02120070 11
CITY OF CUPERTINO '` • "' zu' ' -��>
BUILDING DIVISION PERMIT ',,,CONTRA_CTOWINFORMATION• �I
BUILDING ADDRESS: ABLE SEPTIC PERMIT No.
20725 SCOFIELD DR 02120070
OWNER'SNAME: 520 REED ST. APPLICATION SUR DATE
JANE HOYT 12/17/2002
IFPONE: (408) 377-9990 SANITARY NO. CONTROL NO.
ARCILFECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MP_CI1
0 0 0 0
100 LICENSED CONTRACTOR'S DECLARA'1'lON Job Description
it F 1 hereby affirm ma 1 am Iicenred u d provisinm of Chapter 4(cnmmemm�g p
with Scclion 7(XXq of Division 3 of me Buein JPndcssiona Calc.and my loans=is
mmWom Bt . (, WER CONNECT. /ABANDON SEPTIC TANK
zq�: LiccnmC .s Lr.x NAd`®
�N-Fp Date Cnnlru' r
ARCH qC` DL T
I understand my plans shall he used as public recomb DEC 2 3 2002
OAU
a. Licensed Promisionel
OWNER-BUILDER DECLARnI'ION
1 hereby affirm that 1 am exempt from the Contractor's License Law for the
M� p
0K nO following areson.(secdnn 703 LS,Business and Professions Code:Any city or county BUILDING
t X$ which requires a Permit t4 construct,alter,improve,deob(h,tit repair repair ansummer,
1tI '" prior In its issuance,also requires the applicant lir such permit to rile a signed statement
Sze that he is licensed pmumnno the pmvisionsuflhe Contractor's Lice rise law(Chapter 9 Sq. Ft. Floor Area $52'@Gallon
�$ (commencing with Section 70ab of Division 3rf the Business and Professions Codc)ar
y 5_ mat he is exempt therefrom and the basis for he alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subject the applicant to a civil penally of b Occupancy Type
not more than five hundred dollars Holy).
❑ I.as owner of the pmpcny.or my employees with wages as their sole compensation.
will do me work,and the interum is not intended or offered forsale(See.70,14.Business 8 6
nTp�
and Professions Code:The Contractor's License law does not apply to an owner of 202 — UNDERFL lJK e 1 LV l7
pmpeny who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements arc not intended or offered for sale.If. 301 — ROUGH PLUMBING
however.Be building or improvement is sold within one ycu of completion.Be owner- 302 — TUB & OR SHOWER
builder will have the burden of proving mat he did not build err improve for purpose,(if
sale.). 502 - FINAL PLUMBING ENERGY
❑1,as owner of the property,am exclusively contracting with licensed contractors to 506 — GAS TEST
cr o mait the project(See.70al.Business and profcasions Code)The Contractor's La-
renin Law does no(apply (I an owner of property who Wilds or impmvcs tnemon.and 507 — FINAL PLUMBING
who contracts for such projects with a Catanerons)licensed pursuant o the Contractor's
License Law.
1 am exempt under Sec. .B&P C for this reavon
Owner Date
WORKER'S COMPENSATION DECLARATION
I bereby affirm under Penalty of perjury one of the following deductions:
I have and will maintain a Cenificam of Consent n self-insure for Worker's Compee-
satlon,as provided for by Section 371M of the labor Code,for the perfmmante of the
work for which his permit is issued.
❑ 1 have and will maintain Worker's Compensation Insurance,u required by Section
3700of ON Labor Gale,for me performance of the work for w ch this Permit ix issued.
My oderiC,tapen. lion Insu once ea 'el and Policy nurare
✓ w
ice��Policy No. r arc..
CERTIPIC 'rE FE%EMPI'10N PR WORKERS'
COMPENSATION INSURANCE
(This section nerd not Wcompleted if the permit is forone hundred dollars o 100)
less.)
