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22644 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES— USE BALL POINT PEN ONLY Building Prom Identification PERMITNO. Building Addmes 22644 wKrs aces: one; jAAAL (_ CITY OF CUPERTINOQBUILDING DIVISION �a] APPLICATION /PERMIT / f BUILDINGELECTMCA4PLUMBINC-MECHANICAL CATEGORY CONTROL If Itect/Englnmr. Llc No: CITY ELECTRICPERMIT FEE BUILDING PERMIT INFO Address: Ciq PERMITISSUANCE ❑ ❑ ❑ LICENSE DC NTRACTOR'S DECLARATION I herebyafflrmthat l amlkensed under provisions of Chapter9(commenc- APPLIANCESRFSIDENML ]OB DFSCRII'TTON ingwithSedion7000)ofDlWslon3ofthe Businemand I'rofmslonsC-ade,and my license 1.full and effect. /('q/6F, PANELS Limn IanC- ZLIc4 Date '1 - Contractor J —UP TO 200 AM5 ARCHITECT'S CLARATION 101-1000 AMPS p�p�uu 000 ]undentand my Elam eluBLe used npubacremrda OVER 1000 AMPS /QTfT1�OR f/SCI.FT. k4 Licensed Profmlaul SIGNS ELECTRICAL �C UVJ �tR� 6 OWNEReBUILDER DECLARATION ER M rn a SPECIALCIRCUIT/MISC �Wy)V/'y BB, ••• Zt.., owing reason. lhatlam31.5,Blro ossa Contractor's License Lw to the qqqq (ollowing rcmon.(SMlon 7071.5,Business and Prolmlone Code:M city or Ff'8 muntywhkhmqulreeapermltwmmt dalter,impmwdemollsh,orrepalr TEMP.METER OR POLE INSI. �'�y anyatmcture prlortolte lsivanee,also requlresthe applicant for such permit to pplypR DEVICEassaaS a0 6 file a signed statement that he b licensed pursuant to the provision of the u, Contractors License Law CM er 9(commencin with Section 7(X10)ofDivl- SWIMMING POOL EI'[CTRIc oQ elon3ofth.Huslneuand Praf.I.Gx Code)mthagm he le exempt lhercfroand VALUATION `� •1 the basis for the alleged exemption. Any violation of Section 7071.5 by any applicant fora perenilsubjects rn the applicant to a civil penalty of not orethan OU7LETSSWITCIif5HXT[IIiES $ IT cd.d delta.%S0N. NEW RESIDENTIAL ELECTR FT. as owner of the property,or my employees with wages as their sok STORIES TYPE CONSTRUCTION compensation,will clothe wok and the structure Is not Intended or offered for Osale(Sce.70K Business and Profmlom Code:The Contractors License Law $ does not apply to an ownerof propertywho bulldsor lmprovesthercary and OCC.CROUP RES.I1NI75 whodoessuchworkhim lforthmghhlsownemployee°,providedthatsuch Improvements arenot Intended oroffered(ocule.If,however,thebuilding or TOTAU Improvement Weld within one yearofcomplMlon,the owner-bullderwlll have UA.Ilurden of proving that he did no bund or Improve to purpose ofule.). CITY, PLUMBING PERMIT FEE FLOOD ZONE APN ".L as owner of the property,am exclusively mntraning with Boeneed PERMRISSUANCE O mmntton to construct the project(Sec 7044,Bull...and I'mfessi u Code: The Contractor's License Law does not apply to an owner of property who ALTER-DRAIN k VEM-WATER(EA) Wilds or Improves themon,and who contracts for such p(olects with a cl5actor(s)licensed pursuant to the Contractor's License Law. FEE SUMMARY L_J I am exempt under Sec. B A P C for this reason BACK FLOW PROTECT.DEVICE DRAINS FLOOR ROOF,AREA,MND. SANITARY Y_ N S Owner Date RECEIPT M 21 E31 hereby WORKMAN COMPENSATION DECLARATIONm PER TRAP SCHOOL TAX Y_ N affirthat I have a certificate of consent to u16o FIXTURES.1nsure, a RECEIPTN4 unifiateofWorkers'Compeuationlmunnmo,.Mrtifbclmpythereaf(Sm. b C.) GAS EA.SYSTEM-11NC.4OUTLETS PARK FEE Y N 380D,L Polley«_/23 76/ — 9/ . RECEIPT GAS EA.SYSTEM-OVER 4(CIA) Com ray S'f+tydG_ BUILDING DIVISION FEES Certified copy b herebyth the chd. CREASE/INDUSTRL WASTE NTFRCEPTOR PLANCHECK FEE rtlBed espy b filed with the dty inspection division. CERTIFICATE OF EXEMPTION FROM WORKERS' IGREASETRAP PAID COMPENSATION INSURANCE