Loading...
26190 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINOIJILD .I -EL,C'rRICAI PERMFINO. APPLICATION/PERMIT PLUMBING MECHANICAL ID26190 �� A 9 0 BUILDING DIVISION BUILDING PROJECT RivnFICATION L .IL BUILDING ADDRESS ,///7 SANITARY NO. APPPNLICYDONSU_BMIITFAZDATE 2Z-) fQ IL-1 cafdJ Zd - UNITN LO'TN Y / Ly�.�J OWNS NAM i:� s t)�,� PHONE;: CONTRACTOR'S NAME: LIC NO: 1��� _� C//\ NIC CONI'ROLIf AR HTECr GINEER: LIC NO: ADDRESS: ❑ CONTACT: PHONE: QTY. ELECTRIC PERMIT EEE BUILDING PERMIT INFO BLDG ELECT ���PLU���YiiiB 75,PERMIT ISSUANCE El LICENSED CON'IRACI'ORS DECLARATION APPLIANCES-RESIDEND Al. y OKz I hereby aflinndat[mn license,]under provisionsofChapmr 9(commencing with JOB DESCRIPTION FJOO Section 7")dDivision 3 of the Business and Professions Cada and my license is in PANELS �w Inn farce and arc em. � ¢z License Lie N Z UP T0200 AMPS rn 6 y Date 1 Comrocmr Go 201-1000 AMPS ZC&i— ARCHITECTS DECLARATION OVER I"AMPS SQ.FT.FLOOR AREA, J;/SQF1'. I understand my plans shall be used as public records. SIGNS ELECTRICAL 4yf Licensed Profeasloul Sy�Q OWNER-BUILDER DECLARATION SPECIAL CIRCUTP/MISC. �O0.0 1 hereby stima that I am exempt from the Cenhactols License Law for the w3wy following reason.(Section]031.5,Business and Professions Code:Any city or county THMP.METER OR POLB INST. E W'Y O Q r which requires x permit In construct.altar.improve,demolish,m repair any sweture J� pool its issuance.also re then applicant for such Permit rile a signed statement POWER DEVICES that lieM pursuant the pp pemti g e•Xo¢O 9(Wro means with Sction7h )ofDprovivisionons the Contmmossand Pre Law(Chapter , 9(commencexemit thectiontandthebasisior the alleged ixemptio Professions Cecil) SWIMMING POOL ELECTRIC VALUATION y{_y or that h7031.5 by anyafromwdthe bermitsbects the applicant ci,,ny lPnalty of 41, p.=a not mnethnfiv nommedicollars $permit subjects the epplicnm mncivll penalty of OUTLETS-SWITCHES-FIXTURES pc=G tame than Me handrdrty,ormyeml Kb-o ❑ 1,vsownero0heproperty,ormyemployeeswith wages as theinolecompenaation, NEW RESIDENTIALELF.CI'R _SQ. STORIES TYI'Ii CONS'11tVC1'ION a3a� and the work,undc:The Contractors License does art apply 1144,Business and Professions Code:The Connamor's License Law such not apply tow owner of own property wyees,pdsorimproxach imon,wdwhodues werme ihwce himself or dough his OCC.GROUP RFS.UNITS wnemphnyebuiping or prwchimpmvld wit in ne itaendedoroffered Fatale. r. however,the have It a lou improvemem is isold within one build orcdereveifor tun owner arm).r will have the burden of proving that he did not build m improve for poryose of OTAL: ❑ I,its owner of the prolwrty,remexclusively convecting with licensed contractors to QT' PLUMBING PERMIT FEE FLOOD ZONE APN construct the pmjut(Sec.orano Business and Professions Code)The Contractor's License srawdforsucapply towowacrofpmpcny whnsed pursumproves Canon,and PERMIT ISSUANCE who contracts forxuch projects with u wntraomr(a)licensed pursuant m the Cnnvactora License Law. ALTER-DRAIN&VENT-WATER(FA) _ PIiP.SUMMARY ' , ❑ 1 am exempt uMa Sec. ,B&P C for this reason BACK FLOW PROTECT.DEVICE SANITARY Y J FEESN Owner Date DRAINS+FLOOR,ROOF,AREA,GOND. RECIin# WORKMAN COMPENSATION DECLARATION SCUOOLTAX YN ❑ 1M1cmbyvfr,.tlatlM1aveacenificme ofcanumto self-insure,ornccrtificale of t9%TURES-PER TRAP RECEIPT If Workera Cimpensuint lnmranceoraceNflere