26145 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO RU7I'BR7f'-F,f'UCRANCAPERMI'1'NO.
APPLICATION/PERMIT PLUM ROJECIEDENTIFICA 2 6 1 4 5
BUILUINC DIVISION IIUILnING PROJN:CI'IIINN'TIFICA'I'ION
BUILDING ADDRESS: SANHARYNO. APPLICATION SUBMITTAL DATE
,z%W5, It+f�!/�I(Z� j/�^+ UNIT# LOT
O ERS NA E: PHONE: CO IR OR'S NAME: r /� LIC .
Vis`N•)`Aa N/C CONTROLp
AR
CIII'TF:CI'/ENGINEER: LIC NO: ADDRESS
2L-LJ ti G1
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CONTACT: Pxorve: BNt11Z�3n.x.U '"I't '}l':BUILDINGPERMIT'INFO
QTkgj- V3 EKQT4 I yy,.EMIT ;. , 'FPC
BLDG ELECT PLUMB M[CH
PERMIT ISSUANCE
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL JOB DESCRIVION
y.Z Iherch,affirm that l am licensed under proviaionsof Clamor-9(commencing with
00 Section 7000)of Division 3 of the Business and Professions Code,and my license is in PANELS
CW fullfomeamdaffxt B�
F<c_ Licenu Cas Courn ��_/ O/f /� UP T0200AMP5 5RJ JQ �� \ I`'1/
oe D. Date t-� Contrector r Hwy 201-1000 AMPS ,JI w� ILA VV
Z.O n� ARCHITECTS DECLARATION OVER HIM AMPS SQ.I'I'.FLOORARG $/SQ.Err.
O Za.G I understand my plans shall be used as public records.
r SIGNS ELECTRICAL
�j y-E Liwnxd Prnfcxsionel
"yP' OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MISO
5P'OyF I hereby affirm That 1 can exempt from the Conuacmh License Law for the '
s+131'-m following reason. 703 2.5,Business and Professions Code:Any cityor county TEMP.METER OR POLE INST.
which requires a permit to construct,alter,improve,demolish,or repair any stmeture ® n 11
r^i m its issu:me,rJsorc Iheu licant for such omit to filen si edsmmment POWER DEVICES Ytl\Vi
1 prior ywrca PP Pc en F 11 /-`
that he is licensed pursuant to the provisions of The Connor's License Law(Chapter
9exmmencing with Section 70000.fDivin.r.3 of the Business and Professions Cade) SWIMMING POOL ELECTRIC / VALUATION
y)_y or tem he is exempt there ..and The basis for ther0leged exemption.Any violation of OUTLETS-SWITCHES-FIXTURES
I—Za Section 7071.5 by any applicant for a Permit subjects The applicantto a civil penalty of
$ not more Than rive hundred dollars($500).
Wm C1I,asownerofthepropeny,orniyemployees with wages astheireclecompecertNEW RESIDENTIAL EJion, .I' IES TYPE CONSTRUCTION
m will do the wmk,ad destructors,is not Joundul.,offered for sale(See9094.Business
and Professions Code:The Contractors License Law does not apply To an owner of
property who builds or improves Thereon,and who does such work himxlforthrough his
employees,providedthat such improvements arenotintendedoroffered(orale.if, OCC GROUP RES.UNITS
however,the building or improvement is sold within one year ofeompletion,the awvar-
TOTAL:builderwillhavetheburdenafpproving that he did not huild or improve for Purpose of
a❑)1,as ownerufthe property,am exclusively cnmruning with hearses]emorene....to Qd YI kS�S ° PLUMBING PERMIT i f p d da y.PBli- FLOOD ZONE APN
mumucl The ou t(Sea 7094,Business and Pra[ealoos Cori The Contractor's PERMIT ISSUANCE
License Iawdres nor apply tom ownerofpropeny whobt ildserrimprevnthereon,and
whncommen,fnr such projects with.contrecmrp)licensed.....uothe Convecmes
License Ww. ALTER (A)
FEE SUMMARY
❑ I um exempt under Sec. ,B&P C for this reason BACK FLOW PROTECT.DEVICE OUTSII31: E
SANITARY YN
Owner Dem RIiCfIPT#
RAINS-FLOOR,ROOP,AREA,GOND. SCHOOLTAX YN
WORKMAN COMPENSATION DECLARATION D
❑ Thereby affirm thaO haveaanificme ofwvem To ulf-insure,uraanirinte of RECI?ITT#
Workcri Compensation Insurance urecertified copy thereof(Sec.3g00.labCJ FIXTURES-PER TRAP which PARK FEL: YN
coversnil employee's uadenNs permit. GAS-EA.SYSTEM-1 INC.4 OUTLETS - RECEIPTp
` icy# BUILDING DIVISION FEES
P'ay GAS-EA.SYSTEM-OVLR 4(LA) PIANCHECK FEE
eaf ied en,is hereby furnished.
❑ Certified copy is filed with The city inspection dismon. GREASEBNDUSTRL WASTE INTERCEPTOR GRADING ITE
CERTIFICATE OF EXEMPTION PROM WORKERS' GREASETRAP SOILS FEF.
COMPENSATION INSURANCE
(Thissoainn neednot becmn,lmed nine .it is foronehandred dull.($100) SEWER-SANITARY-STORM IA.200FT. ENERGY PLR
or last.)
