1795 • SO pFCEMCUPE�TINO •
ENT 1981
CITY OF CUPERTINO SAN
APPLICATION FOR RESIDENTIAL BUILDING PERMIT - 1D PERMIT NUMBER 2ys
. AND FOR
CERTIFICATE OF OCCUPANCY
BUILDING INSPECTION DIVISION STREET ADDRESS OF PROJECT:
1018 0..By erl y...C.t..................--......-..................--_.................
DEPARTMENT ONLY Legal Description: Tract.655.1..._....... Block......... Lot..25...............
Plans Received By Description of Work: ............. ......_.
....... ...
y................ Date ..._...._.............. ..........so...ar... erlalt ........................
REO.: Plans.... Survey.... Delos: Struc..... Energy.... Elect..... Mach.... 1st Struct. Improvement on Parcel:Yes.... No.... Area of Bldg...............
Plans Checked By....................................................Date ......................... Separate Structure............ or Addition/Alteration to Exist. Bldg...........
Application Approved By ........................Date ......................... No. of Stories................ Use of Building
Validated By.................................... ..,Date ........................ Valuation of Project: $................................................................................
Compensation Certificate Verified By ................. Date ............. Owner: - Phone:....................
Contractor: ......... City Bus. Lic. # ..............
• • • • • g BAS. HOME S.....iNO. ............... Phone:....................
Contractor's Address: ................. .
Permit Fee (plus penalty if applicable) 24 00 Contractor - Electrical: ............. ........--......................
Plan Check Fee (less deposit of$.......... Rct. #..........)$....................... City Business License # ....... Phone:....................
Energy Plan Check Fee (Dep. of $........ Rct. #........) $................. ..
Plumbing: _..............................._..__..........._................................
Strong Motion Fee ..........................................................$......... City Business License #.................... Phone:....................
� /J-f3�- Healing and Cooling ......_...
Plumbing Permit Fee - ...... ...............................
......._...._.................................$....................... City Business License #..---...._......... Phone:....................
Electrical Permit Fee ......it $........._._............................$....................... Architect/Designer: .. ................._..........._............._ Phone:....................
Mach. Htg./Coolg. Permit $............................. $....................... Engineer: Phone:....................
.... ........................_......._...__..___--........
Residential .......ruction Tax ._.._...._-.........................$....................... Lender: ... _....... ... .. ❑ Unknown
Misc. Fee ........................_.................$..._.................. . ..... ................erfo............of
.............................
... ._ is certify that in the performance of the work for which this permit Ie
MI..C. Fee ........................................................................$....................... issued I shall not employ any parson in any manner so as to become subject
• E 24.50 to the workman's compensation laws of California."
SIGNATURE OF
• • APPLICANT/OWNER .............--..........-........................... ... DATE................
Environmental Status: Exempt............ Other........................................ ..._.. "I certify .hal as the applicant I am licensed undethe provisions of the
Design Review Approval: Bldg. .......... Site .._........ Sign ............ Contractors License Law and further that my Licens. No. ......._...................
Use Zone P.D. Conditions 'o Classification .......--.......................__. is in full force and effect: or
Cond. Use Permit #............ Variance #.._....._. Parking Spaces............ I certify that I am exempt from the "Licensed Required" provisions of the
Approved By Date Contractors License Law. (Slate basis of exemption.)
'""""""'""'""" '""'"'""""""""" """""""""""..... I hereby acknowledge that I have read this application and state that the above Is
•• s _ correct and agree to comply with ell City Ordinances and State Laws regulating
building.
'..CfOOChment Permit........................ Grant Of Easement............. (We) agree to save, indemnify and keep harmless the City of Cupertino
........., against liabilities, judgments, costs and expenses which may In any way
Ourb, Gutter, Sidewalk, Driveway: Replace.......... Repair........., secure against said City in consequence of the granting of this permit."
Sewer............ Conn. Fee $................ Water................ Meter $................ SIGNATURE OF
Agreement for Completion Of Public Works Improvements .................. APPLICANT/CONTRACTOR .............................._....... .... DATE ........................
Plans Checked By........ Date........ Approved By........ Date............ NOTE: when properly validated this form constitutes a Building Permit. This
— permit expires and becomes null and void should work not be commenced within
APPLICATION • 120 days from validation date, or should authorized construction be suspended of
xxxxxx abandoned for a period of 120 days after work is commenced.
PERMIT INSTALLATION NO. EACH FEE
Light Outlets............ Switches............ APPLICATION FOR PLUMBING-PERMIT
Fixtures............ Receptacles........-... PERMIT INSTALLATION NO. EACH 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 Closet.... Water Heater.... Ld. Tray..................... 4.00. .............
Greater than 1 HP not more than 5 HP -........... . 3.50 .............. Lavatory.... Shower Pan.... Bathtub.... Sink................... 3.00...............
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. (see Ord. current)...................................................... Vacuum Breakers ..........................-.............. ..............3.50..............
New Residential Occupancies Flat Rate Interceptor........ Water Softener........ .................. ...4.00. .
........ .Q ,
0
0-500 sq. ft. $22.00 1501-1750 $34.50.............................. Misc. (See Ord. Current) ...Plumbing Piping without fixtures SR 1X..RCX4t7.K.............4.?.r. .Y.....,.,
501-750 24.60 1751-20000 37.50............................'.. Permit Fee ..........................................$ 6.00
................................
75 -1000 28.00 2001-225C 39.50.............................. TOTAL PLUMBING PERMIT FEE (plus penalty if app. CI) E 10.00
1001-1250 28.50 2251-2500 42.00..............................
1251-1500 32.00 2501-2750 49.50.............................. APPLICATIONFOR
PermitFee...............................................$6.00
TOTAL ELECTRICAL PERMIT FEE (Plus penalty If app.p) $ PERMIT INSTALLATION NO. EACH FEE
Forced Air Unit..................to 100M ..........................:...$ 6.00...............
' • ' • ' over 100M ........................ . 10.00.. ............
Comfort Cooling Unit......to 3 ton/HP ........................... 6.00...............
Forme / Foundation .............................. BY:........ . ..... . Date:................ to 15 ton/HP......................... 9.50..............
Plumbing Ground Work ..................... .. .. ................ .......................... to 30 ton/HP............................12.00..............
Rough Electrical ....................................J......................... .......................... to 50 ton/HP............................17.00..
ifframe - Plumbing and Heating .......... ........................ ........................... Space Heater........ Wall Heater .............-.................. 8.00...............
I
ilatlon d Energy.............................. ......................... ........................... Flues - other than above ...................................... ...........
Gas Test ......... 3.00...
............... ........................ ... ........................ .......................... Vent Fan: Kitchen........ Bath ...................................-[- 3.00...............
Temporary Power Gas / Elect. . ____ ......................... ................-......... Commercial Range Hood B.Oq,_ ............
Final - Electrical .......-............ .......................................... .
_.._._...._ ...._................... ........_................. Mise. )See Ord. Current.._............_..__.._._...__..�..................
..... 6.........
Final - Building/ Mechanical ._.....__.. .... ........................................... Permit Fee ........__..........__._.................. E 6.00
..lg....................
Final - Design Review / Landscaping . ... . ...................................._..... TOTAL Htg./ Coolg. Permit Fee (plus penaltyif app. [-)) E
Final-Public Works ...........................................................
V