BEwER,5ANTTARY-SNRM EA mo Date RCCCI t# Rhb sectionneed not COMPENSATION lithe permitNINSURA Islecamhundred doaan a s•00 P 01M)orlms.) WATER HEATERW/VENT/ELECTR ENERGY FEE Y N_ I certifythat In the perfornanceof the work farwhlch this permit is blued, I shall not employ any person In any manner m As to become subject to the WATER SYSTEM/TREATING Workers'Compensation Lwaof Callfmnla.Date PAID O Z Applicant NEW RESIDENTIAL PLMB. SQ.Ff, Date Recel t# Z O NOushould TO APPLICANT,II,aaerns'C. p. At 1.Preisons"ttloryyou H Code,you mustuathwit the Workers'Comp rovisinprovbiomrmit s Lab be TOTAL: a. W dermad remuatfonhwllh comply with each provisions orthls permit shall be W 7 deemed rcvoknd. BUILDING FEE CONSTRUCTION LENDING AGENCY �. p SEISMIC FEE CL Iofthe tOrf.',whhat herebpmut nonlendinga97,Cifor.C.I perform, ELECTRIC FEE D Z ansa o(lhe worklorwhkh this permltlsblued(See 3097,Civ.CJ TOTAL: U O I..dA?.N.me PLUMBING FEE OO LL F Lenders Address QTY-1 MECHANICAL PERMIT FEE MECHANICAL FEE OW tsco 1cenilythat l have mad thlsappgmtlon and Yatethattheabovelnformatlon 6 act.I agree to complywlth all city and county ordinances and state laws PERMLTISSUANCE FEES PAID: >. W relating to building commotion,and hereby authodee representatives of this F Z city to enter upon the above-me-itoned property for Inspection purposes. ALTER OR ADD TO MECH. (We)agree to save,Indemnify an d keep harmlm the City of Cu pen Inca Date Receipt# V agalns bllltles,judgments,coats and expenses which may In any way accrue AIR HANDLING UNIT(TO 10,00)CFM)) SUBTOTAL: ago old City In consequence of the granting of this permlL ATR HANDLING UNIT(OVER 10,000 CIM) CONSTRUCTION TAX 1 alure ofApplicant/Contractor Data EXHAUST HOOD(W/DUCT) CONSTRUCTION TAX PAID: HAZARDOUS MATERIALS DISCLOSURE Wllltheapplia u rat or future building occupant stormhandle hardou> HEATING UNIT CIO 100,=BTU) Date Recei t# o meal as defined by the Cupertino Municipal Code,Chapter 9.1Z.and the I lealth and SafetyCode Section 75537(a)7 HEATING UNIT(OVER 700,000 BTU) TOTAL: d RYes M No lllthe applicant or future bcildingompart use equlpmenturdevices VENTILATION FAN(SINGLE RFSID) DATE which emit haurdoue ak contamiranl°ae defined by the Bay Arca Ab Quality Management Dlatrlct7 BOILFY COMP OHPOR 100,0(10 BTU) T Yes 9.1 �+, � 61991 havercad Health ar�fet m.&,SArequl 25505, under Chapter 6.95 of BORCR-WMP(OVER 100,000 BTU) the erstan thia HealthbSafety Code,Secttaro75505,ve a tenant, ^ understand that notef the the occupant not currentlyhavewhich that It mot NEW RESIDENTIAL MECH. SQ.FT. I/I�,•L./\/ responsibilityto notifytheic to of of requirements which moat be met Aljly n(a� prior to issuance cats Certificate of Ocmpanry, SIO 9a Ae �� j�� Owner or authorized agent Date �7y /yr'/ J TOTAL: ISSUED BY:V 'ter OFFICE COPY C' 2,f1 SEWER CONNECTION PERMIT SERIAL NO. P 15161 CUPERTINO SANITARY DISTRICT R.O.S./EM./Tract No..��`-. �'.. Lot No..:� ......... 20065 Stevens Creek Blvd. A.P.N. Bk..!!. 9.4....... Pg...�.��..... Building C Cupertino, California 95014 Phone (408) 253-7071 Date.....J.. .� ....� .�..................... 19..9 . The undersigned,being the owner(or owner's agent)of the property located at ........................................................ ....................................................... consisting of the following TYPE OF BUILDING: r Residential: Single family....X..... 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. 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) �j 3) To acquire a permit from the ......CLQ:.