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1282CITY OF CUPERTINO APPLICATION FOR RESIDENTIAL BUILDING PERMIT AND • CERTIFICATE OF OCCUPANCY BUILDING INSPECTION DIVISION Plans Received By .................................................... Date ......................... RED.: Plans.... Survey.... CaIcs: Struc ..... Energy.... Elect..... Mach.... Plans Checked By ................................................. . .... Date Application Approved By --------4,...x ......... Date ValidatedBy ................................................ ............. Date ........................ Compensation Certificate Verified By ................. Date ......................... s Permit Fee (plus penalty if applicable) ........................ $-10 ............. Plan Check Fee (less deposit of $ .......... Rol. #..........I $ ....................... Energy Plan Check Fee (Dep. of $........ Rot. #........) $ ............. Strong Motion Fee .................................................. $..........5........... ............. Plumbing Permit Fee ... ............ $............... ....... Electrical Permit Fee .................................. $....................... Mach. Htg./Coolg. Permit.$ ....... $ ....................... Residential Construction Tax ....... E:.'-.:. : ........... $ ....................... Misc. Fee ................................................................. $ ....................... Misc. Fee ...........................................7.....•x....1.... . J $.......---............. $ /0, Sze En,ilronmental Status: Exempt............ Other ........................................ Design Review Approval: Bldg ............. Site ............ Sign ............ Use Zone ............ P.D. Conditions ............................................................ Cord. Use Permit r............ Variance #............ Parking Spaces............ ApprovedBy ........................................................... Date ............................ Gliachment Permit ........................ Grant of Easement........................ Gutter, Sidewalk, Driveway: Replace.......... Repair.......... er ........... Conn. Fee $ ................ Water................ Meter $................ Agreement for Completion of Public Works Improvements .................. Plans Checked By........ Date........ Approved By........ Date .................... PERMIT INSTALLATION NO. EACH IFEE Light Outlets............ Switches............ Fixtures............ Receptacles............ TOTAL NUMBER (less than 1000 watts) ............ $ .50 .. ............ Range........ Cooking Unit........ Oven ......... .. ......... ...... 2.00 .............. Dryer........ Garb. Disp ... ..... Dishwasher ..................... 2.00 .............. MOTORS: I HP or less ....... ..................... __ ........ ...... 2.00 ----- Greater than 1 HP not more than 5 HP ............... 3.50 .............. Temporary Power Pole or Service 100 amp . ...... ..5.00 .............. 200 amp .I........ 7.00 .............. TimeClock ................................................ ................... 1.50 ... ............ Misc. Mcurrent ,...................................................... RFwRe,12Fniik1 Occupancies I ate D-600 sq. ft. $22.00 1501-1750 $34.50 .............................. 501-750 24.50 1751--20000 37.50 .............................. 751-1000 26.00 2001-225C 39.50 .............................. 1001-1250 28.50 2251-2500 42.00 .............................. 1251-1600 32.00 2601-2750 49.50 .............................. Permit Fee ...............................................$9.00 TOTAL ELECTRICAL PERMIT FEE (Plus penalty If app.0) $ Forms / Foundation ...... ............. . .... _1 By:- .......... Plumbing Ground Work ..................... I., .................... . .... Rough Electrical .................. ___ ........... - - 'Ne - Plumbing and Heating .......... o4l L ..'Ion & Energy ............................... ........................... WTest - ......................... * ........................... porary Power Gas / Elect . :.s..: ................... - ...... Final - Electrical .................... ........................... Final - Building / Mechanical ....... - ................. Final - Design Review / Landscaping ...... - .... ............. Final -Public Works ...... dL1 PERMIT NUMBER FOR APPLICANT TO FILL IN STREET ADDRESS OF P CT vot&-s ........ Ze. ................................... Leo'Cescription: Tract.. loc4r,.. ......... I ...................... . Description of Work: ....................... - ...................... ......................... ............................. - ..................................... 