14080212 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 22168 ORCHARD CT CONTRACTOR:ABLE SEPTIC PERMIT NO: 14080212
OWNER'S NAME: YUAN MICONG AND ZHANG LEI P O BOX 24819 DATE ISSUED:08/20/2014
OWNER'S PHONE: 4087722988 SAN JOSE,CA 95154 PHONE NO:(408)377-9990
❑ 4tha
SED CONTRA TOR'S DE L T JOB DESCRIPTION:RESIDENTIAL F] COMMERCIAL
10 ABATEMENT OF SEPTIC TANK,CONNECTION
License ClLic.# PROPERTY LINE
Contractor Date
I hereby alicensed under the provision of C pte
(commencing with Section 7000)of Division 3 of the Business&Professions
Code and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a certificate of consent to self-insure for Worker's
ompensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$8000
have and will maintain Worker's Compensation Insurance,as provided for by
ection 3700 of the Labor Code,for the performance of the work for which this APN Number:32617055 00 Occupancy Type:
p :
ermit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERNLI'180
IBES IF RK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WIT DAYS OF E IT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enterupon the above mentioned property for inspection purposes. (We)agree to save 180 DAROM L CALLED INSP CTION-
indemnify and keep harmless the City of Cupertino against liabilities,judgments, J /
costs,and expenses which may accrue against said City in consequence of the Issued by: Date: C�
granting of this permit. Additionally,the applicant understands and will comply
with all non-point sourc regulations per the Cupertino MuWtion
9 18.
RE-ROOFS:
Signature Date All roofs shall be inspected prior to any roofing material being installed.If a roof is
installed without first obtaining an inspection,I agree to remove all new materials for
inspection.
❑ OWNER-BUILDER DECLARATION Date:
Signature of Applicant:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code)
1,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. I will
I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with the Cup rtmo Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by
the Health&Safety Code,Sect' n 05,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agen Date
permit is issued.
I certify that in the performance 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 Worker's CONSTRUCTION LENDING AGENCY
Compensation laws of California. If,after making this certificate of exemption,I
become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
APPLICANT CERTIFICATION Lender's Address
I certify that I have read this application and state that the above information is
correct.I agree to comply with all city and county ordinances and state laws relating
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9 18.
Signature Date
CONSTRUCTION PERMIT APPLICATION ( ,�1T
COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION �v
10300 TORRE AVENUE-CUPERTINO,CA 95014-3255 1 b
CUPERTINO (408)777-3228-FAX(408)777-3333-building(Mcuaertino.org \
❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TT ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROJECT ADDRESS 2. `I �G � ��J�� APN# /� /w I /��
OWNER NAME�IV� I�CQ l Yo`—VN PH*8�1/9. -2"LJ�i�t!/ EMAIL
STREET ADDRESS nl Y� r Nj� T CrI`Y, STATE,ZIP n � e1`,r FAX
CONTACT NAME•L PHONE ` E-MAIL/
STREET ADDRESS CITY,STATE, ZIP FAX
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME ly� �` LICES^A�,UMBFj /7sr241;.-
COMPANY
BUS.LIC#
NAME 'r`V`�--- �/ fi- `MAIL—t `� `V!� `�-- , L(�t/L FAX`S Q$1 (�D
STREET ADIR62.., r UI(+�,_ CITY,ST �� ()S C I C> -S77-
77• � Vi D
ARCHITECT/ENGINEER NAME I(� LICENSE NUMBER l BUS.LIC# J
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK ,l A,
EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES
USE TYPE OCC. SQ.FT. VALUATION(�)
EXLSTG NEW FLOOR DEMO TOTAL
AREA AREA AREA NET AREA
BATHROOM KITCHEN OTHER
REMODEL AREA REMODEL AREA REMODEL AREA
PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: HDETACH
ATTACH
#DWELLTNG UNITS: IS A SECOND UNIT El YES SECOND STORY []YES
BEING ADDED? ❑NO ADDITION? ❑NO
PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RECEIVED BY`. TO'�,V,(tL ATIO
PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? E]NO
ol/`/Jl `/JI
By my signature below,I certify to each of the f flowing: I am the property owner or authorized ager on the p operty owner's behalf. I have read this
application and the information I have ro 'd is correct. I have read the Description of Work erify it is acc. . I a e to comply with all applicable local
ordinances and state laws relatin to o s . I authorize representatives of Cupertino to en er a od Ado ti ed property for inspection purposes.
