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14100038 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22445 CUPERTINO RD CONTRACTOR:ABLE SEPTIC PERMIT NO: 14100038 OWNER'S NAME: FRONT PORCH COMMN&SERVS P 0 BOX 24819 DATE ISSUED: 10/07/2014 OWNER'S PHONE: 4085683005 SAN JOSE,CA 95154 PHONE NO:(408)377-9990 ±1 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL ❑ REMOVE(E)&INSTALL(N)5000 GAL GREASE License Class _- ( Lic.# (:;743-44-C— INTERCEPTOR - Contractor �RCom_ r _Date/e...)/?-7/4/ I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$28970 vri,I have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this APN Number:32615130.22445 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DA ! 'ERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 D . _ '014 �• frr' ED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the /0/,-//y granting of this permit. Additionally,the ap icant understands and will compl Ue' Date: ( with all non-point source r->-lations per . Cupertino Municipal Code,Section 9 18. / RE-ROOFS: Signatur• % Date ld / All roofs shall be inspected prior to any roofing material being installed.If a roof is installed without first obtaining an inspection,I agree to remove all new materials for inspection. ❑ OWNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I,as owner of the property,or my employees with wages as their sole compensation, will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 2550 ,25533,an, 534. Section 3700 of the Labor Code,for theerformance of the work for which this U p Owner or authorized agen • i Date: O // permit is issued. / I certify that in the performance of the work for which this permit is issued,I shall. not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If,after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address I certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9 18. Signature Date 4 MEP AA GENERAL PERMIT APPLICATION,' 6N.':__-....11 , .-.'' COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 0� " 10300 TORRE AVENUE• CUPERTINO,CA 95014-3255 \\' _—e \ ` (408) 777-3228•1=AX(408)777-3333•buildinoacuoetMISC no.oro LUM31 G ❑1 Ec kylCAL '❑ELS 1 'CAL ❑1 SCELLATEOUS PROr:C;f.DD'r,_S5 ZZ`-1tA� I�•LP �„`-o 'K--�) I 42T4 3 •�/ / r— 130. Z Z ( ii.- O'v.T—"'_1.11k3 kN�..VP.)tilE A3..) 17. -C. �-i0?e ��p �Jo !J F fc� Err:_ �9�I'Gw1 I Cll , STATE,ZP. I FAX i / (gyp CA CONTACT Air--. _ ?HONE AIL STK=ADDRESS CITY,STATE, ZIP FAX 0 oriel0 ovn -=. 0 (M AGz er p(CO RAC'OR 0 cohr&Ci'oR ACN; 0 .kaa.1_ECT 0:AGR'EE. 0 DEN'R O?tee, 0 7,,NAITI CONTRACTORNA1C-/� 1 c- LICZASENU T'r.R LICENSE TYPE BUS.LICr /-�gL-E C zT-. CC,— -7 LOC c_4f, I 2T-Lf l» COM'A?QYhANE E-MAIL rA.''. ST£.cZADDPESwzo �� Y • C-i %STATT4Z �p<-�� 1 i0 P�o '"? -(1190 • A RCIFI GINEEP.1 M I 4• • • LICENSE MASER BUS.LIC 4 COMPANY h'A1 / . ' • E-M-1.• • =AX STc.EFT. ADDR=SS I CITY,STATE,ZIP PHONE Urn OF 0_so or DI PLc'X 0 T�+t1L7.1-PAI.ffi.Y PROTECT-Di WI oT-''D ❑ YES PROTECTE4 0 YES IS T i BLDG AN 0 YES BU-LTDR1G: COIJ .:ROAL t1n3A1!•ZDe AC=AREA , NO FLOOD ZONE �h0 E .HOI E7 ______1=1-'NO • DESCPIPTION OF WORK „.12 ' G12-EAS-F___ 110Cre+2r-PID•iC . • • I TOTAL V A T i1A.TIO : .0.453°r4-0 ,On0 '• .- - 4 fa • _ _ ._ By my signature below,I certi.�'to each of the following: I sinthe•roperty owner or authorize, agent to aC h ,y- half. I have rea. .1 have d isIthean-verily It is accurate. 1 a�ee to compapplicable and the information I provided correcthay -'_d �esc-'�i'n of Work comply with all Ixa ordinances and state laws rel:ting to building ^j"ii:cm-. - or rep, .dives of Cupertino to enteI the above-iden irred Property for inspection purposes. Signature of:_pplicantiAgent: - // _ / Date:-4- `) // r � '. : 1 -PLE\ENTAL INTOR:MA.TION REQUMED ..___.--- -,...4,--.. ...., v=s 4 ., „-�_ .4 :-.,,,____ ------=---, --,- . ws4NZ3 ••, • _ • M.P. iscRpp_2011.doc revised 06/,1111 CITY OF CUPERTINO At � ' FEE ESTIMATOR- BUILDING DIVISION [y ADDRESS: 22445 CUPERTINO RD DATE: 10/07/2014 REVIEWED BY: MELISSA APN: 32615130.22445 BP#: *VALUATION: $28,970 *PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition / Repair PRIMARY PENTAMATION USE: Commercial Building PERMIT TYPE: 1 CPG 4 WORK REMOVE (E) & INSTALL (N) 5000 GAL GREASE INTERCEPTOR SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Interceptor, Ind. Waste 4 1BPINTERCE 1 # $36 TOTALS: $36.00 iee;t P/ r�€ine I I Plumb.Plan Check 10.0 hrs $0.00 Lies.1'ru Cee r l/en/r. Petm/i Fee: Plumb.Permit Fee: 1PPERMIT 1 en 0,i41 iv:.