22599APPLICANT TO FILL IN INFORMATION WITHIN RED LINES —USE BALL POINT PEN ONLY
BuildingProject Identification - 1
Building Address:-
PERMIT NO.
10 L36 E
2 2 5 9 9
wneFs ante
g : r��,
YDQ?� vc�-` Z iap
CITY OF CUPERTINO-BUILDING DIVISION
APPLICATION / PERMIT
BUILDING-ELECTRICALML BING-MECHAMCAL
'
A A
or's Na Lic.No:
"���� �`•� 6
CATEGORY -
CONTROL#
A Itect/En rte k No:
G ys-'
QTY ELECTRIC PERMIT gFEE
BUILDING PERMIT INFO
d' (p�
Address: ,,. y0ist /�i Q e) xE
PERMI7ISSUANCE
LICENSED CONTRACTOR'S DE LARATION
I hereby affirm that l am lkmeed under pmxlidms of Cha pter 9(commonc
APPLIANCESRESIDEMEAL
]OB DESCRIPTION
PANELS
Ing with Section 7000) of Division 3 ofthe Buslneaaand P��roJ/CasionsCode, and rey
license Is In full and died. 3 S `iz
License la Lie.p
Date_ Contrador
RCHITECI'S (LOBATION
I understand plan shall be used as public records.
Licensed Professional
211 -IM AMPS
OVER 1000 AMPS
SQ. Fr.`F OOR ARES
E/SQ. FT.
SIGNSELECTRICAL
SPECIALCIRCUIT/MLS(
OWNER-BUILDER DECLARATION
I hereby affirmthat l am exempt from the Commeor's License Law for the
A
LP
TEMP. METER OR POLE INST.
following reason.(Section 70I1S, Businessand Professions Code: Any dryer
cwntywF ich requlma petmt wcomlmd, altep impmve, demollsh,er mpalr
anystmMmpr loibL ancgaL requ4 theappbmntforsuchper tto
file a signed statement that W ts limned pursuant to the provbloa of the
POWER DEVICES
_
SWIMMING POOL ELECTRIC
Contractors License Law (Chapter 9(commanding with Section 7000)of Divi.
slon 3 oflhe Businev and Pro(emiom Code) orthat hell exempt themfmmand
VALUATION
the basis fortthc alleged exemption. Any violation of Section 70H5 by any
applicant for a permit subjeds the applicant to a dvflpealtydndmomtban
OUCLETSSWIICHESFlXTURES
five hundred dollars (SSM.
1, as owner of the property, or my employees with wagm m that, sok
compensation, willdothe work andthestacture bi not intended or offend for
RESIDEN'DAL ELFLTR SQ.FT.
STORIES-
TYPE CONSTRUCTIONn
sola &c. 7044, Businns and Pmfesdoa Cade: The Contractors License law
does not apply to an owner of property who builds or improves thereon, and
who does
mentsa no tintededoor rougbed ors employees, provided that such
Improvements are noHntended orof(crcd forsale. If, however, thebullding or
OCC.CROUP
p�\�
I
RIS. UNITS
TOTAL:aV
dreving th t he did et buildImprove fner-bu oserwRde.).
the burden neer of the pecedWna6eudorimpmvefacting eaeofcense
LJ d as owner mict the property, am exclusively contracting with licensed
omlo ronicense doe(Sec. ncas and Code:
)f-11
� VAlrovement
QTY. PLUMBING PERMIT FEE
�.R1AID`D`wNB
O tl V JI IL—�
R
PERMIT ISSUANCE
Law of pesbn
Tha,danCo Limas Law ices nor apply m an owner a property who
apply to
The Contractor's improves;
builds or Improves thereon, and who mmnro for such plojects with a
ogntr+darts) ficemed pursuant to the Contractor's License Law.
LJ I am exempt under Sec. B k P C for this reason
ALTER -DRAIN& VENT -WATER (EA)
ATE S
BAIX FLOW PROTECT. DEVICE
DRAINS -FLOOR, AREA, COND.
