The URL can be used to link to this page

1005 CITY OF CUPERTINO APPLICATION FOR RESIDENTIAL BUILDING PERMIT PERMIT NUMBER �Q�S AND FOR APPLICANT TO FILL IN CERTIFICATE OF OCCUPANCY / BUILDING INSPECTION DIVISION STREFT�kDpR 2 OF PFjQJEO -/C, # /G y, 10A .? DEPARTMENT • Legal Description: Tract_//�•..�-...._.._....... Block ... Lot...................... Plans Received By Description of Work: ._..................._._..._............_.................................. y....................................................Date ..........---............ ....._....uct..._..................__......_................__...........AI...a_oI _. ................ REO.: Plana.... Survey.... C9lea: true..... En gy.... Elect.... Mach.... 1st Strutt. Improvement on Parcel:Ves.... No... Area of Bldg............... Plans Checked By.................. . . Date ...r>x..:21.-.,�. 0 Separate Structure ......... or Addition/Alteration to Exist. Bldg........... Application Approved By .�d.. ..Date j.-....2..... No. of Stories Use gg��1 gr .. Validated By......... ..... ............... _Date - -... �O � ..... . ._. ... .... q Valuation,pf Pro�ec �� .. . ...._ .. .. .. Compensation Certificate Verified By ... Date ............. Owner. (r T ._ ��Q'.D _.... Phone. • e • • Contractor: . (!r'!.. /7- _... Lic. f $ Contractor's Address: Ji'_ ./�j.�GsL•i�.. hone_jZ7-S?S Permit Fee (Plus penalty if applicable) .. .. ........$....... .°..".S. Contractor - Electrical: ...___ Plan Check Fee (less deposit of $. ....... Rot. #..........)$....................... City Business License..#............................................Ph h_o..n..e._...._.............................. Energy Plan Check Fee (Dep. of $.--..... Ret. #........)$................ Plumbing: ...................................................................................... Strong Motion Fee ..._............._................._..................$..........b. .. City Business License #.:........._. ..... Phone:................... PlumbingPermit Fee O. O_ Heating and Cooling ...................._........._.................._............. ................................................$......a......Q..... City Business License #.................... Phone:.................... Electrical Permit Fee ermi..._............_......_._..._...._._.$...__/..7,.00. Architect/Designer: ..,$.✓M H., ................_.. Phonet�77" Mech.ResidHtgential Construction Permit x .. .d.1.::.: .......y.... $......rl. ...,4-. Engineer: ... . .._.. ......... .... .................I.......... ....__.. Phone:....Residential Construction Tax ........................ ................$........-.........-.... lender: . Mise. Fee ._..... ........ - 7.;.;... ,., - $.. ._.._.. ... ..........._... .._......_.. ❑ Unknown '""" "I certify that in the Misc. Fee ..._........... "�^ •,..........: ....................... Y performance of the wank lar which this eperniltSubj is """' "" "' """"""'$ ��/'�// issued I shall not employ any person in any manner so as to become aublect • • : $ J&743 3 to the workman's compensation laws/of�C2Wo[nia.5 r SIGNATURE OF S • • APPLICANT/OWNER �... .�._.._-...J...... DATE.._............ Environmental Status: Exempt............ Other........................................ ... I certify that as the applicant 1 am Licensed uncle- the provjsions of the Design Review Approval: Bldg. ....._..... Site ............ Sign .._........ Contractors License Law and further that my Licens, Noj b ...... Use Zone ............ P.D. Conditions ........ in Classification __...1..._........... .._.._.... 1. in full force and effect: of .................................................... Cord. Use Permit #_.......... Variance #_.......... Parking Spaces............ -. I certify that I am exempt from the "Licensed Required" previsions of rhe Contractors License Law. (state basis of exemption.) Approved By......................................................_... Date ......._.._._............ I hereby acknowledge that I have read this application and slate that the above is •, • correct and agree to comply with all City Ordinances and State Laws regulating budding, IcrOBChmenf Permit....................... Grant of EBSBRIBnI........................ 1 (We) agree to save, indemnify and keep harmless the City of Cupertinoagainst Ilab i li tie a, judg agents, c is end noes which may In any way Jrb, Gutter, Sidewalk, Driveway: Replace.......... Repair__....., acture against as id City o q n of a grand ng,of this permit." $ewer............ Conn. Fee $._............. Water............__ Meter $... SIGNATURE OF Agreement for Completion of Public Works Improvements ._...._......... APPLICANT/CONTRACTo _....... .... ....T-.f.f."..:..�y DATE ........................ Plans Checked By........ Date........ Approved By........ Date.................... NOTE- When properly validated this form constilutes a Building Perms. This permit expires and becomes null and void should work not be commenced within APPLICATIONs 120 days from validation date, or should authorized construction be suspended or abandoned for a period of 120 days after work Is commenced. PERM IT_j NSTALLATION�pg EACH NO. EAFEE APPLICATION FOR PLUMBING Light Outlets.... ..... Switches...../.... Fixtures............ Receptacles../0... O.00 PERMIT INSTALLATION NEACH 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 Cio et. . Water Heater.... Ld. Tray4.00 Greater than i HIS not more than 5 HP .........._. . 3.50 ....._....... Lavatory .. Shower Pan./ Bathtub.... Sink.........rw,..... 3.00.-0....... 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. e Ortl. currant)................... ..... .... ....................34..500 New ............................. ... ................. . . .. .. Interceptor... Water Softener...... .. .. ...... 0.. ........-.... ............ Plumbing Piping without fixtures ...................................4.00............... 501-7 0 ft. $22.00 1501-1760 $34.50.............................. Misc. (See Ord. Current) .................................................... 601-750 24.60 20 1-•2250 37.50.............................. Permit Fee ................................................................:.........$6.00 751-1000 28.00 2001-2250 39.60.............................. TOTAL PLUMBING PERMIT FEE (plus penalty if app.0) S a0 °- 1001-1250 28.60 2251-2b00 42.00.............................. 1251-1600 32.00 2501-2750 49.50....................... APPLICATION •• COOLING Permit Fee...............................................$8.00 TOTAL ELECTRICAL PERMIT FEE (Plus penalty If app.p) $/700 PERMIT INSTALLATION NO. EACH FEE Forced Air Unit..................to 100M ......................./.....$ 6.00......... ...-- INSPECTION RECOPI, / over IOOM ....................... . 10.00.. ........... .to Forma /PlumbintG and Heatino By . . Date gi Comfort Cooling Unit.....to 3 ton/HP ....................... . 8.00... .......... NJ to 15 ton/HP 8.50... PlumbingGround Work """" g .._. ,I to 30 ton/HP................ .. ... . 12.00 i W Rough Electrical """" �/� to 50 ton/HP` ...........17.00.. .. u twn 8 Energy - '- 7 -W "" Space Heater........ Wall Heater ...7... 8.00 .a..b'0 Flues - Other then above .. .�. 3.00. Was Teat .I-{•"!E7"�Q.�I Wyk+. Vent Fan: Kitchen....._. Bath ... .. 3.00. Temporary Power Gas / Elect Commercial Range Hood- . ... ///��e��'/// �r oo _ _ 8.00, ,,,, Final - Electrical . ... _ ..w.~;;�W� Misc. (See Ord. Current.. _ ...... . . . Final - Building/ Mechanical . ...1 _ 3:0�7_... permit Fee ................. ...... .. ... .. .... $ 6.00 Final - Design Review Landscaping . ... ._.. . .... ... ... .... TOTAL Htg./ Coolg. Permit Fee (plus penalty if app. p) $/f_e� Final—Puplic Works .......................................................... l