`. � �'� ^.. N.P.............................. Building Depart- ment and obtain inspection and approval b�said BGilding 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 NameY '.rtt, Telephone... ......w.7 t ..................... Mailing address if different from above....Sc... ...................................................................................................... F-1A standard backflow protective device shall be installed, to the satisfaction of the Building Department, for the above property.(Note—See Detail/) FEES: nr Connection Permit Fee ,,,/ Sewer Service charges to June 30, 19�� .., $.....?.r:......./mo.x.1,l.'..mo. ................ Inspection Fee for backflow protection device TOTAL $ e, o eipt of$1(n r'........ 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 maintained by Property Owner. Overflow point of least twelve inches(17) below lowest finished floor containing plumbing. Kelly Valve Installed at Property Line to be readily removable for Lateral Sewer maintenance. J yy FINVloor Level Finish Floor Level p A Kelly Valve E Finish GradeIts Kelly valve Wive Access E a% —/ 2 wile Vented User i Valve Access Be. Backwater Valve— OW Figure I Figure 2 Figure 3 Kelly Vo1ve- Below Surface Backwater Valve—Normally Kelly Valve-Above Ground Inslallelion-Shown al req.i,.d installed al shallowest point Instnllulon-Shmrn installed Property Line Coorioul. along House Sewer between close to building. Properly Line and building. log TA B STANDARD ACKFLOW PROTECTIVE DEVICE INSTALDEIL LATION I iiL�FLOW to be as ble. J gvable Cleanout Plug Ah Grade Wye for Riser wer Cleanout Bos with LID Id be accessible maintained by property owner. Snort length Riser Pipe Adaptor coupiingd _ .FLOW sr �Lal5 House Sewer -ero� r E"•T.linimum slope determined by Building Department. �� •Lateral Sewer Cleanout to be some size as Labral Sewer. 06 DETAIL STANDARD CLEANOUT FOR LATERAL SEWER J APPLICANT TO FILL IN INFORMATION WITHIN RED LINES— USE BALL POINT PEN ONLY Building Prom Identification PERMITNO. Building Addmes 22644 wKrs aces: one; jAAAL (_ CITY OF CUPERTINOQBUILDING DIVISION �a] APPLICATION /PERMIT / f BUILDINGELECTMCA4PLUMBINC-MECHANICAL CATEGORY CONTROL If Itect/Englnmr. Llc No: CITY ELECTRICPERMIT FEE BUILDING PERMIT INFO Address: Ciq PERMITISSUANCE ❑ ❑ ❑ LICENSE DC NTRACTOR'S DECLARATION I herebyafflrmthat l amlkensed under provisions of Chapter9(commenc- APPLIANCESRFSIDENML ]OB DFSCRII'TTON ingwithSedion7000)ofDlWslon3ofthe Businemand I'rofmslonsC-ade,and my license 1.full and effect. /('q/6F, PANELS Limn IanC- ZLIc4 Date '1 - Contractor J —UP TO 200 AM5 ARCHITECT'S CLARATION 101-1000 AMPS p�p�uu 000 ]undentand my Elam eluBLe used npubacremrda OVER 1000 AMPS /QTfT1�OR f/SCI.FT. k4 Licensed Profmlaul SIGNS ELECTRICAL �C UVJ �tR� 6 OWNEReBUILDER DECLARATION ER M rn a SPECIALCIRCUIT/MISC �Wy)V/'y BB, ••• Zt.., owing reason. lhatlam31.5,Blro ossa Contractor's License Lw to the qqqq (ollowing rcmon.(SMlon 7071.5,Business and Prolmlone Code:M city or Ff'8 muntywhkhmqulreeapermltwmmt dalter,impmwdemollsh,orrepalr TEMP.METER OR POLE INSI. �'�y anyatmcture prlortolte lsivanee,also requlresthe applicant for such permit to pplypR DEVICEassaaS a0 6 file a signed statement that he b licensed pursuant to the provision of the u, Contractors License Law CM er 9(commencin with Section 7(X10)ofDivl- SWIMMING POOL EI'[CTRIc oQ elon3ofth.Huslneuand Praf.I.Gx Code)mthagm he le exempt lhercfroand VALUATION `� •1 the basis for the alleged exemption. Any violation of Section 7071.5 by any applicant fora perenilsubjects rn the applicant to a civil penalty of not orethan OU7LETSSWITCIif5HXT[IIiES $ IT cd.d delta.