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2060CITY OF, CUPERTINO CITY OF CUPERTINO APPLICATION FOR RESIDENTIAL BUILDING PERMIT AND CERTIFICATE OF OCCUPANCY BUILDING INSPECTION DIVISION Plane Received By .................................................... Date ........... REO.: Plana.... Survey.... Calce: Struc----- Energy.... Elect..... ecIf.... Plane Checked BY ................ ............................ Date ..... Application Approved By .. .. Date .... .// Validated B " ........................... By............................................................ Date ...................... Compensation Certificate .. ified By ............... Date ....... ........... • • $rLnna Permit Fee (plus penalty if applicable) ........................ Plan Check Fee (less deposit of $.......... Rot. #..........) $....................... Energy Plan Check Fee (Dep. of $........ Rot. #........) $....................... StrongMotion Fee ..... ........... .................. ..................._... $.........r..%.7... Plumbing Permit Fee ..... ........... .......... ........... - ... ..... $....../ ............. Electrical Permit Fee ...................................................... $..�[.r.GiZl....... Mach. Htg./Coolg. Permit $............................. 5....................... Residential Construction Tax ........................................ $....................... Misc. Fee........................................................................ Misc. Fee........................................................................ $ $ ...............r./•.�..... e �7/ % ZONING e Environmental Status: Exempt ............ Other ........................................ Design Review Approval: Bldg ............. Site ............ Sign ............ Use Zone ............ P.D. Conditions............................................................ Cond. Use Permit e .... ........ Variance *.... ....... . Parking Spaces............ ApprovedBy ........ ........ ............. ......__....... ......... Date ................ •• roachment Permit..... ... .......... Grant of Easement...._................... b, Gutter, Sidewalk, Driveway: Replace.......... Repair.......... ewer............ Conn. Fee $.... ........._. Water ..... ..._...... Meter $....... ........ Agreement for Completion of Public Works Improvements ... ...._...... -. Plans Checked By....... Date........ Approved By...._... Date .................... PERMIT INSTALLATION NO. EACH IFEE Light Outlets............ Switches........... Fixtures..... -y. Receptacles..6...... TOTAL NUMBER (less than 1000 watts) ..... ...0.. $ .50` Range........ Cooking Unit........ Oven... ...... _. ....... 2.00 ........ .. Dryer........ Garb. Disp..... .... Dishwasher ....... ............ 2.00 .. ............ MOTORS: 1 HP or less .... ....... .............................. _... 2.00 ............. Greater than 1 HP not more than 5 HP .._... ... .... 3.50 .. .._........ Temporary Power Pole or Service — 100 amp ..........5.00 .............. — 200 amp ......... 7.00 .............. TimeClock ............................ .._.... ................. ........ ........ 1.60 ... Misc. ( ace Ord. current)...................................................... New Residential Occupancies let Rate 0-500 sq. ft. $22.00 1501-1750 $34.50 .............................. 501-750 24.60 1751-•20000 37.50 .............................. 751-1000 2$.00 2001-226C 39.50 .............................. 1001-1250 28.60 2251-2500 42.00 .............................. 1261-1600 32,00 2501-2750 49.50 .............................. PermitFee...............................................$6.00 TOTAL ELECTRICAL PERMIT FEE (Plus penalty if app.p) $//r,v INSPECTION• -r Forme / Foundation ......... ...__._.. .....I BY :.. ..... ...... Date:............... Plumbing Ground Work En ... �. ..... Elect .... .. e pb,...hin.. anA ueanng ' S / Yl tion 8 Energy , I ..... .... Temporary Power Gas / Elect ... .� .. .... Final - Electrical ... ...._ . ... . `... .... Final - Building /Mechanical .. .. _ .._ ..... Final - Design Review /Landscaping ._.... _................... Final- Public Works........................................................... APR 3 PERMIT NUMBER ( 0 FOR APPLICANT TO FILL IN STR�T/JAD�(pAIES�r)1,F PR JE T' .... QYY.0 ..els/...INf/v�iQ ....r7T!/45........._......... _............. .... _....... Legal Description: Tract ....................... Block.......... Lot...................... Description of Work:.__R.�/..T/.o,.V._l._ZLC.C.1.'