03070039 (2) C
BUILDING DIVISION TOR ATIONMI
COPY OF CUPERTINO
PERMIT ......ftp,
ebb ."ELDINGADDRESS: ABLE SEPTIC "'1 "°03070039
056� r.IWR12R
OWNER'S NAME: 520 REED ST. PERMIT ISSUE DATE
KEVIN RAN /9.C)cv;
NE: (408) 377-9990 SANITARY NO. CONTROL NO.
I 1ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
inI hereby affirm that I am licensed under provisions or Chapter 9(commencing Job Description
U
ithsectie, 7 )).rDi,i.iEm3EEfdWRoxi I Professions CO&..nd my]!,.ac is
ff m!iPR
=,,E LicenmC FE r �!? qJI;, SEWER
Oil,0 Eli Contractor
C �Ila!
ARCHITIECTS%X
,gION
I understand my plans shall hic used as records
Licensed Professional
OWNER-BUILDER DECLARATION
gx I hereby affirm that I am exempt from the Contractor's License Law for the
C20 following mason.(Section 7031.5,Business and Professions Code:Any city or county
�Vffo' which serum,.paint in consumer.shor.improve.demolish,Or repair any structure
gPrior LEI its issuance.also Exr sto file claims the applicant fouch Permit le a signed auction,
o that he is licensed pursuant 10 the provistim;of the Contractors Liesnate Law(Chapter 9 Sq. Ft. Floor Area Valuai�
(commencing with Section 7")of Division 3 of the Business and Professions Ctok)or
dust he is Lonooppo therefrom Lord BE,Buis for thin 11a,d ronon,don.Any violation on of 35910016 . 00
Section 7031.5 by any Alipilksart for a Permit objects be&PPIiCImL to S Civil Penalty Of APN Number Occupancy Type
not more,lomfive loundradd.1hos(M). �
C]1,as owner of the property,or my employees with wages u their Sole CGMPCnULion,
will do the work,ork,and Line strucuum is not intended or offered for sale(Sec.7044.Business iUb WE R RpTections
Lord Professions Coda:The Cmuraction't License Law door not apply Wan Lourne,of MI: T 'Tr,
property who bull"or improves therach,and who does such work himselfortmough his 202 =RFIL"efflOF
com employees,provided that such improvements are not intended Looffered for able.If. 301 ROUGH PLUMBING
however,the building or improvement 1.sold within one year of completion,the ovact,
builder will ban the burden of proving that he did not build or improve for purpose,or 507 FINAL PLUMBING
LEI
Cl 1,as manar of the property,am exclusively contracting with licensed contractors to
construct the praicet(Sec.7/44,Business and Professions Couh:)The Cormation's Lt.
came Law does not apply LEE in Owner of property who build,or improves thatmon,and
who contracts for such Projects with a contractor(s)licensed pursuant to III Contractor's >
Licence law.
im uempt under SEE, _.B As P C far this ourium
Owner Data
WORKER'S COMPENSATION DECLARATION
I thereby air.oto under penally or perjury one or Be following duchimmus:
I have and will maintain a Cerdiflemic of Consent to Ulf-insure for Worker's Compich-
inn,as provided for by Section 37M of the Labor Corm,for the Performance of the
work for which Ni,permit is issued.
0 1 how and will maintain Worker's Compensation Insurance,is trainload by Section
37W of she Labor Code,for ft Performance of the work for which this permit is assioned.
My Worker's Compensation Insurance carrier and Poi number am:
_S'T Par Vol]Policy No 4 1-5_<4 1 710
119 C—ER—TITICATF—OFFXEMMON MOSE01iftKERS'
COMPENSATION INSURANCE
(This section mad not be completed If the permit is froom hundred dollen($I00)
m lea&)
I oardfY that in the Performance of the work for which this Permit is issued,I Mall not
employ any Nixon in any Interior an as LEE tomornic subject to the WorlsoxComronsidort
Laws of C.1ifurri Data
Applicant
NOTICE TO APPLICANT If.arter making this CCnIfiC&LC of Exemption,you should
WCOLEW$Object to the Worker's Compensation provisions or the Labor Code,you must
z forthwith comply with such provisions Or this per shall be deemed Invoked.
zo
C7 CONSTRUCTION LENDING AGENCY
thereby affirm that them is a constoction lending agency for the performance of
Urce work for which this permit in;issued(See.3097,Co.C.)
Under',Name
z Under.Add.
U 0 1 ounify dun I have mad this application and SOW that the above information is
" lm" correct.I agree to comply with all city and county conns taiand state laws relating,to
0 U— building construction,and hereby authorm,rophowntatins or this city W enter upon the
121 above-mentioned property for inspection purposes.
(We)-me,to Earn,indemnify and Imcp ham iess Inc City of CapET410 ag.CinM
tqo liabilities,judgracres.costs and expenses which may in any way acerae ago nit mid ELY
in consequence of the granting of this Permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
11ULlll REGULATIONS.
jxa�rs, I 't, C.
-#-/nq
fig Ap:'P'pr,,,VCZ Ouxcun, _0 , -PI-111to Re-roofs
A ARDOUS MATERIALS DISCLOSURE Type of Roof
:EE,-IH , can,or
future Wilding Rme.,xna store or handle haven dons material
Coda,unctidl.y.the Cupertino Municipal Code.Chapter 9.12.and[be Health and Safety
So, 25
r-I Y., 5532(.? All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building Occupant use Equipment or day!=which If a roof is installed without first obtaining an inspection,I agree to remove
it listardoes air catuarroutrus as defined by the Bay Area Air Quality Management
all new materials for inspection.
strict?
