03060200 r,a CITY OF CUPERTINO
BUILDING DIVISION PRRMIT CONTRACTOR-T 40RMATION*,
BUILDING ADDRESS: - PERMITNO03060200
21237 MONTE QT
e , OWNER'S NAME: PERMIT ISSUE DATE
NE: SANITARY N0. CONTROL N0.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BO ELECTO PLUMB MECHO
I00 LICENSED CONTRACTOR'S DECLARATION Job Description
e w. 1 hcmhy Affirm that I am lironud under previsions or Chapter 9(commcuop
ing
e with Saliot 70011)of Division 3orihe Bualnnsued Profession,Codc.md my[lead.is
in full forte and effecL '
>'L Z License Class Lie.• REMOVE SEPTIC TANK/SEWER LINE
e q DataContractor
IIIq---j ARCHITECTS DECLARATION
f W u 1 undersand my phm shall he used a public records
G t; Licensed Professional
5 OWNER-BUILDER DECLARATION
y2 I hereby affirm that I am exempt from the Connor's License Law for the
O O following moon.(Section IID 1.3,Business and Professions Code:Any city or county
<16E which Tryouts a permit to continue,.a]teL impmw,demolish,or repair any structure
pner in lYlauanee.also mOdres the applicant for such permit to Me a xlgned statement
m< that he is licensed pursuant to provisions of the Conmc.fs License law(Chapter 9 Sq.FL Floor Area Valuation
yl-S (commencing with Section 7")of Division 3 of[be Business and ProfesdnruGak)or
Q
that he is exempt therefrom and the bull for the alleged exemption.Any violation of 32619073 . 00
Section 7031.5 by arty Applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not mo.that fiw hundred dollars(8500).
❑1.As owner of the property,or my employes with wages as their.1,eompsmsetion,
will do On work.end the ummoreis not intended or offered fm ask(See.7044.Business — gg
and Prefeuiom Code:The Compasoa
rft License Law does not apply to An wr of 202
- UNDERFLUOR PL ec B I NG
propertywh t builds or improve themod,and who does inch work himself orthrough his
own employes.Provided that such improvements am not intended oroRered for sale.If, 301 — ROUGH PLUMBING
however.the building or improvement is sold within one year of completion.the comer-
builder will naw One burden of proving that he dm not bund or improve for purpose or 0 7 — FINAL PLUMBING
sate.).
❑L as owner of the property am exclusively Busmesand
Proposing with:)The Con trpacren i.
wmws did project(Sec.7044,owner
oil and ny who Wilds;
Code:)The m union,
Li-
cane(ave dors not appy u to owner of property who builo or unt ode u Comas,sad,
who contracts such pmjecu with ncontrumm"I' nod punmmmoe Contractor',
License aw.
I. em rSee. ,B A P C for this..a.
OD.
wn WOR S ENSATION DECLARATION O IO
I hereby affirm under penalty of perjury one of the following distillations:
I haw And will maintain a Certificate of Consent m self-Insure for Worker's Comrso.
Milan,u pmvidcd for by Section 3700 of the labor Code,for the performance of Uw
work for whim this permit is issued. r
❑1 haw and will maintain Workeri Compensation Insurance.u required by Section /
3700 of the Labor Code.for the performance of the work for which this Permit is issued.
My Worker's Compensation Insurance carrier and Policy number am:
Cartier. Policy Na.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thissection need not be compleud If the permit isfor one hundred dollen($100)
ar leu.)
4. I certify that in On performance of the work for which this permit is Issued.1 shall not
employ any perann in any manner an u In become subject o the Workeri Compemeonn
Laws of California.Date
I Applicant
NOTICE TO APPLICANT:II after making this CertlBcalo of Exemption,you should
a become subject to the Worker's Compensation previsions of the labor Code,you must
.J O forthwith comply with such provisions or this Permit shall N deemed revoked,
Z a~ysCONSTRUCTION LENDING AGENCY
f-• I hereby Affirm that there it,conawctinn lending agency tot On performance of
C•� des work for which this permit Is issued(Sec.3097,Civ.C.)
W� Q Lender's Name
D z Lender's Address
U Q I Certify Na 1 hew read this application and sum that the above information is
kr f~' Punct.I agree to comply with All city and county on inencea and show hest rearing to
O� building construction,and hereby authori.representatives ofOil city toenter upon the
U shove-mentioned Property for impetdon purposes.
