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1784 • CITY sUPPLEMETNTAL • CITY OF. CUPERTINO J�fd APPLICATION FOR RESIDENTIAL BUILDING PERMIT ')r111 PERMIT NUMBER �7b/ . AND FOR APPLICANT TO FILL IN CERTIFICATE AND OCCUPANCY ppl BUILDING INSPECTION DIVISION STREET 1822�SAt°honOJPlaca ................ -DEPARTMENT USE ONLY Legal Description: Tract.. 6551..... Block......... Lot.14.............. Plans ReceivedDescription of Work: _..... .. D.........................................Date ".........."._.""....... solar_permit............_._................... .... tr.u1.._....__.... .a. ...nt.........a....a1:-_...._........... .A....a. oI_.........".._.....".. RE .: ens.... Survey..." Celts:.Strut..... Energy.... Elect..... Mach.... 1st Strutt. Improvement on Parcel:Yes.... No Area of Bldg............_. Plans Checked By....................................................Date .......................". Separate Structure............ or Addition/Alteration to Exist. Bldg........... Application Approved By........................_..............Date ...._..."._.."."...".". No. of Stories...__........ Use of Building ValidatedB ...__.._....... _............................. By Date ........................ Valuation of Project: $............. .... .............____................_................ Compensation Certificate Verified By .................. Date ......................... Owner: ...... Phone:.................... NEMEZE • • . . $ • Contractor: ...BAS...HOMES-, INC.----.-City Bus. Lic. # .__......... Contractor's Address: ..... .._......................_.............. Phone:.................... Permit Fee (plus penalty if applicable) ..............._..._..44.'.80............ Contractor - Electrical: ................ Plan Check Fee (less deposit of$.......... Rct. #.........")$..._.................. City Business License #._............._. Phone:..............."".". Ener Plan Check Fee De of ) .__ Plumbing: ......i_ ........................................................................... 9Y .. Rot. #........ $.......__:.... ... Cit ' Business License #._._._...._.._. Phone:_.................. Strong Motion Fee ....._..........._.._".._."........-_................$....... y Plumbing Permit Fee Heating and Cooling ......_._..............._._.-.................................. Electrical Permit Fee .............................. ..._..........._.....$....__............... City Business License #.... ... ...... Phone:................... Architect/Designer: ....._... _ .............._._........._..... Phone:.................... Mesh. mill Construction Permit x ............................ $....................... Engineer: Residential Construction Tax ....._____.............._._.........$.........."............ .........-......._.........._......... ..._....._............... Phone:.................... Misc. Fee ........... ................ Lender: . .. ...__._........__.._... ....._..........._........_..._.._...... ❑ Unknown. Mise. Fee _ $ .._ "I certify that in the performance of the work for which this permit la ""' '"-"""'""".""""" """"""""'"""' issued I shall not employ any person in any manner so as to become subject • $ 24- 90 to the workman's compensation laws of California." SIGNATURE OF ZONING • APPLICANT/OWNER ............ DATE....................... \, . ......................................_............... Environmental Status: Exempt ...._..... Other............. _ ......... ...., I certify that as the applicant I am licensed undethe 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 Cord. Use Permit #..........-. Variance #,._........_ Parking Spaces............ I certify that I am exempt from the "Licensed Required" provisions of the Approved B Contractors License Law. (State basis of exemption.) pp y._......__..............................._....._...._ Date 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. ' iCf08ChmBnt Permit_ (Wei agree to save, indemnify and keep harmless the City of Cupertino ................._... Grant Of Easement-...................... against liabilities, judgments, costs and expenses which may In any way urb, Gutter, Sidewalk, Driveway: Replace.......... Repair.......... acture against said City in consequence of the granting of this permit." Sewer............ Conn. Fee $......__...... Water.............._ Meter $......... SIGNATURF OF Agreement for Completion of Public Works Improvements .................. APPLICANT/CONTRACTOR _._.._.................._.....................__. DATE ____.............. Plans Checked By........ Date........ Approved By........ Date.................... NOTE! when properly validated this form constitute* o Building Permit. This permit expires and becomes null and void should work not be commenced within APPLICATION • . ELECTRICAL PERMIT 120 days from validation date, or should authorized construction be suspended of r abandoned for a period of 120 days after work is commenced. 1 PERMIT INSTALLATION NO. EACH FEE Light Outlets........... Switches............ APPLICATION FOR. PERMIT / Fixtures............ Receptacles............ PERMIT INSTALLATION FN0. EACH FEE j TOTAL NUMBER (less than 1000 watts) ..... ....... $ ,5o ...... ..... Gas System with up to 5 outlets ....................... ..$4,00. ............. Range........ Cooking Unit........ Oven.__._.... ......... ....... 2.0o ....._..._. Each additional outlet ................:................". .. 1.00......""....... Dryer.....".. Garb. Disp......._ Dishwasher 2.00 .....____. Water System (Installation, Alt. or Repair) ...."". .. 4.00......."....... MOTORS: i HP or less .__......_..._._.._...___..__. __._ . 2.00 - - Water Closet.... Water Heater.... Ld. Tray........... .. 4.00"...........-. 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. (see Ord. current)...................................................... Vacuum Breakers ............................................ ..............3.50.............. New Residential Occupancies Flat Rate - Interceptor........ Water Softener........ .................4.00. ............ 0-500 sq. ft. $22.00 1501-1750 $34.50.............................. Plumbing Piping without fixtures ..........".:........".............4.00............... Misc. (see Ord. Current) ...splarpermit..........4..A .......... 501-750 24.60 1751-.20000 37.50.............................. Permit Fee .................. ...................."".."""...............$ 6.00 75f-1000 26.00 2001-2250 39.50.............................. "" 1001-1250 28,60 2251-2500 42.00.............................. TOTAL PLUMBING PERMIT FEE (plus penally if app. [❑) $ 10.00 1251-1600 32.00 2501-2750 49.50.............................. .. • s • HEATING/COOLING PermitFee...............................................$6.00 TOTAL ELECTRICAL PERMIT FEE (Plus penalty if app.p) $ PERMIT INSTALLATION NO. EACH FEE Forced Air Unit............ _... _ "._ _ . to 100M ....... ........... .......$ 6.00 ............. 1 • • . , over 100M ....................... . 10.00.............. Comfort Cooling Unit......to 3 ton/HP ..... . ........... 6.00... ..... .. Forms / Foundation ........ By: _... . Date ............ to 15 ton/HP........... 9.50..........•. Plumbing Ground Work ...__. 1.... __.-_. ...__......_..... to 30 ton/HP... ............12.00. - Rough Electrical .. __ . . """ -— --- to 50 ton/HP ams Plumbing and Heating ...........17.00 . ....---- -- - Space Heater..han Wall Heater ..... 8.00„ ,,,, rulaLon & Energy .... .... ..(_. �--� Flues - other than above .. 11. 3.00. as Test _.Power _c .. . _. Vent Fan: Kitchen .. Bath .. .... 3.00 Temporary Power Gas / Elect .. ._ _ - ..... Commercial Range Hood _ ._._ ..". 8.00 _ Final - Electrical -. $.k.L,R..n ..... ... ..... . ._... Misc. (See Ord. Current..... - ... Final - Building/ Mechanical .........................._........... .__.__..........___ Permit Fee ...... $ 6.00 Final - Design Review / Landscaping . ._.... I—— ­........................... TOTAL Htg./ Coolg. Permit Fee (plus penalty if app. ❑) $ Final—Public Works ................... ....... . .............................