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• ���ry nr ((;;��II�LL aTifdO • 9r0'PPL�MEP VL CITY OF CUPERTINO JAN I ! 1QQ1 APPLICATION FOR RESIDENTIAL BUILDING PERMIT PERMIT. NUMBER �• ANDFill i • . APPLICANT TO FILL IN CERTIFICATE OF OCCUPANCY H BUILDING INSPECTION DIVISION STREET ADDRESS OF PROJECT: .. _ 10250.-Anthony...P.lac.e................._ ......... r • Legal Description: Tract.....6.551........ Block---.... Lot............7........ Description of Work: _. —.. ........_. .. . .. By ........................... solar ermit............._....._........._...--... Plans Received B Data ......................... 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 By................ .............—.......Date ...... ............ No. of Stories................ Use of Building ...... -..........---............ Validated By......-........-.....--............-.....................Date ........................ Valuation of Project: $................. ....._,......__............._............. ...........— Compensation Certificate Verified By ......... Date .....--............... Ownei: .........._........ ............................_._............—.... Phone:.................... Contractor: ...R p . -City Bus. Lic, # _........._. • • " • $ Contractor's Mress©MPS_,-_INC': - .... ........_................. Phone:._................ Permit Fee (Plus penalty If applicable) 24 60 Contractor - Electrical: ..._.._.... (P. P Y t o ) -._._..#........... —......_._........ Plan Check Fee (less deposit of$......_.. Rct. #..._.....)$....._... . City Business License #........_.___... Phone:......._........... .. .......... Plumbing: ..._...__..____......................................_........................ Energy Plan Check Fee (Dep. . ......... Ret. #-.._....$_..__.1............ City Business License #....___._,..._..... Phone:_.................. Strong Motion Fee ..._......._......._.._..................._...._....$..._.....t.,5.•Q.... Heating and Cooling ___..... Plumbing Permit Fee ................................................$.....Q.r.f)'f1..... City Business License #.................... Phone:.................... Electrical Permit Fee _ .........$...._._....__......_...._...._....$....._..........:.... Architect/Designer: -. � ..............___ ...._..._._.. Phone:.................... Mach. H[g./Cool9. Permit $............................. $.............-........ Engineer: ._ _._._._ .._.. .. Residential Construction Tax .._..._...._._.......-......_---$.._......___....... ................_....._....._..,.............. Phone:...............wn .... .... ❑ Unknown Misc. Fee ....._.__.._....._............_...................................$........................ "I certify that in the Misc. Fee ....._._........_....._...... $.... - v performance of the work for which this permit Is -"-�-"""�""""""-""""' "".-..'---.. issued I shall not employ any person In any manner so as to become subject • $ 24.50 to the workman's compensation laws of California.'* SIGNATURE OF 1111111IR-72TTlil APPLICANT/OWNER .......................__........................_....._.__...... DATE........................ Environmental Status: Exempt ............ Other... ........._........................ ......... "I (.ertily that as the applicant I am licensed Inde 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 force and effect: or Cond. Use Permit #............ Variance #.........-. Parking Spaces............ -. I cartify that I am exempt from the "Licensed Required" provisions of the Approved 8 -._. Data Contractors License Law, (State basis of exemption.) PP Y--- ------- --- ---------- - ----- -- - I hereby acknowledge that I have read this application and stale that the above is correct and agree to comply with all City Ordinances and State Laws regulating • • building. I (We) agree to save, indemnify and keep harmless the City of Cupertino ncroachment Permit..................... Grant Of Easement...._ ........._...... against liabilities, Judgments, costa and expanses which may in any way urb, Gutter, Sidewalk, Driveway: Replace.......... Repair___.... occurs against said City In consequence of the granting of this permit." Sewer............ Conn. Fee $__._.._..... Water................ Meter ......... ..... SIGNATURE OF Agreement for Completion of Public Works Improvements ......... APPUCA NTS CONTRACTOR .............................................._.._...... DATE ...__................. Plans Checked By........ Date........ Approved By..._... ..... NOTE: When properly validated this farm constitutes a Building Permit. This permit expires and becomes null and void should work not,be commenced within • • 120 days from validation date, or should authorized construction be suspended or abandoned for a period of 120 days after work Is commenced. PERMIT INSTALLATION NO. EACH FEE APPLICATION FOR 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 .......—......................$4.00. ............. Range........ Cooking Unit._ .... Oven............ ......... .___ 2.00 ............. Each additional outlet ............................................. 1.00............... Dryer......_ Garb. Dis Dishwasher __...__.. ............ 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. (see Ord. current)...................................................... Vacuum Breakers .....................--.................. ..............3.50............-. New Residential Occupancies Flat Rate Interceptor........ Water Softener........ .............................4.00. ............ Plumbing Piping without fixture ..................... ............ 00- , 0-500 sq. ft. $22.00 1501-1750 $34.50.............................. Misc. (See Ord. Current) .SO aL,.FiE~YAl3:C.. .. .:.9. .......... 501-750 24.50 1751-20000 37.50.........; .•••• .................... Permit Fee ..........:..................... ..................................$8.00 751-1000 26.00 2001-2260 39.60.............................. ........ naltpp. ID 1001-1250 28.60 2251-2500 42.00.............................. TOTAL PLUMBING PERMIT FEE (plus penalty If app. [�) $ 1251-1500 32.00 2601-2750 49.50.............................. APPLICATION Fs • HEATING/COOLING PermitFee...............................................$8.00 TOTAL ELECTRICAL PERMIT FEE (Plus penalty if app.❑) $ PERMIT INSTALLATION NO. EACH FEE Forced Air Unit.._..--.......to 100M ..............................$ 6.00............... • - • ' r over 100M ........................ . 10.00.............. Comfort Cooling Unit......to 3 ton/HP ........................... 8.00............... Forms / Foundation __..... ................. By:—..... Date:................ to 15 ton/HP......................... 9.50.............. Plumbing Ground Work ......_.............)..._ _....__..__...___.__._...._... to 30 ton/HP._....................... ..12.00.............. Rough Electrical - ._... i.... ..._.. .................. to 50 ton/HP . 17.00... Alf ame - Plumbing and Heating . ._ ... . .. Space Heater........ Well Heater ........... 5.00 suletlon & Energy .._ ........ . ...... .....• ..•.. - -- - - - - Flues - other than above . .. ....... 3.00.............. Gas Test _ . Power - � �-- -�.... — - ....... Vent Fan: Kitchen ....... Bath _ 3.00. ... Temporary Power Gas / Elect ... - Commercial Range Hood 8.00 Final - Electrical .._.. .... ... Misc. (See Ord. Current.. . .. .. ..... Final - Building/ Mechanical .........—. - - .......... .........._............... ............... Permit Fee ._.._.._._............ ........._.. $ 6.1)0 Final - Design Review / Landscaping .if app. ....... TOTAL Htg./ Coolg. Permit Fee (plus penalty i app. ❑) $ Final—Public Works ...........................................................