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1781 C17�UP(?�rL�`I�r�TR�130 CITY OF CUPERTINO APPLICATION FOR RESIDENTIAL BUILDING PERM,A(V PERMIT NUMBER AND CERTIFICATE OF OCCUPANCY FOR APPLICANT TO FILL IN BUILDING INSPECTION DIVISION PAJEYREET ADDRESS OF PROJECT: — 1Q2S.5...A11thony...R.Z.ace....................................................... • • • • • Legal Description: Tract.....-65.5.1...._. Block............ Lot....1_1............. Plans Received B Date .. Description of Work: .... ......... ........... .........._.._................................. By................................................... solar...P..arm...t............................................... .. REO.: Plans.... Survey.... Calcs: Struc..... Energy.... Elect..... Mach.... 1st Struct. Improvement on Parcel:Yes.... No... Area of Bldg............... Plana Checked By....................................................Date ......................... Separate Structure........,... or Addition/Alteration to Exist. Bldg........... Application Approved BY.........................................Date ......................... No. of Stories................ Use of Building .................. ......_........................ ValidatedBy..............................................................Date ........................ Valuation of Project: $............................................................................... Compensation Certificate Verified By ................. Date,...........,............ Owner: _,.................................................................... Phone:.................... Contractor: ..... ...BAS._HOMES,...INC........City Bus. Lic. x ............1. . • • • • • $ Contractor's Address: .......... ........._.........—........_... Phone:.................... Permit Fee (plus penalty If applicable) 24 CO Contractor - Electrical: .............................................................................. Plan Check Fee (less deposit of$......... Rct. #..........I$....._................ City Business License n..._............... Phone:.................... Energy Plan Check Fee (Dep. of $........ Rct. #........)$......_.._.... ...... Plumbing: ........................ .....................__......._......................._ Q City Business License x.................... Phone:.................... Strong Motion Fee ..........................................................$........7.S......... Heating and .Cooling ............ Plumbing Permit Fee ............................. e:.................... Electrical Permit Fee .....................................................$...................... City Business License x...._............_.. Phone:.................... Mach. Htg./Coolg. Permit S............................. $........_............. Architect/Designer: .. ............_........_.................._... Phone:.................... Residential Construction Tax .....................................—$....................... Engineer: . . . ._... .._....._...._........._......................... Phone:.................. own Lender. .. ...that........the performance ................_........ c E] Unknown Misc. Fee .._....................................................................$.............._....... •�I certify that in the penormence of the work for which this permit Ia Misc. Fee ........................................................................$....................... 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 057-ITTry-N-TINIMM APPLICANT/OWNER ....._.._......_.............-..........—.................... 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 Licene. No. ........................... Use Zone ............ P.D. Conditions .......................................................... in Classification ....................... _...__... is in full force and effect: or Cord. Use Permit #............ Variance +k............ Parking Spaces............ I certify that I am exempt from the "Licensed Required" provisions of the Approved By. Date Contractors License Law. (Slate basis of exemption.) '""""'"""'"""""""""""""'""""""""'"""" "'' ' "-"""""" I hereby acknowledge that I have read this application and state that the above to _ correct and agree to comply with all City Ordinances and Slate Laws regulating • • Luildmg. I (Wel agree to save, indemnify and keep harmless the City of Cupertino ncroachment Permit.._.................... Grant Of Easement............ against liabilities, judgments, costs and expenses which may In any way b, Gutter, Sidewalk, Driveway: Replace.......... Repair..... acture against said City in consequence of the granting of this permit." at............ Conn. Fee $................ Water................ Meter $................ SIGNATURF OF Bement for Completion Of Public Works Improvements .................. APPLICANT/CONTRACTOR ........ ....._._.....................__........ DATE ................... .... Plans Checked By........ Date........ Approved By........ Date.................... NOTe- When properly validated this form 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 alter 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. Disp......... Dishwasher ...... ...... ..._. 2.00 .............. 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 ....'......................................................................... B.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 fixtures ...................................4.00.............., 0-500 sq. ft. $22.00 1501-1750 $34.50......................:. Misc. (See Ord. Current) ...solar...piermi. ...4..D . 501-750 24.60 1751-20000 37.50.............................. •''" •"0 751-1000 26.00 2001-226C 39.50.............................. Permit Fee ........................... ( .............ally......................$ 10. 1001-1260 28.60 2251-2500 42.00.............................. TOTAL PLUMBING PERMIT FEE (plus penalty if app. �) = 10.00 ( 1251-1500 32.00 2501-2750 49.50.............................. APPLICATION FOR PermitFee...............................................$6.00 TOTAL ELECTRICAL PERMIT FEE (Plus penalty It app.0) $ PERMIT INSTALLATION NO. EACH FEE Forced Air Unit..................to 100M ..............................$8.00... ............ INSPECTION Over 100M .......................... 10.00.............. Comfort Cooling Unit......to 3 ton/HP ........................... 6.00............... Forms / Foundation ......_.. .... _..... . . By:. _... ...... . Date:. ...... ...... to 15 ton/HP................. ........ 9.50.............. Plumbing Ground Work . .................... ... _............_ .................._...... to 30 ton/HP...................... Rough Electrical ...................... .....12.00. ............ rams - Plumbin and Heatin H t ton ................ 17.00.............. .......... 9 9. ......... ......................... ........................... Space Heater........ Wall Heater ................................... 6.00... sulatlon a Ener9Y...............__........... .......... .............. .........._............... _ 3 00 ....... Test ..............._................ ..... ._. . .. .... .......................... Flues other then above ............................................... Vent Fan: Kitchen........ Bath ......................................... 3.00............�.. porery Power Gas / Elec[. ..._...: :..._.�. . - 6.00,,,,,,, , f•",, - Commercial Range Hood .. g ........................................ .. An - Electrical ........¢/U%f1../L..........I '. '... ....t .../.!N.'r?a Misc. (See Ord. Current................................................... .. ........... Final - Building/ Mechanical ...........: if' ......... .. ....................... Permit Fee ...___...... $ 8.00 Final - Design Review / Landscaping f ... ..............I.......................... ................ .........................pp.... ) TOTAL Htg./ Coolg. Permit Fee (plus penalty l app. ❑) $ Final—Public Works ...........................................................