1780 SUPPLEMENTAL •
CITY OF, CUPEP.TINO
CITY OF, CUPERTINO
APPLICATION FOR RESIDENTIAL BUILDING PERMITJAN PERMIT NUMBER 7g�
• AND • .
CERTIFICATE OF OCCUPANCY
BUILDING INSPECTION DIVISIONBEET l�DDRESS OF PROJECT:
0265 Anthony_ P,.ace
..................__.........................................
DEPARTMENT USE
ONLY Legal Description: Tract...b 591.......... Block._...:..... Lot......a,0...........
...._..
Plans Received By..... ...................................._ _......,Date .................. Description of Work: ' solar...perl0i.t................._._................
. . _.-..... . . . ..._. ... _.._ .. .. .. . _..... . ...... .. . ._ ..... . ...............
REQ.: Pans.... Survey.... Celts: Strut..... Energy.... Elect..... Mach.... 1st_...Str_ utt.. I.mInprovem. . . .en .
t o_n Parcel:.... .Yes. . .... NN.o..._.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 Protect $..... _
-
.... .. - ................
Compensation Certificate Verified By .... ... Date .. ...... Owner: .....,. .. Phone
• • ,• • $
Contractor: ..........RAS...HOMES,_INC-,-.,.City Bus. Lic. at _............
Contractor's Address: ..................___............_.......... Phone:....................
Permit Fee (plus penalty if applicable) ........._...... ......$.24.80...,.... Contractor - Electrical: ..... ................_......................__..-......................
Plan Check Fee (less deposit of$...... _. Ret. #..........)$...._.......... City Business License'#..................-. Phone:...................
Energy Plan Check Fee (Dep. of $........ Hot, #........) $............ . Plumbing: ....___...... ............................................................................ ...
......... ...............
Strong Motion Fee ..........._..._......._........__....:._....._...$.-_.._f..'2.�...... City Business License #................... Phone:....................
PlumbingPermit Fee ........ ..._........ ..... .....Heating and Cooling ...__..__._ _ ..
.......... ......_. ... _
_. .._..........
._..._......._ . ........$.../a._.u-s1
Electrical Permit Fee ........._... ... ..... ........ City Business License #_._........ ... Phone:....................
- ........ ... . . - ..$................__... ...._.._.._ ....
Mach. Htg./Coo19. Permit $............................. $......... Architect/Designer:............. _.._.......................... Phone:.................... �
Residential Construction Tax ......._.,._.......___...._......$..........._......_.. Engineer: ................_.__......._.._.........._..._........_..... Phone:....................
Misc. Fee Lender: . , ..._..........._....._... . ._..._......._._......._..-.... Unknown
......._........._._..._..._.................._._................$....._................ __.... ❑
Misc. Fee ............... $ ... "I certify that in the performance of the work for which this permit is
"'" """ ""'""'"""""" "" issued I shall not employ any person in any manner so as to become subject
• $ Ila Sri to the workman's compensation laws of California:"
SIGNATURE OF
ZONING • _EMENTS ...... APPLICANT/OWNER ___............._......._..........-......__............. DATE.
.................the h e
Exempt ...... Other ...... . the
Environmental Status: ...... ...__.......
........._. ..., .... ��I certify that as the applicant I am licensed untle� the provisions of
Design Review Approval: Bldg. ........_.. Site ............ Sign ............ Contractors License Lew 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 certify that I am exempt from the "Licensed Required^ provisions of the
Approved By.,__..............__.............__..._ """"'"" """""""' """"""""'
Date Contractors License Law. (State basis of exemption.)
-- " --'"'"" I hereby acknowledge that I have read this application and state that the above la
' s• • torrent and agree to comply with all City Ordinances and State Laws regulating
builomg.
�nCrOaChm Bnt Permit..__...._............ Grant of Easement_........... (We) agree to save, Indemnify and keep harmless the City of Cupertino
.._...... against liabilities, judgments, costs and expenses which may in any way
urb, Gutter, Sidewalk, Driveway: Replace.......... Repair.......... acture 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 _................ 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 after work is commenced.
PERMIT INSTALLATION NO. EACH FEE
Light Outlets.... APPLICATI• • • PLUMBING PERMIT
........ Switches............
Fixtures............ Receptacles............ PERMIT INSTALLATION
JNO..,..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. Disc._.__. 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 ............................_....._.. ............................ .... 8.00...............
Time Clock ._._............_...._ ...... ..._.._......._._.. ...._. 1.50._......___ Lawn Sprinkler Sys. $5.00 Ea. add Sys. $2.00 .........50. .............Isc. seeOrd. current 1..... . .. .................... ... Vacuum Breakers .....-.............._._._... . 3.50. ...........
New Residential Occupancies Flat Rate Interceptor........ Water Softener........ .............................4.00. '
............
Plum
ng
0-500 sq. ft. $22.00 1501-1750 $34.50........................ Miscbl(See Ord. wcu�enijxtusaJ.ar. ........
' 4,Do. . ..... ..
.....
501-750 24.60 1751-•20000 37.60.............................. ..p.2.Y10.1. .........4..A ..........
751-1000 . 26.00 2001-2250 39.50.............................. Permit Fee ..........................................................................$ 6. 0
1001-1250 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 •.
HEATING/COOLING PERMIT
Permit Fee...............................................$6.00
TOTAL ELECTRICAL PERMIT FEE (Plus penalty if app.l $ PERMIT INSTALLATIONI
NO, EACH FEE
INSPECTIForced Air Unit..............._.to 100M ...........$ 6.00...............• • • ' over 100M ... ......... . 10.00 ...........
Forms / Foundation B Date Comfort Cooling Unit.....to 3 ton/HP . . ..... . 6,00,....y" --- ..... to 15 ton/HP. 9.50....Plumbing Ground Work ._. ....., to 30 ton/HP IRough Electrical ... ... 12.00.. ..........
area - Plumbing and Heating l to 50 ton/HP. 17.00....Space Heater........ Wall Heater .... .... 6.00,.,slahon & Energy . .... ... Flues•- other than above ... -Gas Test ._.._ ._. ... .I 3 00Temporary Power Gas / Elect. Vent Fan: Kitchen. Bath 3 00 Commercial Range Hood . 6 00Final - EIeCVlcal ._ .... Misc. (See Ord. Current ..Final - Building/ Mechanical ... -
Permit Fee -
Final - Design Review / Landscaping .. - - ......- $ 8.00
Final-�Pub�lic Works .Q. .., TOTAL Htg./ COolg. Permit Fee (plus penalty if app. ❑) it
S.It
0 ,