>/, Other Plumb Insp. F-0-.71 hrs $48.00 0:/n,' Plumb /i,s/p. (ee Licn. In NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District;etc.). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'1 info. FEE ITEMS (Fee Resolution 11-053 E T 7/1/13) FEE QTY/FEE MISC ITEMS P me: I'(' r c I PME Plan Check: $0.00 Pet roil Pee. Supp/. lrnr :he PME Unit Fee: $36.00 PME Permit Fee: $48.00 i tion /a.v. Administrative Fee: 1ADMIN $45.00 Work Without Permit? 0 Yes 0 No $0.00 f Atli.(MC cul P/annir p Fees`: Travel Documentation Fee: 1TRAVDOC $48.00 I Strong Motion Fee: 1BSEISMICO $8.11 Select an Administrative Item Bldg Stds Commission Fee_ IBCBSC $2.00 : ® . ® .r $187.11 $0.00 TOTAL FEE: $187.11 Revised: 08/20/2014 c ' . i Od•-• 11 RECEIVED OCT 0 7 2014 5000 GALLON • GREASE INTERCEPTOR BY MODEL TY-5000-EBE•G TRAFFIC RATED LISTED BY UPC. I 16'-11"— I IF 199 1! II I! flI I II II 1110 024 - , >- II 0...- \ II 7'-8" II - !I II 0 II iI II 0 I! l l 1! IL II A PLAN VIEW(COVERS NOT SHOWN) 24" DIA. LLJ CAST IRON i RING AND CO R WITH GASKET 12" MINIMUM �� y 3 STANDARD WHEN SUBJECT t. 2432 TO TRAFFIC & 24" i',— - GRADE RINGS Ulm -:;-f:-.. •_ '_ - - AS REQUIRED rm.: ok� C"—VENT 1 OUTLET PVC PIPE A Ofv MUNITY lD ELO MENT DE' 0MENT AND FETTINGS STANDARD 1JBUUNOIINCUPE ° 7'-11" .: ' PR VED 6'-9" ',this set of plans ane ;pe8ificRti3.ns MUST be kept at the ob site during cc n uction. It is unlawful to make any changes or alte bons on same, or to deviate • , _ _ •. . • , ._t >H • . ,.rr t..- ,.:Dprov;-I from the Building Official. ELEVATION SECTIONS he Stamping of this plan and specifications SHALL NOT be held to permit or to b- ..proval of the violation OPERATING CAPACITY: 5000 GALLONS. of any provisi. = rtee :finance or State Law. BY___.- - — DESIGN LOAD: H-20 TRAFFIC WITH DRY SOIL CONDITIONS ( ce ,''1rA- / BELOW TANK) AND 1'-6' EARTH COVER. PERMIT # 411..— T r 0 r SUITABLE SUB—BASE BEDDED WITH GRANULAR MATERIAL SHALL BE PREPARED TO HANDLE ANTICIPATED LOADS. MINIMUM EXCAVATION B'-8" x 17'-11" _ FOR COMPLETE DESIGN AND INFORMATIO ��T�N� x REQ'D DEPTH CONTACT JENSEN PRECAST. ` . ; Building Department •• Je n=Prpeast r serves the right to make changes to product design �� ll on or. imension without notice. Please contact Jensen Precast whenever s 11/3/2008 nee Sorg,ler eon liana►'ir:. @ !��•addee on ci design. II PRECAST 17 TY5000-03E—C_liONV_ADYfG t^...-='•--�-:� " -D200(3 REVIEWED HOF?, CODE COMPLIANCE Reviewed By' ,. •r hgr GREASE INTERCEPTOR INSTALLATION POLICY AND PROCEDURE GENERAL INSTALLATION POLICY INFORMATION The policy contained herein describes specific policy information and purchaser requirements for grease interceptors. Other Jensen Precast company policies, including shipping, terms and conditions, ordering instructions, and others also apply. Contact Jensen Precast for complete information. In general, Jensen Precast provides delivery and setting of the interceptor and sealing of the tank components in accordance with the provisions of this policy. In a situation where our truck cranes cannot set the tank(s) for whatever reason, we will provide a representative to supervise in the proper setting of the interceptor and then seal the components as specified herein. Jensen Precast accepts responsibility for proper setting, assembly, and sealing of the tank when installed or supervised by Jensen Precast or an authorized representative. A A grease interceptor handled, moved, or installed without Jensen Precast supervision, nullifies the responsibility of Jensen Precast. NOTE: Failure to follow proper installation procedures may result in structural damage to the system or compromise its functional design. EXCAVATION AND SITE PREPARATION The grease interceptor must be set on a properly prepared base to insure against movement of either the tank or the inlet and outlet lines. The excavation shall be the proper width and length to accept the model selected and shall have enough extra width and length to allow for safe installation and sealing of the components. Suitable native soil or sub-base shall be prepared to handle anticipated loads.The excavation shall be bedded with suitable granular material and shall be compacted to 