L5. (We)agree to saw,indemnify and kap harmless the City of Cupertino against
rex liebilities.judgmenu,costs and expenses which may in any way acme Against Mid City /�
U in eoaeguence of the granting of Nis permit, v
APPLIC NT UNDERSTANDS AND WILL COMPLALL NON-POINT Issued by: Da
5 o�7
REGULATION
Re-roofs
Signature of ApplieanVC u Data
HAZARD US MATERIALS DISCLOSURE Type of Roof
Will she applicant or(marc bu'Iding nccupam norc or noodle hanrdous mewriel
As de0ned by the Cupcnino Manic' d Calc.Chapur 9.1 i,and On Health and Safety
obese SectionYet 75531(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yet
Will the Applicant m future buil ng oceupant use eyulpmenI or dcvim which If a roof is installed without first obtaining an inspection,I agree to remove
h Murdous air conwmoomw u nc4 by NC Day Arca Air Quality Management all new materials for inspection.
❑Yes
I ha;ad the baarNmama.fialsrequiremcnu under Chapurii.95 ofthe Califor.
Ma,H.1NketyCde,Smiou 25505.25533 and 75534.1un@utand Natifrte Wilding
des trot cot have A wnanl out It h my respomihility te ramify Ne a t ofNe
myui menh' muatbe mer ivuance ora Ccnifinu or Occup Signature Of Applicant Date
0
eruyAaNari.dasemt Data All roof coverings to be Class "B"or better
\/DER:
U CHB:
CV:
7k7-
File:
CUPERTINO SANITARY DISTRICT
20065 Stevens Creek Blvd., Bldg. C
Cupertino, California 95014
(408) 253-7071
"ON-SITE REQUIREMENTS-OVER THE COUNTER REVIEW"
DateT_0T e: �Cu SD M 2003
e: MOP
ilding Dept-Cupertino
Community Development Departme ui"3 0 2003
City of Cupertino
10300 Torre Ave. By
Cupertino, Ca 95014-3202 11
RE: Subject: M P QN�6�-r YD ' W6f— '
Name: YUANPFNa 24+l6�
Address: Zl b 37 IUUNS a"g--r
Approved For Issuing APN: 326-o- o73
Buildingl Plumbing Permits . Control/Plan Ck No.:
Permit No.:
C4, 4, 0. CAN W,1_1ON 'Pint 16634
The Cupertino Sanitary District has reviewed the plans for the'subject project:
❑ No additional conditions/requirements by the District.
❑ Sanitary sewer is available and the existing building is connected to sanitary
sewer, see conditions/requirements listed below.
❑ Sanitary sewer is�)available, see conditions/requirements below.
❑ Sanitary sewer is not provided by the District, please contact the City of
Sunnyvale at(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).
�6 Video Inspection of the existing Cleanout,Point of Connection and Street Lateral
is required prior to passing The City of Cupertino Final Inspection. Owner to call
District 48 hours prior to video inspection to schedule a District Inspector.
Page 1 of 2
' "ON-SITE REQUIREMENTS-OVER THE COUNTER REVIEW'
( c
RE: Subject: Tb�NOON F im�c� " 1 i'C � �
Name:YU1M V aJ6r :Z f f, (,r
Approved For Issuing Address: 21037 0006
Building/ Plumbing Permits APN: 3ZC -19" 0 7,125
Control/Plan Ck No.:
Permit No.:
SNI G16r� �u7'I P 1601
❑ Inspection of Street Portion of Sanitary Sewer Lateral by the District,Please Do
Not Inspect and onsite construction prior to clearanecla-writing bnn the District.
❑ Owner to have a Civil Engineer fix the lowest finish ar'`e 9Ao
plumbing,to the rim of the next upstream manhole. a)plye ti qor-kvi
plumbing is less than(1')foot above the rim,a Sewa df¢({f�ra )f��+
❑ Cupertino Sanitary District Fees or Permits are requi
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 form surface or roof drains, other general surface runoff water or condensate
form any residential HVAC equipment shall not be discharged to the sanitary sewer.
