no. months .7 (31010) Backflow Protection Device Inspection Fee (31020) Connection Permit Fee: — (31020) • Additional Connection Fees ( ) 4 ( ) Total: ?L 1 Considerations and Considerations of this Sanitary Sewer Connection Permit.with attached Exhibits, are hereby agreed to and acknowledged by the undersigned Owner (or Owner's Agent). Failure to comply may'result in termination of pgrmit. Acknowledgement:. --T(--1 ✓J : r a✓/ Owner's Agent: (If Signing for Owner Please Print Your Name) Receipt of 1-50 1-1 acknowledged and permit granted. MARK THOMAS %&�COJ., INC., district Manager -Engineer Revised 5/00 NOTE: See Details on other side of this permit TYPICAL CLEANOUT FOR LATERAL SEWER Distance from Property Line to be as close as practicable, a, not to exceed five (5r) feet. c J I v Removable Cleanoul Plug n 0 o. Finish Grade Wye for Riser Sewer Cleanout Box with Lid to be accessible and maintained by property owner. Short length Riser Pipe Adaptor couplings 1/B Bend Lateral Sewer slopeI, House Sewer slope determined by District 41 determined by building department —CLEANOUT TO BE SAME SIZE AS LATERAL SEWER— Notes: 1. Distance from the property line not to exceed five (5') feet. 2. Property Line Cleanout, Lateral Sewer Cleanout, to be same size as Lateral. 3. The maintenance of the Lateral Sewer Cleanout is the responsibility of the Property Owner. 4. House sewer minimum slope determined by local Building Department plumbing code requirements of the agency having jurisdiction thereover. TYPICAL BACKFLOW PROTECTIVE DEVICE INSTALLATION TYPICAL BACKWATER VALVE TYPICAL KELLY VALVE INSTALLATIONS INSTALLATION Jbriealnnanat RAMriclion. Accepua By All Jurisdictions FIGURE I FIGURE Z FIGURE 3 Installed Below Grade InMalled Below Grade Installed Above Grade Shown Between Strut Right -of -Way and Building Shawn At properly Line Cleanoul Shown Adjacent To Building Relabels Regular Maintenance i Recuires Minimum Maintenance Repuires Minimum Maialenonce Vabe TG Be Removable Valve Should Be Removable > VALVE ACCESS BOX ¢ FINISH FLOOR oNELLY A. VALVE VALVE ACCESS BO% EFinleh Finish Grade f Grade —t a. s BACKWATER VALVE FLOW A t Flaw JT FLOW Notes: 1. The Backflow protective device to be located on site in the house sewer. 2. The type, location and installation of the Backflow Protective Device shall comply with the local Building Department plumbing code requirements of the agency having jurisdiction thereover. 3. Device to be accessible and maintained by the Property Owner. 4. If a Kelly Valve is installed at Property Line, it is to be readily removable for Lateral Sewer Maintenance. 9- _9 F / n CITY OF CUPERTINO v 3 o colo dS-Z REPIPE/SEWERS/MAIN SERVICE -• CUPERTINO PERMIT APPLICATION FORM 6 9 APN # Plumbinj Permit Issuance PLUMBING BPREPIPE Re i e of Fixtures PLUMBING Date: Building Address: BUILDING BPFIXTURE Pb] .Fixture PLUMBING It 1 hieak9y,-j.n-eLt, PLUMBING BPSEWER Sewers at r7 `C. BPSEWAGE Owner's Name: PLUMBING BUSLIC Business License BUILDING Phone #: r Contractor: Phone: License #: i 3 27 -. Q 9. O C - 2 Contact: Phone: Cupertino Business License #: Building Permit Info: Bldg ❑ Elect ❑ Plumb Job Description: v Residential Cora ercial ❑ Cost of Project: / I Qty. if Applidabk Fee ID Fee tlacrrintinn Fan rl,n PPERMITFEE Plumbinj Permit Issuance PLUMBING BPREPIPE Re i e of Fixtures PLUMBING BPERMFEE Bldg. Permit Fees BUILDING BPFIXTURE Pb] .Fixture PLUMBING BPWSVCS Main Water Service PLUMBING BPSEWER Sewers PLUMBING BPSEWAGE Sewa a Dis osal PLUMBING BUSLIC Business License BUILDING