22598 APPLICANT TO FILL IN INFORMATION XAIITH114 RED LINES — USE BALL POINT PEN ONLY
BuildingProject Identification PERMIT NO.
Building drens: 0 l L-O o �- 22598 .
A
LUAM
CITY OF CUPERTINO-BUILDING DIVISION
c 'sName, ,�U , aONST p LIeNa: APPLICATION / PERMIT Z
C� BUILDINGdECTRICALPLUMBINC-MECHANICAL CATEGORY CONTROL#
/En neer. Lic.No:
IKL£� C!6 G
QTY ELECTRIC PERMIT FEB BUILDING PERMIT INFO,
Address ,z 0 /� LE S .� - IAJ .
PERMIT ISSUANCE 4FF LSI 1�/
LICENSEDCONTRACFO 'r UisC RATION �M ,LMO �N
Ihembyaffirm
m,700that l iviscensedunderprovWomof Chapter9de,and c- MPLIANCESRESIDENTIAL JOB DESCRI'IION
ingwdh1.fan 7fX10)of d effect ftheBunnessand ProfesnonaCode,and my
Moen is in full f rad dfM. �'LG l/Z� PONOS ISI 1 1 )
Llcen �� T V a r�'V •
Datvr[/_af muractmrUP IQ 2W AMPS
���a (# CHITECPB D LARATION 201-1000 AMPS
Fq+aZ I understand my plans shall be used as public records. - OVER 1000 AMPS 1 SQ.FT.ELODR FA (b/ .FT.
•&OO
U0 Licensed Professional SIGNS ELECTRICAL I6 Sr.. / 1• !2-
<Q. OWNER-BUILDER DECLARATION
G F SPECLILCIRCUIT/MISC
owing yaxon (hatlamexompt from the Business
ProfessiLicense ons
Code:
fort he
following reason.(Section 70715,Business and Professions Code:Any city or TEMP.METER OR POLE INST. ( V ( V
u9 counlyctum requlreaa issuaneahormt,alter,impmvedemolbh,ormit to
F alc.aigvreuttream priorto that he 0 abensed pestherpplicant fori,it..such rmltta POWER DLYICES
�+y ' file a algned statement that he b licensed pursuant to the pro 7000) o(DM.
On Conrnnors License Law (commereirg withS mpt hemfm Divi- SWIMMING POOL ELECTRIC VALUATION
O slurs 3oRhe Buslnemand Professlom Code)orthat hebexemptrherclromand
Q the basis for the alleged exemption. Any violation of Section 7071.5 by any OUTLETSSWITCHESFIXTURES 9
i applicant for a permit subjects the applicant to a civil penalty d not more than
than /32 36
c. five hundred dollars(s5m. NEW RESIDENTIAL ELECTR 9Q-FT. SIOWSS TYPECONSIRUCTIOR
WWW ❑I,as owner of the property,or my employees with wages as their sole
¢ compensation,willdorhework,andthestructumisnotintended or offeredfor
O sale(Sce.7014,9uslnessand Pmfesslom Cade:The Contractors Lt..Law
(� $ duce net apply torn owner ofthrougywho em orimprovvidedthat
stand _ 1 �� 0� R 5
F,S..
who does pplytwork an owner orthmugh,his wown Wilds employees, vestheem,a d I ra .
