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1778 • CITY OF CUPERTINO • SUPPLEMENTAL JAN 1981 CITY OF CUPERTINO 1 APPLICATION FOR RESIDENTIAL BUILDING PERMIT PERMIT NUMBER 8 • ANDs s CERTIFICATE OF OCCUPANCY FILL IN BUILDING INSPECTION DIVISION STREET ADDRESS OF PROJECT: 102.60..Anthony..Pla..ce.........._............... ................... a • Legal Description: Tract...655.1.......... Block........... Lot...$................ Plans Received By Description of Work: ....... y.................................._........_..__Date ......................... _._..........__ _ _..................solar Permi . .r........................................ REO.: Plans.... Survey.... Coles: 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 .................. ............................... ValidatedBy..............................................................Date ....................... Valuation of Project: $................................................................................ Compensation Certificate Verified By ................. Date ........................ Owner: ....... . Phone:.................... . . a Contractor's Address: ........................Contractor: ........_........BAS-HOMESy-......INCCity Bus- Lic. # .............. $ . ............... Phone:.................... .. Permit Fee (plus penalty If applicable) .. ... ...$..24.G0 . Contractor - Electrical: . ........ ......................................................... Plan Check Fee (less deposit of$.......... Rct. #.... $ ................ City Business license #...............;.... Phone:.................... Plumbing:Energy Plan Check Fee (Dep. of $........ Rct. #.......J$............ 9: ......._....... ......... City Business License #_.................. Phone:.................... Strang Motion Fee ........__................_._.........................$.._. ........Q..... Heating and Cooling ....... . Plumbing Permit Fee ................................................$.....f�...6tp.... City Business License .................... Phone:.................... Electrical Permit Fee ......it $................._.......................$..... Architect/Designer: ................._......_...............__.... Phone:.................... Rech.Residential Construction Permit x ............................ $....................... Engineer: ... Residential Construction Tax ........_............... _..__.._..$....................... . ..............._............................................. Phone:_...........own Lender: ... __. ...........i....._...performance th........rk f which Unknown Misc. Fee ........._.............................................:__...._....$.... '9 certil that in the ❑ Misc. Fee Y pe dormence of the work for which thio a subject is "'��`�'�"""""""""""""""""""""""'"'"""""""""$""""""""""" issued I shall not employ any person in any manner so as to became aubJect • $ 24.50 Turn! workman's compensation laws of California." SIGNATURE OF • • APPLICANT/OWNER .......... _...............__.....:................__........... DATE........................ Environmental Status: Exempt ............ Other.._.................................... .. ..... "I certify that as the applicant I am licensed undethe provisions of the Design Review Approval: Bldg. ............ Site ............ Sign ............ Cnntractors License Law and further that my Licens. No. ............................ Use Zone ............ P.D. Conditions ....................... ............. .................. in Classification ........._.......................... Is in full force and affect: or . . .... Cond. Use Permit #............ Variance #............ 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 slate that the above Is • 07. :orrect and agree to comply with all City Ordinances and State Laws regulating building. (We) agree to save, Indemnify and keep harmless the City of Cupertino eroachment Permit Gram Of Ea5em0nt...._......_.......... against liabilities, judgments, coals and expenses 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 .....I...... APPLICANT/CONTRACTOR .. ...................-................................ DATE ....................... Plans Checked By........ Date........ Approved By........ Date.._............. NOTE: When properly validated this form constitutes a Building Forest. This permit expires and becomes null and void should work not be commenced within • s 120 days from validation date, or should authorized constrdellon be suspended or abandoned for a period of 120 days alter work is commenced. PERMIT INSTALLATION NO. EACH FEE APPLICATION • • PLUMBING 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 ...................................................S.............I.............. 6.00............... _ Time Clock .... ....................................................__......... 1.50............... Lawn Sprinkler Sys. $5.00 Ea. add ys. $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... ermit........4..A 501-750 24.50 1751-20000 37.50.............................. P 751-1000 26.00 2001-225C 39.50.............................. Permit Fee ...........:.............................................................$6.00 1001-1250 28.60 2251-2500 42.00.............. TOTAL PLUMBING PERMIT FEE (plus penalty it app. ❑) $ IMW 1261-1600 32.00 2501-2760 49.50.............................. APPLICATION Fe . HEATING/COOLING PERMIT Permit Fee...............................................$6.00 TOTAL ELECTRICAL PERMIT FEE (Plus penalty if app.0) $ PERMIT INSTALLATION NO.I EACH 77PE — Forced Air Unit..................to 100M ..............................$8.00............... • ' • ' over 100M........................ . 10.00.............. Comfort Cooling Unit......to 3 ton/HP ......................... .. 6.00............... Forms / Foundation ...._......._............... BY:........ . ..... . Date:................ to 15 ton/HP......................... 9.50.............. Plumbing Ground Work ._..........._..... . .._............ ..I......_......... .... to 30 ton/HP................:...........12.00. . Rough Electrical ..... ............ g ........:._.in .-�... ......_...._....... ....... to 50 ton/HP...........................17.00.. ams - Plumbing and Heating ...._.._1.........._................_._._............... Space Heater........ Wall Heater ................................... 6.00.............. au fall on & Ener9Y,........._._............... ..._.........__....... .....................:..... Flues - other than above ............................................�.. 3.00.............. as Test .._........................................ ..........................'.._..__._.............. Vent Fan: Kitchen........ Bath .......................................`.. 3.00............... Temporary Power Gas / Elect. . ._._..._........_............ ..._._.._............... Commercial Range Hood ,L, 8.00 g ......................................... l ............... Final - Electrical _................._..........._.......................... .._......_.............. Misc. (See Ord. Current ...................................._........I..............$ 6......... Final - Building/ Mechanical ............._........ .................._....__............_. permit Fee $ 6.00' ..ig.....er-.....Fe'e'................................:......ED) Final - Design Review / Landscaping . _.... ....................... _...........:.. TOTAL Hig./ Coolg. Permit Fee (plus penalty if app. Q) E Final-Public Works ...........................................................