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CITY OF CUPER•NO APPLICATION FOR RESIDENTIAL BUILDING PERMIT PERMIT NUMBER �� AND FOR APPLICANT TO FILL IN CERTIFICATE OF OCCUPANCY BUILDING INSPECTION DIVISION STRF,T DDR SS OF PROJECT: 1..0. 5 ......._.....Anthony...Place........._............................. • • • • • Legal Description: Tract....6551_....... Block............ Lot.......7............. . Plena Received ey....................................................Date ......................... Description of work: Single...Family...Dwelling.................. REO.: Plans.... Survey.... Calcs: Struc..... Energy.... Elect..... Mach.... tat Struct. Improvement on Parcel:Ves.X No... Area of BIdgZ.8.4g.R- Plans Checked By................................................--Date ......................... Separate Structure...No... or Addition/Alteration to Exist. Bldg.5.7OG Application Approved By.........................................Date ......................... No. of Stories.......2...... Use of Building .....Residential............... Validated By..............................................................Date ........................ Valuation of Project. $..123,.000..........._...................__.._.._............. Compensation Certificate Verified By ................. Date ...............;........ Owner: BAS Hopmes.,-.IrIC............................ Ph6ne:252.-207 $123.000 Contractor. ..i3A5,..Homgs;,_,Inc.,..___....,_.cityy Bus. Lic. x 11061" ' ' • Contractor's Address: ...20823..Stevens....(:rkPhone25.2.-2,0.7.7 Permit Fee (plus penalty if applicable) ........................$.......321..50 Contractor - Electrical: .. .....Best...Electrical...C4..................... Plan Check Fee (less deposit of$-........ Rct. #..........)$..................... . City Business License *..1$172.... Phone:..28.7.-..2.0.4 Energy Plan Check Fee (Dep. of $..........Rct:#........I$..................... . Plumbing: ....CrOWIeY...CO... .. . . .• _........._..... Strong Motion Fee ..........................................................$.............8...61 City Business License «.. 6641.... Phone:..245-.424 Plumbing Permit Fee ._................ .....-....._........$..........$6_.JDO 50 Heating and Cooling ...A1...Bo.yer..Co....._.._.......-............ Electrical Permit Fee ......................... !U.�?1t.:7._?.:....$..........55.50 City Business License x'..............9.5. Phone:.792-.432E Mach. Htg./Coolg. Permit $............................. $..........33..00 Architect/Designer:Swa110w!BateS.838-.9456Phone:Z14....752.- 924 Engineer: .MG.Ka ...$..Som s........_..................... Phone:..985...096 Residential Construction Tax .......................................$....................... yy P Lender. Wells-Fargo-Bank............_............_ E] Unknown Misc. Fee ........................................................................$. "I certify that in the performance of the work for which this permit Is Mise. Fee ........................................................................$............. issued I shall not employan 504.61 y person f any manner so as to become subject • $ to the workman's compensation laws of California." SIGNATURE OF • • APPLICANVOWNER ..............._...................................-................ 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 Law and further that my Licens, No. ............................ Use Zone ............ P.D. Conditions ............................................................ in Classification ......._._.._........ ............ is In full farce and effect: or Cond. Use Permit sf._.. ...... Variance •....... Parking Spaces............ _ I certify that I am exempt from the "Licensed Required" provisions of the Approved ByDate Contractors License Law. (State basis of exemption.) """"""""""""""'""" """""""""'"""'"" I hereby acknowledge that I have read this application and state that the above Is • , • :orreci and agree to comply with all City Ordinances and State*regulaI (We) agree to save, indemnify and keep harmless the Cityencroachment Permit........................ Grant of Easement........................ against liabilities, (udgme ts, coats and expenses which m, Urle, Gutter, Sidewalk, Driveway: Replace.......... Repair.......... occurs against said Ci %nseque of the granting ofer............ Conn. Fee $................ Water................ Meter $................ SIGNATURE OF ement for Completion of Public Works Improvements .................. APPucANrrcorfrRA o _. ..... . ...e. f- 6A .ens Checked By....._. Date........ Approved By........ Date.................... NOTE: When properly validated this form constitutes a Buildi permit expires and becomes null and void should work not be commenced within APPLICATION • 120 days from validation date, or should authorized constrdatlon be suspended or abandoned for a period of 120 days 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 ..........1..........1.......