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1785 roll CITY OF CUPERTINO IIppff� PERMIT NUMBER APPLICATION FOR RESIDENTIAL BUILDING PER7VhIT X785 AND FOR APPLICANT TO FILL IN CERTIFICATE OF OCCUPANCY ?All BUILDING INSPECTION DIVISION STREET A.%RFS AnthonPy lace ..... s . Legal Description: Tract.. .6551........ Block......... Lot 15..... ....... Plans ReceivedDescription of Work: .. solar... erm3 t....................... ............... ... y....................................................Date ......................... p......................................................... RPO.; Plans.... Survey.... Calcs: Struc..... Energy.... Elect..... Mech.... 1st Struct. Improvement on Parcel:Yes.... No... Area of Bldg............... Plans Checked By....................................................Date ......................... Separate Structure...... or Addition/Alteration to Exist. Bld Application A P - g........... PProved BY.......................""................Date ......................... No. of Stories................ Use of Building .................. ............................... Validated By..................................................._.........Date ...... ---------- Valuation of Project: $._._......... Oompensation Certificate Verified By ......_......... Date ......._.... --- ... .. . - Phone:....... ....... .................... ....._.... Owner: . ........................_........... . .._...................._....... Phone::.................... • • •• • Contractor:BAS..HOMES„ .JNC................_City Bus. Lic. # .............. $ Contractor's Address: _.................._.............._.......... Phone:.................... Permit Fee (plus penalty If applicable) 24 60 Contractor - Electrical: .........._....__..........._..........._..._..............._......_. lP P e t o ) -.Ret..#...........$........a............' City Business License #...___......_.. Phone:.................... Plan Check Fee (less deposit of$.......... Rct. #..........)$...................... Energy Plan Check Fee (Dep. of $........ Rct. #........) $................ Plumbing: ..............,....................................................................... Strong Motion Fee ... .................................................$............,J�D City Business License 0.................... Phone:................... Heating and Cooling .......................................................... Plumbing Permit Fee ................................................$.... .. .... ....... y Electrical Permit Fee ......................................................$....................... Cit Business License x.................... Phone:.................... ArchitectDesigner: .._......... ......_........._................. Phone:.................... Mach. Ht9./Cool9. Permit $............................. $....................... Engineer:: ... Phone:.................... Residential Construction Tax ........................................$....................... ..... ......................................................... Misc. Fee $....................... Lender: . .. ,. ..... __......._..... ....__..................................... ❑ Unknown ........................................................................ . "i certify that in the performance of the work for which this permit Is ISC. Fee ..............._......................_............................._ . ......... issued I shall not employ any person In any manner so as to become subject s • $24.SQto the workman's compensation laws of California.” SIGNATURE OF • • APPLICANT/OWNER ..........................___........................_............. DATE........................ • Environmental Status: Exempt ............ Other........................................ . ..... "I rortity that as the applicant I am licensed unde- the provisions of the Design Review Approval: Bldg. ............ Site ....... .... Sign ............ Contractors License Law and further that my Users, No. ............................ Use Zone ............ P.D. Conditions ........._................................_............. In Classification ...... ................ Is in full force and effect: or Cond. Use Permit #._.._..... Variance ... 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 state that the above Is correct and agree to comply with all City Ordinances and State Laws regulating • • building, I (We) agree to save, Indemnify end keep harmless the City of Cupertino ' CrOaChme01 Permit.................._... Grant Of Eaaeme0l.........-_.........._ against liabilities, judgments, costs and expenses which may In any way b, Gutter, Sidewalk, Driveway: Replace.......... Repair.......... accure against said City in consequence of the granting of this permit." war............ Conn. Fee $................ Water................ Meter $................ SIGNATURE OF Agreement for Completion of Public Works Improvements .... APPLICANT/CONTRACTOR ....................................................... DATE ........................ Plans Checked By.... Date........ Approved By........ Date.................... NOTE: When properly validated this form constitutes a Building Permit. 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 abandoned for a period of 120 days after work is commenced. PERMIT INSTALLATION NO. EACH FEE Light Outlets............ Switches............ APPLICATI• •- PLUMBING Fixtures............ Receptacles............ PERMIT INSTALLATION NO. EACH FEE TOTAL NUMBER (less than 1000 watts) ............ $ ,50 -. Gas System with up to 5 outlets .................................$4.00 ............. s Range........ Cooking Unit........ Oven......._.. ................ 2.00 .............. Each additional outlet ............................................. 1.00............... Dryer........ Garb. Disp......... Dishwasher ............. ....... 2.00 .............. Water System (Installation, Alt. or Repair) ................. 4.00............... MOTORS: 1 HP or less ................................................. 2.00 . ............ Water Closet.... Water Heater.... Ld. Tray..................... 4.00. ............. f Greater than 1 HP not more than 5 HP ....... ....... . 3.50 .............. Lavatory.... Shower Pan.... Bathtub.... Sink................... 3.00............... Temporary Power Pole or Service — 100 amp ........ ..5.00 .............. Wash. Mach..... Dishwasher.... Garb. Disp..... ............... 3.00............... —200 amp........ - 7.00 .............. Sewer ............................................................................... 8.00............... Time Clock .............................................................. ......... 1.50............... Lawn Sprinkler Sys. $5.00 Ea. add Sys. $2.00......... ........... ............. Misc. (nee Ord. current)...................................................... Vacuum Breakers ............................................ ..............3.50.............. New Residential Occupancies Flat Rate Interceptor........ Water Softener......-- .............................4.00. ............ Plumbing Piping without fixtures ...................................4.00 ............. 0-500 sq. ft. $22.00 1501-1750 $34.50.............................. Misc. (See Ord. Current) ......S0.1a.T...p.2X •.t....4..A6..........• 501-750 24.50 1751-•20000 37.50.............................. permit Fee 751-1000 26.00 2001-2250 39.50.............................. ..........................................................................$ 6.00 1001-1250 28.60 2251-2500 42.00.............................. TOTAL PLUMBING PERMIT FEE (plus penalty I1 app. ❑) If10.00 1261-1500 32.00 2601-2750 49.50.............................. APPLICATION Permit Fee...............................................$6.00 TOTAL ELECTRICAL PERMIT FEE (Plus penalty If app.p) $ PERMIT INSTALLATION NO. EACH FEE Forced Air Unit..................to 100M .............................-$ 8.00............... • • • • r over 100M .......................... 10.00.. ........... Forms / Foundation ._.._...................... By:........ ..... - Date:. Comfort Cooling Unit......to 3 ton/HP ........................... 6.00............... .............. to 15 ton/HP......................... 9.60.._,......... Plumbing Ground Work . .................... ..... ..........I—.............___.._....... to 30 ton/HP.......................... .12.00. ............ RoughElectrical ......._._..........._.-._...... __............. ........................ g ...- .... ... to 50 ton/HP...........................17.00.. ........... AlIfirame - Plumbing and Heating ..........I......................... ........................... Space Heater........ Wall Heater .................................. 6.00.............. fallen & Energy.............................. ......................... ........................... Flues - other than above ...........................................I_ 3.00.. ...,........ Test ................................. .... .. ........ ........... ... ......................... Vent Fan: Kitchen........ Bath ....................._................ 3.00............... Temporary Power Gas / Elect. .................................C........................... Commercial Range Hood 6.00„-.....,,,,,,, ' Final - Electrical ........... .......................................... .. ........................ ......................... .......................... Misc. (See Ord. Current........................................ ..........,....................... Final - Building /Mechanical ................................................................. Permit Fee ........................................................................ $ 6.00 Final - Design Review / Landscaping . ... _............ . Final-Public Works n............ ... .... .............._.......... TOTAL Htg./ Coolly. Permit Fee (plus penalty if app. p) E o�,,.�................r ...............