improvements are not Intended oroffered for sale I(,however,thebullding or TOTAL: Za YN
Improvement b sold within one year ofcompietion,the owner-buaderwill have
t"Menofpmvingmat hedid notbuildorlmproveforpurposaotsale.). QTY. PLUMBING PERMIT FEE .00 APr
LI L as owner of the property,am exclusively oontrating with licensed PERMIT ISSUANCE
contractors to mrestmct the project(Sec.7014,Business and Professions Code:
The Contractors License law does not apply to an owner of property who ALTER-DRAIN&VENT-WATER(ErU
waft or Improves thereon, and d who contracts for such plu)ectwith a
�q0.t{+turfs)licensed pursuant to the Contractor's License Law. BACK FTAWPROTECT.DEVICE
I_J 1 am exempt under Sec. B k P C for this rc
OUTSIDE FEES
awn DRAINS FLCOR ROOF,AREA,COND. SANRARY Y_ N_
• Owner Date RECEIPT N
WORKMAN COMPENSATION DECLARATION FIXTURES PER TRAP SCHOOL TAX Y_ N_
F11 hereby affirm that I have a certificate of consent to rel(-insure,ora RECEIPT N
certifioteofworkan Compewtionlrourancem a ca certlfk'd copy thereof(Sec. GAS EA.SYSTEM-1 INCA OUTLETS PARK FEE Y N
3800.Lpb C.) „s ` / a�s ( 7 3RFJC
GAS EA.SYSTEM-OVER<(EA) DINGDIV
- BUILDING DIVISION FEES
m�y hereby furnished. PLANCH-CK FEE
Certified copy b filed with the city mipeNan division. GREASEANDUSTRL WASTE INTERCEPTOR
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE TRAP PAID
COMPENSATION INSURANCE SLIYF.R-SANITARY-STORM EA 200FI' Date RCCCI HI
- (Ihissationneednatbecompidediftheper tisforonehundrcd dollars
(S100)orleaa.) WATER HEATER W/VENT/FJ.[CTR ENERGY FEE Y
suAFsI
Ic rtify that In the performance of the week for which this permit la issued, l
an
1 shall not employ any person In any manner n w as become subject to the WATER SYSITM/rnEAnNc P a 9^
Workcri Compensation Lawsof California. Date PAID /
Z Z N077CET0 APPLICANT: aker making this Certificate o(Exemptlon,you NEW RESIDENTIAL PLMB. SQFr.licantDat Rece' t>I
50
0 a hauldbeoomesubjotothewarkeri Comps tionpmvbiom of the Labor OT L:
V), Code,you must forthwith comply with such provisions orthis permit shall be BUILDINGFEE
W j- deemed revoked.
CONSTRUCTION LENDING AGENCY SEISMIC FEE
a I hembyaffirrethauhem is a commutlon lendlegagGGpp y I the petoms- Torpl: ELECTRIC FEE
Z. : once of the work r hicu tLLs issue-1�,e J&%ncCIVys C. O
U O lender's Narrc �{/'1/ •aO l�/1�•Qws- PLUMBING FEE
LL 1— Lenderapddress i0 =� XAS+Fg. 'at1Ve L QTY MECHANICAL PERMIT 1'.E MECHANICAL FEE
O w b=om"°It;a0eh3crc�nwun:u Guiana county
ordinances and nate laiws PeRMrr ISSUANCE FEES PAID:
T 0. relating to building construction,and city
authoriae representatives of this
H N city to enter upon the above-mentioned property for bnpetion pu rposes. ALTER OR ADD TO MECH.
Z (We)agree to save,indemnify an d keep harmless the City of Cu Perim. Date Rete tN
U against liabilities,P dgmente,cons and expenses which may In any ways ARHANUO NG UNIT 010,000 CFM) SUBTO AL:
.gains C yimm�sequen ofthegranHngofthispsnnit CONSTRUCnONTAX -
AIR HANDLING IrN11'(OVER 10,000CFM)
Sig o Applicant/Con razor Date EzrwusT Hoop fee/Duel) CONSTRUCTION TAX 'AID:
HAPARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle ha>ardous HEATING UNIT CFO 100,000 BTT) Date Rec tN
material as defined by the Cupertino Municipal Code,Chapter 9.12,and the -
licalrhandSafetyCod Ion 25532(.)7 HEATING UNIT(OVER 100,000 BTU) TO L:
❑Ys
Will rhe appllanto fu obcilding occupant use equipment or devices VENTILATIONFAN(SINGLE RESID) ISSUANCE DA
which emir haeardom airrtaminanb as defined bythe Bay Area Air -
-� Q..hty Mansgemenr rit7 BOILER-COMP OHPGR100,000 BTU)
yes No
Ravere.dthehP � � D
asa ousmmerialsmquime nbunderChapter6.95ot BOILER-COMP(OVER100,000BTU)
rhe Glifornia Health k Safety Code Sections 2550.5,MS33 and 25536. I
understand that lithe building does not curently have a tenant.that it is my NEW RESIDENTIAL MECH. -SQ.FT.