90% maximum dry density, or to the requirements of the project geotechnical engineer. The bottom of the excavation shall be graded level. On battery tank systems with capacities in excess of 5,000 gallons, redwood grade boards shall be used to insure a level and stable tank joint. A minimum of two 2" x 6" grade boards, laid flat, running the full length of the main tank directly under the outside walls shall be used. The top of compacted fill material shall match top of redwood grade boards prior to setting the tank(s). The owner, customer, contractor, or others shall be responsible for the following: 1. Providing a properly prepared, sized, and graded excavation. 2. Providing job site safety, shoring, water and or flotation control. 3. Providing base preparation, compaction and grading. 4. Supplying and installing redwood grade boards under battery interceptors. 5. Completing the entire installation and all other site work not specified herein. SETTING AND INSTALLATION Jensen Precast requires assistance from the customer or contractor in setting, sealing, and placing the tank (generally one or two laborers). Access and setting location for our boom truck or other equipment must be acceptable to our driver or representative. Tanks 4000 gallons and larger require extreme caution due to the weight of the product. There may be situations where an outside crane may be needed to set the product. Contact Jensen Precast for details. Since site conditions, products, and delivery equipment vary tremendously, the logistics must be carefully considered to determine the best possible approach for setting, including but not limited to: 1. The capacity of the Jensen Precast boom truck (truck crane)to be used. 2. The maximum product weight relative to the setting distance from the center of the crane to the center of the excavation which cannot exceed our truck crane's rated capacity. 3. The type of terrain, site slope, and ground conditions for outrigger footing. 4. The access route for boom truck or other equipment. 5. The overhead restrictions and other physical constraints. ANY of the above could prevent Jensen Precast from setting the interceptor. NOTE: If for any reason Jensen Precast cannot set the interceptor, Jensen Precast will not be responsible or charged for setting by any other means. The owner, customer, contractor, or others shall be responsible for the following: 1. Finished grading, leveling and positioning of interceptor, and access openings. 2. Grouting, sealing, setting and adjusting of grade rings, risers, frames, covers, and all other hardware and appurtenances. 3. Supplying and installing inlet and outlet pipes. 12/11/2003 2 4. Sealing above the top of the tank. Any and all permits, licenses, tests, or approvals from any administrative authority, etc. that are required for installation of the grease interceptor. VENTILATION The grease interceptor is vented as prescribed'by the Uniform Plumbing Code (UPC) unless local regulations supercede. The tank is provided with inlet & outlet tee's which allow gases to escape the tank atmosphere into the building plumbing / ventilation system. Failure to provide proper ventilation for the tank could result in an odor problem or in extreme cases siphoning into the sewer. Please consult the Uniform Plumbing Code and local regualtions for additional information. TANK SEALING (BATTERY TANKS) Jensen Precast will seal the tank only. The tank must be dry in order for the sealant to bond properly to the concrete. Once applied, the sealant must cure for a period of 24 hours before water testing. Jensen Precast is not resonsible for grouting or sealing of grade rings, risers, frames, and covers. WATERTIGHT TESTING POLICY AND PROCEDURE The tank must be tested to insure that the system as a whole is watertight. Watertight testing must be completed and approved after installation, but before the tank is put into service. All tanks of 2000 gallon capacity or greater and all battery tanks must be backfilled to the outlet pipe when water testing to levels up to the underside of the top slab. Backfilling is required on the larger tanks to support sidewalls. Warning: Water testing tanks with a liquid capacity of 2000 gallons or greater without backfilling could result in structural damage. If water testing above the top of any tank