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1302 -7 CITY OF CUPERTINO APPLICATION FOR RESIDENTIAL BUILDING PERMIT PERMIT NUMBER /jU Z AND , . APPLICANT , FILL IN CERTIFICATE OF OCCUPANCY BUILDING INSPECTION DIVISION STREET ADDRESS OF PROJECT: /Qa°f .......Anthony....Place.......................,:....:'.................. s • Legal Description: Tract....;.65551....... Block............ Lot......12.......... Q/ Description of Work: ...Si.n.gle..Fame.ly-pwe.l,l.i.Bg................ Plans Received By.................... /.i. .........-_........Date ... ../..9.x7.1 - .................._......._..................... - .._.....-..._...._......._._.....................---d-..-.... RED.: Plans.... Survey.... C es' Struc..... Energy.... Elect..... Mach.... tat Struct. Improvement on Parcel: Yes.X No... Area of Bldg3i23H.. Plana Checked By.............. ........................Date .... -. .-- .. Separate Structure. No. or Addition/Alteration to Exist. Bldg....582 Y Application Approved B .�_�.,...__------. Date .- ...... �. No. of Stories......2....... Use of Building, PP PP v..-.-.......� � g ....Resa.den.tia.I................ Validated B ........... .Date ..... .. By...................... . . .................... Valuation of Protect: $.132.,.000..........-.................................-........ ... Com Compensation Certificate Verified B . Date .... P Y � � owner: BAS..Homes,,...Inc.................................. phone2527.2.0.7.7 �y s e • $132,000 Contractor. .BAS..Homes. ...Inc................City Bus. Lic. «1106.1.. Contractor's Address:20813..Stev.ens...Cryk,.. Phone:.25.2.-.20.7 Permit Fee (plus penalty f applicable) Contractor - Electrical:The...Be$t..-BLectrical-..CQ.................. (P P e PP ) ..Rcl..#...........$.......335.00 Plan Check Fee (less deposit of$.......... Rct. #........-.)$................... City Business License x.....181.7.2.. phone:.28.7.'2.Q.4 Energy Plan Check Fee (Dep. of $........ Rot. #........)$.. Plumbing: .Cr.Ovule.y..CO......._....._....................................... City Business License �..16641�_�. Phone:.24.5.-4 Strong Motion Fee ....................................................._...$............9..24. Heating and Cooling Al...Bo .er...Co'.............................. Plumbing Permit Fee .... ..... ._..................................$.........55.•AO City Business icense x . ..... ..... Phone:.79.2.-.4 28 Electrical Permit Fee ..............................................$. .......$.........55.50 LL, � Architect/Designer5Wal.lOPy'B.etas..8..38-9.95.6phoneZl.4....75...r.8 24 Mach. Htg./Coolg. Permit $............................. $.........30..00 Engineer: McKay.. Residential Construction Tax ............. $............ .......... n $Farg)gs..............._....._....... P..... 98 Unknown---I.......?.............. Lender: .Wells .Fargo...Bank....._..................which ❑ unknown Mise. Fee ............-.........._............., ....r........:..............$....................... "I certify that in the performance al the work for which This permit is 1 Misc. Fee ............ .......................:...................................$...................._. issued I shall not employ any person in any manner so as to become subject a $ 514.74 to the workman's compensation laws of California." SIGNATURE OF • • APPLICANT/OWNER ..................._................................_............ DATE......................... Environmental Status: Exempt ............ Other........................................ 'I r.ert,fy that as the applicant I am licensed unde the provisions of the Design Review Approval: Bldg. ............ Site ............ Sign _.......... Contractors License Law find further that my Licens. No. -.......................... Use Zone ............ P.D. Conditions ................ ......................................... in Classification ..... ........_... ............. is in full force and effect: or . . Cond. Use Permit n............ Variance +r............ Parking Spaces............ I cerhy that I am exempt from the "Licensed Required" provisions of the Approved ByDate Comractor;License Law. (State basis of exemption.) -"'---"----'------"- -""""'-""' '-""-^""""""" I hprcby acknowledge that I have read this application and state that the above le correct and agree to comply with all City Ordinances and State Laws regulating building. I (we) agree to save, Indemnliy and keep harmless the City of Cups no croachment Permit........_........_... Grant of Easement..._....._........... against liabilities, judg lite, cc ste and expenses which may in y we b, Gutter, Sidewalk, Driveway: Replace.......... Repair........., occurs against eald C' y n c imuSt once of the granting of thl rmit or............ Conn. Fee $._............. Water................ Meter $............ SIGNATURE OF X91/ma y(//t//�,�/•�� { 9eme0t for Completion Of Public Works Improvements .................. APPLICANT/CON .�"'^a'..'..........-..-....`- ...- DATE ..... .P I Plans Checked By..... Date........ Approved By........ Date........._......... NOTE: when properly validated this form constitutes a Building Perin This permit expires and becomes null and void should work not be commenced within • • 120 days from validation dote, or should authorized construction be suspended or abandoned for a period of 120 days alter work Is commenced. PERMIT INSTALLATION NO. EACH FEE APPLICATION FOR Light Outlets............ Switches............ Fixtures............ Receptacles............ PERMIT INSTALLATION NO. EACH FEE TOTAL NUMBER (less than 1000 watts) ..... ....... $ ,50 Gas System with up to 5 outlets ............1.............1-.-$4.00 .....4.•.00 Range........ Cooking Unit........ Oven............ ................ 2.00 .. ............ Each additional outlet ............................................. 1.00............... Dryer........ Garb. Disp......... Dishwasher ........ .... ...... 2.00 .............. Water System (Installation, Alt. or Repali) .1.......1... 4.00.......4...00 MOTORS: 1 HP or less ........................................ .. ..... 2.00 .............. Water Closet..3 Water Heater.l. Li Tray......1.........5... 4.00. .-M-00 Greater than 1 HP not more than 5 HP ............... 3.50 .. ......._... Lavatory.5 Shower Pant.. Bathtub..2 Sink...1I.....Ar 3.00. ..3.0...00 Temporary Power Pole or Service - 100 amp .. ..... ..5.00 .. ........... Wash. Mach.),. Dishwasher..)Garb. Disp.....1.......3... 3.00.......9._00 -200 amp........ . 7.00 .............. Sewer ...../dl.2/....45rx .......................1.......1... 8.00. ......8.,110 Time Clock .................................... .......................... ..........1.50............... Lawn Sprinkle)Sys. $5.00 Ea. add eye. $2.00......... ............ ............. Misc. (see Ord. current I. .. ................................................. Vacuum Breakers ............................................ .....--.-.....3.50.. ............ New Residential Occupancies Flat Rate Interceptor........ Water Softener........ .............................4.00. ..-......... Plumbing Piping without fixtures .................1.......1......4.00.......9....00 0-500 sq. It. $22,00 1501-1750 $34.50.............................. Misc. (See Ord. Current) .......................................... 501-750 24.60 1751-20000 37.50.............................. ........., 751-1000 26.00 2001-225C 39.50.............................. Permit Fee ............................................ alt........................$6.00 1001-1260 28.60 2251-2500 42.00.............................. TOTAL PLUMBING PERMIT FEE (plus penalty if app. ']) $ 85.00 1251-1500 32.00 2501-2760 49.50......3123........•....... APPLICATION FOR HEATING/COOLING PermitFee...............................................$6.00 •- TOTAL ELECTRICAL PERMIT FEE (Plus penalty If app.[)) $55.50 PERMIT INSTALLATION NO. EACH FEE 1 - Forced Air Unit..................to 100M ......................2.....$6.00... .1.2...00 RECORDINSPECTION over 100M ....................... . 10.00.. ........... Comfort Cooling Unit......to 3 ton/HP ................. .......... 6.00............... Forma / Foundation ._....... .... .............771_14rntf Date:................ to 15 ton/HP........................ 9.50... PlumbingGround Work . ................. ........... ._ to 30 ton/HP...........................12.00. ............ Vinal lectrical .....,.. .�.1..Z.Z..".� J . to 50 ton/HP...........................17.00.. ........... lumbing and Heating .......... ....... Space Heater........ Wall Heater ................................... 6.00 ..... o en , Energy............................... .. ....... " Flues - other than above ................ 3.00 .......... st ........................... i r Power Gas / Elect. ... .................... ... _. I Vent Fan: l Range Bath 2......(OT.yer....1.....4.. 6.00�� 12...00 v y ..... Commercial Ran a Hood .............. .......................... .. ............ g Electrical ...................... ._.......... . . . °.--'....._.. .�.� J C Misc. (See Ord. Current.. ........... Final - Building / Mechanical .................. ............ .�. ./ .... Permit Fee ............. ................. $ 6.00 Final - Design Review / Landscaping � " ' g P g ' ' '' Final-Public War ..... TOTAL H ./ Coolg. Permit Fee (plus peneIt iy app. ❑) $ 30.00 Lei .... p�4✓ , -T260 . .(a . 4? 660. 5�.�►10-L -Bo (!j$ Z Z'� f e te� '�'r+�++«t✓�4n. !o-/j�_. v.F,U[�Stk.fUfFLri(i.fl_k�" l(3►-W�"P 5!•1me.«. 1-'sY'-Br f Date Locatlon -- I t 1 Suter r� � c Notes d -- i Aoorove�3. 2-- 4 — C Date pec cr OFFICE ., CITY OF CUPERTINO COPY t GAS SERVICE NOTICE 19 i • j To You are hereby authorized to connect the GAS service for Owner or TenantG "" r Ai New Service No. of Meters r Reconnect s No. of Add. Meters Move Service .•p ��/ Mov�ef'M^eter j PLUMBING INSPECTOR —C r T BUILDING INSPECTOR'S OFFICE Bldg.Dept. CITY OF CUPERTINO Office Copy ❑ Backflow Device Sanitary Permit No. t�- Sewer Connection Plumbing Permit No. r�2 Plumbing FinaLot No.l Owner or Tenant i At � �� f\ �IJ I 1 �• e i Tract Date Connected �(7 �� b 980 Date Final 190 © �P UMBING INSPECTOR CERTIFICATE OF COMPLETION BUILDING INSPECTOR'S OFFICE CITY OF CUPERTINO DATE > 19� CBLDG. PERMIT,NO. U/�—� THE BLDG. LOCATED AT y 7 �A� Vttn '�7 �( OWNED BY // v� 7 ' / l U `�"" /,kj c- ,HAS BEEN ( MPLET FOR USE AS' (ALTERED) I I 4 BUILDING INSPECTOR I ELECTRIC SERVICE NOTICE OFFICE COPY BUILDING INSPECTOR'S NOTICE CITY OF CUPERTINO To � You are hereby authorized to Connect electrical service for Owner or Tenant Loz V C- ' At oN / No.of Wires Size of Wires Size of Switch Motor Load Voltage Phase Heating Load K.W. Voltage / Light y— 110New Service Reconnect No.of Meters T Heat 120—Three Wire More Service No.of Add.Meters Power Three Pi Move Meter ©" ELECTRICAL INSPECTOR I