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20151 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY Bulldin Project Identification PERMIT N/O..- a-� Building Address: '/O C /0/1 _ 5-CC /�jEGfN CP-T G J e J//17 h/Ori l� one. CITY OF CUPERTINO-BUILDING DIVISION rte[ APPLICATION / PERMIT Contractor's Name: LIc.No Qy BIZLDING-ELECTRICAUMtJMBINGMECIIAMCAL CATEGORY CONTROL# J/S Architect/Engineer. Lie.No �•7 I,ECTRIC PERIN�.T t, '�'�",FEtvy N O , BUILDING PERMIT I ' Address: - PERh4TISSUANCE - ❑ ❑. . . ❑ LICENSED CONTRACTOR'S DECLARATION' I hereby affirm that am licensed under provisions of Chapter9(common- APPLIANCES-RESIDENTIAL ,.JOB DESCRR'IION Ingwith Section 7000)of Divlslon3 ofthe Buslneasand Professions Code,and my license Is In full force and effect. - PANELS License Class Lle IfiLG✓ C: /// Date Contractor ' —UP TO 200 ANTS ARCHRECT'S DECLARATION 701-1000 AMPS M2 I understand my plana shall be used as public recoMs. OVERIOOOAMPS SQ.FT.FLOORARFA $/SQ.FT: q�v O Licensed professional SIGNSELECTR16AL- a - OWNER-BUILDER DECLARATION SPF.CIALC T/MISC Z � herebya(fimntFatlam exemp (romlhe Contractar'sLlcenee Law for the Frat following reason.(Section7031Z,Business and Professions Code:Any city or + , c�. countywhlchrequiresapermlttommtmR,alteglmpmve,demollah,orrepair TEMP.METTA AR PCLBVNST. g5 .n anyslmcture priorto its Issuance,alsorequireatheappllcantforsuch percutto LOWER DEV[ L5 r file a signed statement that he is lice®ed pursuant to the provisions of the W6 µ, Contractors License Law(Chapter 9(commencing with Section 7000)of Divi- {{{...... OIr' sion 3 ofthe Business and Professions Code)or that he is exempt therefrom and SWEdMING ECIRIC VALUATION S the basis for the alleged exemption. Any violation of Section 7¢31.5 by any O ETS-S R - - - < applicant fora permit subjects theapplicant to a civil penalty and more than w ofive hundred dollars(S500). NE RESI AL EL STORIES TYPE CONSTRUCTION ❑1,as owner of the property,or my employees with wages as their sole C G corn ensatlon,willdothe work andthe structure is not intended or offered for q sale(See.7044,Business and Professions Code:The Contractors License Law 3$ does net apply to an owner of property who builds or Improves thereon,and OCC.GROUP RES.UNITS who doessuch workhimselforlhecugh hisownemployms,provided thatsuch Improvements are not Intended oroffered forsale.It however,thebullding or TOTAL: Impmvementlssoldwithlnoneyearofcompl6lb theowner-builderwillhave ` th,�jLden of proving that he did rat build or improve 'purpose ofsale.) QTY. PL'13NGTERMIT ; ''.,FEE,' LJ I,as owner of the property,am exclusively contracting with licensed FLOOD ZONE APN contractors to construct the project(Sec.7044,Business and Professions Code: PERMIT ISSUANCE 00 The Contractor's License Taw does not apply to an owner of property who ALTER-DRAIN&VENT-WATER(EA) V Wilds or Improves thereon,and who contracts for such ptojeds with a T `, FEE$UtVSMARY CW�fader(a)licensed pursuant to the Contractors License Law. BACK FLOW PROTECT.DEVICE LJI.am exempt under Sec. B&P C for this reason Q-ITSI DE FEE S Owner Date DRAINS F(.00R ROOF AREA,COND. SANITARY Y_ N_ WORKMAN COMPENSATION DECLARATION RECEIPT p ❑I hereby affirm that I have a certificate of consent to aelf4caurs,or a MTURRS PER TRAP SCHOOL TAX Y N certificate of Workers'Compensation Insurance or a certified copy thereof(Sec. RECEIPT X 3800,Tab CJ GAS EA.SYSTEM-1 INCA OUTLETS PARK FEE .Y_ N_ RECEIT T# Policy X GAS EA.SYSTEM-OVER 4(PA) Cam a - BUILDING DIVISION FEES 1 rimed copy 19 herebyfamished.the cid. GREASE/INDUSTRL WASTE INTERCEPTOR PLANCHECKFEE ^' CeAl ied ropy Is(Teed with the city Inspection division. CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE TRAP ' PAID COMPENSATION INSURANCE