is required, please contact Jensen Precast. WATER TESTING Jensen Precast's standard tanks are designed to be watertight below the liquid operational level (invert of outlet pipe). The tank shall be filled to the operational liquid level with water and allowed to stand to achieve complete concrete absorption, then refilled to the same level. Once refilled, there shall be no measurable liquid loss in the following hour. (Ref. ASTM C-1227-02b 9.2.2) For areas requiring prevention of infiltration above the operational level, a tank with a sealed lid is required. Contact Jensen Precast for more details. The owner, customer, contractor, or others shall be solely responsible for the following: 1. Conducting and approval of the water test. 12/11/2003 3 2. Providing water and means to pump or evacuate water for testing or any subsequent retesting. 3. Sealing or testing grade rings, risers, covers, other openings, etc. 4. Any required sealing and testing of inlet and outlet pipelines. Warning: Water tests conducted above the lid of the tank may have structrual implications. Any water test conducted 2 feet above the top slab of the tank could exceed the structural design of the tank. Contact Jensen Precast for complete details. VACUUM TESTING As an alternative to water testing, the contractor or customer may conduct a vacuum test to insure water tightness. Vacuum testing methods should be approved and supervised by Jensen Precast. A vacuum test must be performed before the tank is backfilled. Vacuum testing a tank that has been backfilled could have structural ramifications. Seal the empty tank and apply a vacuum of 4 in. (100 mm) of mercury. Hold the vacuum for 2 minutes. There should be no more than a 10% loss in vacuum at the end of 2 minutes. (Ref ASTM C-1227-02b 9.2.1) The owner, customer, contractor, or others shall be responsible for the following: 1. Conducting and approving the vaccum test. 2. Providing a vacuum pump for testing or any subsequent retesting. 3. Sealing or testing grade rings, risers, covers, other openings, etc. 4. Any required sealing and testing of inlet and outlet pipelines. PRE-TEST INSPECTION Before any applicable tests are performed and before the tank is placed into service, a visual inspection is to be performed to insure that the tank is free of trash and debris that could prevent the tank from functioning properly. All foreign objects such as rocks, trash, tools, construction materials, etc left inside the tank from the installation process should be removed at this time. 12/11/2003 4 PRECAUTIONARY NOTE Interceptors, utility vaults, manholes, septic tanks, and other similar type enclosures are confined spaces and entry is not recommended as the atmosphere may be hazardous. If entry is necessary, enter only with the proper equipment and follow O.S.H.A. confined space entry procedures. Jensen Precast recommends that all applicable O.S.H.A. recommendations are read and followed, including the current section on confined spaces and "Permit Required Confined Space". This warning is presented for precautionary safety advise only. Owners, users, installers, contractors, etc. are responsible for safety on the job and O.S.H.A. compliance. ACCEPTANCE Jensen Precast's reponsibility for the grease interceptor installation and sealing shall be considered finished and accepted once any of the following occurs: 1. The owner, contractor, customer, or engineer accepts the system. 2. A water or vacuum water tightness test has been completed and satisfactorily passed. 3. The tank has been covered or backfilled. 4. The grease interceptor has been placed in service. 5. The safety conditions on the job site are not acceptable to Jensen Precast or its authorized representative. 6. Failure or gross neglect in following the instructions contained herein. BACKFILLING Failure to comply with proper backfill procedures could result in structural damage or leakage from pipe connections, or tank, due to settling, point loading, inpacting, etc. Backfill shall be suitable material and shall be laid in lifts and adequately compacted from bottom to top to prevent movement or settling under the pipe or fittings. 