I eeelify that in he performance of the work for which this permit is issued.I shall not
employ any person in any manner s4 as In become Subject n the Workers'Compensation
Laws of California.Dare
Applicata
NMICE TO APPLICANT:If,after making this Cenificare of Exemption,you should
become subject to the Worker's Compewtion previsions of the Labor Code,you most
�z forthwith comply with such provisions or this Permit shall he deemed revoked.
z� CONSTRUCTION LENDING AGENCY
[r 14 I hereby affirm mm mere is a construction lending agency for the Performance of
7 the work for which his perm it is issued(Sec.3047,Cot C.)
W 1<ndcr's
N.
W z Len cats Address
U O I trebly mu 1 have read this application and sure that the above infmmmion is /7
W U Wilda.l ogre=to comply with all oily and amtay ordinances and stem laws relating a /[ /
0C) Wildingconstruction.nand hereby atahomoc n purposes. Lives of moscityroenaruprm the
W abovo(Wr) gree to pertynve for emnify an keepha
� (We)agree to save,indemnify and keep harmless the Ciry pf Cupertino against
N liabilities.judgments,cos¢and expenses which may in anyway ace cagainsl id City
U z in consequence of the granting of this permit.
r APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL POINT Issued by: Date QT./
SOURC- EGU TIONS.
Re-roofs
9gnamre fnpNicanVCr RIDOr Dam
HAZARDOU S MATERIALS DISCLOSURE Type of Roof
IIthe applicantnr IMuniipal aske.Chapter
None or handle Heard,and
do ed by the Cupertino Municipal Cuc.Chapter 9.12,and he Hcalh and Safcryi .Section2552m)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes KNoWill the applicant err future building occupant use equipment or devices whichIf a roof is installed without first obtaining an inspection, I agree to remove
41'a
Civil haeanous air conmmiwnu as defined by the Bay Arca Air Quality Management all new materials for inspection.
Di.unt,?
❑Yes flu
1 have mad me harallous materials requirements under Chapter 6.95 of the Califnr
niaffcallh&SafcryC4c.Sadmes25Y)5.25533md25531.lundcre, dread building
Jrws nal currently have a Icnarn,mm it is my rcxpmsihility m nosily c r Pant of thc
requiemn i w <nmust lrmrtpf;mmiaaant=nraceeircmraraOM Signature of Applicant - Date
Oernrammori.edagent 'I3� � All roof coverings to be Class "B" or better
CUPERTINO SANITARY DISTRICT
20065 Stevens Creek Blvd.,Bldg. C DER:
Cupertino,California 95014 CHB:
(408)253-7071 CV:
File: _
"ON-SITE REQUIREMENTS-OVER THE COUNTER REG C` R �� w2'Date:
File: CuSD-MOP
Building Dept-Cupertino
Community Development Department-Building
City of Cupertino ��/ //__�y(/''
10300 Torre Ave. V riI�� PoK UNS 1X& ttc TT�fv1c, 1M
Cupertino,CA 95014-3202 A,I
Re: Subject: A ' C Q N QCT To � 6e,.
Name: 'J/`aVS/ VI��' CC.IN �IYT
Approved For Issuing Address: 2b Z 5 scOFle SLP PPAV�
Building/ Plumbing Permits co��o�?a`3 Nuoq-oi5
Permit No: /
CNr `7,1. 60NNCCLIO ftlt (T 165gG
The Cupertino Sanitary District has reviewed the plans for the subject project:
0 ,, No additional conditions/requirements by the District.
❑ Sanitary sewer is available and the existing building is connected to sanitary wer, conditions/requireme is listed
below.
❑. Sanitary sewer is)(t)available,see conditions/requirements listed below.
• ❑ Sanitary sewer is not provided by the District, please contact the City of Sunnyvale(408)730-7510.
The following Conditions/Requtrements are made:
❑ Install new Property Line cleanout or locate and mise 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).
