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26118 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO HOLDING-ECLL RI A" PERMIT NO. APPLICATION/PERMITPLUMBING-MECHANICAL26118 BUILDING..DIVISION BUILDING PROJECT'IDENTIFICATION BUILIIING ADDRESS: f /) r/n/ SANITARY NO. APPLICATIOON�SUBBMIITTAL DATE 2640 2, Ca/cl yvLJ. UNIT# LOTa 2y�JA OWNERS NAME: .PHONE CONTRA OR'S NAME: LIC NO: N/C CONTROLtl J o.w1 e S G u i �f/ 2 e✓ r Co . (G�lol9 RCfl1T l_CI'/EI4GINCI;R: LIC NO: ZZ-� h e G�. 1rxdsJ?J� CI] CA. CONTACT: PHONE: QTY, FL17CTRIC PERMIT FI'E ' BUILDING PERMIT INFO tfu Q. Ile tell y/ 68-/570-7 BLDG ELECT' PL MB MECH 0 J PERMIT ISSUANCE LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL El El cci I hereby affirm mat l nm locowd underprovisiuns ofCTapler 9(commencing with JOB DESCRIPfION uJ00{'; Section 7000)ofDivision 3 of the Business and Professions Code,and my license is in PANELSod ull pass and effect. 6FZy( LiceCl nse ss l.ic.p L+2 / UP T02fq AMPS ori Dam Cmanco mr n. r LO. 201-I"AMPS z0ooARCHITECTS DECLARATION OVER 1000 AMPS SQ.FT.FLOOR AREA $/SQ.ET. O Z—O I understood my plans shall he used as public records. F-H F-WSIGNS ELECTRICAL M71LicensedLicend Rofessirinel < OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MISC. C'6F I hereby affirm that 1 am exempt from the Contractor's License Law for the following reason.(Section 7031.5,Business and Professions Code:Any city or county 'I Ii MP.METE?R OR PILE INST. / �LLJw..I which rcyuiresnpnrnitmcnnswn.oha,improve,demolish,or repair any stmeturc POWER DEVICES = ® �r K }� prinnmiys issuance,alsmrcquiresthe applicant for such pemtiuo film signed stommmt e'V p that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter Cq�K 9(commencing with Section TIDO)of Division 3 ofthe Business and Professions Code) SWIMMING POOL ELECTRIC ( VALUATION yX(_ky. or hour he is exempnhercfrnmand the basis for thealleged exemption.Any A.Lono nr OU9'LE'rS- r X-Za Section 7031.5 by any agglicsno for.pemtitsubject,theapplicanl lox civil pendtyof SWITCHES-PI%TU F.S z not more than five hundred dollars($500). NEW RFSIDII4TIALELNCIR J�As il ��•� ❑ I,asriwnemfthe prmpcory,ormyemployttswiNwagesas theirsolecompersmion, W^sR RIES TYPE CONSTRUCf10N L willdo the work,and lheamuclon,is not imendedoroffined for sale(See.7044,Business .. stop Crile:'rhe Crinlmcnsrs License Low does not...Y tri an owner of progeny who buiWscrimproves Nerenmand whodres such work himselforrhmughhis ran employees,providedthm suchimpnrventiosarmor imendedoroffered formic.If. OCC.GROUP RIS.,UNITS however,the building or improvement is sold within one year of ecmplction,theowner. a builder will have the burden of in that he did not build or int for TOTAL' Prov g improve purpose of sale.). ` FL I as Owner Ofae progeny, os y,am asclvely encountering with licensed contractor m QTY a fi s-PLUMBING 1 ERMIT'. FF; OOD zorvE APry construct the protect(Sce.7004,Business and Professions Code)The Conuacusrs PERMIT ISSUANCE License law does not apply w an owncr of property w ho bee ilds or improves Hereon,and whocommets for such pmjems with acommeter(s)licensed pursuant to the Contractor's ALTER (EA) License l.uw. - FEF,SUMMARY ❑ 1 not eoempl under Sec. ,B&1'C for this reason BACK FLOW PROTECT.DEVICE Of1T.ID SANITARY Y N Owner Dam RECF.IPI'Y GRAINS-FLOOR,ROOF,AREA,GOND. WORKMAN COMioffIONDECLARATION SCHOOLTAX Y N ❑Workers' pecourni Nmay..I have can.verified cipentre.f(See 380 .Lab C.)c m orwhich RECEII'fp Workerv'Com Insurance in.certified end thereof Sec.3Xhh,Lab