12/11/2003 5 JENSEN PRECAST GREASE INTERCEPTOR OPERATION AND MAINTENANCE There are no moving or mechanical parts in a grease interceptor, so there is nothing that needs to be done operationally once the unit has been installed and hooked up. There is, however, a very important maintenance function that must be performed periodically to insure efficient operation of the interceptor. Grease intereptors must be cleaned regularly. The frequency of grease removal is dependent upon the capacity of the Interceptor and the quanity of grease in the waste water. Grease interceptor maintenance is best done by completely removing all materials and water that accumulate between cleanings. The removal and disposal of this material should be done by a professional pumping contractor that is trained and licensed in this field of expertise.The frequency of cleaning is dependent on the loading. The more solids and grease discharged to a grease interceptor, the more frequently it needs cleaning. Grease intercpetor cleaning will range somewhere from 30 days to every 6 months. On a new installation the first cleaning should be done at 30 days to help establish the cleaning frequency. If cleaning is needed more frequently than every thirty days, the grease interceptor is probably too small. Oversizing the size of the interceptor can reduce the required cleaning frequency. The frequency of cleaning at any given installation can best be determined by experience based on observation. Generally, cleaning should be done when 50% of the grease retention capacity has been reached. This level can be determined by removing the inlet side manhole cover, and using a probe, determing the depth of grease build up and comparing it to the depth of the bottom of the baffle inlet pipe fitting. Regular cleaning at prescriped intervals is necessary to maintain the efficiency of an interceptor. After the accumulated grease and waste material have been removed, the interceptor should be checked thoroughly to make certain that the inlet, outlet and air relief ports are clear of obstructions. Backups prior to scheduled maintenace intervals indicate a clogged system, which could result in surcharge. Also, the performance of the interceptor becomes impaired as grease and other materials accumulate because of reduced retention time, resulting from less interceptor volume. The maintenance frequency should be reevaluated on any system that has clogged. Changes in effluent input quanity and quality are not unusual in comercial and institutional installations. Consequently, reevaluations of maintenance frequencies are common practice for the pretreatment of grease-laden wastewater. Disposal of Intercepted Materials: Grease and other waste matter that has been removed from the interceptor should not be introduced into any drain, sewer, stormdrain or natural body of water. All material should be disposed of according to local regulations. Contact your city official for information. 12/11/2003 6 10-06-'14 10:39 FROM- SunnyView Retirement 408-255-6015 T-538 P0001/0003 F-728 .i;rivirvrirricrtaur• vcr vit-c 1-.1(1114 I 4 1 �,.,it«t4Tsr�F SAN JOSE/SANTA CLARA WATER POLLUTION CONTROL PLANT CONTRIBUTING AGENCIFS ;u. ;.�,. •��,_: . ','-,y�>.. CITY OF SAN JOSE CITY OF SANTA CLARA 't OFFICIAL WARNING NOTICE CITYOFMILPITAS 4j CUPERTINO SANITARY 4-J ,, COUNTYICT SAN SANITATION DIST.NO.2-3 WEST VALLEY SANITATION DISTRICT KEEP 6RFE OUT OF THE SYSTEM (CITIES OF CAMPBELL.LOS GATOS. MONTE SERENO AND SARATOGA) BURBANK SANITARY DISTRICT • Facility Name:Sunny View Manor Responsible Person:Charlis Younan Facility ID: 42295 Address:22445 Cupertino Rd Phone: (Bus)408-454-5655 Issue Date: 08/05/2014 Cupertino, CA 95014 This warning is to notify you of violations of the Municipal or Sanitary District Code as noted below.You are hereby notified to take appropriate remedial actions to avoid additional legal actions from being taken against you. • Municipal or Sanitary District Code Violations SCCD230C-6221 -Oil and Grease Removal Devices • i Vio atlo.ii/ Remedial Action Duo. 7/29/14 Grease interceptor • Repair and/or maintain in proper working condition • 8/12/14 - You need to have your clogged outflow line from the 4500 gallon grease interceptor immediately backflushed/hydrojetted from the City main sewer line to your grease interceptor. • You will need to coordinate with your plumber,grease pumper,and the Cupertino Sanitary District to have this work perfomed and to return your grease