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22632 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY Building Project Identification PERMIT NO. Building Address, 22632 �/P_d'S� 6 aecJ viEsJ<t/ r ss-83o7 one: A P/�LPf� CI L/FFEl�d Ia_A* A— CITY OF CUPERTINO-BUILDINGDIVISION Ge^tr•"° •"•^n Ix."or APPLICATION /PERMIT Bl1RlNNG-EL0.'f7UCA nP HINGMECHANICAI. CATEGORY CONTROL Y AehBect/Englrcer. Llc.Na Q ELECTRIC PERMIT FEE BUILDING PERMIT INFO Aednem PERMTLSSUANCE ❑ ❑ ❑ LICENSED CO\TRACTOR'S DECLARATION I hereby affirmtlutiamlkmeed undn pmvblansof Ch,pter9(osmmmc APPLIANCES RESIDENIAL Ingwtth Section7000)of Di m3ofthe Buslemandfhafea Code,and JOB N llaae Is in full fora and effect. PANF3S SOW Llanl Clan Lk.Y SO Dale Contractor ARCHITECPS DECLARATION 2QI.IOOO AMPS I undeotand my pl•ret dull be used u public remda. JOVERIODOAMM SQ.FT.FLOOR AREA S/SQ.FT. �(3 GG ED Lhcnaed Profcssbrul SIGNSprmTRKA OWNER-BUILDER DECLARATION SITGIALCRCIJR/MISC a, 3 owingrI hereby-ffisses. hatlam 31-5,B M..centh.ContractorbsCod,:Lux. awfor the T E R rP— fo0owing recant.LSsctlon 70715,Bu,,lnes and Profeabns Code:Any cityor 6 G F. 117.fP.ME1'Et OR POLE INST. K ppS county which rtqulroapemdtmcondruuR,cite,Mprwe,demolbh,orrrpalr BOLL any awttudepMtolt that rice,,bernsed rtst.tto ant(asuchpe d the POWER DEVICES / //_•' k5 s file a signed statement ( to t Bmucd punuant to the provbbv of the f7!T 30rn danC0ot3o Rhee Buvinwla dPro(mbns Codne orth,t he bhbn7000)of Dlv4 g�MING IDOL ELECTRIC y 5 mpt therefeem,M ALUA ON S y.' the beet,,for the alleged exemption. Any vlofatbn of Section 7WIS by any applIart for a pemtlt wbFcta the appB t to civil penalty of nor mon than OUTLESSVITt_HFSFTXTIIRES EvS.,hun readdlan(SW. �n �I,as owes of the property,or my employee with wag.a their ante NEW RESIDENTIAL ELECTR SQFT. STORIES =CONSTRUCTION compevatlon,wllldothe wak,nd theatromunbmt intended or offered for Osale bee 70K Business and Professbu Cade:The Cordractoh License Law $ dos not apply to an owner of property who Wilds or lmpr thenar,and who does such work himself athtough hi,,own employ.,provided that such OCC.GROUP RCS UNITS Improvements am not intended or offered for sale.If,however,the build ing or TOTAL improvermed W Bald wHhln one yearofcornpledorc the owner-bullderwAl have t ban of proving that he did not bund or Improve fee purpose ofule.). QTy. PLUMBING PERMIT FEE L as owner of the property,am exchuively contracting wW licensed FIDOD7ZINE APN PERMIT ISSUANCE contnaon to construct the pm*d(See 7016,Business and Professions Code: Tin Contractors License Lnor eg aw donapply to an owner of property who ALTER-DRAIN 4 VENT-WATER LEA) C V builds or improvesthemon, and who contracts for such ptv(ects whin 9111(actortd lkxn•ed pumunt to the Cmtr•ctd•License law. BAIX FLOW PROTLCf.DEVICE FEE SUMMARY UI am exempt under Sec B 4 P C for this reason DRAINS.FLOOR ROOF,AREA,GOND. SANITARY Y_ N f/^I (sle7 Owner Date RECEI'I'Y •l. CJ L' WORIQ.tAN COMPENSATION DECLARATION FDnURpg PER TRAP SCHOOL TAX Y_ N_ ❑I hereby affirm,that I have•38rdliute of eaweni to e<B-4wre,a• RECEIPT Y 3800,Ubc.Workera'CampewtlminuunnaaaaOBied copy theeol LScc GAS EA.SYSTEM-1 ING4 OUTD.EpS Policy# CJ PARK FEE Y N_ CpmY GAS EA.SYSTEMJOVER 4(FA) RECEBPf Y BUILDING DIVISION FEES Cc fledcopy bftkd fumished. GRFASEANDUSTRL WASTE IxTERCEPTOR PLANCHECK FEE Cc0lfled ropy b fated with the dty Ivpectbn diddm. CERTIFICATE OF EXEMPTION FROM WORKERS' GRFASETRAP PAID COMPENSATION INSURANCE SELVE,SAM.I.ARY-STORMEA HIOFI' Date - Recd the (TNs sMbn need not he completed Bthe permit b(aorc hundred d.11. (S10� yth WATER HEATER W/VENT/EI.FLTR ENERGYFEE Y N l snot tnrt m the performance of the wnrk.st,t oh t"a pemdt b bsaed, 1,,ban not empby any person h any manrcr eo ss to becarrc s ubf,d to the WATTRSYSTEM/TREAUNG Walicant mpeualbn lawn o/Califomla.Date PAID ' O Z AppNOTICE NEW RESIDENTIAL PLMB. FT. Date Rceei [M Z O Mould b To APPLICANT.If,cher rs'Co thio CeOBlateof EnempteLyou `''Q HN Mould become subject to the Woken'Compensatlon provbbns of the labor � TOTAL: � _ deemedmevmut/o0hwtlh comply wiU such prowbns or thio pemdt shillhe �Qrl-' t `> deemed oked. ' dO CONSTRICTION LENDING AGENCY SEISMI9 EEE Z m I hereby aMrthat then b a constructlm Lending agency for the perform Al,- ELECTRIC FEE 7 anon of the work for which this permit b Swed Oise 3097,Cie.C.) QQI VJ O