0 Yes 4k No
rr
Ihave ial the Mn�ousmawrialsmquimmcnuunder�apWY6.95ofthe Califfir-
ni,Heal"SafctyCo .Secdom259)5,25533md25534.1undemandthmifft Wilding
door not currently ban.re arc that it is my ouppronsibelity in notify the OnInNrL Of ft
requirements which must W met prions issuance of a Curtness,of Occ cy ore of Applicant Date
W" Signal
C
Ownerhmi,cdC j 7— 'd Z16 All roof coverings to be Class "B"or better
�jm11A Dfac
a
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• •y PERMtaITu � V6P 6 G
44
CUPERTINO SANITARY DISTRICT cxf ( � o
Santa Clara County
cE DCOen)0
20065 Stevens Creek Boulevard, Building C ��
Cupertino, California 95014
JUL 0 7 Telephone 408-253-7071
=> CONNECTION PERMIT
Date > At 7 `311APN: Books:3C Page /PParcel6:2A,
Y. / ROS/PM/Tract No. Lot No.
Property Owner: iJ P N ket/t h f7 6 vj
Mailing Address: '1.���n. L 7 �<jt'1 r i
r
Approved For Issuing
G�` �'� '" �3 Building/ Plumbing Permits
(]/We),being the owner(s)(owner's agent),hereby make application for connection of the at: Za !�-4, 7 -
�5 v A)e 15L 7)R I t/E IVFZr-1 77A)0
consisting of the following Type of Buildings:
Residential: Single Family Dwelling_; Multi Family Dwelling X ; No. Units Z
Commercial ; Industrial ; Other No.Units
Do hereby request a permit to connect the sewer system of the Cupertino Sanitary District.
IN CONSIDERATION OF THE GRANTING 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 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 easement. / I
3.To acquire a Plumbing Permit from the / / of )�.�.�t M YI lj,Building Department and obtain the required
Building Department inspections and approval prior to use.
4.To expose 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 encroachment permit for sewer construction in the
street/public right-of-way of the agency having jurisdiction thereover.
6.To connect to sewer within one(1)calendar year from the date of issuance of this permit.
7.To call UNDERGROUND SERVICE ALERT(U(SA)/1-800-227-2600,at least 4/8 hours prior to starting construction.f
8.SPECIAL PERMIT CONDITIONS: Q L'
V/400 19 s PE-i-1-10,( 14,T-)42C� / A T;L-V.,41 ED
ro A BACKFLOW PROTECTIVE DEVICE shall be installed to protect the above properly 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 30,zOU
No. Units 2 x$ 1 94Ont
/moh x ?no. months 43.2 60 (31010)
Backflow Protection Device Inspection Fee (31020)
Connection Permit Fee: % (31020)
Additional Connection Fees ( )
Total: J`rC
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:
Owner's Agent:
(If Signing for Owner Please Print Your Name)
q d
Receipt of Set acknowledged and permit granted.
MARK'THOMAS &&,CO..,,INC.,district Manager-Engineer
By:
Revised 5/00 NOTE: See Details on other side of this permit
I 1
TYPICAL CLEANOUT FOR LATERAL SEWER t
Distance from Property Line
to be as close as practicable,
a, not to exceed five(5) feet.
c
J
T
w Removable Cleanout Plug
a
0
a' Finish Grade
Wye for Riser
Sewer Cleanout Bax with Lid to be accessible
and maintained by property owner.
Short 'length Riser Pipe
Adaptor coupling _ 1/8 Bend
--------' FLOW m
Lateral Sewer House Sewer
Loteral Sewer slope House Sewer slope
determined by District E.Jdetermined by building deportment
— CLEANOUT TO BE SAME SIZE AS LATERAL SEWER—
Notes:
1. Distance from the property line not to exceed five (5')feet.
2. Property 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
agency having jurisdiction thereover.
TYPICAL BACKFLOW PROTECTIVE
DEVICE INSTALLATION
TYPICAL BACKWATER VALVE TYPICAL KELLY VALVE INSTALLATIONS
INSTALLATION uuriseicllbnal Raflriniona
Accosted By All dur'bdiClionf
FIGURE I FIGURE 2 FIGURE 3
lnelall ed Beldw Grade Inflalled Below Grade Inelolled Above Grade
Sharp Bolwon SH."RienLor-Way and Building Shoran Al Prepaly Line ClwonouI Shown Adjannl To Buildlna
li Requires Regular Molatenonce i Reauine Minimum Moir,ens race Reauiree Minimum Maintenance
• Volvo To Be Removable Volvo Should Be Removable
ar VALVE ACCESS BOX FINISH FLOOR
wilnrvemea coyer
o L vel FINISH FLooR
KELLY VALVE
^_'r nigh Grade
VALVE ACCESS BOX ,r77��-
KELLY VALVE �L j.,
XFiNi%N Grade
Anon Grade 5
P
S
BACKWATER n
VALVE
FLOW .LT FLOW Al ( FLOW m'
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.
CITY OF CUPERTINO
REPIPE/SEWERS/MAIN SERVICE 6 .3 7 s �3�
CUPERTINO PERMIT APPLICATION FORM
APN# D/ Date:
i
Building Address:
Owner's Name: r ' c ho
Contractor: Ph n : 7' 1 License#:
1
Contact: h Cupertino Business License #:
J i2726
Building Permit o:
Bldg Elect ❑ Plumb
Job Description:
Residential� Commercial ❑'_ �/`
Cost of Project:
•
Qty ,.
Appl)c4ble Fee ID Fee Description Fee Group
PPERMITFEE Plumbing Permit Issuance PLUMBING
BPREPIPE Re i e of Fixtures PLUMBING
BPERMFEE Bldg. Permit Fees BUILDING
BPFIXTURE Pbl . Fixture PLUMBING
BPWSVCS Main Water Service PLUMBING
BPSEWER Sewers PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BUSLIC Business License BUILDING