SEWER-SANUARY-STORM EA,200F1'. aJ,(�fO Date Recei t# (fhissection need not be completed tithe permit Is forces hundred dollars ($100)orle..) WATFRHEATERW/VENT/ELECTR ENERGYFEE Y N Icertifythat In the performanw 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 WATER SYSTEM/TREATING Workeri Compensation Laws of California. Date PAID ZZ Z Applicant NEW RESIDENTIAL PLMB. SQ.FT. Date Recei t# O NODCETO APPLICANT.If,after ma king this Certificate of Exemption,you .H should become subject to the Workers'Compensation provislons ofthe Labor TOTAL: N Code,you must forthwith comply with such provisions or this permit shall be B NG FEE W ] deemedrevoked. . [LCONSTRUCTION LENDING AGENCY _ SEISMIC FEE I hereby affirm that them is a construction lending agency for the perform- .TOTAL; 4' ELECTRIC FEE, O an.of the work for which this permit is houed(See.3097,CIv,C.) Lender's Name - • PLUMBING FEE Tril_00 LL F- Lcnder's Address QTY.' MECHANICAL.,P.IiRIvITT 7R7MECHANICAL FEE IcertifythatI have read this applicationand statethatthe above information O W 1 Is correct.I agree to comply with all city and county ordinances and state laws PERMITISSUANCE FEES PAID: relating to building conumctloe,and hereby authorize representatives of this - F W city to enter upon the above-mentioned property for Inspection purposes. ALTERORADDTOMECH. Z Date Recei t# _ a(We)agree tosave,Indemnify a d keep harmless h,City of Cupertino P tllabilitles,pdgments,coarsen naso whk ylna wayeceme AIR HANDLING UMI'(TO 10,OW CFM) SUBTOTAL• at said Citya!re t ming oft lertnit - P AIR HANDLING UNIT(ovm 10,0oocrM) CONSTRUCTION TAX Signatu ofppllant/Contractor Data EXHAUST HOOD(W/DUCT) CONSTRUCTIONTAX PAID: HAZARDOUS MATERIALS DISCLOSURE Will the applicant orfuiure building occupant store or handle hazardous HEATING UNIT(TO 100,000 BTU) Date Recei I# material as defined by the Cupertino Municipal Code,Chapter 9.17,and the - Health and Safety Code Section 75532(a)? HEATING UNIT(OVER 100,000 BTU) ❑Yes [ No - - - Will the applicant orlure building occupant use equipment or devices VENTILATION FAN(SINGLE RESID) ISSUANCI DATE which emit harardous air contaminants as defined bylhe Bay Area Air �isilty Management District? BOILER-COMP OHP OR 100,0(q BTU, �J Yes ❑n No iha°ereadihe hazardous materials requirements under Chapter 6.95 of BOILER-COMP(OVER 100,ODD BTU) pf,�pBR no ~ /01 the California Health&Safety Code,Sections 25505,75533 and 25534.1 of,! ,.ra`^" understand thatif the building does not currently have a tens n5 that it is my NEW RESIDENTIAL MECH, SQ.FT. responsibility in notify the occupant of the requirements which must be and A prior to Issuance of a Certificate of Occupa ney. Owner or authorized agent Date 1551113TOTAL: -G OFFICE COPY SERIAL P .Se ' 5009 SEWER CONNECTION PERMIT NO. A*UPERTINO SANITARY DISTRICT R.O.S./P.M./Tract No.............. Lot No.............. 20065 Stevens Creek Blvd. A.P.N. Bk... P Building g•••• ••••• Par.... Cupertino, California 95014 Phone (408) 253-7071 Date...............�Z ........//.., 19.`jn. /~ The undersigned,being the owner(or owner's agent)of the property located at .../.._•(. .{,?:P,/ 5 ........................................:.'...................................... .......................... consisting of the following TYPE OF BUILDING: • ING: IL� Residential: Single family...../.\.... 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 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 .......rte J.. ...!? i.,{�Y� ✓. 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...fJ/ ,,,5!?>Q/Jb,�//�/1.,,, ..•• Telephone...1.. �r $�.... .......... Mailing address if different from above... � .,,,•,,, •.„• .n . ~ ....... . By.... .... ..®Yb2!..4hr. A standard backflow protective device shall be installed, to the satisfaction of the Building Department, for the above property.