SANITARY RFiCQPTN
Owner Date -
WORKMAN COMPENSATION DECLARATION
❑I hereby affirm that I have a certificate of consent to ae161nwre, or a
certificate ofWorlomi Comp<nntine lnuranre or. copy thereof(Sec.
FLXIlIRFS PER TRAP
SCHOOLTAX Y_ N_
RECEIPT N
GAS EA.SYSTEM-1 INCAOUTLETS
PARKFEE Y N_-
RECEIPT #
Com an ,���1 ��
Goa
CAS EA. SYSTEM -OVER 4 (EA)
flU1LDINC DI VISION FEES
GREASE/INDUSTRL WASTE INTERCEPTOR
PLANCHECKFEE
crtllled by furnished.
copy is filed with the city impaction division.
GREASE7RAP
CERTIFICATE OF EXEMPTION FROM WORKERS'
PAID
SEWER-SANRARY-STORM EA. 200FT.
COMPENSATION INSURANCE
(This seelon need net be completed lithe permit Is feron hundred dollars
Date Recd t#
WATIIFATERW/VENT/ELECTR
ER
FEE YN
(6100) or less.)ENGI2GY
I Wilily that In the perfmmanceefthe week for which this pemdt is Lwued,
WATER SYSTEM/TREATING
1 shall not employ any person In any manner so as to become subject to the
Wmkcrs'Compenntim Lswsof Callfomla. Date
Applicant
NOTICETO APPLICANT: If, after raking this Certificate of Exemption, you
should be mnesubyd to the Worken'Compe.l providoaoftbe Labor
)
PAID r'l
Re t#
500
NEW RESIDENTIALPLMB. SQ.FT.
TOTAL:
BUILDING FEE
Code, you =at forthwith comply with such pmvedoes orthls permit shall be
decd revoked,
CONSTRUCTION LENDING AGENCY
-
'
SEISMIC FEE
l'OTAL:
-
ELECTRIC FEE
I herebyafOrmthat there is a construction kndingageney(prthe perform-
anccoltheworkf, hick th a Wwµd( 30# l C.)
Lender's Nara _
1<nder's Address ,3
I cert lfy that l have rcad hisapplica tIn. h net state that the above infomustim
is corma.I agree to comply with all city and county ordinances and state laws
PLUMBING FEE
QTY. MECHANICAL PERMIT FEE
MECHAMCALFEE
E3 IC
PERMIT ISSUANCE
FEES PAID:
relating to building contrudlon, and hereby authomee representatives of this
city to enter upon the above-mentioned property for impection purposes. '
(We) agree to save, Indemnify and keep bareness the City of Cupertino
-galppy4((l1ttaab' In,judgments, costa and expenses which may In anywayactue
ALTERORADDTOMECH.
_
Date ReeciP #
AIR HANDLING UNIT (TO 10,0D) CFM)
SUBTOT L:
agaiZui yin cmax�t ceof the a panting of this penrny
7
AIR HAIvouNc t>r1I'r (OvEz 10,0100 CFM)
CONSTRUCTION TAX
n
VL-
Signature of Applicant/Contractor I Dat
HAZARDOUS MATERIALS DISCLOSURE-
EglAINr HOOD(W/DUCT)
CONSTRUCTION TAX AID:
HEATING UNIT (TO 100,000 BTU)
Date Rece t#
WllltheappllcantorfutureWildingoccupantstoreorhandlehanrdous.
material as defined by the Cupertino Munidpal Code, Chaptcr 9.12, and the
Ikalth and Safety Cod%ydim 25532(1)7
HEATING UNIT (OVER 100,1100 BTU)
TOTA
_(
RhoYtl
Illtheappllcant or (u re buildingompanluxequipment or dnvims
VENTILATION FAN (SINGLE RFSID)
ISSUANCE DATE
which emit haeardous air contaminants as defined by the Bay Area Air
Quality Management'r���p��r��J,It7
IMav .adtheba rdomomaterialsrequimm ntsunderChapter6.9561
PAID
P M 1 D
BOIIER-COMP(3IQ'OR 100,000 BTU)
BOILER-COMP(OVEI100,C00 BTU)
the California Health A Safety Code, Sed1on 25505, 25533 and 25534. I
u adersta ad that if the W llding does not currently have a tenant, that it is my
rsponibilily, to notify the occupant of the requirements which must be met
once!.(a�CertlfiKcaautfOmpancy.