$4.00 ....4...0.0 Range........ Cooking Unit........ Oven............ ................ 2.00 .. ............ Each additional outlet .._........................- .--- 1.00...... Dryer........ Garb. Disp......... Dishwasher ............. ...... 2.00 .............. Water System (Installation, Alt. or Repair) ..1..I........ 4.00.....d�'0'0 MOTORS: 1 HP or less ......................................... .. .... . 2.00 Water Closet4. Water Heater-1 Ld. Tray......1..6........ 4.00. .24...nX.nnKK Greater than 1 HP not more than 5 HP .............. . 3.50 -..-....... Lavatory6. Shower Pan.l. Bathtub.3. Sink....1...1.1..... 3.00...3.S...tf.0 Temporary Power Pole or Service — 100 amp .1.........5.00 .. ..... ...... Wash. Mact].. . Dishwasherl. Garb. Dap..... .1.. ...3..... 3.00, —200 amp......... 7.00 .. ............ Sewer ...,�C'1. 16.... /a..............................1.....I..... 8.00. .... B...Q. Time Clock .................-........................ .. ................... 1.50............... Lawn Sprinkler Sys. $5.00 Ea. add Sys. $2.00......... ........... ............. Mise. (sae Ord. current 1...................................................... Vacuum Breakers ............................................ ..............3.50.............. L New Residential Occupant ies Flet Rata Interceptor........ Water Softener........ .............................4.00. ............ Plumbing Piping without fixtures ...................1..............4.00, ,.„4-,0D 0-500 sq. ft. $22.00 1501-1750 $34.50.............................. Misc. (See Ord. Current) .................................................... .... 501-750 24.60 1751-•20000 37.60.............................. Permit Fee ............................................................ 751-1000 26.00 2001-225C 39.50.............................. TOTAL PLUMBING PERMIT FEE (plus penalty If a $ 8.00 1001-1250 28.50 2251-2500 42.00......... . y app. CD f 86.00 ... ........ .. 1251-1600 32.00 2601-2760 49.50.......... A8.............. . . • • . HEATING/COOLING PERMIT zjlv� Permit Fee...............................................$8.00 TOTAL ELECTRICAL PERMIT FEE (Plus penalty If app.p) $,5.50 PERMIT INSTALLATION . EACH FEE S Forced Air Unit..................to 100M ..............................$ 6.00,.. .. • • ' ' over 10OM ........................ . 10.00.............. Comfort CoolingUnit......to 3 ton/HP ................. .......... 6.00... ........... Forms / Foundation ...........-- ........... . BY: ate: ..... ... �A.. to 15 ton/HP......................... 9.50.............. Plumbing Ground Work . .................... {. .1��.............. .. ....;r .04L.- to 30 ton/HP........................... ..12.00. ............ ROUgJLElectri -al .... __.. !.. ._ .. to 50 ton/HP.................. ...._.... 17.00.. ........... v - Plumbingand Heating Z- 9 ................ ............... ..TT.11...................... Space Hester........ Wall Heater .................................. s.00.............. � ellen 8 Energy.............................. .... ......__`...y.^.I,$.. .�'.. Vent Fan: Kitchen...1- Bdath ..3.../DrYer...L-'...5_. _ 3.00 00---- 5.00 ary nge - Electrical ....�.............................. _....(/{� ........ .y... .9.v.. / Misc. (See Ord. '\ Final orBuil9lnw/rMechan clalct....P...9 ...� L.... ....... ........... TOTAermit Fee ..... ePeomit.Fee.(plus.penelty.ir.ap....... ) $ 6.00 h Final - Design Review i Landscaping Final 1P,abbll cc arks .. ................. ....... . V ' e Vf-Ielary, Io ii-g• Q*�*/�Tw� l- ) > '(«..�. t vela• www M TliiS 2-`f-81 5 P 8/ . esrr -S Cve File No .- Da'I-c o .Datc -- cn �fi 7 A s 0 S Approved Date nI46 p,&ctor CERTIFICATE OF COMPLETION 1 BUILDING INSPECTOR'S OFFICE fCITY OF CUPERTINO I "-1: - : : . / Z }' DATE r 2' B 19 g BLDG. PERMIT NO. z�/ THE BLDG. LOCATED AT CC �Z � / l to OWNED BY . HAS BEEN IALTEREDDI USE AS a f f i ©M s UILDING INSPEC OR I OFFICE CITY OF CUPERTINO COPY GAS SERVICE NOTICE 198/ i To.._. VYou=are hereby authorized to connect the GAS service for Owner or Tenant 's C At / V°z S New Service No. of Meters f Reconnect Move Service No. of Add. Meters Move Meter PLUMBING INSPECTOR ©M j ELECTRIC SERVICE NOTICE OFFICE COPY BUILDtNG-INSPECTOR'S NOTICE CITY OF CUPERTINO To � / , 19�-I You are hereby authorized to Connect electrical yservice for ' Owner or Tenant -A5 .ol ) At /0 2.5"0 f r No.of Wires Size of Wires Size of Switch Motor Load Voltage Phase Heating Load K.W. Voltage No.of Meters Light I10New Service Reconnect Heaf 120ihree Wire Mare Service No.of Add.Meters Power Three Phose Move Meter 0" ELECTRICAL INSPECTOR `— re` � r BUILDING INSPECTOR'S OFFICE Bldg.Dept, CITY OF CUPERTINO Office Copy ❑ Backflow Device Sanitary Permit No. ❑ Sewer Connection Plumbing Permit No. Plumbing Final Lot No. Owner or Tenant BT Vl(G� �iJL At 0 . Tract Date Connected 10 — 1 LI A D Dote Fin 1 ��1'� 19 ©M ZYLUMBING INSPECTOR