responsibility to notify the occupant of the requirements which must be melt NOV 25 1991
pm�r`.i .nceofa Certi teo(Occupanry. / j
cl*
r or aurhotlad agentDZ - )SgUpp g
TOTAL:
`� OFFICE COPY
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CITY OF.CUPERTINO
- INSPECTION DIVISION
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SEWER CONNECTION PERMIT SERIALNO. P Bt c 15202
OCUPERTINO SANITARY DISTRICT R.O.S./P.M./Tract No..P`l/"A ... Lot No....f.........
20065 Stevens Creek Blvd. i A.P.N. Bk.3.rJ. ...... Pg....I........ Par............
Building C
Cupertino, California 95014
Phone (408) 253-7071 Date.../( � ' l
P! . 2 . 19 /.< ...
The undersigned,being the owner(or owner's agent)of the property located at ........................................................
........ i /D O �. ..... � e /.... <.�. t !r�
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.
t
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)
• 3) To acquire a permit from the ..6-�7....a.'1....(�.P F!r.T!!�0............................ Building Depart-
ment
epart
ment and obtain inspection and approval by said Buildin 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.�f!YG�s...f�i e4>!?...C..�?!! ....... Telephone....1/. .5�.�.. .�Z..Z.................
Mailing address if
differentfrom above..................................................................................................................
By... .....................
A standard backflow protective device shall be installed, to the satisfaction of the Building Department, for the above
property.(Note—See Detail/)
FEES:
m0
Connection Permit Fee �r $��• �•��•'•••• G
Sewer Service charges to June 30, 19.%7.,$...1��.'G...../mo. X..//.mo. //
Inspection Fee for backflow protection device
TOTAL 7
5-a �
/ r
•'eceipt of$ . ..... acknowledged and permit granted. MARK THOMAS &CO. INC., District Manager-Engineer
N OCE: /1
NO physical connection of the house sewer By., „ ;ar ................................
to the lateral server shall be made until writ- '
ren permission is received from the Distlet. ;See Details on other side of this permit
CUPERT/NO SANITARY DISTRICT
NOTES: All valves to be accessible and maintained by Properly Owner.
Overflow point of least twelve inahes 82°I below lowest finished
floor containing plumbing.
Kelly Volve installed at Property Line to be readily removable
' for Lateral Sewer maintenance.
J
Finish Floor Level
in,E Kelly Volvo Finish Floor Level
Finish Grades
Kelly Volve� .-11E LL
ni
Valve ACCeEe B x —
ni
with Vented C er / �E Valve Access Box f' ro m
Backwater Valve
x w
Figure I Figure 2 Figure 3
Kelly Valve- Below Surface Backwater Valve—Normally Kelly Valve-Above Ground
In510110tion-Shown at reauiretl installed of shallowest point Installation-Shown installed
Property Line Clecnaat, along Nouse Sewer between close to building.
Property Line and Wilding. •
DETAIL
STANDARD BACKFLOW PROTECTIVE DEVICE INSTALLATION I
Distance from R to be as
close as Practicable.
J
Removable Cleanout Plug
A. Finish Grade
Wye for Riser
Sewer Cleanout Box with Lid to be occassiple
Start length and maintained by property owner.
Riser Pipe
Adaptor Coupling 1/8 Bend
— FLOW m
Laleml Sewe I Nouse Sewer
i � TE'moral slopeewer determined by Building Department.
giftLateral Sewer Cleanout to be some
size as Lateral Sewer. •
STANDARD CLEANOUT FOR LATERAL OE TAL
SEWER TAI