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1298 ^CITY OF CUPER i' NO PLen/ 030 APPLICATION FOR RESIDENTIAL BUILDING PERMIT PERMIT NUMBER �� AND FOR APPLICANT TO FILL IN CERTIFICATE OF OCCUPANCY 0111 BUILDING INSPECTION DIVISION STREET ADDRESS OF PROJECT: r (j a. Anthony...P..lace_..............................._....... 0 a • Le al escri 1[-on: TracL....b55.1...._.. Block............ Lot...........8......... M 9 P 'f r Description of Werk: ...S.ingl.e...Fame.ly..Dwel..ling................ y PlansReceived By. .. :....J/..... IePl` ...............Date ........................ ....................-... ....................................................--.....I....................... ...... REO.: Plans.... Survey.... C@Ics• Struc..... Energy.... Elect..... Mach.... tat Struct. Improvement on Parcel: YesX. No... Area of Bldg.30.3.OH Plans Checked By.........._„ ...LL/....L...................Date .. ,.......... Separate Structure-No-, or Addition/Alteration to Exist. BIdg639G Application Approved By........... .•............._._.....Date .. las-"e.... No. of Stories......Z... ... Use of Building .....Re.siden.tia.L............. Validated B .............. ........Date ..... y.......... ...................... 8 .... .. Valuation of Project: $129.,000....-........................................................ � Compensation Certificate Verified By .. /`./..:.. Date .... fTt. owner: ..BAS .Homes Inc.......-....................... Phone:.252r 2.0.77 Contractor: BAS..Homes, ...Inc....._..........Cityy Bus. Lic. * .1106.1 • • . $ 129,000 Contractor's Address:208',3..Stelrens...Cr.k.. Phone:.2.52r..2.0.77 Permit Fee lux penalty f applicable) $......33.0...50. Contractor - Electrical: .The...Bes.t..Electrical-Co..... ....... (P P Y i t o ) ....................... Plan Check Fee (less deposit of$.......... Rct. #.:........)$................... City Business License x..1817.2..... Phone:.28.7-.2.0.4.0 .. Energy Plan Check Fee (Dep. of $....... Rct. #........) $.:..................... Plumbing: ...CrOWl ey..CO............_..._.............._.................... � Strong Motion Fee ............................!1%f` City Business License a.. 664.1..... Phone:.245-.4.24.0 g ,,,.•.,../,.._...._.....$......._..9...0.3. 1 Heating and Cooling ....Al.... .oyer..CO................................ F�ectrPlumbing Permit Fee ..............-................................$.........85.-.0.0. City Business License #.........--...... Phone:792-.4328 Mech. Permit Fee ......it $..........................................$.........55...5.0. Architect/Desi ne . _ Mach. Hig./Coolg. Permit $.........:.......:........... $.........33...0.0. g 5wa11oty�Bates-.838...9956 Phone7.lA...752-.8 24 Mesidential Construction Tax ........................................$....................... Engineer: . .McKaY...B. .Som pS............................. Phone:.985-.0960 isc. Fee Lender: . ..Well s..F.argo. .Bank........__..._............... ❑ Unknown " "" - " ' " ' "" "' """ "' " '" ' '-$ " """"'."""" "I certify that in the performance of the work for which this permit It MISG, F00 ........................................................................ __................. .. issued I shall not employ any person in any manner so as to become subject • $ 514.03 to 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 Design Review Approval: Bldg. ............ Site ............ Sign ............ Contractors License Law and further that my Licens. No. ............................ Ts Use Zone P.D. Conditions in Classification ......................... ........- Is in full farce and effect: or Cond. Use Permit 4............ Variance #............ Parking Spaces............ I canny u,at en exempt from the "Licensed Required" provisions of the Approved By..... Date Contractors License Law. (Stale basis li exemption.) """-""""""""""""""""""""""' """"""""""""" I hereby acknowledge that I have read this application and stale that the above le J%* • . correct and agree to comply with all City Ordinances and State Laws reg feting Uuild,ng. _ I (We) agree to save, Indemnify end keep harmless the City of Cu rtlno ,`/(�� neroachment Permit........................ Grant Of Easement....................... against liabilities, judgm to costs and expenses which may I ny�,ay urb, Gutter, Sidewalk, Driveway: Replace.......... Repair.......... secure against Bald Cit n nsequence o th cooling of th er�f t.'• ewer............ Conn. Fee $................ Water................ Meter $.............. SIGNATURE OF /bC(� �•/ ��(/ GG� greement for Completion of Public Works Improvements .................. APPUCA NT/CONTRACT . ......L .�..%:.6.4C4mvTE ......./........ �!.. Plans Checked By........ Date........ Approved By........ Date.................... NOTE: When properly validated this form constitute$ a Building Permit. This permit expires and becomes null and void should work not be commenced within . • $ 120 days from validation data, or should authorized construction be sull ad or abandoned for a period of 120 days after work Is commenced. PERMIT INSTALLATION NO, EACH FEE • • • . Light Outlets....... Switches............ PLUMBING PERMIT Fixtures............ Receptacles PERMIT INSTALLATION NO. EACH FEE TOTAL NUMBER (less than 1000 watts) ............ $ ,50 . - Gas System with up to 5 outlets .................I.......1...$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) .1........I... 4.00...... .4.r.¢D MOTORS: 1 HP or less ...................--................. ...... . 2.00 --. - Water Closet-4 Water Heaterl. Ld. Tray.....1.......6... 4.00 ..24.-DO L� Greater than 1 HP not more than 5 HP .............. . 3.50 .. ............ Lavatory.6 Shower Part Bathtub..3 Sink...1.....11.... 3.00....3.3...00 tr• Temporary Power Pole or Service - 100 amp .. .......5.00 .............. Wash. Mach 1 Dishwasher..) Garb. Disp.....1.......3.... 3.00......9...00 `� -200 amp......... 7.00 .............. Sewer .....1. 'I�.�I'... &F........................1........1.... 8.00.......8...0.0 o Time Clock ........................-.......... .................--..... ........- 1.50............... Lawn Sprinkler Sys. $6.00 Ea. add Sys. $2.00..................... ............. .1 Misc. (See Ord. current)...................................................... Vacuum Breakers ..........-................................ ..............3.50.............. �t7 New Residential Occupancies Flat Rate Interceptor........ Water Softener........ .............................4.00. ........... Plumbing Piping without fixtures .................1........1......4.00.......4...0 0-500 sq. ft. $22.00 1501-1750 $34.50.............................. Misc. (See Ord. Current) .................................................... N 501-750 24.60 ` 1751-•20000 37.60.............................. Permit Fee ................... ... .........$ 8.00 751-1000 26.00 2001-225C 39.50.............................. ..........(plu..........alty.....a .. 1001-1250 28.50 2251-2500 ' 42.00.............................. TOTAL PLUMBING PERMIT FEE (plus penalty It app. �) $ 86.00 N� 1251-1600 32.00 2501-2750 49.50............ D3D........... . • . • • T-4% PermitFee...............................................$6.00 TOTAL ELECTRICAL PERMIT FEE (Plus penalty If epp.0 $55.50 PERMIT INSTALLATION NO. EACH FEE Forced Air Unit..................to 100M .........-!.......... ;..$ 6.00 2•• INSPECTION over to 3 HP 6.00 • r to l5 too/HP.......•...._\._........ 19.50.'....'...... Forms / Foundation ............... _ By� �� � ����� . Date ......... Comfort Cooling Unit����'o Oton/HP...._�...�`......... ...12.00�.� � Plumbing ound Work . amatlo6rEPlumbing y d He ............�. ......-- 3�.It. Space Heater........ Wall Heater ..... .......................... ..16.00.............. N Rough Electrical 1 el Flues other than above .............................................�.. 3.00.. ............ as Test .................--...-....-. .... .. . .. . j!..� C... .� Vent Fan: Kitchen...)... Bath 3...../Dryer....1.....5.... 3.00....1.5...0.0 1. emporary Power Gas / Elect. ........ .... ... ........... .... ... 0.00 Im; Commercial Range Hood .....................I.................... .. ..1. .......... Final - Electrical ...................... ............. . .............. ... ....� . y` Misc. (See Ord. Current............................................................... ............ Final - Building/ Mechaniral ............._.. ......_.... .. .....:...ysz .� Permit Fee .............. ... ... $ 6.00 a Final - Design Review / Landscaping .... ....._... .._..._......._............. TOTAL Htg./ Coolg. Permit Fee (plus penalty If app. ❑) $ Final- Public Works 33.00 O� ..... ...................... ... . . L4) Lvwrr -fb. 1%�0 f,? VI 11 ill,IB' S/ . 0,64GA �In' tdtsp9aQ,�i rsNta� rraw i•13-his nO '_^E SLIP t File No. Date- Loca.t:cn � S!-,b,;r.-c t J n h e 2K2,vaz e,,Cd App- Date �n�Gp eto„ CERTIFICATE OF COMPLETION BUILDING INSPECTOR'S OFFICE I CITY OF CUPERTINO DATE " '3 19 I BLDG. PERMIT NO. Z� i THE BLDG, LOCATED AT� 0 -460 14J � Tf-L-U f�v (� OWNED BY " ✓/'�-S /�67•t o a //-1 �' 't ! COMPLET 1 HAS BEEN FOR USE AS �• ti r (ALTERED) I 1 J` tSUILUING INSPECTOR ELECTRIC SERVICE NOTICE OFFICE COPY BUILDING INSPECTOR'S NOTICE CITY OF CUPERTINO / 19� To You are hereby authorized to Connect electrical service for / Owner ar Tenant '/ 16 S 4L � f— 5 ,1.1! AI 11 9 No,ofWires Size of Wires Size of Switch Motor Load Voltage Phase Heating Load I W. Voltage No.of Meters / Light 110 / New Service / Reconnect • , Heat 120 Three Wire More Service No.of Add.Meters Power Three hose Move Meter ©M ELECTRICAL INSPECTOR �niR-I J CITY OF CUPERTINO COPYE GAS SERVICE NOTICE �J — I , 19 "I To ` You are hereby authorized M . f too connect the GAS service for Owner or Tenant_ AS G New Service No. of Meters Reconnect No. of Add. Meters Move Service Move Meter PLUMBING INSPECTOR i 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 �f-Yt'1%trn..7.�.+ ./o C-- Tract Date Connected 19�fl Date Final /3'D 19� - PLUMBING INSPECTOR