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25270 AFM41LDINGADDRESS: PPPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY OFERTINO I . , .CI'RI.AL PHRMITNO. APPLICATION/PERMIT PLUMIIING MI:CHANICAI, n C(� O ISION BUILDING PROJECT IDEN"fIFIUATION G J L a[ �. / SANITARY NO. APPLICATION SUBMMFTAL DATE q LOT PHONE: COM'RACTpR'S NAME: LIC NO: ad L © NC CON ROLM RCI ITTECTN F.ER: �� LIC NO: O ADDRESS: ❑ CONTACT: PHONE: QTY. ELECFRIC PIiRMIT FF.P. BUILDING PERMIT INFO BLDG ELECTPLUMB MECH PERMIT ISSUANCE LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RBSIDENTIAI. SCRIPTION Q y.Z Thereby ufOrLIthatCEN uEDCONTRACunder provisDECL RATIO (commencing with la 0 Senion 1lN10l of Divis on3of the Nosiness antl Rofessions CrWe.end my license is in PANELS C� full force nod effect. a ('J� FzE License Clens Lic.M UP TO 200 AMPS to Ilam Contractor 201-1000 AMPS zo,,z ARCHITECI'S DECLARATION OVER IOW AMPS SQ.PC FLOOR AREA $/SQ.M. O z—O I understand my plans shall be uxd as public records. P2 J SIGNS ELECTRICAL ....II Licensed Prom."wom e''6 aOOWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MISC. xA, I hereby affran That 1 pan exempt from the Communities Lieenx Law for the following reuaon.(Section 7031,5,Business and professions Cade:Any city or county TEMP.METER OR POLE INST. , which requims a pemniuntrnnmit,nker,improve,demolish,or repairany slofc1m, FRED : ; im prinnoils issuance,also rcgvires the applicant forxuch permitlofilensigned statamem POWER DEVICES q<O that he is licensed pursuant to the provisions of the Contractors License Law(Chapter 0.� C 9 'th Se,i0n90gBrfDivision 3oflhe Businessand Prnfe.ssians Code SWIMMING POOL ELECTRIC op, that heis exempt wa ) VALUATION y_, option 7031.5 by myap romnt f the permit sujeallegedesemptloo, civil of OUTLETS-SWITCHES-FIXTURES �zQ Section l(IJLS by any applicant ddiaorapermiT suM1jects the applicannopcivil penehy of ;G nm mom than five hundred dollars yempl m ❑ Luewrirkof\heproparty,0rmyempinded aro ered Forsahe(Sole termination, NEW RESIDENTIAL EL[CIR _SQ.fT. STORIES TYPE CONSTRUCTION a3,-, will drthewons and the he Cialsl is License La it., apply 0044,Business and Professions Cade:g1Te Cnnwnor's License Law tlecs not apply to an owner of propertywhobuildsurimproves there0n,andwhodoes such work himxlforthriugh his OCCGROUP RFS.UNITS own employees,provided that such improvements arenot inrcndedoroffered farsale.If, however,The huilJing(ir improvement is.sold within one year ol'completion,the owner- 101AL' sale.). bwill have the burden of proving that he did not build orimprove for puapox of ❑ Las owneroOhe property,amexdusivdycontracting with licensed contractors to QTY. PLUMBING PERMIT FEE, FLOOD_ZONE qpN construct the project(See.9044,Business and Professions Gade:)The Conmictore License Law does not apply w arrownerofproperty whobuildsorimproves Thereon,and PERMITISSUANCH whnamtrectsforsuch projects with aconmicmr(s)licensed pursuant to Be Committers ALTER WATER Els License Law. ( ) FEESUMMARY ❑ 1 nm exempt undo,Sec. ,B&P C for this reason BACK FLAW PROTECT.DEV ICE '1.TDF.PEh. SANITARY Y N Owner Dam— DRAINSRECEIVI'k WORKMAN COMPENSATION DECLARATION -FLOOR,ROOF.AREA,CONU. SCHWLTAX Y N_ ❑ I hereby affirm that l have a cmErate ufeonxmmself-insme,nru eerificam of FIXTURIS-PER TRAP RF.CF.IVI'p Wrnkers'Compensalien lnsuranceorpcenifiedcopy lhereof(Su.3gW,Lab CJwhich PARK FEE YN covers all employee's under this peanut. GAS-EA.SYSTEM-]INC.4 OUTLET'S RECEIPT'4 Policy# BUILDING DIVISION FEES Company GAS-EA.SYSTEM-OVER4(ITA) PLANCHECK FEE ❑ Cenified copy is hereby famished. ❑ CenifieJ copy is fled wish the city insprelion division GREASE/INDUSTRL WASTE INTERCEPTOR GRADING FEE CERTIFICATE OF EXEMPTION FROM WORKERS' ORGSETRAP SOILS FEE COMPENSATION INSURANCE (This aeclumareedmm Mcompleted ifthe permit is intone hundreddollars($IW) SEWER- NITARY.STORM E- .I001T. a � ENERGY FEE or less.) I certify that in the performance of the work for which This permit is issued.lshall WATER HEATER W/VENT/FI,ETI'R not employ my person any manner in as m become subject m the Workers' PAID z Cnmpensmiou Lawsof Celifomia. Data WATER SYSTEM/TREATING Dam ReecipTp O O Applicant NO'I'ICE'I0 APPLICANT:If.after making this Certificate of Exemption,you should NEW RESI DENTIAL PLMEL SQ.FT. TOTAL: p) became subject to the Workers Compensation provisions of the Labor Code,you must a ; forthwith comply with such provisions or