1779 • 6IYPlh. E?fiNO •
CITY OF CUPERTINO JAN 1
APPLICATION FOR RESIDENTIAL BUILDING PERMIT PERMIT NUMBER 7 7
AND 7-y FOR
CERTIFICATE OF OCCUPANCY P-
BUILDING INSPECTION DIVISION STREET ADDRESS OF PROJECT:
.- ....1.0275-.Anthony..Place.......__...............................................
DEPARTMENT USE ONLY Legal Description: Tract_......6551.... Block............ Lot...9.................
Plans Received B Description of Work: . .. . .....................
....................
. ............. ..
By............... ._..........................-... Date .............. ............ . ,solar permit
--_.._.....nton.. ..rc ..._..o.....A' _a*ol_..................
REO.: Pens.... Survey.... Calcs: 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 ey......................................... Date ...............-.-...--- No. of Stories................ Use of Building _.... .
Validated 8y........ .... _.. .... _.._Date . --. Valuation of Protect $..__
. .... ......................... .......
Compensation Certificate Verified 8y .. .... Date ... ...... Owner . Phone: ..
Contractor: ..�BAS HOMES, INC. _
. , .City Bus. Lic. # ...-... _...
• • • III $ Contractor's Address: .... -... Phone
Permit Fee (plus penalty if applicable) .... $ 24,400 Contractor - Electrical: ._. ...... -. _..... ...... ............
Plan Check Fee (less deposit of$.......... Rct. #_........ $......._.............. City Business License #.._................ Phone:.._...._..........
Energy Plan Check Fee (Dep. of $........ Rct. #........ $.____...._...._. Plumbing: ..._.._._----..................................................................
Strong Motion Fee .._.............._ ....... $..._.....r.,i City Business License #__................ Phone:....................
Heating and Cooling __. ..
PlumbingPermit Fee .. ... ... . g 9 ._ . .. ..._..............._.._....._.........._..........
Electrical Permit Fee _.........................._-................._.$..._.....____..._ City Business License #.. .... Phone:....................
Mach. Htg./Cools. Permit $............................. $..... ................. Architect/Designer: ..... .._.............._................._.... Phone:....................
Residential Construction Tax ...._......._....... ........... Engineer: ...._...._..._..._.._..._......_............ ......... Phone:...................
..$._........_.......... Lender:
Misc. Fee ......_._.-....._.._._._......_...._._........._....__._..$......_............._ _.. ........._._............._..__.....__..... ❑ Unknown
Misc. Fee ........ """""$ - '9 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
• $ 24.50 to the workman's compensation laws of California."
SIGNATURE OF
• • APPLICANT/OWNER ..........._._.............--........... .................. .... DATE:......................
Environmental Status: Exempt............ Other.._..._......_._.................... 'I certify that as the applicant I em licensed unde the provisions of the
Design Review Approval: Bldg. _---.... Site ............ Sign ....... Contractors License Law and further that my Users, No. ...........................
Use Zone ............ P.D. Conditions .........._..._ -.................. in Classificationis in full force and effect: or
Cord. 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 Is
:orrect and agree to comply with all City Ordinances and State Laws regulating
• • building.
I (We) agree to save, indemnify and keep harmless the City of Cupertino
croachment Permit-...................... Grant of Easement ........_. against liabilities, judgments, costs and expenses which may in any way
ON, 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 ........— APPLICANT/CONTRACTOR ....... ................_........................ DATE .......................
Plans Checked By. ...... Date........ Approved By.___.. Date................... NOTES When properly validated this form constitutes a Building Permit. This
permit expires and becomes null and void should work not.be commenced within
APPLICATION • ' ELECTRICAL PERMIT 120 days from validation date, or should authorized construction be suspended or
PERMIT INSTALLATION NO. EACH FEE abandoned for a period of 120 days after work is commenced.
'
Light Outlets... Switches__........ APPLICATION • . PLUMBING
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 ._._...............................................---................... 8.00...............
Time Clock ...._................................_........._._..._._.___.. 1.50_._......... Lawn Sprinkler Sys. $5.00 Ea. add Sys. $2.00.................._................
Misc. (see Ord. current 1.......... ............. ......... ................. Vacuum Breakers ......................................_..... ..............3.50..............
New Residential Occupancies Flat Rete Interceptor........ Water Softener........ .............................4.00. ............
Plumbing Piping without fixtures ...................................4,00,
0-500 0 ft. $22.60 1501-1750 $34.50......................... e p g
••••• Misc. (See Ord. Current) .SOlar..ge,Y.lni,k..........yi...O. ........,,
501-750 24.60 1751-20000 37.50..............................
...
751-1000 26.00 2001-225C 39.50.......................... ... Permit Fee _............................ .............ally........ ...........$g p0
1001-1250 28.60 2251-2500 42.00.............................. TOTAL PLUMBING PERMIT FEE (plus penalty if app. []) $ 18.00
1251-1500 32.00 2501-2750 49.50..........................:... APPLICATION •,
HEATING/COOLING PERMIT
PermitFee...............................................$8.00
TOTAL ELECTRICAL PERMIT FEE (Plus penalty if app.[]) $ PERMIT INSTALLATION NO. EACH FEE
—
INSPECTION RECORD Forced Air Unit..................to 100M ..............................$ 6.00...............
over 100M ........................ . 10.00...
Forms / Foundation _.. ._. B . Date Comfort Cooling Unit.... 3 ton/HP . _.... ... 6.00. ...........
By:.. --- - "" to 15 ton/HP .. .... 9.50.
Plumbing Ground Work ... j .. . ... ...... to 30 tort...............
Rough Electrical .-. .. ...... 12.00.. ........
_-... _ ... . ._ _.._ to 50 ton/HP ... ... .......17.00.. ...
ams - Plumbing and Heating ... ._. ._ - Space Heater........ Wall Heater . .................... 6.00
sulatlon & Energy .._.... ...._.. . . .... Flues - other than above _. .. 3.00.
'as Test _ .. ... --_.. .. .. -- Vent Fan: Kitchen ..... Bath .._ .. 3.00 ..
Temporary Power Gas / Elect. .
-_." -- Commercial Range Hood .... 8.00
Final - Electrical ._ - - -- ��
- .-... - "- -- Misc. (See Ord Current.. ...
Final - Building/ Mechamcal � ---- � � ��
" ' - - -' Permit Fee
Final - Design Review r Landscaping ... --"`t
- TOTAL Htg./ Coolg. Permit Fee (plus penalty it app. ❑) $
Final-Public Works ...........................................................