1782 CITY SUPfil IliiMA
CITY OF CUPERTINO JAN 13 1981.
APPLICATION FOR RESIDENTIAL BUILDING PERMIT?A, PERMIT NUMBER
• AND -- • . APPLICANT TO FILL IN
CERTIFICATE OF OCCUPANCY
BUILDING INSPECTION DIVISION STREET ADDRESS OF PROJECT:
...........10245...Anthony...P.la Ce.........................................................
DEPARTMENT USE ONLY Legal Description: Tract......6.551....... Block.._........ Lot.12...............
Plans Received B Description of Work: ............ ................
y......... .......................................Date ......................... So...ar...P.erm3 t.................. ..................-..
REQ.: Plans.... Survey.... Calcs: Struc..... Energy.... Elect..... Mach.... 1st SIruct. Improvement on Parcel:Yes.... No.... Area of Bldg...............
Plans Checked By....................................................Date ......................... 'Separate Structure............ or Addition/Alteration to Exist. Bldg
Application Approved By......................................... Date ......................... ' No. of Stories......._........ Use of Building .................. .
................ ...........
Validated By.......... .................. ..........................Date ....................... Valuation of Project $..... ....
...........................................
Compensation Certificate Verified By .. . Date ................. ..... Owner ..... ..... _... Phone: ........ .
Contractor: ,.BAS HOMES• INC......_.__CityBus Llc. x .. ...........
• • . . • $ Contractor's Address: .......... ................................... Phone:.........:.........
Permit Fee (Plus penalty if applicable) .. .. ..... $....... .a0...... Contractor - Electrical: __. _ . . ............ ...._ ...................................
Plan Check Fee (less deposit of$.......... Rot. #.........- $....................... City Business License •... ... Phone:....................
_............ ...... ......................... .,. Plumbing:
.................._._..................._..__....................................
Energy Plan Check Fee (Dep, of .......... Rct. #........ $........I............. City Business
Business License 4.................... Phone:....................
PlumbingPermit Fee
Strong Motion Fee .._ . _ . _ $.....I... ...... Heating and Cooling� 9 9 -._...................._..................._. ................
Electrical Permit Fee ......................................................$......... City Business License *........__....... Phone%. ............
Mach. Htg./Ccolg. Permit $............................. $....................... Architect/Designer: ....................__...................__... Phone:....................
Engineer: ... _.. _._....... ............... _ _
........................ .. .. Phone:....................
Residential Construction Tax ........................................$....................... Lender:
Mist. Fee . .. ..._... ....._......... ... ...................._.......__. .......... ❑ Unknown
.......................................__.............................$.......................
Mise. Fee -- $ 24.50 is certify I s that in the performance of the work for which this permit is
'I
sued shall not o to any employ y person In any manner so as to become subject
• $ o 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
Deslgn 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 rr___._.... Variance M............ 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 .-.......__...._........ I hereby acknowledge that I have read this application and state that the above is
WORKSPUBLIC REQUIREMENTS :orrect and agree to comply with all City Ordinances antl State Laws regulating
building,
Cf08Chment Permit........................ Grant of Easement........................ (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.......... acture against said City In consequence of the granting of this permit."
Sewer............ Conn. Fee $................ Water................ Meter $................ SIGNATURE OF
Agreement for Completion o1 Public Works Improvements ......... APPLICANT/CONTRACTOR ......................................_............. DATE ..........
Plans Checked By.---.... Date........ Approved By.... _ Date.... ....... ...._. NOTE: when properly validated this form constitutes a Building Partnit. This
permit expires and becomes null and void should work not be commenced within
APPLICATION • 12D days tram validation dela, or should authorized construletlun be suspended or
abandoned for a period of 120 day after work Is commenced.
PERMIT INSTALLATION NO, EACH FEE
APPLICATION • . PLUMBING PERMIT
Light Outlets............ Switches..........
Fixtures............ Receptacles............ PERMIT INSTALLATION NO. EACH FEE
TOTAL NUMBER (less than 1000 watts) ............ $ ,50 .............. Gas System with up to 5 outlets .................................$q,00. .............
Range........ Cooking Unit........ Oven............ ........ ...._ 2.00 .. ............ Each additional outlet ............................................. 1.00. ..........
Dryer.....-.- Garb. or less
Dishwasher 2.00 ......._..... Water System ShoweraPanlon,Balthtub Re Sink..._.............. 3.00...............
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....
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. (see Ord. current l.................. ........ ........ . ... ..... . Vacuum Breakers ............................................ ..............3.50IG,11111111*
............
New Residential Occupancies Flat Rate Interceptor........ Water Softener........ .............................4.00 ..-.........
Plumbing Piping without fixtur
501-7D-600 0 it. $22.60 1501-1750 $34.50.............................. SQd51flY... eY`ttit ...... . 4.D0 .
4
501-750 24.50 1751-2250 37.50............................•.
Mist. (See Ord. Current) ............... ....................................
751-1000 26.00 2001-225C 39.50............................ . Permit Fee .........................................................................$ 8.00
1001-1250 28.60 2261-2500 42.00.............................. TOTAL PLUMBING PERMIT FEE (plus penalty if app. ❑) $ 10 00
1251-1500 32.00 2501-2750 49.50.............................. APPLICATION • .
HEATINGICOOLING PERMIT
PermitFee...............................................$5.00
TOTAL ELECTRICAL PERMIT FEE (Plus penalty if app.p) $ PERMIT INSTALLATION NO. EACH FEE
Forced Air Unit..................to 100M .........
..........-..........$8.00:..............
• • RECORD over 100M _...................... . 10.00.........INS
Comfort Cooling Unit......to 3 ton/HP ......................_ _ 5.00,..............
Forms ng Ground
.............................. ... ...... ....... . Date:................ to 15 ton/HP..............._........ 9.60..............
Plumbing Ground Work . ............._..... {_... ..........__.. ..............__.........
Rough Electrical .............................. to 30 torl......................... .. 12.00. ............
--_..J.._....._......_....._ .......................... Space Heater........ Well Heater ................................... 6.00
ulation & Ener ............ ......................WVent Fan: Kitchen........ Bath ........................................ 3.00...............
Temporary Power Gas / Elect. ...._. ......._........_...... .....W..................... Commercial Range Hood .............._.........................}Ir 5.00......
Final - Electrical ............................._..._....................... Misc. (See Ord. Current............._..._......_........_..........L......... .........
. ...........................
Final - Building/ Mechanical ..... _.........._......... ......................... Permit Fee
Final - Design Review r Landscaping _..._................__._....................._.............. ... ... .00
$ 8
'--- ------ TOTAL Htg./ Coolg. Permit Fee (Plus penalty if app. D) $
Final—Public Works ..... .... .................
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