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1299 J 47 CITY OF CUPERTINO ALtgvy APPLICATION FOR RESIDENTIAL BUILDING PERMIT PERMIT NUMBER /�� AND FOR APPLICANT TO FILL IN CERTIFICATE OF OCCUPANCY BUILDING INSPECTION DIVISION STREE AD RESS OF�sFO� place ja. 7 ....I..................y . ................._............................. r • Legal Description: Tract.......6551...... Block............ Lot....9............... Description of Work: ....Sin le..:Famil. 'Dwelling"""'"""' PlansReceived By........... . .. .. Date �._.�,�... _..............._............................................__..................... REQ.: Plans.... Survey.... C,�Ics: Strue..... Energy.... Elect..... Mach.... 1st Struct. Improvement on Parcel: Yes..X No... Area of Bldg28.98H. Plane Checked By..................L�/. Date .... ... Separate Structure....No... or Addition/Alteration to Exist. Bldg..5.70Ca Application Approved B .c. _y............ No. of Stories....2......... Us ofB ilding ._Residential.................. PP PP Y.....----A.... ...._..........Date .IS�/eZ. :. Validated B / By...... Date .... Valuation of Protect $_1L3.,.�1J0 Compensation Certificate Verified By ... ! .... Date .._ 0.2. . . Owner: ..BAS..Home S.,....Inc.............................. Phone:252-.20.77 ContractorBAS, Homes.,._Inc..................,.city Bus. Lic. # 11061. • . $ 123,000 Contractor's Address: ...20823..S.tevens..CrkPhone252-2077 Permit Fee (plus penalty If applicable) 321.SO Contractor - Electrical: The-Best..Electrical_.Co.................. (P P Y PP ) . Rct. �- - $....................... Cit Business License #...18.1.72... Phone:287-.2.04.0 Plan Check Fee (less deposit of$.......... Rct. #..........)$....................... y Energy Plan Check Fee (Dep. of $........ Rct. #........)$._.................._ Plumbing: ..Crowley...CO......_............................................... City Business License #16641...... Phone:..24.5.-424 Strong Motion Fee ..............................:... .-...........$........-.96...00 Heating and Cooling ...Al..Boyer...Co....._,................ . Plumbing Permit Fee $................A... . -- ij/ T „ City Business L'cense # Phone' 8 Electrical Permit Fee ..............'................_............... $..........55..50 Mach. Htg./Coolg. Permit $...........r' Architect/Designer:SwallolBates.838-99.,$6 Phone:... ..............- 924 .....:........... $...........33...Q0 r Engineer:McKay,$...Somps......................_....._.. Phone:..9.$.5.-09.6 Residential Construction Tax ...................... $_..............__... Lender: )ye11s..Fargo.-Bank......_.................... ❑ Unknown Misc, Fee ... ...................................................... $.....—............... "I certify that in the performance of the work for which this permit is ISC. Fee ........................:............................................... .................. issued issuotl I shnll not employ any person In any manner so as to become subject • $ 504.61 to the workman's compensation laws of California." SIGNATURE OF • • APPLICANT/OWNER .,._..... ......__..................._.. .............. DATE........................ Environmental Status: Exempt............ Other........................................ .. ._. A comfy that as the applicant I am licensed unde the provisions of the Design Review Approval: Bldg. ............ Site ............ Sign ............ Contraclors License Law and further that my Users, No. ........................... Use Zone P.D. Conditions in Classification ...... ............... ............ is in full force and effect: or Cond. Use Permit k........... 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 is correct and agree to comply with all City Ordinances and State Laws regulating WORKSPUBLIC REQUIREMENTS building. (We) agree to save, indemnify and keep harmless the City of C arts nCfOa utter, Permit.........rive...ay: Grant l Easement.......pal:........... against lateldtles, judgments, costs and expanses which m i any ay b, Gutter, Sidewalk, Driveway: Replace.......... Repel r.......... secure against said City In onsequence of the granting of i per or............ Conn. Fee $................ Water................ Meter $................ SIGNATURE OF ��rr eement for Completion of Public Works Improvements .................. •{ti APPLICANT/COP _ ....% AT .... ....X..J Plans Checked By........ Date........ Approved By........ Date.................... \ NOTE: When properly validated this form constitutes a Build g Pe it. This permit expires and becomes null and void should work not be commenced within APPLICATION • 120 days from validation date, or should authorized constriction be su•pandedbr abandoned for a period of 120 days after work Is commenced. PERMIT INSTALLATION NO. EACH FEE Light Outlets............ Switches............ APPLICATION • . PLUMBING Fixtures............ Receptacles............ yyy PERMIT INSTALLATION NO. EACH FEE TOTAL NUMBER (less than 1000 watts) ............ $ .60 ........ -i Gas System with up to 5 outlets .............1...........1.....$4.00 ...4...0.0 Range........ Cooking Unit........ Oven............ ................ 2.00 .. ............ `Y` Each additional outlet ............................................. 