I cenifytha afhe perm.ce.f the word for which this pcmrit is issued,l shell WATER HEATER W/VENT/ELECTR
not employ my person in any w as to become subject m the Waders' PAID
z Campenation Eawsof Celifomia. Data sit WATER SYSTEM,`UEATING Data Receipt If
Applicant
z 0 NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should NEW RESIDENTIAL PCMB. SQ.PT. TOTAL:
p+ Ze, become subject to me Worker's Compensation provisions of the Lear Cade,you most
Com .' for i@ comply with such provisions or This permit ahall be deemed revoked. BUILDING PER
a (] CONSTRUCTION LENDING AGENCY SEISMIC RIi
5 z I hereby affrn That there is a comwmion lending agency for the Minfarroance of
U O the work for which this permit is issued(Sec.3097,Civ.C.) Tcz., ELECTRIC FEE
Lenders Name e, s PLh
OF Leader's Address
ssHANICALI LR,II'h" x ;PEE; PLUMBING
# U I c1 have read This application end some that the above informs ation as
correct.l agree as comply with all city and county intimates and state laws relating To PERMIT ISSUANCE MECHANICAL IEE
E" D,, building construction,anahereby amhmire representatives ofthlsciry menterupon the CONSTRUCTION TAX
U move-mentioned property for inspection purposes. ALTER OR ADD TO MECH.
(We)agree or save,indemnify it keep hmmless the City of Capstan..against
liabilities,judgments,costs and expenses which may in anyway acerueagainm said CAIR HANDLING UNIT(TO 10,000 CFM)
eco muting ofthis pe T
AIR HANDLING UNIT(OVER 10,000 CFM)
Signamm of ApplicanUCantr or D EXHAUST I IOOD(W/DUC)
PAID
II RDOUS MATERIALS DISCLOSURE HEATING UNIT(TO 100,000 BTU) Ilam Receipt#
Will the appheam or furore building xcup:mf sInrc m handle mentors material
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safely HEATING UNII'(OVER 100,0110 BTU) L:
Corl Section 25532(a)7 VENTILATION FAN(SINGLE RPSID)
❑Yes ❑No
BOILER-COMP T3HP OR IWJTX BTU) PAID
q I D DATE
Will The upplicantorfamre building by the Bay Area it orality Management i'� (� D
harnrdous vii contaminants as Relined by the Bay Area Air Quality Management BOILER-COMP(OVER 100,000 BTU) ryppy!-,g
J ❑Yes El No NEW RESIDENTIAL MECH. SQ.PT. MAR 16 1994
1 have rand The latera x mauM®s repiremcma under Chapter 6.95 of the �� �7u
Culifomiu
Health&Safety Coag Sections 25505,2553)end 25534. 1 understand Net
if The building Jres not currently have etenant,that it is my responsibilityto notify the Ut- �Ur'ttYttry
ecupant of the requirements which must he met print it issuance of a Certificate of - V
Occupancy.
Owner or amhoriaed agent Dam TOTAL: ISSUED BY:
OFFICE
...."t^: -ti3`..' �• -T`•..v'•i-NM,yr.�SM ntRTO".1p^.".-..reFW: . . �..fs.:'im rvv t w.�.- i F"C`7�`T."Xfp'wV�y�Nr"@—"—w•yTr N a• ,
PERMIT P-15339
t m
t 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.P.N.: Book 5541 Page Parcel ��p Data
Property Owner:Na.4-o 1d C . )a AX rVr! F. ,Sa r�lny
Mailing Address:
(If different)
Telephone: '1 N
Sirs:
(I/We), being the owner(s) (owner's agent), hereby make application for connection of the property at:
22G045 co,P/e4,rlee.-Z /, &)aer 4r no
consisting of the following TYPE OF BUILDING(S):
Residential: Single Family Multiple Family ; No. Units—e
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 the 6-4-7 of Q21 ✓70 Building Department 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 (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.
FEES:
Connection Permit Fee: �,� $
9 t-T ,$ 4 cw
Sewer Service charges to June 30, 19 /MO.x mo.: $ �o
Inspection Fee for backflow protection device: $
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: �• J G�
Owner's Agent: ! /�Yi ✓G' ���
(print name)
Receipt of$ ��.3 acknowledged and permit granted.
MARK THOMAS &CO., INC., District Manager-Engineer
Note:See Details on other side of this permit. I
r1
i
1
TYPICAL CLEANOUT FOR LATERAL SEWER
Distance from Property Line
to be as close as practicable,
a, not to exceed five(5�) feet.
c
J
w Removable Cleanout Plug
n
0
o_ Finish Grade
Wye for Riser
Sewer Cleanout Box with Lid to be accessible
and maintained by property owner.
Short length Riser Pipe
1/8 Bend
Adaptor coupling
__ _- `FLOW �
},Lateral Sewer House Sewer
Lateral Sewer slope House Sewer slope
determined by District arldetermined by building department
—CLEANOUT TO BE SAME SIZE AS LATERAL SEWER—
Notes:
1. Distance from the property line not to exceed five (5')feet.
e 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 uadaaictional Reelrlmione
Accepted By All dunedkrlane
FIGURE I FIGURE 2 FIGURE 3
Installed Below Grade Inelolled Below Grade Installed Above Grade
Shown Bowan Street RiYM-obWay and Building Shown At Properly Line Cleanout Shown Adjacent To Building
Requires Regular Molnlenonce z Reauirn Minimum Maintenance Require. Minimum Maintenance
Volve Ta Be Removoole VAN. should Be Removable
VALVE ACCESS BOX FINISH FLOOR
a
iii rvemeduu
cover
Ao v o F NI H FLOOR KELLY VALVE
A c MKELLY
VALVE ACCESS BO% EFlnieh Grade Flnieh Grade
in
M
BACKWATER
VALVE
FLOW FLOW Ar FLOW sl
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.
w_l 4. If a Kelly Valve is installed at Property Line, it is to be readily removable for Lateral Sewer Maintenance.