interceptor to proper working condition. Notes/Comments Since the grease interceptor violation has not been resolved and the Inspector was not contacted before the due date,an Official Warning Notice is being issued. Please continue to coordinate with your plumber,grease pumper,and the Cupertino Sanitary District to have your grease interceptor returned to an operational condition. You will need to coordinate with your plumber, grease pumper, and the Cupertino Sanitary District to have this work perfomed and to return your grease interceptor to proper working condition. ID:115263 RECEIVED BY: INSPECTOR: 4_6•11/- Date 1 Date Jos a Villa 408-793-5332 w _ 200 E.Santa Clara Street.7th floor.San josh,CA 95113-1905 rel(408)793-5300 td(4%8)945-3000fox(408)271-1930 www.sanjoseca.gov/eSd 10-06-'14 10:39 FROM- SunnyView Retirement 408-255-6015 T-538 P0002/0003 F-728 L/GvtrvrentL'rfSUi Vcr vtc.GJ ,L.c to tllfclft SAN JOSE/SANTA CLARA WATER POLLUTION CONTROL PLANT 41.13T 54 CONTRIOUTING AGENCIES Fats, Oils, and Grease Program CITY OF$ JOSE CITY OF SANTA CLARA N OF MILPITAS / CORRECTION NOTICE GI CUPERTINOSANITARY 0pen • •• DISTRICT(CITY OF CUPERTINO) F%.O WY SANITATION DIST.Na 2-3 EST COUVALLEYSANITATION DISTRICT (CITIES OF CAMPBELL.LOS GATOS. MONTE SERENO ANCSARATOGA) KEEP 6RF.AS5 OUT OF THE SYSTEM BURBANK SANITARY DISTRICT Inspection Date:07/29/2014,Tuesday inspection Type:Initial Inspection Time: 2:17 pm Racility Name:Sunny View Manor(42295) Contact:Senna Lee/Environmental Compliance Manager Facility Phone:408-454-5600 Phone:408-454-5646(Bus) 9,ddress: 22445 Cupertino Rd Facility Group: POG-CU Project ID: 123018 Cupertino,CA 95014 SIC/NAICS Codes:5812 • Task ID:760113 7/29/14 Sinks with strainers • Provide 8/5/14 - Install strainers in all of your kitchen sinks to help prevent the movement of food wastes and `• • solids into the grease interceptor and sanitary sewer. 7/29/14 Grease interceptor • Repair and/or maintain in proper working condition 8/5/14 - You need to have your clogged outflow line from the 4500 gallon grease interceptor immediately backflushed/hydrojetted from the city main sewer line to your grease interceptor. You will need to coordinate with your plumber,grease pumper,and the Cupertino Sanitary District to have this work perfomed and to return your grease interceptor to proper working condition. • CuLvoE&`TTA0 S ni=-TAs.1 k, Ts-rl1-Z•C� Key:OWN-Official Warning Notice :R,kikj)t ( 4 oli) 2.S, — 7 0 7 Recommendations All grease interceptor cleaning events must be documented and the cleaning records must be available on site for three years. Replace dome strainer(s)/ineffective baskets in floor sink(s)with more effective basket strainer(s). Use strainers in all sinks to prevent food wastes from going down the drain. Scrape food waste and grease into the trash or compost container before washing dishes. Wipe off pots,pans,trays,and dishes prior to washing ' . Train employees on kitchen best management practices. If you have any questions regarding this inspection or compliance with your violations,please contact the Inspector before the due date, 08/05/2014. /� • 07/29/2014 Inspector: `► 408-793-5332 Selina Lee Date Joshua Phone (5.°C)LI ..qoo° et WO-. 10-06-'14 10:39 FROM- SunnyView Retirement 408-255-6015 T-538 P0003/0003 F-728 ............... ......,.......,,....,w...t..c-1.-dtl/E'1WINIIL<'V1lWl.t•I MVI V Flo-) .�/'4L1K/ .%/f 4V/F4 SAN JOSE/SANTA CLARA WATER POLLUTION CONTROL PLANT eg �F CONTRIBUTING AGENCIES '•..Axa: �;x�•�. TTYOFSANJOSE ' ::14% ., Fats, Oils, and Grease Program CITCYoF$ANTACLARA CITY OF MILPITAS R"ri;.. '•�•� CUPERTINO SANITARY ♦'.. "� W DISTRICT(CITY OFCUPERTINO) � tlt:1 F t O COUNTY SANITATION DIST-NO.2-3 I WEST VALLEY SANITATION DISTRICT (CITIES OF CAINPBELL,LOS CATOS. mONTE SERENO AND SARATOGA) KEEP 6RrASa OUT OF THE SYSTEM BURBANK SANITARY DISTRICT Inspection Date:08/05/2014,Tuesday Inspection Type:Follow-up Inspection Time: 2:56 pm Facility Name:Sunny View Manor(42295) • Contact:Challis Younan/Director of Environmental Services • Facility Phone:408-454-5600 . Phone:408-454-5655(Bus) Address: 22445 Cupertino Rd Facility Group: FOG-CU Project ID: 123018 Cupertino,CA 95014 SIC/NAICS Codes:5812 Task ID:761997 1 r 104001 ne.. 7/29/14 Grease interceptor • Repair and/or maintain in proper working condition(OWN) 8112/14 - You need to have your clogged outflow line from the 4500 gallon grease interceptor immediately baekflushed/hydrojetted from the City main sewer line to your grease interceptor. You will need to coordinate with your plumber,grease pumper,and the Cupertino Sanitary District to have this work perfumed and to return your grease interceptor to proper working condition. • .. :.rir'.',r.v.t. "` 5.