NOTE: Contact CuSD for"OFF-SITE REQUIREMENTS"
— second sewer By: N Vv�
Lateral TV Inspection
Required After Connection
Inspection nate___Inspector
Pace 2 of 2
.t
PERMIT P16 6 3 0
• CUPERTINO SANITARY DISTRICT
Santa Clara County
20065 Stevens Creek Boulevard,Building C
Cupertino, California 95014
Telephone 408-253-7071
r r� �/�,/ CONNECTION PERMIT
Date 11A4 12 i ' 6 APN: Boon26 Pagqn_Parcel
(,��g ��� ,+i KI�� ROS/PM/Tract No. Lot No.
i
Property Owner: Y
Mailing Address:
? 107 WN11, COW
(Vu rr(; "f Int, l GA /1S64 JUN'3 0 2003
By
(I/We),being three owner(s�)^(owner's agent),hCTebv
rmake application for connection of the at:
j 0
q
consisting of the following Type of Buildings:
Residential: Single Family Dwelling; Multi Family Dwelling_; No.Units
Commercial ; Industrial ; Other ; No. Units
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. ��I, p q VJt
3.To acquire a Plumbing Permit from the fl '4 of t Of(� I E N Building Department and obtain the required
Building Department inspections and approval prior 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--2217-266000. 4866--
,-tat least 48 hours prior to starting pc^onstruction.
8.SPECIAL PERMIT CONDITIONS 1/wI(E�� y �?I Ayc ' L 0Pf( (i I1( t 9
{� 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 30,1(0 !
No.Units J—x S.16 r /month x �+-^ no. months (31010)
Backflow Protection Device Inspection Fee t / (31020)
N
Connection Permit Fee: t�� r ,r it �~ (31020) A
Additional Connection Fees Nxf t'V Noy( kNC4-1T �' (A 't,ix
(3z 1)
Total:
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 permit.
Acknowledgement:-
Owner's
cknowledgementsOwner's Agent:
+ // ri (If Signing for Owner Please Print Your Name)
Receipt o ! (1 1;71 /cknowledged and permit granted.
t
MARK THOMAS & CO.,INC.,district Manager-Engineer
By: 1r. A ice.
Revised 5100 NOTE: See Details on other side of this permit
TYPICAL CLEANOUT FOR LATERAL SEWER ,
Distance from Property Line
to be as close as practicable,
not to exceed five(51) feet.
c
' J
d Removable Cleanout Plug
Cs
0
a• Finish Grade
�.,
Wye for Riser i
Sewer Cleanout Box with Lid to be accessible
and maintained by property owner.
Short length Riser Pipe
Adaptor coupling 1/8 Bend
FLOW m
Lateral Sewer House Sewer _
Lateral sewer slope House sewer slope
determined by District determined by building department
— CLEANOUT TO BE SAME SIZE AS LATERAL SEWER—
Notes:
1. Distance from the property line not to exceed five(5')feel.
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 Juriediclianal Restrictions
Accepted By All Jurisdiction,
FIGURE I FIGURE 2 FIGURE 3
Installed Below Grade Installed Below Grade In.alled Abave Grade
Shown Between Street Rlght-0-101ay and Building Shown At Properly Line Cleanoul Shown Adjacent To Building
Regains Regular Maintenance i Require, Minimum Main..nonce Reauire, Minimum Mair...ante •
Volvo To 8e Removable Valve should Be Removable
¢I VALVE ACCESS BOX FINISH FLOOR
winiv.Iled Cover
a v 1 o FINISH 00
¢ KELLY VALVE
,N Z Inish Grade
VALVE ACCESS BOX
KELLY VALVE ?
,Fihish Grade
Finish Grade .mZ
P
F �
BACKWATER in
VALVE
FLOW s/ FLOW Pr FLOW 9/
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.
411 N"I
County Records: Property Owner: Yuan en Zhan
Tract& Lot No. 1570/45 APN Number: 326-18-073
Permit Number: 16630 Agreement Signup DATE: r-May I2, 20031
Permit Date: Ma 12, 2003 SSC Revenue Study
2003 / 2004 ..................................................................
.................................. ........ $0.00
S S C In a rg a:F-i-OK-0-C BENEFIT ZONE Payment:
Construction Date: Jul 1, 1981 FAWD bm r O �) D
.....................................
