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1965 CITY OF CUPERTINO CITY OF CUPERTINO "lo 10 PERMIT NUMBER APPLICATION FOR RESIDENTIAL BUILDING PERMIT `/( S AND , . APPLICANT , FILL IN CERTIFICATE OF OCCUPANCY PAI BUILDING INSPECTION DIVISION STREET3ADp�ES O��+ROJECT: 23. .._. c ...�.n ..... DEPARTMENT USE ONLY Legal Description: Tract.... ..'..... Block......�...!�....Lot ................"..... Description of Work: 1nQ.._ ' syr..__.QyQQJ!_..i,BYt................... PlansReceived BY..............................................."....Date ......................... .. .................................................................................................................. REO.: Plane.... Survey.... Celca: Struc..... Energy.... Elect..... Mach.... tat Struct. Improvement on Parcel: Yes.... No... Area of Bldg............... Plans Checked By"....."...........""".".. Date . Separate Structure............ or Addition/Alteration to Exist. Bldg." lApplication Approved By.......... ... .. Date .. . ... �. No. of Stories............. Use of Building g.. . Validated By......................... ... "...Data ... ..... Valuation Qf-pr�lact: �_ Compensation Certificate Verified By .......... ." Date ..". Owner: . �"/j0� . fi.125•e say. .. phone Yy657js i • • a // Coniractor:�� . 1 , City Bus Lia » eo Contractor's Address LS'B6 �'9P.o.x . f4ri..- PhonQ.*. -f6?f • Permit Fee (plus penalty if applicable) S Contractor - Electrical: . _. .._ ._......: ................. J City Business License e......_._......... Phone:.................... Plan Check Fee (less deposit of$.......... Rot. #........"")$...................... V Energy Plan Check Fee (Dep. of $........ Rct. #........) $.._...._......... Plumbing: ..._...._...._......................_._.................._..........._.._._.. b City Business License A............. Strong Motion Fee .... . ....... ... . .... ... . ....$ . ....... Phone:.................... .e�r� H Plumbing Permit Fee .. ,, „$ /(,(�,,,p,.Q eating and Cooling __. . . - ... ...- ho .... .. ”" City Business Licensee ..... Phone Electrical Permit Fee . . ..... ..... .. $ d.srJ rSQ � � � �`.............. Architect/Designer: .. ... .._.._........_....._.. Phone:................... .Z Mech. Htg./Cool9• Permit $............................. $.....40rLj.f� Engineer: . . .. .. .. Phone:....... Residential Construction Tax ... . ...- . . $ ------..-- -- Unknown "" Lender: . .. .. ..... -._ Unknown Misc. Fee ._.. ....._..............._.._....._...... ................".......................................................$.................""... .. I cerldy that in the performance al the work for which this permit la �1 Misc. Fee ........................................................................$...."..p"..".. "."... issued I shall not employ any person in any manner so as to become subject 0 • S J D to the workman' ompensation is sol California." f r C SIGNATURE OF /y/�/ ` 1 it • • APPLICANT/OWNER .. . .... /. ................... ... _............. OATE..Jv./GL...*.... Environmental Status: Exempt-........... Other...................................." I certify that as the applicant I am licensed uncle the provisions f track y Design Review Approval: Bldg. ............ Site .. Site Sign ...._...... Contractors Licensq�Laand further that my Livens. No.1A1 ..1.4..... _ . Use Zone ............ P.D. Conditions . .................... . .... ml in Classification ...f .-1 ....................... is in full force and effect: or Cond. Use Permit A............ Variance M............ 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 state that the above Is WORKS corract and agree to comply with ail City Ordinances and State Laws regulating b uild,rrq. PUBLIC I (We) agree to save, indemnify and keep harmless the City of Cupertino Aftcroachment Permit........................ Grant of Easement........................ against liabilities, judgments, coats and expenses which may In any way ;y rb, Gutter, Sidewalk, Driveway: Replace.......... Repair.......... acture against said City Iyy77yyonce3uen�x� 1 the anting of this permisS." ewer............ Conn. Fee $................ Water................ Meter $................ SIGNATURE OF ,r -Y1117/ 3 Agreement for Completion of Public Works Improvements .................. APPLICANT/cogrRAc1'wt� .. .. _... DATE . // Plans Checked By........ Date.... Approved By........ Date.____........_. NOTE: When properly validated this form constitutes a Building Parisi tf• t permit expires and becomes null and void should work not be uromm•ne•d Mlkts APPLICATION •• ELECTRICAL PERMIT 120 days from validation data, or should authorized construction be sumpendM or abandoned for a period of 120 day after work Is commenced. PERMI . INSTALLATION NO. EACH FEE APPLICATION FOR PLUMBING PEriMIT �c Light Outlet5..... ..... Switches...re?. .. . / Fixtures.....`.. Receptacles......0!. . PERMIT INSTALLATION NO, EACH FEE J TOTAL NUMBER (less than 1000 watts) ... . . $ ,50 ��v'xU 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 ClosetY Water Heater.... Ld. Tray A ". 4.00. d o ` Greater than 1 HP not more than 5 HP ....... ....... . 3.50 .............. Lavatory... Shower Pan.... Bathtub.)( Sink...........2 ." 3.00. .4,,. .V • Temporary Power Pole or Service 100 amp . . .... . 5.00 ........ . Wash. Mach..... Dishwasher.... Garb. Disp..... ............... 3.00. ............- 200 amp. ___. . 7.00............. . Sewer .............................................................................. 8.00............... 1 Time Clock .................................... ................................. . 1.50............... Lawn Sprinkler Sys. $5.00 Ea. add Sys. $2.00..................... .........."". F� Misc. see Ord. current .......... ........................................... Vacuum Breakers ........................................... ........".....3.50.............. t New Resldenti al Occupancies tet' ate Interceptor........ Water Softener......." .............................4.00. ............ Plumbing Piping without fixtures .... ..............4.00............... 0-500 0 ft. $22.00 1501-1760 $34.50.............................. Misc. (See Ord. Current) .................................................... 501-750 24.60 1751-.20000 37.50.............................. Permit Fee .......................................................................$6.00 751-1000 26.00 2001-2260 39.50................... .......... pp. 1001-1260 28.60 2251-2500 42.00.............................. TOTAL PLUMBING PERMIT FEE (plus penalty i} app. �j $ (p,O 1251-1500 32.00 2501-2750 49.50.............................. • •• •• Permit Fee...............................................$6.00 LING PERMIf TOTAL ELECTRICAL PERMIT FEE (Plus penalty if app.p) $aQ PERMIT INSTALLATION NO. EACH FEE Forced Air Unit..................to 100M .............................$6.00............... • ' over 1DOM . . ... . 10.00 Comfort Cooling Unit._...to 3 ton/HP .... . .. 6.00.. ........ VN Forms / Foundation . By. Dat .. ... to 15 ton/HP ...... .. . 8.50 .......... Plumbing c.a�SMeak elVr-4 2 i _. {Q.r �. to 30 ton/HP .. 12.00 Rough Electrical ..... .J... . /�' ._. .. �E•' �. to 50 ton/HP . .......17.00.. ........... 'rPme - Plumbing and Heating .I._ 6.00 -- -- - Space Heater........ Wall Heater .......... -'atlon & Energy ..... .�... ..I .. Flues - other then above ....... 3.00 .. ....... was Test - ....... .__ Vent Fan: Kitchen........ Bath 3.00. 'Temporary Power Gas / Elect - - Commercial Range Hood 8.00 Final - Electrical ..... - Misc. (See Ord. Current.. Final - Building/ Mechanical ... ..I Permit Fee . ......... ..... ... ...... . $ 6.00 Final -//Design Review / Landscaping . .. ..... _. ..... ........... S TOTAL Htg./ Coolg. Permit Fee (plus penalty If app. 0) /Q d-t) FinaJzzc��lv^^KAIOIII iu... I�DL?�i�s 3•L'�'n8.1�..,1��Q•«.�.d•.1>Tf �.tt' I 3 18�8 � " 4RIA .0 40 F'rLt' ill TGT - -