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1783 (2"zeu2 'IfyOF SUPPLFJ5NJAL CITY OF CUPS TINO JAN 1 j0 f APPLICATION FOR RESIDENTIAL BUILDING FERMI PERMIT PERMIT NUMBER 8 AND F • , CERTIFICATE OF OCCUPANCY APPLICANT TO FILL IN BUILDING INSPECTION DIVISION STRETO9pSEEthF P (VEC :AnR . a e Legal Description: Tract......6551....... Block........ Lot 13............ Plans Received By..................................................Date ..................... solar Description of Work: .......... . . ... ..permit .. .. ................................. REO.: Plans.... Survey.... Calcs: Struc..... Energy.... Elect..... Mach.... 1st Struct. Improvement on Parcel: Yes.... No... Area of Bldg............... Plans Checked By....................................................Date ......................... Separate Structure............ or Addition/Alteration to Exist. Bldg Application Approved B P g........... A PP PP Y................_......_......_.......Date ......................... No. of Stories_...... ....... Use of Building .................. ............................... ValidatedBY..............................................................Date ....................... Valuation of Project: $................................................................................ Compensation Certificate Verified By ................. Date ........................ Owner: Phone:.................... • • Contractor: ..... ....-BAS-HOPIES-,. INC., -City Bus. Lic. # .............. $ . . Contractor's Address: .........._.................... ............ Phone:.................... Permit Fee (Plus penalty if applicable) ........................$ 2440....... Contractor - Electrical: _ ...... ................._............................. Plan Check Fee (less deposit of$.......... Rct, #.......... $.................. City Business License #.................... Phone:.................... Energy Plan Check Fee (Dep. of $........ Rot. #........)$...................... Plumbing: .......................................City Business License #.............. ..... Phone:.................................................................. . . Strong Motion Fee ..........................................................$.........'.....0.... Heating and Cooling Plumbing' Permit Fee ................................................$.... ..D...Q.�.... Electrical Permit Fee ......................................................$.......... City Business License #......._............ Phone:.................... Htg Rech.Residential Construction Permit x............................. $....................... Architect/Designer: ............. .................................... Phone:.................... Engineer: Phone: . Residential Construction Tax ....................._................$.......... Lender: . .. .........._....._......_......................._.... own .. a .in th.. performance ......................................... c ❑ Unknown Misc. Fee ..............._............._......................................_$..._.................. '•I cerlily that in the pedormanco of the work for which this permit is Misc. Fee ..............................._....................................._$.......... �� issued I Shan not employ any Parson in any manner so as to became subject • $ 24-Sn 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 unde• the provisions of the Design Review Approval: Bldg. __....._ Site ............ Sign ............ Contractors License Lew and further that my Lidera, 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 • , • earrect and agree to comply with all City Ordinances and State Laws regulating building. 1 nCfOBChment Permit........................ Grant of Easement......... I (We) agree to save, indemnify and keep harmtoes the City of Cupertino ............... against liabilities, judgments, costs and expenses which may In any way Gutter, Sidewalk, Driveway: Replace.......... Repair.......... occurs against said City in consequence of the granting of this permit." L....._.... Conn. Fee $................ Water............... Meter $................ SIGNATURE OF greement for Completion of Public Works Improvements ....._____ APPLICANT/CONTRACTOR ......._. ...............................:............ DATE ........................ t 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 • 120 days from validation date, or should authorized construction be suspended or abandoned for a period of 120 days altar work Is commenced. PERMIT INSTALLATION NO. EACH FEE APPLICATION • . PLUMBING Light Outlets............ Switches.......... . 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 ............. ....... 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 ............. 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,_ so Ord. current)...................................................... Vacuum Breakers ................................ ..............3.50.............. New Residential Occupancies Flat R ...........ate Interceptor........ Water Softener........ ...4.00. Plumbing Piping without fixtures ................ ...............a.0q .............. 0-500 sq. ft. $22.00 1501-1750 $34.50.............................. Misc. (See Ord. Current) ... .8.@xnli• .24.50 1751-.20000 37.50.............................. ...............6.00 .... 501-750 Permit Fee ............... 751-1000 26.00 2001-2260 39.50.............................. .......................( ........alty......................$ 10. 1001-1250 28.60 2261-2500 42.00.............................. TOTAL PLUMBING PERMIT FEE (plus penalty II app. ❑) $ 10.00 1251-1500 32.00 2501-2750 49.50.............................. APPLICATION FOR HEATING/COOLING PERMIT Permit Fee...............................................$5.00 TOTAL ELECTRICAL PERMIT FEE (Plus penalty if app.p) $ PERMIT INSTALLATION NO. EACH FEE Forced Air Unit..................to 100M ..............................$ 6.00............... • ' ' ' over 100M........................ . 10.00.............. Comfort Cooling Unit......to 3 ton/HP ........................... 5.00............... Forms / Foundation ............. ............. . By:. ..... . ..... . Date:................ to 15 ton/HP......................... 9.50.............. Plumbing Ground Work . . . ................ ....__................... to 30 ton/HP.................. ....... ..12.00. ............ Rough Electrical ..__...._.................._... _. ..._...... rame - Plumbing and Heating to at ton/HP. .........................17.00.. ........... ......... ........................... ANI[ 9 9 ................................... ........................... Space Heater........ Well Heater .................................. 6.00.. l ellen & Energy.............................. ............ ....................................... Flues - other than above ............................................�.. 3.00.............. Test ........ ................. ...... . .._................. . .............. ............. Vent Fan: Kitchen........ Bath .... .................................... 3.00............... porary Power Gas / Elect. _............._................ ...I....................... Commercial Range Hood • ..............._......_.......... ....... .. Final - Electrical ......5. '.k..cS...._.............._............... ........................... Misc. (See Ord. Current.............. ....... ....._.............................................. Final - Building/ Mechanical ..._................................. ......................... Permit Fee ................. .. $ 5.00 . .... .................pp.... ) Final - Design Review / Landscaping . ... ........................................... TOTAL Htg./ Coolg. Permit Fee (plus penalty it app. ❑) $ Final— Pub�lice Works .......................................... ............... �'�`�. 1 'S p.O'J TE tr L Date Sub ect 1 Notes -- // '" — ---- Approve Date , :_ I