CJ which FIXTURES-PCR TRAP PARK FEE Y N pensnu"o IY rs all emphoyere,under this Pemil. GAS-EA.SYS'H?h14 INC. OUTLETS RECEIPTp Policy p BUILDING DIVISION FEPS Company GAS-EA.SYSTEM-OVER 4(RA) PLANCHECK FEE ❑ Cenifiedcopyishercbyfrmished. ❑ CcnifieA copy is fled with rho oily inspection Jivisiov. GREASE/INDUSTRL WASTE INTERCEPTOR GRADING FEE CERTIFICATE OF EXEMPTION MOM WORKERS' GREASETRAP SOILS FEE COMPENSATION INSURANCE Ghissemior need not be completedHNe permit is formic hundred dollms($Hill) SEWER-SANITARY-STORM EA,200FT. ENERGY FEE or less.) I certify that in the performance of the work for which this permit is issued,l shall WATER HEATER W/VENTpILECTR no, employ any person in any m as to become subjcM to the Workers' PAID z Compenaationlowsof C.lifmcdoc Data so WATFRSYSTBM/IREATING Data ReceipN Applicant �7 NOTICE TO APPLICANT:If,after .making This Cmdremeof Exemption,you should NEWRESIDEMI'IALPLMII. SQ.FT. TOTAL: F ` became subject o the Worker's Compensation provisions ofthe Labor Code,you must C' > forthwith comply with such provisions or this permit shall be deemed revoked. BUILDING FEB UJ Z CONSTRUCTION LENDING AGENCY SEISMIC FEF. I hereby from that the.is.e...tructiun lending agency polio performance of U 0 the work for which this permit is issued(Sec.3097,Civ.C.) TOTAL: ELECTRIC FEE V. rat Lenders Name r' Lenders Address QTY. MFCHANICAL PERMIT FEE PLUMBING PCE U I certify Thar I have read this application it slate that the above information is correct. logree tri comgly with all city and enemy ordinances and smmlaws relaying rte PERMIT ISSUANCE MECHANICAL FEE F" y buildingconsimction,and hereby euthnrire represemolivcsof this city,.crmrupnn the CONSTRUCTION TAX UI',Z, above-mentioned pare poses.for inspection paosee. ALTER OR ADD TO MECI I. (We)agree to save,indemnify and keep harmless,the City of Cupertino against liabilities,judgments,crisis and expenses which may in any way accrue gain tsaid City AIR HANDLING UNIT(TO 10,000 CFM) in rinse pence he gmming nni~_ AIR HANDLING UNIT(OVER 10,000 CPM) 00, alureof Applk; m.oa a' Dale EXHAUST HOOD(W/)UCT) PAID HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO 10(1,011(1 BTU) Dam Receiptg W ill the applicant or furore building wcupom score or handle huznrdous mount al as defined by the Cupeniro Municipal Code,Chapter 9.12,and the He.Rh and Safety I I RATING ON]'1'(OVER I Nid00 BTU) TOTAL: Cede,Seed. Yes ❑No 25532(.)4 ❑ VENTILATION FAN(SINGLE RFSID) 4 s Will Neupplicumorfmurebui Wing uccupam useequipmentnrduvices whichBOILER-COST(3HP OR INLON)BTU) ISSUANCE DATE emit pprry� hazardous air conundrums as defined by the Bay Are.Air Quality Management BOILER-COMP(OVER 100,0110 BTU) y (� ' D District? \ ❑Yes ❑No NEW RESIDEJ4TIAL MECH.—SQ.FT. I have read the hazardous mmed.1,requiremems trader Chapter 6.95 of the MAR =9 1994 California Health&Safety Code,Sections 25505,25533 and 25534. 1 understand that ifthe building does or currently have a tarred,Nat it is my responsibility to norify the •Iy s,u� occupant of the requirements which man be met prior to issuance of a Certificate of CITY f Ur- (iU Occupancy. \N/I��r_/V�IrJttrlt(t`\AHIJ [�SSiFuyl-r/— Owner or indevized agent Date TO'T'AL: ISSUED BY OFFICE m�e.Ss•[i T�_v.'.AFe-F Tfs`v`nTl�!