1775 • CITY OF CUPERTINO •
SUPPLEMENTAL
CITY OF CUPERTINO JAN
APPLICATION FOR RESIDENTIAL BUILDING PERMITAND
PERMIT NUMBER 7 3
• CERTIFICATE OF OCCUPANCY PFOR APPLICANT TO FILL IN 10
BUILDING INSPECTION DIVISION STREET yy QR ESS OF PROJECT:
......_._._4444.......
' • Legal Description: Tract....__.65.51.._ Block............ Lot....5................
Plans ReceivedDescription
of Work: __..
y............ Date -_........-4444.- SoiaY"'1JEYt11Tt...._.........._......_..............
_._._.r.u._.................._._....._._....-...................I _......Ar.......I.B..fg.._...........
....REC.: ens.... Survey-... Calcs: 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_...........444.....4._...............Date ......................_. No. of Stories................ Use of Building ...........
Validated B ..._....__......_................_..........
By............................._............._...._._.......Date ................._..... Valuation of Project: $444.4. _._..._..........
Compensation Certificate Verified By ................. Date ....__................. ._ ..-............--.".... e:...."".."'..""".'
Owner: ....._.........._...._t._...__..._...__._._........_.._.... Phone:.....
• • •
Contractor: ....BAS-HOMES, -INC.. City Bus. Lic. # _. ..........
. . $ Contractor's Address: _4.44...............4..._.................... Phone:....................
Permit Fee (Plus penalty if applicable) -4444--444 .
......$..2.4. .0...
...._ Contractor - Electrical: .. ... _.... _ ........... ... . . .... .._._...._.......................
Plan Check Fee'(less deposit of$..... Rct. #..._ $....................
City Business License #............_...... Phone:....................
Energy Plan Check Fee (Dep. of $........ Plot. #........) $........... Plumbing: .__.._...._..........................................................._.........
Strong Motion Fee ............................... ..................4_444$.......e.�t.�d..._.. City Business License #__ ............. Phone:....................
Plumbing Permit Fee Heating and Cooling ........ ............
City Business License #...._.............. Phone:....................
, Electrical Permit Fee _.......$................_..........._....._... $...4....__4.44._.... Architect/Designer: ............_.......4___44.......__4._..... Phone:....................
Htg
Rech.Residential
Construction
Permit x ............................ $.._...............-... Engineer:
4444_................ .. .............._........ Phone:....................
Misc. Fee Construction Tax .................._....................$....... lender: . .. ................. . .. _4444... EJ Unknown
........................................................................
.......................
. . ....... ...._.._........--..._.._4444...
... "I certify that in the y any person
of the work for which ethisco permit is
Misc. Fee ..._.........._...............4444_._.. -------- ...... $4444.._-.............. issued I shall not employ any person in any manner so as to become subject
• $ 9L S(1 to the workman's compensation laws of California."
SIGNATURE OF
ZONING • APPLICANT/OWNER ...... .................._................ OATE..._..................
Environmental Status: Exempt............ Other...... ......................... 1........ "1 certify 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 Licens. No. ............._.............
Use Zone P.D. Conditions in Classification ....................._........_._.... Is in full force and effect: or
444__4_.. ..._.__...__..__...................._...............
Cond. Use Permit #............ Variance #44_44__. 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 ..........4..........444... I hereby acknowledge that I have read this application and state that the above Is
PUBLIC WORKS REQUIREMENTS correct 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
lcroachment PermlL._.............__... Grant of Easement.._.__......_....... against liabilities, judgments, costs and expenses which may in any way
Ourb, Gutter, Sidewalk, Driveway: Replace........- Repair.......... acture against said City In consequence of the granting of this permit.^
Sewer............ 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
APPLICATION
• e 170 days from validation date, or should authorized construction be suspended or
abandoned for a period of 170 days after work is commenced.
PERMIT INSTALLATION NO. EACH FEE
Light Outlets............ Switches............ APPLICATION •.