%S0N. NEW RESIDENTIAL ELECTR FT. as owner of the property,or my employees with wages as their sok STORIES TYPE CONSTRUCTION compensation,will clothe wok and the structure Is not Intended or offered for Osale(Sce.70K Business and Profmlom Code:The Contractors License Law $ does not apply to an ownerof propertywho bulldsor lmprovesthercary and OCC.CROUP RES.I1NI75 whodoessuchworkhim lforthmghhlsownemployee°,providedthatsuch Improvements arenot Intended oroffered(ocule.If,however,thebuilding or TOTAU Improvement Weld within one yearofcomplMlon,the owner-bullderwlll have UA.Ilurden of proving that he did no bund or Improve to purpose ofule.). CITY, PLUMBING PERMIT FEE FLOOD ZONE APN ".L as owner of the property,am exclusively mntraning with Boeneed PERMRISSUANCE O mmntton to construct the project(Sec 7044,Bull...and I'mfessi u Code: The Contractor's License Law does not apply to an owner of property who ALTER-DRAIN k VEM-WATER(EA) Wilds or Improves themon,and who contracts for such p(olects with a cl5actor(s)licensed pursuant to the Contractor's License Law. FEE SUMMARY L_J I am exempt under Sec. B A P C for this reason BACK FLOW PROTECT.DEVICE DRAINS FLOOR ROOF,AREA,MND. SANITARY Y_ N S Owner Date RECEIPT M 21 E31 hereby WORKMAN COMPENSATION DECLARATIONm PER TRAP SCHOOL TAX Y_ N affirthat I have a certificate of consent to u16o FIXTURES.1nsure, a RECEIPTN4 unifiateofWorkers'Compeuationlmunnmo,.Mrtifbclmpythereaf(Sm. b C.) GAS EA.SYSTEM-11NC.4OUTLETS PARK FEE Y N 380D,L Polley«_/23 76/ — 9/ . RECEIPT GAS EA.SYSTEM-OVER 4(CIA) Com ray S'f+tydG_ BUILDING DIVISION FEES Certified copy b herebyth the chd. CREASE/INDUSTRL WASTE NTFRCEPTOR PLANCHECK FEE rtlBed espy b filed with the dty inspection division. CERTIFICATE OF EXEMPTION FROM WORKERS' IGREASETRAP PAID COMPENSATION INSURANCE BEwER,5ANTTARY-SNRM EA mo Date RCCCI t# Rhb sectionneed not COMPENSATION lithe permitNINSURA Islecamhundred doaan a s•00 P 01M)orlms.) WATER HEATERW/VENT/ELECTR ENERGY FEE Y N_ I certifythat In the perfornanceof the work farwhlch this permit is blued, I shall not employ any person In any manner m As to become subject to the WATER SYSTEM/TREATING Workers'Compensation Lwaof Callfmnla.Date PAID O Z Applicant NEW RESIDENTIAL PLMB. SQ.Ff, Date Recel t# Z O NOushould TO APPLICANT,II,aaerns'C. p. At 1.Preisons"ttloryyou H Code,you mustuathwit the Workers'Comp rovisinprovbiomrmit s Lab be TOTAL: a. W dermad remuatfonhwllh comply with each provisions orthls permit shall be W 7 deemed rcvoknd. BUILDING FEE CONSTRUCTION LENDING AGENCY �. p SEISMIC FEE CL Iofthe tOrf.',whhat herebpmut nonlendinga97,Cifor.C.I perform, ELECTRIC FEE D Z ansa o(lhe worklorwhkh this permltlsblued(See 3097,Civ.CJ TOTAL: U O I..dA?.N.me PLUMBING FEE OO LL F Lenders Address QTY-1 MECHANICAL PERMIT FEE MECHANICAL FEE OW tsco 1cenilythat l have mad thlsappgmtlon and Yatethattheabovelnformatlon 6 act.I agree to complywlth all city and county ordinances and state laws PERMLTISSUANCE FEES PAID: >. W relating to building commotion,and hereby authodee representatives of this F Z city to enter upon the above-me-itoned property for Inspection purposes. ALTER OR ADD TO MECH. (We)agree to save,Indemnify an d keep harmlm the City of Cu pen Inca Date Receipt# V agalns bllltles,judgments,coats and expenses which may In any way accrue AIR HANDLING UNIT(TO 10,00)CFM)) SUBTOTAL: ago old City In consequence of the granting of this permlL ATR HANDLING UNIT(OVER 10,000 CIM) CONSTRUCTION TAX 1 alure ofApplicant/Contractor Data EXHAUST HOOD(W/DUCT) CONSTRUCTION TAX PAID: HAZARDOUS MATERIALS DISCLOSURE Wllltheapplia u rat or future building occupant stormhandle hardou> HEATING UNIT CIO 100,=BTU) Date Recei t# o meal as defined by the Cupertino Municipal Code,Chapter 9.1Z.and the I lealth and SafetyCode Section 75537(a)7 HEATING UNIT(OVER 700,000 BTU) TOTAL: d RYes M No lllthe applicant or future bcildingompart use equlpmenturdevices VENTILATION FAN(SINGLE RFSID) DATE which emit haurdoue ak contamiranl°ae defined by the Bay Arca Ab Quality Management Dlatrlct7 BOILFY COMP OHPOR 100,0(10 BTU) T Yes 9.1 �+, � 61991 havercad Health ar�fet m.