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1271 ♦ s •' Y� CITY OF CUPERTINO APPLICATION FOR RESIDENTIAL BUILDING PERMIT PERMIT NUMBER AMD CERTIFICATE OF OCCUPANCY FOR APPLICANT • BUILDING INSPECTION DIVISION STR ET ADDRESSQF PROJECT- - /.�7B.Z......'10Y XBdy....I�LZ.�...CUP.. !..4_. Legal Description: Tract... 3.3 ..... Block............ Lot.....4•7....... �$ / Plana Received By Description of Work: D.. ."/O.N............."................................ y........................................ ........Date ......................-.. REO.: Plana.... Survey.... CSIcS: Strut..... Ener tat -'�-� Energy....D lett..... Mach.... tat Strutt. Improvement on Parcel:Yes g„�Q�gtD• Plena Checked By....................... . . .. Date .. P ....... No... Area of Bld Application Approved B Separate Structure............ or Addition/Ajteration to Exist. Bldg........... PP DP .............. ...... .............Date . .1.y �� Validated B �'r a"""”" No. of Stories.._..2... Use of Building By..............................................................Date ........................ 9 ..... Compensation Certificate Verified B Valuation ggf Project: b& 0.. ,O."".__,."".. By ................. Date ......................... Owner:•�/6 /1 ../'.... • . . . • E 4!ed Contractor City City Bus. Lic. a .............. ` a'2- Contractor's Address: S4: G-C.t.F.$T,#�.......... Phone:(�fBffp Permit Fee (plus penalty if applicable) ........................$..�`-!3......... Contractor - Electrical: .. ......,.M4,!I�ri..,......,...""",".,..,.".."",..",..,......""""........ Plan Check Fee (less deposit of$.......... Rct. #..........)$.................... City Business License #.................... Phone:.................... Energy Plan Check Fee (Dep. of $........ Rct. #........)$.......�3.5..0"O Plumbing: ...................................................................................... Strong Motion Fee ...........................CSS".,;a..f��_.T..$......... Q' City Business License e.................... Phone:.................... Plumbing Permit Fee ................ ............... W Heating and Cooling ...$rj•2y�,,.....,",,,.,_"_..,,,,. $......a?`31.A..... ................"..... Electrical Permit Fee .................. , $..,.,."r(. �_,S� City Business Lic nsse a.................. Phone:.................... Mach. Htg,/Coolg, Permit $......... .7. i Architect/Designer:�iriti•K. ",-CA�. J. Phone:.................... $...................... Engineer: Residential Construction Tax ............................._........ $....................... ...._........_..................._............................... PhonyU............. Misc. Fee .................................. ....., Lender: ... ........_......_........... .... . . $...................... ........................................ Unknown Misc. FSB .................. $ .. . ... "I certify that in the performance of the work for which this permit Ja ...-.......P..............................." "' issued shall not employ any pen e . , , . y manner so a to become subject $ 0 m the workmen's co tlo s Calllgrnln" SIGNATURE OF ZONINGREQUIREMENTS APPLICANT/OWNE .. p �y . . _ .... ................ DATE_G/.q Environmental Statue: Exam t............ Other._."............... ... -.. "I cerbly that as a applicant I am licensed under the provisions of the UDesign Review Approval: Bldg. ............ Site ............ Sign ............ Contractors License Law and further that my Licens, No. ............................ se Zone ............ P.D. Conditions .............................. in Classification ................._.-.........._...... ill full force end affect: or . g ......................... Cond. Use Permit e............ Variance ♦............ Parking Spaces............ I certify that I am exempt from the .'Licensed Required" provislons of the Approved By............................ Date Contractors License Law. (Stale basis of exemption.) ............................... ........................... I horeby and agree that I have read City application and state that La the above Is s • burdent and agree to comply with all City OMinenees and Slate Laws regulating building. croachment Permit........................ Grant of Easement........................ I (We) agree to save, Indemnify and keep harmless the City of Cupertino ift against liabilities, judgments, costa and a rb, Gutter, Sidewalk, Driveway: Replace.......... Repair es which may In any way P occurs against said City In cense eaffir gronting of this permit." war............ Conn. Fee $................ Water................ Meter 5............ SIGNATURE OF greement for Completion of Public Works Improvements ._............... APPLICANT/CONTRACTOR .._. DATEPlans Checked By........ DatO..._... ApprOVed By........ Date........... ...... NOTE: When Properly valida his form coutes a Building PermN. This permit expires and becomes null and void should work not M commenced within INSTALLATION • e • 120 days from validallon date. or should authorised comiW ben m""ended m abandoned for a Period of 120 days after work is commenced. `' Light Outlets.....�r..... Switehes..... NO. EACH FEE�. IY`� APPLICATION • ' • FOR PLUMBING PFPIMIT well .7 Fixtures.... ... Receptacles....../... PERMIT INSTALLATION NO. WC-0 SKE TOTAL NUMBER (less than 1000 watts) ..... ....... $ ,50 ""MI0 I Gas System with up to 5 outlets .............................. Range........ Cooking Unit........ Oven............ ."....._ . "...$4.00. ............. ...... 2.00 .............. ` Each additional outlet............................................. 1.00............... Dryer........ Garb. Disp......... Dishwasher 2.00 .............. Water System (Installation, Alt. or Repair) ................. 4.00. ............. MOTORS: 1 HP or less ........_...._............._......._. ....... . 2.00 ". ....""""""". 1 Water ClQgot.. Water Heater.... Ld. Tray..................... 4.00 ... ..�? Greater than 1 HP not more than 5 HP .............. . 3.80 .. ............ Lavator X Shower Pan. Bathtub./ Sink.$,........... 3.00. .`.c d'D Temporary Power Pole or Service — 100 am �.r4 � p ........ ."5.00 .......1......� Wash:Mach....: Dishwasher.... Garb: Dlep..... ............... 3,00. ............. —200 amp......... 7.00............... Sewer 8.00. ............. ......................................"........................................ Time Clock .................................................................... . 1.50............... h Lawn Sprinkler Sys. $5.00 Ea. add Sys. $2.00......... lac see new necucrrceunp . .... . - Vacuum Breakers ...... . ...........................................................4-"."0---0".. ...........".. eat0Or%l OancInterceptor........ Water Solt n3.50 0-500 sq. ft. $22.00 1501-1750 .$34.50.............................. Plumbing Piping without fixtures ...................................4.00, 501-750 24.60 1751-•20000. 37.50............................ Misc. (See Ord. Current) .........................I............... ............ 761-1000 2e.00 2001-2260. 39.80............... ... .. . ... Permit Fee ............................ ............................................$8.00 1001-1260 28.60 2261-2600 42.00.................... TOTAL PLUMBING PERMIT FEE (plus penalty It app. 7]) _ 1251-1500 32.00 2501-2750, 49.50.............................. APPLICATION FOR se Permit Fee...............................................$6.00 TOTAL ELECTRICAL PERMIT FEE (Plus penalty If apP•a E/7 INSPECTION RECORD — 4-D PERMIT INSTALLATION NO. EACH FEE Forced Air Unit..................to 100M .. Forms / Foundation ..♦ B D te: Comfort Cooling Unit....Ao 3ton/ H1 P ................. .. .......... 9.00 . ... Plumbing 48f0Q11C-We,* I .. I ..-...... / - to 15 ton/HP........................ 9.50.............. Rough Electrical ....................... � �" to 30 ton/HP........................ ..12.00. .. -wine -•Wnrrrkfingbnd-FfeBlhlg i __...._ ._ to 501on/HP........................ ..17.00.. ......... ..... ............ � .....� .... . .. Space Heater........ Wall Heater .................................. 6.00.. .. uletion 8 Energ ........_ Flues - other than above ............................................�.. 3.00.. .. ,f........ -. .._ .._.._..__...t2. ./.7 ¢a�•_. Vent Fan: Kitchen........ Bath ........._................... _ porary Power Oae / E ct. . ............. ........... 3.00... """ Commercial Ran " Final - Electrical ................................... .... .... /L.. 1y Misc. (See Ord. currents...........................................� ....9.00............... Final - Building/ �Jk,.�� " "-"-....".-T Permit Fea Final - Design Review / Landscaping .............._ ... .... 00 TOTAL Htg./ ....ty ... ......... $ 9. Final-Publ Works .......... P g.��... .,p.,,..�.............r...w.... �� , 9• Coolg. Permit Fea (Plus pe ty if aPP• O) E ` l+o+ T^��' leer-1'9 k4}I � -