ed copy thof(Sca 3800,Lnic.) hick PARK FEE Y N coverxvll em to ea's under this t. RECEIPTN p Y o<^^t OAS-f:A.SYSTEM-1 INC.40UTLCTS - Policy as BUILDING DIVISION FEES Company GAS-PA.SYSTEM-OVER 4 LEA) PIANCH17CK FEE ❑ Cenifed copy is hereby famished. ❑ Ceniried copy is file,]with the city inapecdon Division. GREASHENDUSTRLWASIEINTERCEPTOR GRADING ITE CERTIFICATE OF FAHMPTION FROM WORK17RSI GREASETRAP SOILS FEE COMPENSATION INSURANCE (Thi,,cetion need nm fecomplaed ifthe Permit is forone madded dollars($10(d SEWER-SANITARY-STORM EIA.200FT. ENERGY ITE orlcxs.) I certify that in the Performance of the work for which this permit is issued,I shall WATER H EATER W(VE.NT/ELEMR not employ any person in any towner ao as m become subject m the Workers PAID Compensation Lawsof Califomia. Date WAMRSYSTCM(TREATING Dam Receiptp O z Applicant z2 NOTICE TOAPPLICANT:If,after makingthis CertificateofExemption,you should NEW RESIDENTIAL PLM SQ.Fr. TOTAL: F" rA become subject to the Worker's Compenartitm provisions of the labor Code,you must Forthwith comply with such Provisions or this permit shall be deemed revoked. BUILDING FIRE w Q CONSTRUCTION LENDING AGENCY SEISMIC FEE z I hereby affirm that there iso construction lending agency forth,piebarmance of O the walk for which this permit is issued(Set.3007,Civ.C.) T L3Q ELECTRIC FEE L.eadeh Name u" PLUMBING.FEE�^ Lender's Address QTY. °r MECHANICAL PERMIT FEE L) I certify tial 1 have read this application and stem that the above information is correct. I agree,to comply with all city and county oninwces and stare laws refining to PERMIT ISSUANCE MECHANICAL FBI! building construction,and hereby umhmize Tepresentativex of this city to eater upon the CONSTRUCTION'1'AX V Z above-namionnl property for inspection purposes. ALTER OR ADD TO MECH. (We)agree to save,indemnify and keep harmless the City of Cupertino against liabilities,judgments,costs andexpemes which may in any wayacemeagnia,s id City AIR HANDLING UNIT(TO 10,0110 CFM) in cons t uence of th ming of .permit. 2 AIR HANDLING UNIT(OVER IRM)CFM) Stgnmure pp of Aican ontacher Dat EXHAUST HOOD(W/DUCT) J PAID HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO 10(1,000 BTU) Date Nereid# Will the applicant or future building occupant nom or handle havMoua material HEATING UNIT(OVER 100,000 BTU) T '1 us S deliSeJ by the Cupertino Municipal Code,Chapmr 9.12,anJ the Health and Safety Code,Section 25332(,)? ❑Yes El No VENTILATION PAN(SINGLE RESID) Wi II the applicant nr(amts building by themuseequipmentordeviceswhichemit BOILER-COMI'(3HP OR 100,0[0 BTU) ISSUANCE DATE t humito? air contwdnw1 as dated by the Bay Aree Air Quality Mwegement BOILCR-COMP(OVER Im,000 NTD) Ifs A ' D Distrito? r ❑Yes ❑No NEW RESIDENTIAL MECH.—SQ.FT. I have read the hazaMaas materials amuiremems Lader Carpue,E95 of the INAR 2 4 Iumboula �gQq, a Culiliuniu lleahh&Safety Cnde,Sections 255115,25533 and 25534. dthat iftheanto 'ldoesnotmnts whovenll hm,Ihmit is my issuance of enotify the occupant of the requirements which must be and prior to isswnce of a Certificate of C'f Y V Owner or authnrimd agent Date TOTAL: ISSUED pY: OFFICE �::�.a,m:n 'JS^"a:pnc:�i.* .. `1 / . • � ��•,�a.ro,.-m.^fav.mq,�,..,,._„�„-„p � '�1a"'y'rvrymsrCa•w+-y a'*"u '.v 4�{;;—+'�' .