Construction Cost:i $4,152.23 1; construction Escalation Rate.: 7,00%
.......... ................
...........-.......*................ 1003
Days Calculated:;............4 33Current CONSTRUCTION COST:
.................I
.................................... ....................................
ACRE Fee Rate:':. $1,040...00 :: ACRE Fees Paid::....................$0.-R0j By.
.......................... ........
PARCEL ACREAGE:F-10-.2610 RATE PER ACRE:F7$1=,040=.00
ACREAGE FEE:
Current Construction cost&Acreage Fee:
IIIIIIIIIIIIIIIIIIIIIIIIIIIIII.....Jill..... ...loll,.... ou'll.... HI.....its...lot...I'll ....it's
...........
SIGNUP DATE LOAN INTEREST RATEd......................8.5 0%:
................. . ..
... ...........
To End of Tax Year:t..Jun...... Y003
INITIAL PAYMENT: F $9,544.2871
• a ' ........ ....... .I
... .............. ........._.....
... .............. ...
Fiscal YBegins:; Jul A . Days Calculated:; .
PREPAY INTERES RES
INTEREST Through: 6/30/2003 ................. -R $0.00T
�
STARTING BALANCE without Interest thru: Jun 30, 2003V- $0.00
L--------
CURRENT BALANCE as of: May 12, 2003
Interest: 5/12/2003 $0.00
12, 2003 FINAL PAYMENT: ..... ...... REFUND = $0.00
Closing Difference: F, ---$-O-.Oo-] ENDING BALANCE: $�0.00
First Year Payment includes the interest thru: 6/30/2003 $0.00 + $0.00 $0.00
- xx
.......
ol A
gN
A.X
TAXROLL YEAR Beginning Annual Payment Ending Extra Annual
July 1 - June 30 Balance Interest Principal Balance Payment Payment.
2003 1 2004 0.00 0.00 0.00 0.00 0.00 0.00
2004 2 2005 -000 0.00 0.00 0.00 0.00 0.00
2005 3 2006 0.00 E-00 --0.0-0 0.00 0.00 -0.00
0.00 0.00 0.00 0.00 0.00
2006 4 2007 �OO 0 - 0.00
20080.000.00 0.00 0.00 0.00
2007 5 - - 2 - 0.00 0.00
2008 6 2009 H.20 0.00 0.00 0.00 -
2009 7 2010 0.00 0.00
0.00 0.00 0.00
2010 8 2011 0.00 0.00 0.00 0.00 0.00
2011 9 2012 0.00 0.00 0.00 0.00 0.00 0.00
0.00
2012 10201321013 E 0.00 0.00 6300-- 0.00 0.00
Totals: 0.00 0.00 0.00 0.00
nwnnnnmmmmmnm" IIIIIII.IHIIIIIIIIIIII... ... ....moll...
TOTAL AMOUNT PAID at TERM:
Note: Total Amount includes (interest, Principal & Extra Payments) 5112/2003
32619073.XLS
{� CITY OF CUPERTINO
CUP TYOF O PERMIT APPLICATION FORM
APN# -3 2— L C 07 -S Date:
V' - 3 —a - 03
Building Address:
�C a 7 +�,.L, c*
Owner's Name: PhoneW:
uevn 2� f q&-gj c.Pc(,6 zr S3
Contractor: License#:
Contact: 2 i Cupertino Business License#:
Building Permit Info: /
BldgEl Elect ❑ Plumb e_ Mech ❑
Job Description: 9," v2 k---"V 5 r C7r
Residential ❑ r �� S,&a ommercial ❑ ,J
Sq.Ft. Floor Area: $/Sq.Ft.:
Cost of Project: 0 ,9 C) Occupancy Group:
Type of Constructio :
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBLDGFEE Bldg Permits . foot BUILDING
BBOILERI Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> 100K to 500K Btu MECHANICAL
' BBOILER3 Boiler> 500K to 1M Btu MECHANICAL
BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL
• BBOILER5 Boiler> 1.75M Btu MECHANICAL
BCONSTAX Construction Tax BUILDING
BCONSTAX Ind/Off/Comm/Quasi BUILDING
BCONSTAXBQ Con. Tax for BQ Zone BUILDING
BCONSTAXH Hotel and Motel BUILDING
