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17940 CITY OF CUPERTINO • APPLICATION FOR RESIDENTIAL BUILDING AND CERTIFICATE OF OCCUPANCY BUILDING INSPECTION DIVISION DEPARTMENT USE ONLY CITY OE covA110 • SUPPLE MAL JAN 13 PERMIT PA' Plans Received By ........................ Date ....... ......------...... REO.: Plans.... Survey.... Celcs: Struc..... Energy.... Elect..... Mach.... PlansChecked By .................................................... Date ......................... Application Approved By ......................................... Date ......................... ValidatedBy.............................................................. Date ........................ Compensation Certificate Verified By ................ Date .................... VALUATION OF PROJECT Permit Fee (plus penalty if applicable) ................... $..24_d0 Plan Check Fee (less deposit of $.......... Rct. #... ....--- I $....................... FEE Energy Plan Check Fee (Dep. of $........ Ret. #........) $........ ....... ....... StrongMotion Fee .......................................................... $...........k:..... No. of Stories ................ Use of Building ................................................. Plumbing Permit Fee ............. ............. .._... _........ $.... ./�...Q�..... Electrical Permit Fee ...................................................... $....... .---............ Mach. Htg./Coolg. Permit $............................. $......................I ............ Residential Construction Tax ........................................ $....................... ............ Misc. Fee .................................. ........... .................... $....................... ._...... .. Misc. Fee........................................................................ $....................... APPLICANT/OWNER............. ..... ....... ..................... .... ............. ......... DATE........................ 01000KR $ 24.50 Time Clock .................. ........ ._...........____ ........ 1.50 _- --- ........ Misc. (see Ord. current)....................................................... building. I (We) agree to save, indemnify and keep harmless the City of Cupertino Environmental Status: Exempt ............ Other ...._ ....... .................. ........ . Design Review Approval: Bldg. _ ... ..... Site ............ Sign ............ Use Zone ............ P.D. Conditions............................................................ abandoned for a period 01120 days eller work Is commenced. APPLICATION•. PLUMBING PERMIT Cord. Use Permit e............ Variance #... ......... Parking Spaces............ ApprovedBy .......................................................... Date ........................... Each additional outlet ............................................. 1.00............... hcroachment Permit ........................ Grant of Easement.... urb, Gutter, Sidewalk, Driveway: Replace.......... Repair.......... Sewer............ Conn. Fee $................ Water................ Meter $................ Agreement for Completion of Public Works Improvements .................. Plans Checked By........ Date........ Approved By........ Date .................... PERMIT INSTALLATION NO. EACH FEE Light Outlets............ Switches............ Description of Work: ................................................................................ ...... _................ _........... ....... _.. so 1 a r... p er mi t.......... _......... _............. - Fixtures............ Receptacles............ Separate Structure............ or Addition/ Alteration to Exist. Bldg........... No. of Stories ................ Use of Building ................................................. TOTAL NUMBER (less than 1000 watts) ............ $ .50 ...... Range........ Cooking Unit........ Oven.. .... ..... ......... ...... 2.00 .............. City Business License e .......... .......... Phone:.................... 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 .............. APPLICANT/OWNER............. ..... ....... ..................... .... ............. ......... DATE........................ — 200 amp ........ 7.00 ............... in Classification ... .... ...... ............ .......... ... is in full force and effect: or Time Clock .................. ........ ._...........____ ........ 1.50 _- --- ........ Misc. (see Ord. current)....................................................... building. I (We) agree to save, indemnify and keep harmless the City of Cupertino New Residential Occupancies Flat Rate D-600 sq, ft. $22,00 1501-1750 $34.60 .............................. 501-750 24.60 1761-20000 37.60 .............................. 751-1000 26.00 2001-2250 39.50 .............................. 1001-1250 28.60 2251-2500 42.00 .............................. 1261-1500 32.00 2601-2750 49.50 .............................: Permit Fee...............................................$6.00 TOTAL ELECTRICAL PERMIT FEE (Plus penalty if app.[]) $ Forms / Foundation .._........... ...... __... Plumbing Ground Work ........ ......._... Rough Electrical ................................... larame - Plumbing and Heating .....:... sulatlon & Energy ............................ . GasTest ............... __-.............. .... ... Temporary Power Gas / Elect. __.. Final - Electrical ...._ .. .................... ....._. Final - Building / Mechanical ........... _. Final - Design Review / Landscaping Final -Public Works .................... By: ..... .. . ..... 1. Date:................ PERMIT NUMBER FOR APPLICANT TO FILL IN STREET ADDRESSIOFFP Byerly..Court?........... ......... ................ Legal Description: Tract .... .....6551... Block........... Lot .... 24............. Description of Work: ................................................................................ ...... _................ _........... ....... _.. so 1 a r... p er mi t.......... _......... _............. - fall Struct. Improvement on Parcel: Yes.... No ....Area of Bldg ............... Separate Structure............ or Addition/ Alteration to Exist. Bldg........... No. of Stories ................ Use of Building ................................................. Valuation of Project:$................................................................................ Owner: . ___ .................... __ ... _ ........... .... .._........ Phone:.................... Contractor:.._...._ BAS -HOMES-,- INC. City Bus. Lic. e' .............. Contractor's Address: _ .................................. Phone:.................... Contractor - Electrical:....._ ..... ............ ......._.._............ ....... ..... ................. City Business License e .......... .......... Phone:.................... Plumbing: ............. ................ ..................... ... _ ................... City Business License *..--- ____ .... Phone: ............... : .... Heating and Cooling................................................................. City Business License e...-..___....... Phone: .................... Architect/Designer:...___ .__.............................. Phone:_.................. Engineer: ... ........ ...... ............_............._...._._............ Phone:.................... Lender: . .. ... .... .............. . . _ _ ............ ..... _ ................ __ ❑ Unknown _ "1 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 APPLICANT/OWNER............. ..... ....... ..................... .... ............. ......... DATE........................ .. ._. "1 rarely that as the applicant I am licensed unde the provisions of the Contractors License Law and further that my Linens. 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 torrerl 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, coats 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 constitutes a Building Permit. This permit expires and becomes null and void should work nol.be commenced within 120 days from validation date, or should authorized constnietion be suspended or abandoned for a period 01120 days eller work Is commenced. APPLICATION•. PLUMBING PERMIT 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 ............................................ Interceptor........ Water Softener..................Plumbing Piping without fixtures ...................................4.00,,,,,........ t Misc. (See Ord. Current) .....gp.18F'..p@L it......4..0......... PermitFee.......................................................................... $ 6.00 TOTAL PLUMBING PERMIT FEE (plus penalty If app. ❑) $ 10.00 APPLICATION••HEATING/COOLING PERMIT INSTALLATION NO. EACH FEE Forced Air Unit .................. to IOOM ..............................$ 6.00............... over 100M ......._................ 10.00 ............. Comfort Cooling Unit ...... to 3 ton/HP ........................... 5.00.............. to 15 ton/HP ......................... 9.50 ............... to 30 ton/HP ........................... 12.00 . ............ to 50 ton/HP ... --- ___ .............. 17.00_ ........... Space Heater........ Wall Heater ................................... 6.00.............. Flues - other than above.............................................I. 3.00.............. Vent Fan: Kitchen........ Bath ....................................... .. 3.00............... Commercial Range Hood ................................... ......... 8.00............... Misc. (See Ord. Current... .......................__....................,....................... PermitFee........................................................................ $ 8.00 TOTAL Htg./ Coolg. Permit Fee (plus penalty if app. ❑) $