&,SArequl 25505, under Chapter 6.95 of BORCR-WMP(OVER 100,000 BTU) the erstan thia HealthbSafety Code,Secttaro75505,ve a tenant, ^ understand that notef the the occupant not currentlyhavewhich that It mot NEW RESIDENTIAL MECH. SQ.FT. I/I�,•L./\/ responsibilityto notifytheic to of of requirements which moat be met Aljly n(a� prior to issuance cats Certificate of Ocmpanry, SIO 9a Ae �� j�� Owner or authorized agent Date �7y /yr'/ J TOTAL: ISSUED BY:V 'ter OFFICE COPY C' 2,f1 SEWER CONNECTION PERMIT SERIAL NO. P 15161 CUPERTINO SANITARY DISTRICT R.O.S./EM./Tract No..��`-. �'.. Lot No..:� ......... 20065 Stevens Creek Blvd. A.P.N. Bk..!!. 9.4....... Pg...�.��..... Building C Cupertino, California 95014 Phone (408) 253-7071 Date.....J.. .� ....� .�..................... 19..9 . The undersigned,being the owner(or owner's agent)of the property located at ........................................................ ....................................................... consisting of the following TYPE OF BUILDING: r Residential: Single family....X..... 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. 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) �j 3) To acquire a permit from the ......CLQ:.`. � �'� ^.. N.P.............................. Building Depart- ment and obtain inspection and approval b�said BGilding 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 NameY '.rtt, Telephone... ......w.7 t ..................... Mailing address if different from above....Sc... ...................................................................................................... F-1A standard backflow protective device shall be installed, to the satisfaction of the Building Department, for the above property.(Note—See Detail/) FEES: nr Connection Permit Fee ,,,/ Sewer Service charges to June 30, 19�� .., $.....?.r:......./mo.x.1,l.'..mo. ................ Inspection Fee for backflow protection device TOTAL $ e, o eipt of$1(n r'........ 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 maintained by Property Owner. Overflow point of least twelve inches(17) below lowest finished floor containing plumbing. Kelly Valve Installed at Property Line to be readily removable for Lateral Sewer maintenance. J yy FINVloor Level Finish Floor Level p A Kelly Valve E Finish GradeIts Kelly valve Wive Access E a% —/ 2 wile Vented User i Valve Access Be. Backwater Valve— OW Figure I Figure 2 Figure 3 Kelly Vo1ve- Below Surface Backwater Valve—Normally Kelly Valve-Above Ground Inslallelion-Shown al req.i,.d installed al shallowest point Instnllulon-Shmrn installed Property Line Coorioul. along House Sewer between close to building. Properly Line and building. log TA B STANDARD ACKFLOW PROTECTIVE DEVICE INSTALDEIL LATION I iiL�FLOW to be as ble. J gvable Cleanout Plug Ah Grade Wye for Riser wer Cleanout Bos with LID Id be accessible maintained by property owner. Snort length Riser Pipe Adaptor coupiingd _ .FLOW sr �Lal5 House Sewer -ero� r E"•T.linimum slope determined by Building Department. �� •Lateral Sewer Cleanout to be some size as Labral Sewer. 06 DETAIL STANDARD CLEANOUT FOR LATERAL SEWER J