1.00.............-. Dryer........ Garb. Disp......... Dishwasher ............. ...... 2.00 .............. Water System (Installation, Alt. or Repair) 1........1..... 4.00.....4...0.0 MOTORS: 1 HP or less ........................................ ...... . 2.00 Water Closet4.. Water Heater.. Ld. Tray......1.....6..... 4.00 .24.•.0.0 Greater than 1 HP not more than 5 HP .............. . 3.50 .. ............ Lavatory.6 Shower Pan.l. Bathtub.3. Sink....I...1.1..... 3.00...33_0.0 Temporary Power Pole or Service — 100 amp . . ..... ..5.00 .............. Wash. Mach.,l. Dishhw sher-lGarb. Disp.-I........3..... 3.00.....3gqQ....0.lXR1 —200 amp......... 7.00 .. .........._ Sewer .....� ../.I�.. ........... .. ...1 .. 1..... 8.00.....¢.,.O.Y Time Clock ...................................................................... 1.50.............. Lawn SprinkleSys. $5.00 Ea. add Sys. $2.00..................... ............. ��• Misc. (sae Ortl. current 1...................................................... Vacuum Breakers ............................................ ..............3.50.........-.... New Residential Occupancies Flat Rate Interceptor........ Water Softener........ ................. ............4.00. ............ 0-500 sq. ft. $22.00 1501-1750 $34.50.............................. Plumbing Piping without fixtures ..........1.............I.......4.00.....4_0D .+ Misc. (See Ord. Current) .................................................... e 501-750 24.50 1751-20000 37.50.............................. PermitFee .................................................... .. ................8 8.00 751-1000 26.00 2001-2250 39.50.............................. "' h 1001-1250 28.60 2261-2500 42.00.............................. TOTAL PLUMBING PERMIT FEE (plus penalty if app. []) $ 86.00 , 1251-1500 32.00 2501-2760 49.50.......28.9.8................ APPLICATION FOR HEATING/COOLING PERMIT Permit Fee...............................................$13.00 ; 11 TOTAL ELECTRICAL PERMIT FEE (Plus penalty If app.p) $ PERMIT INSTALLATION NO. EACH FEE 55.50 Forced Air Unit..................to 10oM .............._.......2....$ 6.00-. -12. ►L • - • - r over 100M ........................ . 10.00.. ........... Comfort Cooling Unit......to 3 ton/HP ................. .......... 6.00............... r Forma / Foundation .............. ...... ..... . BY' ...... . ate:. ........ to 15 ton/HP......................... 9.50.. ............ F� Plumbing Ground Work . ....... ... . -�'.'�.- ....... F ... to 30 ton/HP...........................12.00. ............ Rough Electrical .M!1.•... ,. .... ._ .... _.(....... - ,1'hT 9 `ting ... . .... .. �... t0 SO ton/HP...........................17.00.. J 1� 'tame - Plumbing and Westing ............................................................... Space Heater........ Wall Heater ................................... 6.00, ........... sulation & Energy............. ........... Flues - other than above ........... ....................1- ... 3.00............. Test Q��. ................................... I ..... 1 0 _. 3 �. ...... ......._................ 1 3 Dr er 1 S 3.00... porary Power Gas / Elect. ...... Vent Fan. Kitchen.... o Bath ...............y............. .......... ....J...�. . ... i.. .�C 1 Commercial Range Hood .......................................... 8.00....... �.xN al - Electrical ..........................._.... ..... .. � I Misc. (See Ord. Current............................................................... r . ......... .. Final - Building / Mechanical ..... ...... ...... .... ...........a.�.�.`...J.... Permit Fee ._........... $ B.00 ..............................................pp........ Final - Design Review y Landscaping . .. ...... ................................... TOTAL Htg./ Coolg. Permit Fee (plus penalty if app. p) E33.00 1, Final- Public Works . ............... . ....................... .. �f.Aoh , /�-1 g YYi . Tv(S5 2-z�F-6� L.tP• etao UFGr/.ye 5.4. 4.�i 1j�.(a-2 a�4o RlI II fM�!?1Fe4.dTMNeti f-�F•Pr/ POU-E SLIP File No . 3Q k Da u c Loca.ticn S U.b otes :11:'provcw1�� Date .V rector 1 lr % CERTIFICATE OF COMPLETION BUILDING INSPECTOR'S OFFICE CITY OF CUPERTINO „::.; ` n { DATE` � -' � � 19� � BLDG. PERMIT NO. �� 7 . THE BLDG. LO TED AT E OWNED BY I' HAS BEEN FOR USE AS— (ALTERED) S(ALTERED) l: I. - t I � BUILDIN PECTOR 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. 10 Owner or Tenant `' � b/A..--1'�''`— -" C" At /Ul AI%f�n i1 v�L Tract J I 4/ Date Connected ��! _ ( 19_Date Final�__y/_J___� —19 I OP M P.L•UMBING IN PECTO� ELECTRIC SERVICE NOTICE OFFICECOPY BUILDING INSPECTOR'S NOTICE CITY OF CUPERTINO 19 To You are here/bey 7authorized to Connect electrical service for Owner or Tenant a /�� r�r. �"'a --ie- Ar No.of Wires Siz%Wires Size of Switch Motor Load Voltage Phase Healing Load K.W. Voltage / Light 110 New Service Reconnect Na.of Meters Heat 120Three Wire More Service No.of Add.Meters Power 1 Three�Phhose..' Move Meter �• ELECTRICAL INSPECTOR �`-��—✓ '"M^ _OFFICE CITY OF CUPERTINO COPY tJ GAS SERVICE NOTICE i eiaA� /f , 19 ;f t I To i You are hereby authorized to connect t�he�GAS'service for jOwner or Tenant ec.,7- New Service No. of Meters Reconnect t No. of Add, Meters Move Service Move Meter PLUMBING INSPECTOR - 1