(Note—See Detail I) FEES: Connection Permit Fee Sewer Service charges to June 30, 199...., $.. ?,........../mo. x......mo. 0 3 Inspection Fee for backflow protection device TOTAL $ �� • ' S� , __S'ceipt of$• ��'.-'.... acknowledged and permit granted. MARK THOMAS&CO. INC., District Manager-Engineer B>�� . r1�.............................. NOTE.•See Details on other side of this permit CUPERT/NO SANITARY D/STR/CT NOTES: Alt valves to be accessible and maintained by Property Owner. Overflow point m lead twelve inches G2"1. below lowest finished floor containing plumbing. Kelly Valve Installed of Property Line to be readily removable for Lateral Sewer maintenance. J ' w FiltiVFp r Level finish Floor Level Kelly Valve ^'Tjt § As Finish Grade Kelly ValveIS —sem` LL IS Volvo Access Bids —/ e d an with Vented ver E Valva Attees Boa —_ Backwater,Valva— ja� Figura I Figure 2 Figure 3 Kelly Valve-Below Surface Backwater Valve r Normally Kelly Valve-Above Ground -- Instollo,jarr hownvl�eauired , - metalled at shallowest point Instnllulian-Shown Installed Property Lina Clealipul. along House-Sewer between close to building. Properly Lina and building. DETAIL STANDARD BACKFLOW PROTECTIVE DEVICE INSTALLATION I t Distance from R tp be as "'"s as practicable. J Removable Cleanout Plug i Finish Grade anor Wye for Riser Sewer Cleanout Bos with Lid to be accessible n and maintained by property owner. Shari length Riser Pipe Adaptor couplingzv� x-1/8 Bend FLOW w Lpleral Sewer '�—Fl TNouse Sewer t3Enimum slope determined by Building Deportment. •Lateral*Sower Cleanoul to be some silly as Lateral Sewer. DETAIL STANDARD CLEANOUT FOR - LATERAL SEWER J May 22, 1990 Mr. Jerry Brager City of Cupertino Building Division 10300 Torre Ave Cupertino, CA 95014 re: Building Permit No. +2015f, Dear Jerry, Sorry that we missed your visit yesterday. Following your request for an engineering analysis of the water source, we have contacted multiple engineering firms. In each case, the engineers have been unable to understand or provide what was required and we have been referred to many different engineering firms without success. In the meantime, we have audited the septic tank daily and the water accumulation has ceased. In fact, the tank has been dry for several . weeks. It appears that the water we saw earlier was due to incomplete and improper pumping. After your last visit, the sewer contractor did a final pumping and the tank has been dry since then. ( "- n zQ A1QV(- 4, C.� In view of this, we are requesting that you make afinal visit to ' � approve the work, so that we may fill and seal the septic tank. We fi would like your advice as to whether the septic tank should be filled1° entirely with concrete, or if it should be sand, with a concrete cap. We are looking forward to your visit at your earliest possible convenience. I will call this afternoon to see what times are available. Thank you for your assistance. Sincerely, i E CH W E D /V4 di� MAY 1990 LJ 2 Z$ U D Alex Simonnovich /-O/- BLDG. INSPECTION DEPARTMENT CITY OF CUPERTINO s �-�- -- • ^ 16 .t W l} °,,, -%,CITY„OF CUPERTINO ' ° M r 'k710300 Torre Avenue k ,Telephone 252 4505;M dat• ...,r „}+ INSPECTION BUILDING DIVISION: :� �'� ,° d A "J#M'f Ll. S F K .1i;C, .N' yvc ' +� y" F..d.. 'F7✓w „ e'y'«r1{. . td3 JOB 101 ADDRESS r TIME fit. h DAILY. REPORT �.a :CORRECTION NOTICE❑ ;,; VIOLATION❑ * 3 TYPE INSP.: {a BLDG. j ELEC ❑ ,PLBG.($ MECH ❑ 0. { ILL r to _tV x + � kea b-�t,:i `x'-i:+"" .p°t: ,•.. � } =p�,�Yf + _..-T�.v�' (� '�i�. T"J"•. y ,/7<7' � •� �--I� Vic.- . . .• � � - /�(� ,^b J..) T �dam' � f.n.- //�i� � 'YI Sf 4 + W. ;} ..a d1 i "qy� ,s, d 1 ',f pk WEATHER a '�in�.� 4.; �ANSP .. �' .... I �l,E �•