BCONSTAXR Constax—Resi/Mobile BUILDING
BELEC1000 Elec 600V <= 1000A ELECTRICAL
BELEC1001 Elec 600V> 1000A ELECTRICAL
BELEC200 Elec Svcs 600V <=200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
BMITIGATC Comm. Housing Mit. Fee BUILDING
1 of 3
a
CITY OF CUPERTINO
CUPEIo PERMIT APPLICATION FORM
QuantityFee ID Fee Description Fee Group
BMITIGATR Res. Housing Mit Fee BUILDING
BMNEWMULTI New Multi-Family Res MECHANICAL
BMNEWSF&2F New Sf&2F Res Bldgs MECHANICAL
BNEWMULTI Multifamily Res ELECTRICAL
BNUCOM M New Comm Electric ELECTRICAL
BNUCONV M New Comm Mechanical MECHANICAL
BNUCOMMP New Comm Plumb PLUMBING
BNUMULTI New Multifamily Res PLUMBING
BNUSFD New Single Family Res BUILDING
BOVERTINM Inspection Overtime BUILDING
BPBACKFLOW Atmospheric Vacuum PLUMBING
BPCESSPOOL Cesspool PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
BPFIXTUR.E Pb1g Fixture PLUMBING
BPGAS Gas Piping System Fee PLUMBING
BPINTERCEP Ind Waste Interceptor PLUMBING
BPLANCHK Plan Check Fee BUILDING
BPLANCKADD Plan Check Add Multi BUILDING
BPLANCKREP Plan Check Repeat Fee BUILDING
BPREPIPE Re i e Of Fixtures PLUMBING
/ BPSEWAGE Sewage Disposal PLUMBING
BPSEWER Sewers PLUMBING
BPSPRINK Lawn S rinklerBackflo PLUMBING
BPSTORM Storm/Rain Water PLUMBING
BPTRAP Kitchen Trap PLUMBING
BPVENT Alt of Drain &Vent PLUMBING
BPWATER Install/Alter Water Pie PLUMBING
BPWHEATER Water HeaterNent PLUMBING
BPWSVCS Main Water Service PLUMBING
BREINSPECT Reinspection Fee BUILDING
BREMACOVER A/C Unit> 10,000 din MECHANICAL
BREMAIRHAN A/C Units <= 10,000 din MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY Remodel Busways ELECTRICAL
BREMFD{T Lighting Fixtures ELECTRICAL
BREMFURN Relocation of Furnace MECHANICAL
BREMFURNOV Relo Furnace> l OK btu MECHANICAL
BREMHEAT Heater Installation MECHANICAL
BREMINHOOD Installation of Hood MECHANICAL
BREMMISC Misc Apparatus ELECTRICAL
BREMNRAPP Rem Non-Res Appliance ELECTRICAL
BREMPOLE Pole/Platform Fixture ELECTRICAL
2 of 3
CITY OF CUPERTINO
cuPEr F . PERMIT APPLICATION FORM
QuantityFee ID Fee Description Fee Group
BREMPOWER Power Device/Apparatus ELECTRICAL
BREMRECEPT Rc tl, Switch&Outlets ELECTRICAL
BREMRELOCA Relocation of Hood MECHANICAL
BREMREPALT Repair/Alter Heating MECHANICAL
BREMRESAPP Remodel Res Appliance ELECTRICAL
BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL
BREMSIGNS Remodel Signs, Marquee ELECTRICAL
BREMTHEATR Theatrical Lighting Fix ELECTRICAL
BREMVENFAN Vent Fan Single Duct MECHANICAL
BREMVENSYS Ventilation Systems MECHANICAL
BSCBLVD Scb Specific Plan BUILDING
BSEISNECOM Seismic Commercial BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSPECIAL Special Insection BUILDING
BSWIM Swimming Pool BUILDING
BTEMP Temporary Power ELECTRICAL
BTEMPPERM Temporary Bldg Permit BUILDING
BTEMPSVCS Temp Dist Svcs ELECTRICAL
BUSLIC Business License BUILDING
ELECTRIC Electrical sq foot ELECTRICAL
EPERMITFEE Elec Permit Issuance ELECTRICAL
MPERMFEE Mechanicals . foot MECHANICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issuance PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
ZADDCHG Address Chane BUILDING
3 of 3