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1402 CITY OF CUPERTINO APPLICATION FOR RESIDENTIAL BUILDING PERMIT PERMIT NUMBER 1,4o -Z-:] AND CERTIFICATE OF.OCCUPANCY FOR APPLICANT TO FILL IN BUILDING INSPECTION DIVISION kEJ)T SNWR,�4wivoi Legal Description: Tract.. ....... Plans Received By................................................... Date .................. ---- Description of A .=?Z..... .......... REO.: Plans---- Survey.... CaIcs: Strut..... Energy.... Elect..... Mach.... 1.at S I I r..u..ct Improvement. 1.... .I . .....o.n Parcel:. ..Yes. No... Area'of Bldg"""...... : Plans Checked By if Date Separate Structure or Addition/Alteration to Exist. Bldg........... Application Approved By- � i X-� Dat. ?i -AX-A"i No. of Stories- -&... Use of Building ....... ......... .............._.............. Validated By............................-............-- --....... Date ........................ Valuation f r jject- .............. Compensation Certificate Verified By ........ Date ...... ........ Owner; Contr Dqr . Phone. - 7 aso Ct Bus LIC # Contractor's Add 'A * AT,... P�O-e' 22#4 $........ ------ 9W 0 Permit Fee (plus penalty if applicable) .....--.............$__............... Contractor - Ele, , - 4 / d Plan Check Fee (less deposit of$._.._...Ftctt #-. City Business License' r, - on eo�IJ Energy Plan Check Fee (Dep. of $........ Rct.-#-c Plumbing: .......... . . . . ...... .................. ........ ..................... Strong Motion Fee ..................... ........... $. ......... ........ City Business License ....... Phone:...... ............. Plumbing Permit Fee ......... �P�61-4.083--............... Heating and Cooling . ........ .. . ........ ...... . ......... Electrical Permit Fee ........... .... .. City Business License fir...... Phone:.....__........... Mach. Htg./Coolg. Permit $............. $ Architect/Desi gner: ... Phone: ....... ...i....I--- - Engineer: .... .... ___ Residential Construction Tax ... ....... .' _/.... r$ _.. ............ .... Phone:...._............. ✓Misc. Fee .................-.... ....... .........---...-..........7,$...................... antler: . . .. ..... . . ........ . . .... .......... ....... � . ED Unknown Misc. Fee ...... ......... .-.............................. ...... ......$--.........-------- I certify that in the performance of the work for which this permit is issued I shall not employ any person in any manner so as to become subject $ to the work Is compensation lavv of ivornia." SIGNATURE OF ZONING REQUIREMENTS APPLICANVOW DAT .:p(/.....'.Stat-us.-Exempt ....... .... Other ....-.- L/I I certify that a. the applicant I am licensed A th ,xDesign Review Approval: Bldg. ............ Site .-....... Sign ..... Contractors License I-Ctorther that sroy L�rcenes, )Nedpaa)dth"I 0 �011Z Use Zone P.D, Conditions ..... ........ ........ in Class fire is in full force and effect: or Pond. Use Permit #__ .... Variance #...... .... Parking Spaces....... i certify that I am exempt from the "Licensed Required" provisions of the ,Approved By....... ........ ....... .. ...._....... Date .......... . ...... Contractors License Law. (Stale basis of exemption.) 1 heetry acknowledge that I have read this application and state that the above [a PUBLIC WORKS REQUIREMENTS =orrert and agree to comply with all City Ordinances and State Laws regulating brild,eq, croachrient Permit.......... ... Grant of Easement................... I (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may in any way ,urb, Gutter, Sidewalk, Driveway: Replace......._. Repair_........ secure against said City in consequence of the gra�t(" of his permit." "Fu Sewer..... Conn. Fee $................ Water................ Meter $................ SIGNATURE OF Agreement for Completion of Public Works Improvements ....... .... APPL ICA NT/CONTRACTOJ(�. ...... ............ Plans Checked By. Date........ Approved By.......- Date , -- .1. ? .................. NOTE: When properly vallflated this form constitutes a Building Permit. This I permit expires and becomes null and void should work not be commenced within APPLICATION FOR ELECTRICAL PERMIT 120 days from validation date, or should authorized construction be suspended or PERMIT INSTALLATION NO. EACH IFEE abandoned for a period of 120 days after work Is commenced. Light Outlets..... ...... Switches............ APPLICATION FOR 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 ............. .. ... 2.00 .. ......... Water System (installation, Alt. or Repair) ................. 4.00 ............... MOTORS: I HP or less ........ 2.00 ...... Water Closet.... Water Fleeter.... Ld. Tray..................... 4.00. ........... Greater than I HP not more than 5 His .... 3.50 __ .. Lavatory.... Shower Pan.... Bathtub.... Sink......... .......... 3.00.. ............. Temporary Power Pole or Service 100 amp IF 5.00 - Wash. Mach..... Dish-washer.... 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................. ... ............. '!so-Residential00ri� u rrent)................................................... Vacuum Breakers ...... occupancies Flat Hate ....... 3 New �05 Interceptor....... Water Softener........ ............................4.00. 50 0-500 sq. ft. $22.00 1501-1750 $34.50........................... Plumbing Piping without fixtures .-............ ..................4.00. .............. 501-750 24.60 1751-20000 37.50................................. Misc. (See Ord. Current) ........................I.....I.......... ........ 751-1000 26.00 2001-225C 39.50............................. Permit Fee ...................................... ...................-$6.0o 1001-1250 28.50 2251-2500 42.00.............................. TOTAL PLUMBING PERMIT FEE (plus penalty it app. CI) $ -- 1261-1500 32.00 2501-2760 49.50.............................. APPLICATION FOR HEATING/COOLING PERMIT PermitFee...............................................$6.00 TOTAL ELECTRICAL PERMIT FEE (Plus penalty If app.E]) $1/,Ao PERMIT INSTALLATION -7071RC-H FEE INSPECTION RECORD Forced Air Unit........ ..... ..to 100M ..............................$ 8.00.. .......... over 100M ........................ 10.00.. A GH 8 0 Forms / Foundation .....--. . ...... By: Date: ...... ...... Comfort Cooling UrI 3 ton/HP ........................ 6.00. ... ..... 0.0 Plumbing Ground Work . ...... . .. ... .. to 15 ton/HP. .......-........... 9.50.............. Rough Electrical ........_......... ... ..... 1o30ton/HP. .................... 12.00. ............ , '1 1 .0 - Plumbing and Heating to 50 ton/HP..... .............. ..17 00.............. 11�on &'Energ Space Heater........ Wall Heater ........... . . 6:00 iy ....... .. .... awRest, Flues - other than above ....... .......... ....... 00 3.00 Temporary Power a., �4tqe . 0 ...... Vent Fan: Kitchen.....- Bath ... ...... .................... 3.00............... Final - Electrical ..... ./ Mechanical ....... Commercial Flange Hood ......... ..-.............. I- 1. 6.00............... Final - Building / M .. ...... .. Misc. (See Ord. Current. ....... . Final - Design Review / Landscaping . . .. ........ . ... ...... Permit Fee ......... .......... ...... ............ Final- Public Works .............................................. TOTAL Htg./ COO19. Permit Fee (plus penalty if app. 0) If .............