his permit shall lx demes!revoked. BUILDING FEE aQ CONSTRUCTION LENDING AGENCY SEISMIC PER Z I hereby affirm bar the.is a conswchum lending agency for the performance of T F1f:CfRIC f12 U O the work for which this permit is issued(See.3091,civ.C.) Tinder's Name handers Addms,_ Z11 TY. MECHANICAL PERMIT' FEE PLUMBING FTE. U I certify That 1 have on p kation end sat that the ebov ,enation is T cmpaxu.lagreco na loc wit amlcounlyo ncesuw ndzt saelalingto PERMIT ISSUANCE MECHANICAL FEE laiddingeonetruc' a It flamiz r its lativesofthis ' to enter upon the CONSTRUCTION TAX U above-menti, per or pectin n a. ALTER OR ADD TO MECH. 1 gre 05 in ni fy e re barMess the of Cupertino against liebi' s,ju rnndespen. chmey inan cmeeguinsT said Ciry AIR HANDLING UNIT(TO IO,Wp CFM) in nsey ce eg ingofth' AIR HANDLING UNIT(OVER I(I,OW CPM) S' alure o Applicant corrector Date FXHAUSTHOOD(W/DUCT) PAID HAZARDOUS RIALS DISCLOSURE HEATING UNIT(TO 100,000 BTU) Date Receipt as Will me,plicam mfutmelool ' goccupantawre orhandlehaurdous materiel HEATING UNIT(OVER 100,000 BTG) TOl'AL: as defined by the Cupertino Mudd, Code.Chapter 9.12,and Ne Heath and Safety CINe,Semina 25532(n)^ 11 Yes 1:1 No VENTILATION FAN(SINGLE RESID) es IE Will tai,connotations sbuilding by themme Arco Aemt Quality Management BOILER-COMP(3HP OR 100,050 BTU) ISSUANCE DA hpamdous air comnminums M defined by The Bey Area Air Quality Management District? BOILER-COMP(OVER 100,000 BTU) PAID❑Yes ❑No NEW RESIDENTIAL.MECH.—SQ.FT. R A I D 1 have read the hazardous materials requirements under Chapter 6.95 of the �� California l lmdTh&Safety Cede,Sections 25505,25533.,125534. 1 understandlhoT A' Ogs ��� occupant of t e re,umarmret which must he h Thep o is my nuance bf a Ce nficat Ne 'Y Fj y Occupant n(Ille 2quiRmenTs which moil be TCI pllOr In issuance of a Cenl(Ic81e of Dcanpancy. Owner or eutlnoriud.genu Dam TOTAL: ISSUI3D BY: OF � . .01 PERMIT P-15300 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 .3.5 7 Page 12 Parcel O/ O Date--,) 04 e 7 3 , 1993 Property Owner: 1y ,j Mailing Address: ///I c n n e I Z• •�' //t o )len (If different) 2 ! e) I II r-a-- Telephone: 6w pp/,^ n>1 y , LA 95014 Sirs: (I/We), being the owner(s) (owner's agent), hereby make application for connection of the property at: 12 OGJ? 5ct v+ Few rno n Jv C41 Cy y24,y f1 rI v 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). II 3. To acquire a Plumbing Permit from the G of 6.1 ee-V in h D Building Department and obtain inspection and approval by said Building Department• rior 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: $ Sewer Service charges to June 30, 19eI�i,$�SQD /mo.x I mo.: $ I S Inspection Fee for backflow protection device: $ // Considerations and Restrictions of this Sanitary Sewer Connection Permit with attached Exhibits (when noted), are hereby agre' ed to and acknowledged by the undersigned Owner(or Owner's Agent). Failure to comply will void As perm t. , Acknowledgment:" <✓ Owner's Agent: (print name) 1 S Receipt of$ L/ 2 ::E-0 acknowledged and permit granted. MARK THOMAS &CO., INC., District Manager-Engineer by:: Note:See Details on other side of this permit. i TYPICAL CLEANOUT FOR LATERAL SEWER Distance from Property Line to be as close as practicable, ar not to exceed five(5) feet. J T Removable Cleanout Plug n 0 0- Finish Grade Wye for Riser , Sewer Cleanout Box with Lid to be accessible and maintained by property owner. Short length Riser Pipe Adaptor coupling /8 Bend Laleral Sewer House Sewer Laleral Sewer slope House Sewer slope determined by District 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. 0 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 s INSTALLATION Juristli<lianol RWrictiov Accepted By All Jurisdictions FIGURE I FIGURE Z FIGURE 3 Installed Bemw Grade Installed Below Grade Installed Above Grade Shawn Betneen Street Right-at-Way and Building Shown At Process Line Cleanout Shown Adjacent To Building . Require. Regular Maintenance u, Require, Minimum Maintenance Requires Minimum Monononce J Valve To Be Removable Valve Should Be Removable > VALVE 4LCE55 BOX FINISH FLOOR w with/Vented Lover a °al al Fj�iSM[yp9-R KELLY VALVE e 1 A inion Grada Nf VALVE ACCESS BOX KELLY VALVE ](7� Finish Grade IRMIln Grade F n � Gi n BACKWATER VALVE FLOW q t FLOW ET' .0 FLOW e 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 Devlce 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. •