NOV 25. 1991
NEW RESIDENTIAL MEClL SQ.ET.
M_
er or u orf d a t to
gen
M_ ,fagent
ISSUED BY:
TOTAL: a �
OFFICE COPY
CITY OF CUPERTINO
INSPECTION DIVISION
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El
`18UPERTINO SANITARY DISTRICT
20065 Stevens Creek Blvd.
Building C
Cupertino, California 95014
Phone (408) 253-7071
SERIAL
SEWER CONNECTION PERMIT A�NO.
P :,IG 9 5203
R.O.S./RM./Tract No .... PI)M.... Lot No.... �.,.....
A.P.N. Bk..S5 7..... Pg .... L77... Par............
Date. %lB?/(iYN L� �r......2.........., 19 C% �. .
The undersigned, being the owner (or owner's agent) of the property located at .:......................................................
............................................................................
consisting of the following TYPE OF BUBUILDING: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
r a cleanout raised to grade at the pro/p�er[ line or at th/e limits of any ex/�'sung District easement. (Note —Detail J)
) mencquire a permit from the .....(_..(.... ... • .9 _ { ....� ..... T'�^!' .O ........................... Building Depart-
;
�t 3 Toa.. .
x...� nd obtain inspection and approval y 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. Telephone ... i�% 2.2 .....................
Mailing address if
differentfrom above..................................................................................................................
By ...... -�. ,_? _37-7777 ....................
®A standard backflow protective device shall be installed, to the satisfaction of the Building Department, for the above
property. (Note — See Detail I )
FEES: a G
'Connection Permit Fee $
r (l
Sewer Service charges to June 30, 19.9) Z, $ .... ...../mo. x ...... mo.U`
...........sem.
Inspection Fee for backflow protection device
TOTAL $ v
lceipt of $ . ✓! . 7. JL 7.... acknowledged and permit granted. MARK THOMAS & CO. INC., Distric Manager -Engineer
°�N.OTIE: .
'.,
NO physical' connection of the house sewer - By���
the 1'atcral sewer shall be made until writ-
'toieu perimssion is received from the District.
TE: See Details on other side of this permit
CUPERT/NO SANITARY DISTRICT
NOTES: All valves tb be accessible and maintained by Properly Owner.
Overflow point at least twelve inches(12") below lowest finished
floor containing plumbing.
Kelly Valve installed at Property Line to be readily removable
for Lateral Sewer maintenance,
Kelly Valve
r Finish Grade
Valve Access B�xm Id
with Vented ter E Valve Access Box
Backwater Valve
Figure I
Kelly Valve- Below Surface
IMtolletion-Shown at required
Property Line Cleanout.
Kelly
Figure 2 Figure 3
Backwater Valve—Normally Kelly Valve -Above Ground
installed or shallowest point Instnllmian-Shown installed
along House Sewer between close to building.
Property Line and building.
a1
STANDARD BACKFLOW PROTECTIVE DEVICE INSTALLATION I DETAIL
ul CllCo m
Distance /ram be as
Close as practi it 1.
Removable Cleanout Plug
n Finish Grade
Wye for Riser
k
Sewer Cleanout Box with Lid to be accessible
and maintained by property owner.
' Snort length � Riser Pipe
Adopter cauplin" 1/8 Bend
FLOW nr
Minimum slope determined by Building Department.
-Lo teral Sewer Cleanout to be some
size as Lateral Sewer.
I I OE TAIL I
STANDARD CLEANOUT FOR LATERAL SEWER J
W,