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1151 CITY OF. .CUPERTINO APPLICATION FOR RESIDENTIAL BUILDING PERMIT PERMIT NUMBER AND / CERTIFICATE OF OCCUPANCY � ' •• • BUILDING INSPECTION DIVISION STREET�pDORESS p�,PROJECT • , • `9..0..!. ._.._.rJ�.11%3 Ga auY�. ........... • Legal Description: Tract ............... .. Lot. .. Plane Received By .... .,Date . Description Work: REO.: Plana... Survey . Calcs: Struc.. EnerElect..... .... .. .....'-' o�i9'i lti� -- ""— - - 9Y.--. Elect. . Mach.--- .. Plans Checked ro ........y........ 1st Struct. Improvement on Parcel: YelaC No... Area of Bldg•, Application A Date ...... ........ Separate Structure. ... or Addition/ to Exi . Sdg..�..� Approved-By...... ...By Date ........................ � .. .. U of ildin __ ...... Compensation Certificate Verified By . ........ Date Valuation of Project: $ - - ' Owner: ...WirYDSaYL ... ._ .....- . . . • • Contractor: ES f$•{}) -- Phone�t.S4$$c[� • $ T- -... City Bus Llc ;/o tl o Contractors Address: .71'rj'1 Permit Fee (plus penalty if applicable) .... ...................$... Contractor - Electrical: .. _._. _,.._._.., R+GI/YA Phone: b -715 Plan Check Fee (less dethosil-of$.......... Ret. #..........)$....................... y Business license •......... Cit ..__..._.........._.. Energy Plan Check Fee (Dep. nt, Plumbing: ..._.... ------' Phone:................ ......Lit Strong _........ g Motion Fee ....._........._....._........:..................._$..... ..r0..�.... City Business License *.��..__......_...._..__.__................._. Plumbing permit Fee • + - -. Phone.... ...,..1......�..............................$..... r00 Heatin and Coolin ................. 9 9 ...._ ._..........._._. .. .. Electrical Per Fee .......................Y.:...... .._._... ... $._l.. 00... City Business License N........._...... ................ Mach. Htg./Coolg. Permit $ d e Phone: $../ ... . .. .. Architect/ .._. Residential Construction Tax -.4 . $ -- ---- . Phone:.... Misc. Fee ......... D. .............. Engineer:. . . ._... Phone: Misc. Fee - - - — --.- - ❑ Unknown "- -- --- $ __ "I certify that in t performance of the work for which this permit ie ONMDesign Review Approval: Bldg. issued';shall not e .............................. _ e $ .6 3 en any person in any manners sa to bac aublect P to the workman's c ensatlon I alifornle." SIGNATUpE OF Q� EnWronmental Status: Exempt._......... Other..._........_ AP°ucapryowNE .. ... 0 ...D p,V ...... 9 "I certily the as the applicant am licensed undo the PP Use Zone g Site '.-'-"""" $Ig0 Contractors License Law antl further that my L Provisions o ��...... P.D. Conditions ��""- icena No Cord. .. ..............._...._ark........._.ccs.........,.. in Classification ....._ Approved Use Permit x._...__.. Variance *...__._.. Parking Spaces............ "��--"'rom t----- fa in mu fogrce-andProvisions eoltescr�'r e A rove0 B .. .. Contractors that en exempt from the "Licensed Required" r v ion of the PP y `"""" """"- Date Contractors License Law. (State basis of exemption.) I hereby acknowledge that I have read this application and state that the above is ' s - 0d,ht and agree to comply with all City Ordinances and State Laws regulating ouildmg. 9ncroachment Permit,....-...--....... .. Grant of Ease ment_..........._......_. I (we) agree to save, indemnify end keep harmless the City of Cupertino ufb, Gutter, Sidewalk, Driveway: Replace.......... Re Bif.......... against liabilities, judgment costa and expenses which may in any way iWef........... Conn. Fee $_.............. Water............ - Meter p acture against said City i nsequence 1 grantin of IN -v $--..... SIGNATURE OF °e l!••� greement for Completion of Public Works ImproVemBOfa ........_........ APPLICANT/CONTRAC Plana Checked By. _.... Date........ Approved By._.._. Date.................... - --- .... . oa 7 °l... ..._.. NOTE- when properly dated this loan conelitutes a Building pemill. This • , , permit expires and becomes null and vold should work not G commenced within 120 dap Irom va0dallon data, or should authorized eonmrdtitbn M wperltlW or PERMIT INSTALLAT19 abandoned for a period of 120 days after work Is commenced. Light Outlets. �... Switches...w• N0. EACH FEE ZAPPLICATIONe PLUMBING Fixtures............ Receptacles;....�yr. TOTAL NUMBER (less than 1000 watts // PERMIT INSTALLATION NO. EACH FEE . ... .. $ .50 .fOt 0,0 Gas System with up to 5 outlets ................................$4.00. ............. Range........ Cooking Unit........ Oven............ ................ 2.00 .............. Dryer._..._ Garb. Disp._...... Dishwasher 2.00 ...._..... . Each additional outlet ._._.._............_..................... 1.00............... MOTORS: 1 HP or less ............... .. Water System (Installation, Alt. or Repair) ................. 4.00 n ............._. ....... . 2.00 ........._... Water Closet.... Water Heater.... Ld. Tray..................... 4.00. ............. Greater than 1 He not more than 5 HP ..__....._. . 3.50 .............. Temporary Power Pole or Service — 100 amp ....... ..5.00 ._ Lavatory:Shower Pan.... Bathtub.... Sink---I.....A..... 3.00. —200 m Wash. Mach..... Dishwasher.... Garb. Disp..... ............... 3.00............... Time Clock .... ..................... p. ........ 7.00 ..__...._.. Sewer ................................................................I.............. 8.00............... Misc, Ise. Ortl current l.... - ""'"" ""'" -- 0-.--. -. . Lawn Sprinkler Sys. $5.00 Ea. add Sys. $2.00................. New Hestdentlal Occupanmee tat nate Vacuum Breakers -" .......-... ..............3.50.............. Interceptor........ Water Softener........ ................... 0-500 0 it. $22.00 1501-1760 $34.50................ .--.4.00. ............ Plumbing Piping without fixtures ...................................4.00.. 501-750 24.60 1751-20000 37.60.............................. Misc. (See Ord. Current """"'- 751-1000 26.00 2001-2260 39.50:'............................ ) .................................................... 1001-1250 28.60 2251- Permit Fee .........$8.00 00 42.00.............................. TOTAL PLUMBING PER FEE (plus penalty if app. ) _ 1251-1600 32.00 2501-2760 49.50......................... .... � Permit Fee................................. .$8.00 APPLICATION • ' e a LI TOTAL ELECTRICAL PERMIT FEE (Plus penalty Ii app,0) $ NG PERMIT PERMIT INSTALLATION NO. EACH FEE . , Forced Air Unit... to 100M .............................. over 100M ......................_.$ 8.00............... Farms / Foundation .. .... _�` Comfort Cooling Unit.... to 3 ton/HP .................._...._16.00_. . •. Plumbing Ground Work BY` - Date:.. Ihtb - - + {� to l5 ton/HP....... .. .. 9,50. . `ugh Electrical .. - ---- p ...... .._ ._. ... - ..... to 30 ton/HP. ... ....... ... . 12.00. ........... me - Plumbing and Heating I ._, to 50 ton/HP .' ulatl on S Energy - S ace Heater.... Wall Heater . ... 16.00 Test - �` .......... Flues - other than above .. " ';D'd ct 1�.., `�'�� ... _... .. . .. nyAl'l.'. .. porary Power Gas / Elect Vent Fan: Kitchen. Bath 3.00.. !yg mal - Electrical _. - t. 3.00.. S,Q. Commercial Range Hood.._...- Jl, 5.00 Final • Building/Mechanical .. ' ""'�- Misc. (See Ord. Current..... �� ' """ Final - Design Review / Landscaping - _L... Permit Fee 'I "' "' "' ..................................................................... Final—Pub l+c Works ,B .... `""" "-""""-" TOTAL Htg./ COolg. Permit Fee lus penalty it $ 8.00 pp. bil q4-70(jV1-�66 10,1 o