`:':.5: �.l'.''n'"•i.r ''•1,:Vie:GEscalation ux'rent Coxa I>«;Ince•�>€st, . :.,.:...,.. .:'s-:.:::._;.;':,,;::,'_.•, .I�, ::�;:' .=.1..Gt. : ... : :�'� IA�eted: , . . . 7/29/14 Sinks with strainers • • Provide 8/5/14 8/5/14 • 7/29/14 Grease interceptor • • Repair and/or maintain in proper working condition 8/5/14 Failed OWN • Key:OWN-Official Warning Notice Recommendations Continue to use strainers in all sinks to prevent food wastes from going down the drain. Continue to coordinate with your plumber,grease pumper,and the Cupertino Sanitary District to have the necessary work performed to return your grease interceptor to proper working condition. If you have any questions or problems resolving your violation,it is your responsibility to contact the Inspector before the due date, 08/12/2014_ • �. 08/05/2014 Inspector: 408-793-5332 Charlis Younan Date ° Joshua Villa Phone 10-06—'14 11 :12 FROM— SunnyView Retirement 408-255-6015 T-539 P0002/0003 F-729 .LarIvcrvrcrrccriLccii L.,c urrrrac.r1L SAN JOSE/SANTA CLARA WATER POLLUTION CONTROL PLANT FN1'sF ��` CONTRIBUTING AGENCIE=S . ,: a, .. Fats, '�Oils and Grease Program CITY OFSAI)(,JOSE ?: 5 CITY OF SANTA CLARA 114 CITY OF MILPITAS • a CORRECTION NOTICE CUAER7INOSANITARY • �9 DISTRICT(CITY OF CUPERTINO) COUNTY SANITATION DIST NO.2-3 N4R Fta� ' • WEST VALLEY SANITATION DISTRICT (CITIES OF CAMPBELL,LOS GATOS. • MONTE SERENO AND SARATOGA) KEEP GREASE OUT OF THE SYSTEM BURBANK SANITARY DISTRICT • Inspection Date:07/29/2014,Tuesday Inspection Type:Initial Inspectionn Time: 2:17 pm Facility Name:Sunny View Manor(42295) Contact:Serina Lee/Environmental Compliance Manager Facility Phone:408-454-5600 Phone:408-454-5646(Bus) • kddress: 22445 Cupertino Rd Facility Group: FOG-CU Project ID: 123018 Cupertino,CA 95014 SIC/NAICS Codes:5812 • Task ID:760113 ',.. ��. .�J.n �Y')� :+:f e'V. > .l.`Y :C:!'.'.t,.�,g:.f V.V•t::i r,•ift.:N '.tlii:< '.•li1 �7 .l. ''�9 1 :I• .,TI� di'• .,;�: ..j.rk :', a� t.^''✓fi• :at;:' ti-'i:^;Yr:&�;r' .y. g p tir(C�A �f :e??'%x.. ,ar'f.•V\„I a,�,.,r.�s, .il'r::51;: .): ;;. :ps .�,.t.,��,, ..>k?al' ;.', • , . : (� ..��5.•Qix. ...Y.. .Sft�1•#�1•�lf�': ��.(,+.^ .;iii\;'ilii .'a6.: ,1 7,i',�ar••/";Y's:�, , f� Ci.,,.: 7/29/14 Sinks with strainers • Provide 8/5/14 - Install strainers in all of your kitchen sinks to help prevent the movement of food wastes and •• solids into the grease interceptor and sanitary sewer. 7/29/14 Grease interceptor • Repair and/or maintain in proper working condition 8/5/14 - You need to have your clogged outflow line from the 4500 gallon grease interceptor immediately • backflushed/hydrojetted from the City main sewer line to your grease interceptor. You will need to coordinate with your plumber,grease pumper,and the Cupertino Sanitary District to have this work perfomed and to return your grease interceptor to proper working •• condition. • CW9E�-CL TA SaNZ/AA.,/ OTr71.-x C1 Key:OWN-Official Warning Notice (4 ô ) i ll - 1 Q 1 , • Recommendations All grease interceptor cleaning events must be documented and the cleaning records must be available on site for three years. Replace dome strainer(s)/ineffective baskets in floor sink(s)with more effective basket strainer(s). • Use strainers in all sinks to prevent food wastes from going down the drain. Scrape food waste and grease into the trash or compost container before washing dishes. • Wipe off pots,pans,trays,and dishes prior to washing Train employees on kitchen best management practices. If you have any questions regarding this inspection or compliance with your violations,please contact the Inspector before the due date, 08/05/2014. • 07/29/2014 Inspector: 408-793-5332 Serina Lee Date • Joshua ► Phone (501)44n-qc,00 • 4,I 10-06-'14 11 :13 FROM- SunnyView Retirement 408-255-6015 T-539 PO003/0003 F-729 ,.,.. ,.-.,.�. M-, . .• yY,-^J—r 61 6/MI AI £(.1I,1,14 is,.41 V VL..-.)