-':,�_. Y ✓,q .PERMIT P-15340 CUPERTINO SANITARY DISTRICT Santa Clara County • 20065 Stevens Creek Blvd., Bldg C, Fax (408) 253-5173 Cupertino, California 95014 ' Phone (408)253-7071 CONNECTION PERMIT R.O.S./P.M./Tract No. Lot No. A.P.N.: Book 351- Page O Parcel O© Z Date`x/441, 941 /9 9f Property Owner:XV00e/,r ✓. ow,eka/ Mailing Address:^ sQAAA.V— (If different) Telephone: Sirs: (I/We), being the owner(s) (owner's agent), hereby make application for connection of the property at: -0."5wc Irlcaw o% Zv4-d, li,oes* consisting of the following TYPE OF BUILDING(S): Residential: Single Family X , Multiple Family ; No. Units Commercial , Industrial ; Other ; No. Units do hereby request a permit to connect to the sewer system of the Cupertino Sanitary District. IN CONSIDERATION OF THE GRANTING OF 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 cleanout (raised to grade and accessible) located at the point of connection with the Lateral Sewer (that portion of the sewer in the street right-of-way or District Easement). / 3. To acquire a Plumbing Permit from the `r of 4gew An Building Department and obtain inspection and approval by said Building Department prior to covering of the work or use of the sewer. r 4. To first expose and inspect for serviceability the Lateral Sewer (that portion of the sewer within the street right-of-way or easement), 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 call Underground Service Alert(USA) 1-800-227-2600, at least 48 hours prior to starting grading or digging operations. SPECIAL PERMIT CONDITIONS(Exhibits): N , A BACKFLOW Protective Device shall be installed on 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: Connection Permit Fee: $ F v Sewer Service charges to June 30, 19ygL-�// ,$ 14-0— /mo. x mo.: $ to� • �— Inspection Fee for backflow protection device: $ Considerations and Restrictions of this Sanitary Sewer Connection Permit with attached Exhibits (when noted), are hereby agreed to and acknowledged by the undersigned Owner(or Owner's Agent). Failure to comply will void this permit. Acknowledgment: �YjG> lJe6P� Owner's Agent: (print name) Receipt of$ �3' acknowledged and permit granted. MARK THOMAS& CO., INC.,., District y Note:See Details on other side of this permit. x y TYPICAL CLEANOUT FOR LATERAL SEWER Distance from Property Line to be as close as practicable, du not to exceed five(51 feet. J m Removable Cleanout Plug 0 A. Finish Grade Wye for Riser Sewer Cleanout Box with lid to be accessible and maintained by property owner. Short length Riser, Pipe Adaptor coupling /B 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')feet. 2. Properly 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 d agency having jurisdiction thereover. e TYPICAL BACKFLOW PROTECTIVE DEVICE INSTALLATION TYPICAL BACKWATER VALVE TYPICAL KELLY VALVE INSTALLATIONS INSTALLATION au.isdictionad Rutriaione - AccepfeG By All Jurisdiatione FIGURE I FIGURE 2 FIGURE 3 Installed Below Grade Installed Below Grade Installed Above Grade shown Between Strew Right-of-Way and Building Shown Al Properly Line Cleanout Shown Adjacenl To Building Requires Regular Malnbnanoe = Reguiree Minimum Malmengnce Requires Minimum Mainlenonce Valve To Be Removable Valve Should Be Removable VALVE ACCESS BOX FINISH FLOOR wIIN VenbdCoen e I of F NI H FLOOR KELLY VALVE At VALVE ACCESS BO% E �'�"7Finish Grade �1Finish Grade m BAC NWATER VALVE FLOW t FLOW A' 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.