PLUMBING PERMIT
Fixtures............ Receptacles...........- PERMIT INSTALLATION NO. EACH FEE
TOTAL NUMBER (less than 1000 watts) ............ $ .50 -... Gas System with up to 5 outlets ............$4.00. .............
Range........ Cooking Unit........ Oven......... ....._.. ....... 2.00 .............. Each additional outlet ............................................. 1.00...............
Dryer........ Garb. Disp......... Dishwasher .......... 44.._ . 2.00 ....._....... Water System (Installation, Alt. or Repair) ................. 4.00...............
MOTORS: 1 HP or less .._._............ ..........._._.... __._ . 2.00 - - -.- -- Water Closet.... Water Heater.... Lot. Tray..................... 4.OU................
Greater than 1 HE not more than 5 HP 4...4..._44.. . 3.50 ....__..._. Lavatory.... Shower Pan.... Bathtub.... Sink................. .. 3.00...............
Temporary Power Pole or Service - 100 amp ........ ..5.00 ,.44__4._4. Wash. Mach..... Dishwasher.... Garb. Disp..... ............... 3.00...............
-200 amp-444__ 4 7.00...._......... Sewer ................._.......;.........._..................................... .. 8.00...............
Time Clock 4444..._ _._ 1.50....._.__._. Lawn Sprinkler Sys. $5.00 Ea. add Sys. $2.00 .... ... ...4.......4.44.
Misc. (see Ord. current 1................... .................................. Vacuum Breakers .__.-. ...4444 ..... .....__-.....3.50..............
New Residential Occupancies Flat Rate Interceptor........ Water Softener........ ............................4.00. ............
Plumbing Piping without fixtures ...................................4.00...-...........
0-500 sq. ft. $22.00 1501-1760 $34.50.............................. Misc. (See Ord. Current)Sol aC..Pt EL ...... ...4.r.0. .
501-750 24.60 1751-20000 37.50.............................. """ """•••
751-1000 26.00 2001-2250 39.60.......................4444... Permit Fee ............................._.......-.....nail.......app...._..-.$ 8, 0
1001-1250 28.50 2251-2500 42.00.......................4444... TOTAL PLUMBING PERMIT FEE (plus penalty It app.[)) :;-�.0.0
1251-1500 32.00 2501-2750 49.50........................ APPLICATION FOR HEATING/COOLING PERMIT
Permit Fee...............................................$8.00
TOTAL ELECTRICAL PERMIT FEE (Plus penalty If app.0) $ PERMIT INSTALLATION NO. EACH FEE
Forced Air Unit................Ao 100M ..............._............ .$ 6.00...............
• ' ' ' over 100M ................. ....... . 10.00..............
Comfort Cooling Unit.....to 3 ton/HP ................. 6.00 . ..........
Forms / Foundation .._ By .. . Date _._. ..
Plumbing Ground Work 4 4_44 to 15 ton ....................
...... .... 9.50............
_ - -- - to 30 ton/HP 4444. 4444.. 12.00.
Rough Electrical . 44tin 4444... to 50 ton/HP. 17.00 .
*are - Plumbing and Heating 4444 .. . Space Heater........ Wall Heater .. ..-... .. 6.00
..............
auletion 8 Energy _ .__.. _._ .. .. . ......___... Flues - other than above .............4444_.................. ........
Gas Test - ...... .. . .... 4444 .__.. - Vent Fan: Kitchen........ Bath -- ... ....... 3 00.
Jl
Temporary Power Gas / Elect 4444 ._ ......................-... Commercial Range Hood _ 4444. . . 6.00
Final - Electrical . -...... '
-
Misc. (See Ord. Current...
Final - Building / Mechanical ".......
- - -` -- - Permit.Fee - 4444. .. $ 6.00
Final - Design Review / Landscaping --
9 TOTAL Hig./ Coolg. Permit Fee (Plus penalty If aPP• ❑) $
Final-Public Warks ...........................................................