Y Video Inspection of the existing Cleanout,Point of Connection and Street Lateral is required prior to passing The City of
Cupertino Final Plumbing. Owner to call District 48 hours prior to video inspection to schedule a District Inspector.
❑ Inspection of Street Portion of Sanitary Sewer lateral by the District,Please Do Not Inspect any onsite construction prior
to clearance in writing by the District.
❑ Owner to have a Civil Engineer fix the lowest finished floor elevation,with plumbing,to the rim of the next upstream
manhole. If the lowest floor with plumbing is less than one(I')foot above the rim a Sewage Pump may be required.
❑ Cupertino Sanitary District Fees or Permits are required for the subject improvements please do not
issue any building permits.
0 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.
0 Verify existence and serviceability of an existing backflow protective device.
0 Break areas authorized minor electrical appliances only.(No commercial disposal or commercial dishwasher installations.)
• ❑ Other: ..................................................................................................................................................................................
Storm water from surface or roof drains,other general surface runoff water or condensate from any residential HVAC equipment shall not
be discharged to the sanitary sewer.
NOTE: Contact Cu,SD/ for "OFF-S;TE REQUIREMENTS"
fly• ���tirt.t�.Gvt/Li
File Building Letter-OTC /"fL Ch \/i A
PERMIT P
CUPERTINO SANITARY DISTRICT
Santa Clara County
20065 Stevens Creek Boulevard, Building C
Cupertino, California 95014
Telephone 408-253-7071
CONNECTION PERMIT
Date. L•C•'t' r�1+ tZ' APN: Book'4;J Page Parcel' 1
NN + l
roperty OwnerROS/PM/Tract No. Lot No.
P : ��'��� C..• ��� ��.ISI �r�i'T -i ���D
Mailing Address: i
-20-72- 5 :.�Lt}=1LG-I� E DE 1 7 2002 i
h BY:
. 'ZO 7Z 5 I
(I/We),being theyowtnerrr((s�s)(owner's�aggenQ,hercliy`make a{)pfp`li�c�atioriftor connection of a al:
<c. d rI tt G li T 2I` , ) - .i 4 �/� C L'K-�?1'11 �? consisting of the following Type of Buildings:
Residential Single Family Dwelling_V ; Multi Family Dwelling_; No. Units
Commercial ; •Industrial Other ; No. Units
I�N
o hereby request a permit to connect the sewer.system of the Cupertino Sanitary District.
CONSIDERATION OF THE GRANTING THIS PERMIT, THE OWNER AGREES:
1.To comply with all existing Ordinances;Rules and Regulations of the Cupertino Sanitary.District asnow or hereafter amended.
2.To maintain the House Sewer,(that portion of the sewer witliiwprivate;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 casement. �r t�� y
3.To acquire a Plumbing Permit from the&THI of t..�•l+Y C tTi M 0 ,Building Department and obtain the required
Building Department inspections and approval prior to use.
4.Toexpose 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 encroacliment'pennit for sewer constructionin the
street/public right-of-way of the agency having jurisdiction thereover. .
6.To connect to sewerwithin one(1),calendar year from the date of issuance of this permit.
7..To call UNDERGROUND SERVICE ALERT(USA) 1-800-227-2600,ry0,at least 48 hours prior to starting construction:
8.SPECIALPEBMITCONDITIONS: ry Rc �'fl(•�l K. (Ctlllf ��.
t -
ABACKFLOW 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 311,
No. Units x SJP4;/month x no. months (31010)
Backflow Protection Device Inspection Fee (31020)
Connection Permit F= { � (31020)
Additional Connection Fees V-P,0N!*T 'roo-rA(�?�' 't� z? fi 7-)
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:, ^ ..-4.2_ !
Owner's Agent:
t (/f Signing for Owner Please Print Your Name)
eceipt of y� s/t2 a�owledged and.permit granted.
MARK THOMAS & CO.,INC., district Manager-Engineer
By: a ��.t.•'( 1. 'L �L
'Revned sioo NOTE: See Details on other side of,this permit