16667 S
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File:
CUPERTINO SANITARY DISTRICT
20065 Stevens Creek Blvd., Bldg. C
Cupertino, California 95014
(408) 253-7071
"ON-SITE REQUIREMENTS-OVER THE COUNTER REVIEW"
Date: Qttiq it. o6l 7-003
File: CuSD MOP
Building Dept-Cupertino
Community Development Department-Building
City of Cupertino
10300 Torre Ave.
Cupertino, Ca 95014-3202 �N fi
RE: Subject: ANP CONK(�,T! "rV � �
Name: WW
Approved For Issuing Address: 10 6+S
� l
Building/ Plumbing Permits APN: 3 16 - OZ — �3Z
Control/Plan Ck No.:
. Permit No.: �N j O'I � n_ ��667
The Cupertino Sanitary District has reviewed the plans for the sublel`et project: r
❑ No additional conditions/requirements by the District.
❑ Sanitary sewer is available and the existing building is connected to sanitary
sewer, see conditions/requirements listed below.
Sanitary sewer is(�A) available, see conditions/requirements below.
❑ Sanitary sewer is not provided by the District, please contact the City of
Sunnyvale at (408) 730-7510.
The following Conditions/Requirements are made:
❑ Install new Property Line Cleanout or locate and raise 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).
VVideo Inspection of the Property Line Cleanout, Point of Connection and Street
Lateral is required prior to passing The City of Cupertino Final Inspection.
Owner to call District 48 hours prior to video inspection to schedule a District
Inspector. District to provide Building Department with Written Notification
upon completion of Inspection.
Page 1 of 2
"ON-SITE REQUIREMENTS-OVER THE COUNTER REVIEW'
Tb km oa wu;Tl a 4Mrt99, 04
RE: Subject: /ENO GoNktcf '(Q1j r
Name: NOW fb"njtrt1__J1
Address: 10642. t I
APN: 316- 02 -03?�
ControUPlan Ck No.:
Permit No.:
CU 4 64 t o N 16667
❑ Inspection of Street Portion of Sanitary Sewer Lateral by the District, Please Do
Not Inspect and 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 (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.
❑ 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.
❑ Verify existence and serviceability of an existing backflow protective device.
❑ Break areas authorized minor electrical appliances only. (No commercial
disposal or commercial dishwasher installations.)
❑ Other:
Storm water form surface or roof drains, other general surface runoff water or condensate
form any residential HVAC equipment shall not be discharged to the sanitary sewer.
NOTE: Contact CuSD for "OFF-SITE REQUIREMENTS"
By:
Page 2 of 2 .
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PERMIT P
' �..,� 16G67
CUPERTINO SANITARY DISTRICT
Santa Clara County
20065 Stevens Creek Boulevard, Building C
Cupertino, California 95014
Telephone 408-253-7071
CONNECTION PERMIT / �7
Date I I �'r Ir ir:� f l:I:. Z APN: Book Page(.'Z Parcel (. L
}� r / ROS/PM/Tract No. Lot No.
Properly Owner: I l'i -A �� +'c 61 r t-
MailingAddress: 1 t t'4, I rt.Le WALE
rr,rrre -nKt cu /i if
(I/We),being the owner(s)(owner's agent),hereby make application for connection of the at: I r o-J /
consisting of the following Type of Buildings:
Residential: Single Family Dwelling 1L; I Multi Family Dwelling_; No.Units
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.
3.To acquire a Plumbing Permit from they 7� lf, of t`f 1 tlrr(1 IN 0 ,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(USA) 1-800-227-2600,at least 48 hours prior to starting construction.
8.SPECIAL PERMIT CONDITIONS: T S I 'R f"Tl (t N r fm I f Co)
A BACKFLOW 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 30,�� � r'
No. Units a$ I/r h.. /month a X no. months 4 1 r / (31010)
Backflow Protection Device Inspection Fee ^� (31020)
Connection Permit Fee: / (31020)
Additional Connection Fees ( )
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: }
f
Owner's Agent:
j n (IjSig
ning or vn'er Please Print Your Name)
Receipt of�.��� I tlacknowledged and permit granted.
MARK THOMAS & CO.,INJC.,district Manager-Engineer
By:
Revised S100 NOTE: See Details on other side of this permit
• � = C
TYPICAL CLEANOUT FOR LATERAL SEWER
Distance from Property Line
to be as close as practicable,
°i not to exceed five(5') feet.
c
_I
'
Removable Cleanout Plug
n
0
n. Finish Grade
Wye for Riser
Sewer Cleanout Box with Lid to be accessible
and maintained by property owner.
Short length Riser Pipe
Adaptor coupling 1/8 Bend
—FLOW m
Latera House Sewer
Lateral Sewer slope House Sewer slope
determined by District erJ 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. 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 Jud.aimlonal R..v lm ion.
Acc.plea ey An Jurisdiction,
FIGURE I FIGURE 2 FIGURE 3
Inetoll.d Be'..Orod. Inuall.d Below Grad. Inaallad Aeava Grad.
Show.B.InNn Slr.a R;pM-0-Way..it Building shown At Properly Line Cleanout Shown Adjacent To Building
R.auire. Regulon M.Inbnonc. u, Requires Minimum Moinononce Requires Minimum Mainbnanc.
Valve To Be R.mevabl. Valve Should B.Removable
'• VALVE ACCESS BOX
¢ with/V.nlb Cover FINISRq FL00R
o I FINIRR FLOOR
!JK �KELLY VALVE
in,
Irish Groe. \
VALVE ACCESS BOX
ELLYVALVE ` d
- Finish Grad. Finish Orad.
♦ �
BACKWATER '� n
VALVE
FLOW A' FLOW 3T FLOW o/
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.