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1196 CITY OF CUPERTINO l� APPLICATION FOR RESIDENTIAL BUILDING PERMIT PERMIT NUMBER AND FOR APPLICANT TO FILL IN CERTIFICATE OF OCCUPANCY BUILDING INSPECTION DIVISION ST ET ADORE S OF PROJEG 4 q....��1cNAe........�.�,.............CAA-P .. a • Legal Description: Tract........................ Block............ Lot................ . 9 P Description of Work: :11J�..._ SIf1P0�.K(_1l.....�jtTj-rfra ... PlansReceived BY--------------......................................Date ......................... 11 REQ.: Plans.... Survey.... Calcs: Struc..... Energy.... Elect..... Mech.... 1st Structs Improvement on Parcel: Yes.... No... Area of Bldg............... Plans Checked By...........__.....................................Date ................. .. Separate Structure........-.., or Addition/Alteration to Exist. Bldg........... Application Approved By.....f;l:f...�,,.........._.__.....Date ' -7; No. of Stories......._....._ Use of Building ..........._..... Validated By..............................................................Date ........................ Valuationf Pro'e t: Compensation Certificate Verified By ....._......... Date ___................... Owner: : .....9_..Mu2A.I-6_C0- ........... Contractor: _................_._......_........_.._..........City Bus. Lia # _...._...... • • • • • $ Contractor's Address: .......... ...... .............................. Phone:.................... Permit Fee (plus penalty if applicable) ................. $......_.............. Contractor - Electrical: ....... _____... ____...................._._........................... ' Plan Check Fee (less deposit of$.......... Rct. #..........)$__.........-..... City Business License #.......-__..... Phone:._................. Energy Plan Check Fee (Dep. of $........ Rct. #........) $__............... Plumbing: ............................................_.........._............................ Strong Motion Fee ...................................... .-......$........ .....-........ City Business License #.................... Phone:.................... r .... .I":+ / Heating and Cooling ........... . ....................................... Plumbing Permit Fee ..........{,tt............'.`::..�...... $.....I<. .......... City Business License #.................... Phone% .................. Electrical Permit Fee ........ ............ ............ .....i Architect/Designer: ...... ............-..... Phone:.... . $....................... ........................ ................ Mach. Htg./Ccolg. Permit $.....yy:::. .. .� ..... ....................... ...... ........................... Residential Construction Tax ....>l.0�-..9 r. $ Engineer: . . .. _.........__.... . . _......_. Phone:............... .. ................$.-..................... Misc. Fee . .. ._ .. ...... ...._ . ... .._._......._.........._........_....... ❑ Unknown ........................................................ $....................... MISC. FOB �� i� ��$ Lender:l certify that in the performance of the work /or which this permit Is """"""""""""""""""""""__t.�,,,,st.,,,,,...____,___ ""-""""""""' issued I shall not employ any person in any manner so as to become subject • • . - $ to the workman' mpensetion ws of California" n SIGNATURE OF r � _J G^ • • APPLICANT/OWNERfEm�I../.1f.,^'. .. ....................._......._.... OAT _6..2../Ov. Environmental Status: Exempt ....._..... Other..__..........._..................... .... 'I certify that as the applicant I am licensed uncle' the pre rsions of the Design Review Approval: Bldg. ............ Site ....—..... Sign ............ Contractors License Law and further that my Utters, No. ............................ Use Zone P.D. Conditions in Claseificalion ..._.........................._..... 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. (Stale 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 \ building. I two) 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 _ 'urb, Gutter, Sidewalk, Driveway: Replace.......... Repair.......... secure against said City In consequence of the granting of this permit." -r 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 constitute• a Building Permit. This permit expires and becomes null and void should work not be commenced within t, • • 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 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 Repalr) ................. 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 ..........................-...................____...................... 8.001....... 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 Rate Interceptor........ Water Softener........ .............................4.00. ............ Plumbing Piping without fixtures ...................................4.00_,,............ 0-600 sq, ft. $22,00 1501-1750 $34.50.............................. Misc. (See Ord. Current) ......,................... ................., 501-750 24.60 1751-20000 37.50.............................. •.•..� ' 751-1000 26.00 2001-225C 39.50.............................. Permit Fee ..............................................alty.......pp.....) fi .00 1001-1250 28.60 2251-2500 42.00.............................. TOTAL PLUMBING PERMIT FEE (plus penalty if app. [�) $��fhi 1251-1600 32.00 2501-2760 49.50.............................. APPLICATION FOR HEATING/COOLING PERMIT PermitFee...............................................$6.00 TOTAL ELECTRICAL PERMIT FEE (Plus penalty if app.0) $ PERMIT INSTALLATION NO. EACH FEE Farted Air Unit..................to 1DOM ..............................$6.00............... INSPECTION • ' r over 100M ....................... . 10.00.. ........... Comfort Cooling Unit......to 3 ton/HP .........._............. .. 6.00... ........... Forms / Foundation ............... ............ . By:........ ....... . Date:................ to 15 torl......................... 9.50.............. Plumbing Ground Work . .................... ...._.................................... - to 30 ton/HP...........................12.00. ----........ -ugh Electrical .. _................................ ......_....... ..........._..._.................. to 50 ton/HP...........................17.00.. ............ • 1e - Plumbing and Heating .. ....L.._....._..._......., ._ ....................... Space Heater........ Wall Heater ................................... 6.00.............. etion & Energy......__........._.._..... ............._.........._..........__.......... Flues - other than above ................................._. .......1.. 3.00.............. •Test ._....... ..... • ' .... .. .. ....................... 3.00 ....... ....... .... Vent Fan: Kitchen........ Bath ......................................... .mporary Power Gas / Elect. ........ ....... ........ ................._....... Commercial Range Hood 8.00_..,,_,,...... 1 ................................... .......... Final - Electrical ....._............... .._........ ..._.................... .......................... Mist. (See Ord. Current...... . .................. Final - Building/ Mechanical ............... .._.........._.................................. ................- .... ........................... Permit Fee ...................................... $ 8.00 Final - Design Review / Landscaping �� 9 P. 9 .. . TOTAL Htg./ Coolg. Permit Fee (plus penalty If app. O) $ Final-Public Works ........................................................... d�-�--t`' ,.. . � � � � .� � � �� o� �.