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1305 CITY OF CUPERTINO APPLICATION FOR RESIDENTIAL BUILDING PERMIT PERMIT NUMBER 130j- AND APPLICANTFOR CERTIFICATE OF OCCUPANCY BUILDING INSPECTION DIVISION STR ET ADDRESS OF PROJECT: (Jot IS.._...Antho.ny...P.lac.e......._........................................... r • Legal Description: Tract......65S1-..... Block............ Lot.......15.......... ''// oescrIptIon o1 work: ....._Single._FatoiIy...DwelIi.ng..........— Plans Received B .H...... Date .... ..1.. ........................................................................................................................ RBO.: Plana.... Survey.... Carya: Struc..... Energy.... Elect..--- Mach.... fat Struct. Improvement on Parcel:Yes.X No... Area of BIdg2.89.8H.. Plans Checked By................i/-H.......................Date .... ./.............,,,..rrr,.... Separate Structure- NO... or Addition/Alteration to Exist. SIdg.S7.0G Application Approved By........._. 9,..4.1..............Data . jal�S/. No. of Stories....._2....... Use of Building _Residential... --......... Validated By........................._......... .._..... Date .../.. .. ../._.. .. Valuatio P 'act: $.123., 90 ... Obmpensetion Certificate Verified By .. . .. . Date ...C�.ol . .rte. t, Mgs.l. Inq,.._ ­252­2977... H�/.. �. Owner: .__.... Phone..... Contractor: ....BAS..Homes,,._Inc.......__-Cit Bus. Lic. wL1.Ob1 • $123.000 Contractor's Address: 20823..Stevens..Crk. Phone%.2.52-.2.0.7 Permit Fee (plus penalty if applicable)•....:.:.:.._.....:....$.......32.1...50 Contractor - Electrical: .The,..Best...Electrical...Co............... Plan Check Fee (less deposit of$.......... Rct. #.........J$._.................. City Business License 1'...1817.2.... Phone:..28.7. .2.04 Energy Check Fee (Depof $. Rot: #........ $.__.................. Plumbing: ....Crowley-CO.... Strong Motion e .. . : ...., J.......... ......................_....._......... $..._.......B...6.1 City Business License «..1664.1..., Phone:.245-424 Plumbing Permit Fee ..._...........................................$..._.....8{ QQ Heating Cityand Cooliiness LgNc�eAe.Boyer-CoPhone:....792-.432 Electrical Permit Fee ......................................................$..........SS..,5V 9 Architect/ : N i. .. Mach. Htg./Coolg. Permit $............................. $..._.....33...00 - g ..............ho unknown Residential Construction Tax ............................_..........$-..........._....... Le moor. Well .SOm sankt�........ P.....09.Unknown ...................... LendeDeWenelr'S..theporlCOrmBeoce)alma gor9k�lor�whicnihlelpermlt5ls 8924 Mist. Fee ........................................................................$. ertify at in Misc. Fee _.......... ............. ...._............................._........$--.................... issued I shall not employ any person in any manner so as to become subject ONEEMEB7, $ 504.61 to the workman's compensation laws of California." SIGNATURE OF •TWEN-VIETTI117M APPLICANT/OWNER ......... ..................................._................... DATE........................ Environmental Status: Exempt.........- Other.__..............._................. ..... I certify that as the applicant I am licensed uncle' the provisions of the Design Review Approval: Bldg. ............ Site ............ Sign ......-.... Contractors License Law and further that my Licens. No. ............................. Use Zone P.D. Conditions in Classification ..... --............. .......-. is in full force and effect: or Cond. Use Permit +k............ Variance +M............ Parking Spaces............ - I certify that I am exempt from the "Licensed Required" provisions of the Approved By. Date Contractors License Law. (State basis of exemption.) """"'""-"""""""'"-""""""""""""""""""" "-'""'""'-"-"-""'""-'"- I hereby acknowledge that I have read this application and slate that the above Is s s :orrecl and agree to comply with all City Ordinances and State Laws regulating bulldog. IWe) agree to save, indemnify and keep harmless the City of yCup ,.t.t Oroachment Permit........................ Grant Of Easement......................., against liabilities, judgments, costs antl expenses which may warb, Gutter, Sidewalk, Driveway: Replace.......... Repair.......... acture against said Cit i consequent of the granting of thi .ewer............ Conn. Fee $................ Water................ Meter $................ SIGNATAgreement for Completion of Public Works Improvements .................. APPLICANTicoeraac _.F�. .. . DATE .Plans Checked By....... Date........ Approved By........ Date.................... NOTE: When properly validated this form constitutes a Building This permit expires and becomes null and void should work not be commenced within APPLICATIONs 120 days from validation date, or should authorized construction be suspended or abandoned for a period of 120 days alter work is commenced, PERMIT INSTALLATION NO. EACH FEE APPLICATION FOR PLUMBING PERMIT Light Outlets............ Switches.......... . Fixtures............ Receptacles............ PERMIT INSTALLATION NO. EACH FEE TOTAL NUMBER (less than 1000 watts) ............ $ .50 ............ Gas System with up to 5 outlets ............1.......... .....$4.00 .-. Range........ Cooking Unit......._ Oven............ ................ 