.................. ......._......._._......._.................... .............. .— _.....__.___ ..... ......... _.... ....... .. 1st Struct. Improvement on Parcel: Yes_.. No... Area of Bldg ............... Separate Structure............ or Addition/Alteration to Exist. Bldg........... No. of Stories ............... Use of Building ............ ........ ._........... ........ Valuation f Prolec . $ .. .... ......_. ..... Owner: �,Q,�/..._. .... Phone:.. .. ...... ... Contractor: . _ ......... / . ........_.....City Bus. Lic. ♦ .___ ....... Contractor's Address: .... ......... .....__......................... Phone:.................... Contractor - Electrical: .. ........................ ._.... .... ..... ._.._....................... City Business License ..... Phone:. . Plumbing:.. .. City Business License *.......... _.. _.... Phone: ... ........ Heating and Cooling .......__ ... ........... _.... ........ ..... _... ............... City Business License +r.._____ ......... Phone: ...... __ .......... Architect/ Designer: ....._..._...... ... .... .......... .__ Phone: .................... Engineer:....._ _......_.._....... .._........... _.._._._........ Phone:. ...... - ........... Lender: .. .... .._.. _ ................... _.......... ..._....... .... .. ❑ Unknown "I 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 to the workman's compensation laws of California." SIGNATURE OF �/ p APPLICANT/OWN ��... lr ......... DATBj :Q/ .I certify that as the applicant I am license nde the provisions of the Contractors License Law and lu rther that my Users, No . ....... ..................... In Classification _ .......... ............._...- is in full force and effect; or I certify that I am exempt from the "Licensed Required" provisions of the Contractors License Law. (State basis of exemption.) I hereby acknowledge that I have read this application and state that the above is rorrect 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 against liabilities, judgments, costs and expenses which may in any way Secure against said City in consequence of the granting of this permit." SIGNATURE. OF APPLICANT/ CONTRACTOR .........._...._........_....._......_......_... DATE .............. ......... NOTE: When properly validated this form eonsiltutes a Building Permit. This permit expires and becomes null and void should work not be commenced within 120 days from validation date, or should authorized construction be multilevel or abandoned for a period of 120 tlrys after work Is commenced. APPLICATION PERMIT INSTALLATION NO. EACH FEE Gas System with up to 5 outlets .................................$4.00 ............ Each additional outlet ............................................ 1.00............... Water System (Installation, Alt. or Repair) ................. 4.00.............. Water Closet.... Water Heater.... Ld. Tray ........... ........ .. 4.00 ............. Lavatory.... Shower Pan.... Bathtub.... Sink ................... 3.00............... Wash. Mach..... Dishwasher.... Garb. Disp.................... 3.00............... Sewer............................................................................... 8.00............... Lawn Sprinkler Sys. $5.00 Ea. add Sys.$2.00.................................. Vacuum Breakers ............................................ ..............3.50. ............ Interceptor........ Water Softener.....................................4.00............. Plumbing Piping without fixtures ...................................4.00............... Misc. (See Ord. Current) .................................................... PermitFee . ............. ............ ................................................ $ 6.00 TOTAL PLUMBING PERMIT FEE (plus penalty if app. :2) $ APPLICATION••HEATING/COOLING PERMIT INSTALLATIONNO. EACH FEE Forced Air Unit.... .... ........ Jo 100M ..............................$ 8.00............... over100M ..............I........ . 10.00 ............. Comfort Cooling Unit _.... to 3 ton/HP ........... .............. 8.00,.. ,.......... to 15 ton/HP .......................- 9.50.............. to 30 ton/HP . .......... ... 12.00 ............. to 50 ton/HP .. ...........1. 17.00............. Space Heater........ Wall Heater ........ .... I 5.00 ............. Flues - other than above .. ............... ....I 3.00 . Vent Fan: Kitchen .. Bath 3 00 .. Commercial Range Hood _.. 6.00 .. Misc. (See Ord. Curren[ .. ... .. ....... . .... Permit Fee .... ...... ....... $ 6.00 TOTAL Htg./ Coolg. Permit Fee (plus penalty if app. ❑) $ M R