1st Struct. Improvement on Parcel: Yes.... No.... Area of Bldg ............... Separate Structure............ or Addition/Alteration to Exist. Bldg........... No. of Stories..... I .............. Valuation Oj .... .......... wOwner:.... o7/.. ........ Phone ... Contractor:7 r.. .... I Bus Lic7�Contractor's L*2.)2..///7"94PhonM. Contractor - Electrical:..,......__ _................... __ ................................... City Business License # .................... Phone:.................... Plumbing: .................. ............... .............................................. City Business License #..... ............... Phone:.................... Heating and Cooling .......................................... ............. ........ City Business License #..........._...... Phon: .................... Architect/Designer:................ - ...... ........................ Phone:.................... Engineer: ........ __: ...................................................... Phone:.................... Lender: . .. .......... ................. ...................................... .. .p Uni�rl "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 workmen's compensation laws of California." 51UNATUHt OF APPLICANT/OWNER .. ........... .............. ............................................. DATE........................ "I certify that as the applicant I am licensed unde- the provisions of the Conractofs License Law and further that my Ucens, No . ............................ in Classification ........................................ Is in full force and effect: or Icomity that I am exempt from the "Licensed Required" provision of the Contractors License Law. (State basis of exemption.) I hereby acknowledge that I have read this application and state that the above Is :orrect and agree to comply with all City Ordinances and State Laws regulating building, I (We) agree to save, Indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs in any way City and expk"!"28 wthino'.Toy occurs against said Cit I consequence of an a in Is permit." SIGNATURE OF, APPLICANT/CON OAT NOTE: When properly validated This 1 conslit to$ a Building a L This permit expires and becomes null and void should work not be commenced within 120 days from validation date, or should authorized construction be suspended or I abandoned for a period of 120 days after work In commenced. APPLICATION FOR PLUMBING PERMIT PERMIT INSTALLATION NO. EACH _FTff_ Gas System with up to 5 outlets ....................... ........ .. $4.00 . .............. Each additional outlet ................................... ........ .. 1.00............... Water System (installation, Alt. or Repair) ....... ........ .. 4.00 . .............. Water Closet.... Water Heater.... Ld. Tray ........... ........ .. 4.00• .............. Lavatory.... Shower Pan.... Bathtub.... Sink......-........... 3.00..........._. Wash. Mach..... Dishwasher.... Garb. Disp ..... ..... ........ .. 3.00 . .............. Sewer..................................................................... ........ .. 8.00 . .............. Lawn Sprinkler Sys. $5.00 Ea. add sys. $2.00 .................................. Vacuum Breakers .......... ................ 3:11: ­:::::��::::::_.:: :::::::: 00 ...... Interceptor........ Water Softener ........ ::::4 Plumbing Piping without fixtures ...................................4.00• .....;••..... Misc. (See Ord. Current) ......................... II I ........................... PermitFee .......................................................................... $6.00 TOTAL PLUMBING PERMIT FEE (plus penalty If app. 0) if - s FOR HEATING/COOLING PERMIT - - - - I PERMIT INSTALLATION NO. EACH IFEE I Forced Air Unit .................. to 100M ................. _...........$ 6.00 ... ............ over100M ....................... . . 10.00 ............. Comfort Cooling Unit...... to 3 ton/HP ................. ......... .. 6.00 ... ............ to 15 ton/HP ......................... 9.50 ............. to 30 ton/ HID ................. ......... .. 12.00 .............. to 50 ton/HP ................. ......... .. 17.00 .. ............ Space Heater........ Well Heater ................................... 6.00 Flues - other than above .............................................. 3.00 Vent Fan: Kitchen........ Bath ...................... 3.00 ... ............ Commercial Range Hood .......................... 6.00 ............... Misc. (See Ord. Current ................................................ ............ ............ PermitFee ............. : .......................................................... $ 6.00 TOTAL Htg./ Coolg. Permit Fee (plus penalty It app. I