Signature of Applicant/Agent Date: �I1[///
SUPPLEMENTAL TION REQUIRED PLAN CHECK TYPE ROUTING SLIP
_New SFD or Multifamily dwellings: Apply for demolition permit for OVER-THF-COUNTER ❑ BUILDING PLAN REVIEW
existing building(s). Demolition permit is required prior to issuance of building
permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS
form if any Hazardous Materials are being used as part of this project. :0 rARGE ❑ DEPT
_Copy of Planning Approval Letter or Meeting with Planning prior to
submittal of Building Permit application. ❑ MAJOR ❑ SANITARY SEWER DISTRICT
❑ 'ENVIRONMENTALHEALTH
B1dgApp 2011.doc revised 06121/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 22168 orchard ct DATE: 08/20/2014 REVIEWED BY: Mendez
APN: BP#: *VALUATION: $8,000
*PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition / Repair
PRIMARY SFD or Duplex PENTAMATION
p 1 RPSS
USE: PERMIT TYPE:
WORK abatement of septic tank connection property line
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Sewer, Sanitary 1PRSEWER 1 # $25
TOTALS: $25.00
,
Plumb.Plan Check 0.0 hrs $0.00
./arJ;. i'<>rmil Fee: Plumb.Permit Fee: IPPERMIT
F 17 T
Other Plumb Insp. 0.0 hrs $48.00 01""R r°f rt ..' s . Li
1>i'ind). hasp. /;eco. 11"ec lnT
NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc. . These fees are based on the prelimina information available and are only an estimate. Contact the Dept-for addn'l in o.
FEE ITEMS (I ee Resolution 11-053&....711113) FEE QTY/FEE MISC ITEMS
FA
PME Plan Check: $0.00
PME Unit Fee: $25.00
PME Permit Fee: $48.00 T_7�
Administrative Fee: 1ADMIN $45.00
Work Without Permit? ® Yes (F) No $0.00
Travel Documentation Fee: ITR,4VDOC $48.00
Strong Motion Fee: IBSEISMICR $1.04 1.0 hrs Inspections
Bldg Stds Commission.Fee: IBCBSC $1.00 $143.00 ISTINSP Inspection,Hourly
r
_ $168.04 $143.00 TOTALFEE: $311.04
Revised: 07/10/2014
DISTRICT MANAGER-ENGINEER c� BOARD OF DIRECTORS
MARK THOMAS&COMPANY,INC. v WILLIAM A.BOSWORTH
RICHARD K.TANAKA JOHN M.GAT-17
DISTRICT COUNSELF �o STEVE C.ANDREWS
ATKINSON FARASYN,LLP. Sr'9B j S H ED , . WENDELL H.KERR,JR.
HAROLD S.TOPPEL ANGELA S.CHEN
20863 STEVENS CREEK BOULEVARD,SUITE 100
CUPERTINO,CALIFORNIA 95014-2154
(408)253-7071 PHONE•(408)253.5173 FAX
www.cupertinosonitarydistrict.org
August 20, 2014 File: CSD—MOP #14-324
Building Dept.—Cupertino
City of Cupertino
Attn: Building Department
10300 Torre Ave.
Cupertino, CA 95014-3202
Subject: Septic to Sewer Appir(ftived For Tesoro
Name: XXX Residence Building/
��� ��
Address: 22168 Orchard Court, CupertinoPermits
APN:' 326-17-055
Permit No.: NA
The Cupertino Sanitary District has reviewed the plans for the subject project:
■ Sanitary sewer is available and the existing building is NOT connected to sanitary sewer,
see conditions/requirements listed below.
The following Conditions/Requirements are made:
• Install new property line cleanout or locate and raise to grade an existing property line
cleanout. Property line cleanout must be within 5 feet of the property line.
Cleanout shall be the same diameter as the street portion of the service lateral.
Gravity lateral is 4" diameter minimum. (O.C. 4101)
• District inspection is required prior to clearance for City of Cupertino Final
Inspection: Owner to call District at least 48 hours to schedule District inspection.
District to provide Building Department with written notification upon completion
of inspection. (O.C. 5104)
SUPPLYING SANITARY SEWERAGE SERVICES FOR:CITY OF CUPERTINO,PORTIONS OF THE CITIES OF SARATOGA,SUNNYVALE,LOS ALTOS AND SURROUNDING UNINCORPORATED AREAS