2.00 .....-...... . Each additional outlet ............-.............................. 1.00...............Ict Dryer........ Garb. Disp......... Dishwasher ............. ...... 2.00 .............. Water System (Installation, Alt. or Repalr) ..1.....1..... 4,00.....4...0 aj MOTORS: 1 HP or less ........................................ ...... . 2.00 • Water closet..4 Water Ffeater.l Ld. Tray...y.......6.... .. 4.00..24...QQ r Greater than 1 HP not more than 5 HP .............. . 3.50 .. ............ Lavatory..6 Shower Pahl-. Bathtub..3 Sink........ 1..... 3.00.33..90 Temporary Power Pole or Service — 100 amp .........5.00 ,,......__... Wash. Mach.l. Dishw Sher...l�-G+arb. Disp..... 1.....3..... 3.00. .,.9.-Q0 r 200 amp........ . 7.00 .. ............ Sewer ...A0 It I... O.�''.......................1.....1..... 8.00.....8...00 so Time Clock ..............-.................. .............. .................... 1.50............... Lawn Sprinkl r Sys. $5.00 Ea. add Sys. $2.00................................... Misc. (see Ord. current)...................................................... Vacuum Breakers ............................................ ..............3.50.............. New Residential Occupancies Flat Rate Interceptor........ Water Softener........ .............................4,00. ............ 0-500 sq. ft. $22.00 1501-1760 $34.50................. Plumbing Piping without fixtures ............1........ ..1........a.00..... 4...9.0 ............. Misc. (See Ord. Current) .................................................... 501-750 24.60 1751-20000 37.60.............................. Permit Fee ........................................... 751-1000 ' 26.00 2001-225C 39.50.............................. TOTAL PLUMBING PERMIT FEE (plus penalty if app. C)) j $6000 1001-1250 28.50 2251-2500 42.00.............................. 1251-1500 32.00 2501-2760 49.50........2$98.............. APPLICATION . HEATING/COOLING PERMIT PermitFee....................................:..........$6.00 00 TOTAL ELECTRICAL PERMIT FEE (Plus penalty if app.0) $ PERMIT INSTALLATION NO. EACH FEE 55.50 Forced Air Unit..................to 100M .......................2.....$8.00.....1 ..0 f INSPECTION RECORD over 100M ........................ . 10.00.. I........... Lip Comfort Cooling Unit......to 3 ton/HP ........................... B.00,_ ........_. Forms / Foundation .......... -. .... .... �a�l�ee.. to 15 ton/HP.........................f 9.50.............. Plumbing Ground Work . .... ... ........- . . ;k.gD....... b ... ............ .. to 30 ton/H P...........................12.00...".......... Rough Electrical ........__........_.............. ... ...._ ........ .3r(,.c.L9.l..... 7 ams - Plumbing and Heating to 50 ton/HP................. ..........17.00.............. J g ..........1........................ .......................... Space Heater........ Well Heater ................................... 6.00.............. ulation & Energy............................. Flues - other than above ........................... .. 3.00.............. /�C ..................1 s Test ..............._._..........._ .. ..3 Vent Fan: Kitchen........ Bath .3......Dr. er...1._. ..5...... 3.00.....15.,.. ur .. ...... ......................... .................................... Temporary Power Gas / Elect. Commercial Range Hood y 6.00,,, , ff g .......................................... ........... Final - Electrical ..............ical................ I "w.^�I Misc. (See Ord. Current..................._........................... {+ Final Building/ Mechanical ............. ... ....... .J_..............{.._. Permit Fee -................................................_.................. $ 8.00 .) Final - Design Review i Landscaping . ... .......................................... TOTAL Htg./ Cooleg. Pee�r�mitt Fee (plus penalty i app. p) $33.00 Final- Public Works ................................G..../1•••.....:......... _ V 1 ^/1' �t `6fA T bs 3-6�- di0t9.•5"6 £ &Aflel war to• ( � ufi M. U �,b rr, SOCOM L»w ?.- St .6 1 �' R61JTF SLIP File No . Date S / Date pecto,, CITY OF CUPERTINO OFFICE COPY 1 GAS SERVICE NOTICE , tv To You are hereby authorized to connect the GAS service for Owner or Tenant At New Service 4- r No. of Meters Reconnect I No. of Add. Meters Move Service I Move Meter PLUMBING INSPECTORll� � ELECTRIC SERVICE NOTICE OFFICE COPY BUILDING INSPECTOR'S NOTICE CITY OF CUPERTINO 5i �D 19 To You are hereby authorized to Connect electrical service for Owner or Tenant ISA , A At VZ No.of Wires Size of Wires Size of Switch Motor Load Voltage Phase Heating Load K.W. Voltage / Light I10_New Service Reconnect No.of Meters _�_ Heat 120Three Wire More Service II No.of Add.Meters Power (/ — A Thfee Phase Move Meter 1 CSM ELECTRICAL INSPECTOR BUILDING INSPECTOR'S OFFICE Bldg.Dept. CITY OF CUPERTINO Office Copy t ❑ Backflow Device Sanitary Permit No. Sewer Connection - Plumbing Permit No. �3o I r / r� Plumbing Final Lot No. �S f 1 u Owner or Tenant AA-1� /J At / °tiJyI�TIfoNC f Tract Date Connected l- 198_/_DoteFinal 5^- "lu lcf�l I dM —� PLUMBI G INSPECTOR i CERTIFICATE OF COMPLETION BUILDING INSPECTOR'S OFFICE _ CITY OF CUPERTINO DATE 19&� BLDG. PERMIT NO. �30� I THE BLDG. LOCATED AT OWNED BY //�Q7 S /(JE I MPLETE C I HAS BEEN vR USE AS J• �- (ALTERED) i iO� i i -BUILDING INSPECTOR i