lender•"ame PLUMBING FEE LL ~ I<eder',Aadrem QTY. MECHANICAL PERMIT FEE MECHANICAL FEE O W Icertlfy thrtlluve read thio appBatlonud aatethat thcabove lnfarrtudon iscorrm.Iegrm to comply wRhaR city and county ordlnanm and state laws PEtMLIISSUANCE FEES PAID-. } G rdatoenterupongmnsxw lmc property orierectionp Bvn o/thio F Z N( )anupon thnabove-mentbrcd propeharm] the Cit purpose. ALTER ORADD7D MECH Date Revel the V — (We)agree to rave,Irdemdty an d keep harmiess the City of CupertBw ag,WtllabWt pdgmetw,mesa rape khmaytnanyway AIR HANDLING UNIT'CTO 10,000 CFM) SUBTOTAL: aha" ss hconsequerseo Rhee pertnX. AIR HANIXING UNIT(OVER Io,Il00CFhf) CONSTRUCTION TAX gruture Appllant/Cmtracta - to EXHAUST HOOD(W/DUC) CONSTRUCTION TAX PAID: HAZARDOUS MATERIALS DISCLOSURF Wliltheappnardorfuture WBdingoecupantatomorhardleh-7, me, HEATING UNIT(TO 100,000 BTU) Date Recei tN materbt ate defined by the C.pent.Munielpal Cade,Chapter 9.1 Z end the Fleahh and Safety Code Seaton 7S32(a)i HEATING UNIT(OVER 108000 FM TOTAL: n Yn No IllthcappB Mr tush-0dingamupantueeequipmcrdmdevkn VENTILATIONFAN(SINGIERFSID) ISSUANCE DATE which emit huandms air contaminants as defined by the Bay Area Ab Qua My hlanagemcrd Don BORFRODMP DFB'GRIW,IXD BTU) Rai Yn No LRSR� have read the bog meterlab requirements under Cha pier 6.95 of BOILER-COMP(OVER 100,000 BLU) the California Heehh k Safety Code,Sections 75505,Z5533,nd 75534. I underataM that if the building does not currently have a tenant,that it is my NrEW RfSIDFNITAL MECH. SQ.F7. 4 rnponsmnRy to notify the oaV pant of the requirements which at he met , prior to Issuance of,Certificate of Occupancy. _u Iwi•1,6Y�(�rwe.Lw Owner or authortad•gent Date ISSl1EDe �3I�� a TOTAL: — OFFICE COPY 3 SERIAL SEWER CONNECTION PERMIT NO. P "',v 15182 WPERTINO SANITARY DISTRICT R.O.S./P.M./Tract No../'g.9o.. Lot No..Z.6..... 20065 Stevens Creek Blvd. A.P.N. Bk. ✓?i4? ..... Pg, Building C Cupertino, California 95014 Phone (408) 253-7071 Date. TGG z_7 ........ 19.�/1 ....... The undersigned,beim the owner or owner's 2I eF, " �U/` g g ( agent)of the property located at ........................ ............................ consisting of the following TYPE OF BUILDING: Residential: Single family....1..... Multiple............ No. Units............ 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 Y 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 ........ >� G��T.Hd.................. Building Depart- ment and obtain inspection and approval by 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. l!�!��>.../r,/e/�CB........... , Telephone...,-1'6 ...2 rs– .9'307 .................................... Mailing address if differentfrom above............. ........................................................................................ ell ❑ A standard backflow protective device shall be installed, to the satisfaction of the Building Department, for the above property. (Note—See Detail/) FEES: Connection Permit Fee $ Gae9 Sewer Service charges to June 30, 19./Ar.,$.�Q -�.../mo. x/l...mo. Inspection Fee for backflow protection device TOTAL $ } xeipt of S.�✓............ 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 t NOTES: All valves to be accessible and maintained by Property Owner. Overflow point al Twat twelve Inches(12') below lowest fudsh.d floor containing plool Kelly Valve installed at Property Line to be readily removable for Lateral Sewer maintenance. F J ^' n to r Level d E Kelly Valve Finish Floor Leval Fir's M1 Grade �f Kelly Valve —sl Vahe AcceY s —/ !,J.S lvm with Vaned C er E VANAccess Bar. Backwater VON. -FLOW Figure I Figure 2 Fgure 3 Kelly Valve- Below Surface Backwater Valve—Normally Kelly Valve-Abdo.-Ground Inslallation-Slow, al reairetl imtalled ul shallowest point Instillation-SM1own instalyd Property Line Claonaut. along House Sewer between close la building. Property Line and building. f DETAIL STANDARD BACKFLOW PROTECTIVE DEVICE INSTALLATIONcJ I Distance from IL m be as dose as practicable. J Removable Cleanoul Mug a' Finish Grade Wye fm Riser Sewer Cbanoul Bos with LIE 1p be acnulble and maintained by property owner. Short IenglM1 Riser PIP, Adapter coupling I/O Bend OW aI Sewer Hare Sewer --r T'��Alnimum slope tletnmined by Building Deparlm.N. AJ Lateral Sewer Clwnout to be some size ae Lateral Sewer. DETAIL STANDARD CLEANOUT FOR LATERAL SEWER J