..,,ir kg,114.t v,,I try v .../•••• SAN JOSE/SANTA CLARA WATER POLLUTION CONTROL PLANT to.N T Sw CONTRIBUTING AGENCIES Fats, Oils, and Grease Program CITY OF SAN JOSE a-� CITY OF SANTA CLARA CITY OF MILPITAS a' .,_'. `- .• CUPERTINO SANITARY COUNTYISACTN SANITATION D IST. -CITY OF 3 4' F WEST VALLEY SANITATION DISTRICT b (CMES OF CAMPBELL,LOS GATOS, MONTE SERENO AND SARATOGA) KEEP GRFAS,E OUT OF THE SYSTEM BURBANK SANITARY OISTRICT Inspection Date:08/05/2014,Tuesday Inspection Type:Follow-up Inspection Time: 2:56 pm Facility Name:Sunny View Manor(42295) Contact:Charlis Younan/Director of Environmental Services Facility Phone:408-4545600 Phone:408-454-5655(Bus) Address: 22445 Cupertino Rd Facility Group: FOG-CU Project ID: 123018 Cupertino,CA•95014 . SIC/NAICS Codes:5812 Task ID:761997 • Y i n• 'R edea h :: ;:_<..:...::: .:. :....... 7/29/14 Grease interceptor • • Repair and/or maintain in proper working condition(OWN) 8/12/14 - You need to have your clogged outflow line from the 4500 gallon grease interceptor immediately backflushed/hydrojetted from the City main sewer line to your grease interceptor. You will need to coordinate with your plumber,grease pumper,and the Cupertino Sanitary District to have this work perfomed and to return your grease interceptor to proper working • condition_ • •..Curren#Compii#0:ce istory;:':::: •". ., . , . ; ;:�,. . . .. ... . ......�. ... :.P. , 7/29/14 Sinks with strainers • Provide• 8/5/14 8/5/14 7/29/14 Grease interceptor • Repair and/or maintain in proper working condition 8/5/14 Failed OWN • • Key:OWN-Official Warning Notice Recommendations Continue to use strainers in all sinks to prevent food wastes from going down the drain. Continue to coordinate with your plumber,grease pumper,and the Cupertino Sanitary District to have the necessary work performed to return your grease interceptor to proper working condition. If you have any questions or problems resolving your violation,it is your responsibility to contact the Inspector before the due date, 08/12/2014. 08/05/2014 Inspector: 4 / 408-793-5332 Charlis Younan Date - Josh a Villa '/ Phone .10-06-'14 11 :12 FROM- SunnyV i ew Retirement 408-255-6015 T-539 P0001/0003 F-729 IAV ,.. .. .. ...-K LA'PI,L1V16ffLC-fb1 L.+,�L-1 L-7 f�444J Lt�L./ 4!W %-ll4 ly07 SAN JOSE/SANTA CLARA WATER POLLUTION CONTROL PLANT <l f� CONTRIBUTING AGENCIES CITY OF SAN JOSE F f,.. 4`, , OFFICIAL WARNING NOTICE CITYOTYOFACLARA CITY OF MILPCTA3 �+ ^,. L.:::41 CUPERTINOSANTARY s R F LTJ COUNTY SATN SANITATION DIST.CITY OF NO.2-3 WEST VALLEY SANITATION DISTRICT KEEP GREASE OUT OF THE SYSTEM (CITIES OF CAMPBELL,LOS GATOS, MONTE SERENO AND SARATOGA) BURBANK SANITARY DISTRICT Facility Name:Sunny View Manor Responsible Person:Challis Younan • Facility ID: 42295 Address:22445 Cupertino Rd Phone: (Bus)40$-454-5655 Issue Date: 08/05/2014 Cupertino, CA 95014 • This warning is to notify you of violations of the Municipal or Sanitary District Code as noted below.You are hereby notified•to take appropriate remedial actions to avoid additional legal actions from being taken against you. • Municipal or Sanitary District Code Violations SCCD230C-6221 -Oil and Grease Removal Devices Violation/ Remedial Action •• Due 7/29/14 Grease interceptor • Repair and/or maintain in proper working condition • 8/12114 - You need to have your clogged outflow line from the 4500 gallon grease interceptor immediately backflushed/hydrojetted from the City main sewer line to your grease interceptor. You will need to coordinate with your plumber,grease pumper,and the Cupertino Sanitary District to have this work perfomed and to return your grease interceptor to proper working condition. Notes/Comment% ' Since the grease interceptor violation has not been resolved and the Inspector was not contacted before the due date,an Official Warning Notice is being issued.Please continue to coordinate with your plumber, grease pumper, and the Cupertino Sanitary District to have your grease interceptor returned to an operational condition. You will need to coordinate with your plumber, grease pumper,and the Cupertino Sanitary District to have this work perfomed and to return your grease interceptor to proper working condition. ID:115263 • RECEIVED BY: INSPECTOR: 7. %,/ Date Jos •a Villa. 408-793-5332 200 E.Santa Clara Sirect,7th Floor,San Jox&,CA 95113.1905 td(403)793-5300 td(4/8)945-30001w(408)271-1930 www..sanjosesmgov/esd