`a7r'"^'0"�T^^arPie-�P"�rF .,NS'(vi['i /^h`7F7•"moi+^v5w2�W�l'�n�t-.;. , � PERMIT P-15338 CUPERTINO SANITARY DISTRICT Santa Clara County 20065 Stevens Creek Blvd., Bldg C, Fax (408) 253-5173 Cupertino, California 95014 Phone (408) 253-7071 CONNECTION PERMIT R.O.S./P.M./Tract No. Lot No. ,A A.P.N.: Book A s/�o Page Parcel 1D'O Z Date /r I�'�� 7 , Property Owner: jo w Ps t� u/ r c4© rT r Mailing Address: 2/2/0 4 D P 1 CXV 06 (If different) W AAA �Ap O Telephone: r Sirs (I/We), being the owner(s) (owner's agent), hereby make application for connection of the property at: 7 Z &4 y P. C CW CI.E> Ro 0.4 C, VL-Q.A �.•w O consisting of the following TYPE OF BUILDING(S): Residential: Single Family_,X; Multiple Family_; No. Units Commercial ; Industrial ; Other ; No. Units do hereby request a permit to connect to the sewer system of the Cupertino Sanitary District. IN CONSIDERATION OF THE GRANTING OF 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 cleanout (raised to grade and accessible) located at the point of connection with the Lateral Sewer (that portion of the sewer in the street right-of-way or District Easement). 3. To acquire a Plumbing Permit from theof a,��t¢iA kw o Building Department and obtain inspection and approval by said Building Departmen pnor to covering of the work or use of the sewer. 4. To first expose and inspect for serviceability the Lateral Sewer (that portion of the sewer within the street right-of-way or easement), 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 call Underground Service Alert(USA) 1-800.227-2600, at least 48 hours prior to starting grading or digging operations. • SPECIAL PERMIT CONDITIONS(Exhibits): �--, A BACKFLOW Protective Device shall be installed on 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. i FEES: Connection Permit Fee: $ 7(pe--- i U Sewer Service charges to June 30, 19�, $-L&-S---L/mo. x Amo.: $ 6, Inspection Fee for backflow protection device: $ 1570 Considerations and Restrictions of this Sanitary Sewer Connection Permit with attached Exhibits (when noted), are hereby agreed to and acknowledged by the undersigned Owner(or Owner's Agent). Failure to comply will void this permit. Acknowledgment:W4 v Owner's Agent:Agent: / r r•/a-s ✓G�j fz (print name) Receipt of$ 3 acknowledged and permit granted. MARK THOMAS &CO., INC., District Manager-Engineer by: 3� Note:See Details on other side of this permit. A TYPICAL CLEANOUT FOR LATERAL SEWER Distance from Property Line to be as close as practicable, not to exceed five(5) feet. J T to Removable Cleanout Plug C. 0 a. 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 Lateral Sewer House Sewer Lateral Sewer slope House Sewer elope determined by District EP determined by building department —CLEANOUT TO BE SAME SIZE AS LATERAL SEWER— Notes: 1. Distance from the properly line not to exceed five(5')feet. i 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. e • TYPICAL BACKFLOW PROTECTIVE DEVICE INSTALLATION TYPICAL BACKWATER VALVE TYPICAL KELLY VALVE INSTALLATIONS INSTALLATION Jurledlatlonal Reetrlmlons ' Accepted By Au Jurisdicnan, FIGURE I FIGURE 2 FIGURE 3 Installed Below Grade Installed Below Grade Installed Above Grade Shoed Between Street Right-ol-Way and Building Shown At Properly Line Cwanoul Shown Adjacent To Building Requires Regular Maintenance z Requires Minimum Malntemnae Requires Minimum Maintenance Valve To Be Removable Valve Should Be Removable > VALVE ACCESS BOX 2 with/VenbdCover FINISH FLOOR vel of FINI R FLOOR KELLY VALVE ntKELLY VALVE ACCESS Bo% E � pFinish Grade tLFinish Grade Z t n BACKWATER VALVE FlyW,m FLOW a/' FLOW a/ 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. e 4. it a Kelly Valve is installed at Property Line, it is to be readily removable for Lateral Sewer Maintenance. e