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1295 * aitz-d r66 CITY OF CUPERTINO 3 'oF APPLICATION FOR RESIDENTIAL BUILDING PERMIT PERMIT NUMBER �a Jib D yf� ' ANFOR APPLICANT CERTIFICATE AND OCCUPANCY BUILDING INSPECTION DIVISION STRE T ADpRESS OF PR ECT: /.0. .3.U...Anthony �l,ace.......................................................... DEPARTMENT USE ONLY Legal Description: Tract........6551..... Block............ Lot....._$........... Plane Received By....................................................Date ...................... Description of work: -Single...Famil.y...Dwelling.:............... ... ........................................................................................................................ REO.: Plans.... Survey.... Calcs: Struc..... Energy.... Elect..... Mach.... 1st Struct. Improvement on Parcel:YesX. No... Area of Bldg....3123H Plans Checked By....................................................Date ......................... Separate Structure..... Application Approved B P NO or Addition/Alteration to Exist. BIdg58.2G A PP PP Y.........................................Date ......................... No. of Stories........2..... Use of Building ...Res.ldential................. Validated By..............................................................Date ..... Valuation of Project: s132,000......................... Compensation Certificate Verified By ................. Date ............,............ Owner: .,BAS..Home s.,...Inc................................ Phone:.2.5.2r 2.0.77 • • • $ 132,000 Contractor: BAS..Homes. Inc.-.............City Bus. Lic. +x11061.. Contractor's Address: ....268.23_.Steuens...Crlehone:.252-.2.0.77 Permit Fee (plus penalty if applicable) ........................$......3.3.S...O.O. Contractor - Electrical: .The...Best...Electrical._CO................. Plan Check Fee (less deposit of $.......... Rct. #..........)$_.................... City Business License #....18172.. Phone:.28.7r.2.040 Plumbing: ......__CrOwley...C.io............................... Energy Plan Check Fee (Dep. of $.........Rct. .. ..........$ $...................... 41 248 424 Strong Motion Fee .......................... ..: ' J ' City Business License #,,,,166.. ..... Phone:............'...... ng Plumbing Permit Fee --...I,'(��w i-_.1..�............_.$:_:::___SS...SO. Heatingand Business License BOyer..Co..Phone:..792-.432 Electrical Permit Fee ......it $....1................................�.� ... Engineer: eeer Designer:MGKa SW SemiBank.. at k 838-.9958'hone:.985-.0360 924 Mach. Htg./Coolg. Permit $..:.......................... $.........30...00. Residential Construction Tax .....,...___.......... $.......... ...... y -Wells ergo... an _.........._................ ❑ Unknown Misc. Fee ._........_............................................... _.........$......._.............. "I certify that in the .... ., y penny person of the work for aswhich this permit Is MISC. Fee ......_......................................................_........$..._.................. issued 1 shall not employ any person in any manner so as to become subject _ • $ S 14•74 to the workman's compensation laws of California." SIGNATURE OF • ! 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............ 1. . . I certify that I am exempt from the "Licensed Required" provisions of the 1 Approved By. Date Contractom License Law. (State basis of exemption.) """"""""""""'- """""""""""""' """"""""""""' I hereby acknowledge that I have read this application and state that the above Is �orrecl and ngme to comply with all City Ordinances and State Laws regulating s • ! building. I (Wel agree to save, Indemnify and keep harmless the City of Cupe ino %ir oachment Permit Grant of Easement........................ against liabilities, jutlgmen s, costa and ex pensee which may in y way Gutter, Sohl k, Driveway: Replace.......... Repair.......... acture against said Clty I consequence of the granting of Ihi r q • ............ Conn. Fee $............._. Water..........._... Meter $................ SIGNATURE OF - , , / q� •7 Agreement for Completion of Public Works Improvements .................. APpucANT/coura4cr . ............_................_.. ATE .. ..._"' Plans Checked By........ Date........ Approved By........ Date.................... NOTE- When properly validated this form constitutes a Building Perm t. This permit expires and becomes null and void should work not be commenced within • • 12D 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............ APPLICATION FOR_ Fixtures............ Receptacles............ PERMIT INSTALLATION NO. EACH ' TOTAL NUMBER (less than 1000 watts) ............ $ .50 Gas System with up to 5 outlets ............ .............x....$4.00 """ ..•.. - Range........ Cooking Unit........ Oven............ ......... ....... 2.00 ............. Each additional outlet ............................................ 1.00..............! Dryer........ Garb. Disp..... Dishwasher ............. ...... 2.00 .. Water System (Installation, Alt. or Repalr) .1.......1... 4.00........4...0 `l ............ MOTORS: 1 HP or less ........................................ ....... . 2.00 _ Water Closet..3 Water Ffeater.l. Ld. Tray......I.......S... 4.00 ..20-.00 0!? Greater than 1 HP not more than 5 HP .............. . 3.50 .. ............ Lavatory.5 Shower Pan2.. Bethtub2.. Sink...1......10. .. 3,00....30...00 1�t Temporary Power Pole or Service - 100 amp . .........5.00 .,...... .... Wash. Mach.l.. Dis IN sher..l Garb. Disp.....1.......3... 3.00.......9.- 0 M -200 amp. ....... . 7.00 .............. Sewer ....IL."" ... �1'....� ........................1........�.... 8.00........8..,..0.0 N� Time Clock ...................................................................... 1.50............... Lawn Sprinkler Sys. $5.00 Ea. add Sys. $2.00................_... ............. Mti Misc. fees Ord. current I...................................................... Vacuum Breakers ............................................ ..............3.50.............. New Realden[lal occupancies Flat Rate Interceptor........ Water Softener........ .............................4.00. ............ Plumbing Piping without fixtures .................1.......1.....4,00.......4...00 0-500 Sq. ft. $22.00 1501-1760 $34.50.............................. Misc. (See Ord. Current) ............. 501-750 24.60 1751-20000 37.50.............................. ....................................... 751-1000 26.00 2001-225C 39.50.............................. Permit Fee ...........................___......................................E 6.00 1001-1250 28.50 2251-2500 42.00.............................. TOTAL PLUMBING PERMIT FEE (plus penalty if app. 0) t 85.0 Oyu 1251-1600 32.00 2501-2760 49.50........3123.............. • •• HEATING/COOLING PERMIT Permit Fee...............................................$6.00 W 1 TOTAL ELECTRICAL PERMIT FEE (Plus penalty If app.p) $55.5 PERMIT INSTALLATION NO. EACH I FEE Itryk Forced Air Unit..................to 100M ......................2.....E 8.00 ^" 0 INSPECTION 4° over 100M.......................... 10.00.. ........... IM Comfort Cooling Unit......to 3 ton/HP ........................... 6,00,..._......... Forms / Foundation ...... B '........ . ..... . D te: (JNFc.�... . /o�aa✓"*!.... T to 30 ton/HP......................... 9.50.. ............ Plumbing Ground Work ..................... (.. .. ................................. } to 30 ton/HP...........................12.00. . __............._..�_. ..........._.......................... ..... ........... Rough Electrical ............... -rams - Plumbing and Healing I.... to 50 ton/HP................. ..........17.00.. ........... 9 9 .......... ..................... ........................... Space Heater........ Wall Heater ................................... 6.00All .............. a` laden & Energy............................... ... .................. ............ p p Flues - other than above .................................. .......�.. 3.00.............. Test ...................................... .. ... ' I$^.D Vent Fan: Kitchea_l.. Bath .2....../Drye.x...1....4.... 3.00....12..00 A� ml - aryElectrical Power Ga.. / Elect. .._.... ... .. ........ Commercial Range Hood 8.00 r ' .......... .... Final - Electrical .............._................._.... ... ........... .�3-d ...... •g Misc. (See Ord. Current................._..............._._..........., .... ........ Final - Design Building / Mechanical .................... ........... ... ...:1.;... ....... Permit Fee ............._............................ $ 6.00 to Final - Design Review / Landscaping . .... ............._........_._.............. TOTAL Htg./ Coolg. Permit Fee (plus penalty if app. ❑) $ 30.00 Final-Pub tic Wqr s ............. .. ....... ........... .. . � GAQ• mG- l�-� 1 1-8-gf . 4p!-w✓ t9•t ,a„ti• slP •`"M„gotN pa+7I LrCSf D�CiS +,R.BLf(fl�l-t !, OUTS ST r. n No .__ Date � J Location z�2 2 Notes Date 1 G'_ pe,� CERTIFICATE OF COMPLETION BUILDING INSPECTOR'S OFFICE CITY OF CUPERTINO DATE 19 6 1 BLDG. PERMIT NO. THE BLDG, LOCAIEDAT �J �7� • OWNED BY [/ `�/"7 / /!/ "{�iu . <• #4 HAS BEEN 1601 FOR USE AS �• �' �' (ALTERED) i i yiy 1'. Y4 -BUILDING INSPECTOR �9 ' I BUILDING INSPECTOR'S OFFICE Bldg.Dep. CITY OF CUPERTINO Office Copy r ❑ Backflow Device Sanitary Permit No. I Sewer Connection Plumbing Permit No. Z� ' [( Plumbing Final �j lot No. Owner or Tenant At I U�— 7 0 '61 ) Tract V Date Connected —1 9�Dctte Final 195V @" BIN . NSPECTOR OFFICE CITY OF CUPERTINO COP) GAS SERVICE NOTICE I.,r(3 , 19 & I I To You are hereby authorized to[[connect the GAS service for Owner or Tenant At 107-3-0 tiJ TA, n✓ //��. New Service No. of Meters Reconnect No. of Add. Meters - Move Service - Move Meter PLUMBING INSPECTOR OO M i I ELECTRIC SERVICE NOTICE OFFICE COPY BUILDING INSPECTOR'S NOTICE CITY OF CUPERTINO I To ' 19I You are hereby authorized to Connect electrical service for Owner or Tenant M'S f /w✓Ci (� At I V [�^t) O A1.��--Cts A.(,,//A^ No.of Wires Size'df Wires Size of Switch t Motor Load Voltage Phase Heating Load K.W. Voltage No.of Meters Llghr 110 New Service Reconnect Heat 1P0Three Wire More Service No.of Add.Meters Power \� Three Phase Move Merer �"' ELECTRICAL INSPECTOR v/ '� '"'��