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1792 0 CITV OF. un?.1I10 • SUPPL"TAL CITY OF CUPERTINO JAN 1 APPLICATION FOR RESIDENTIAL BUILDING PERMRPAID• PERMIT NUMBER / '79;L- • 'AND FOR APPLICANT TO FILL IN CERTIFICATE OF OCCUPANCY EEcc BUILDING INSPECTION DIVISION STREET ADDTBJ%% F EROJ ly:Court • • • • • Legal Description Tract........6551.... Block......... Lot...22.............. Description of Work: ................................................................................ PlanaReceived By....................................................Date .................. ................ .............._.......... ......solar...permit............-....................... 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........... Applicatlon Approved By...................... Date ......................... No. of Stories................ Use of Building ........._....-. . Validated By...................................... ......Date ........................ Valuation of Project: $................................................................................ Compensation Certificate Verified By ........ Date ......................... Owner: _............ BAS" HOMES'; INC ..........,..... Phone:.................... Contractor: ..............................................:........City Bus. Lic. # .............. • • • • • $ Contractor's Address: ................._._..........__._._...._ Phone:.................... l Permit Fee (plus penalty if applicable) -. .. ........$...24480 Contractor - Electrical: ........ _ ....... Plan Check Fee (less deposit of$..... Ret. #.......... $....................... City Business License #...............:... Phone:.................... Energy Plan Check Fee (Dep. of $--...... Rct. #........)$...................... Plumbing: ..__......_.__......................._.._................................__.. Strong Motion Fee ..........................................................$---_---.-�.... Heating and Cooling ..................._City Business License #.................... Phone:.................... _..__...-....__.........._._----..... l Plumbing Permit Fee ...................._..........-....._.......$..../Q.:. ......... City Business License #....__...____ Phone:.................... Electrical Permit Fee .............. ------- $....................... Architect/Designer: ___. Phone:.................... Mach. Hig./Coolg. Permit $............................. $............... ....................._..._........._... """.. LeEngineer: Phone:.............own Residential Construction Tax ........................._.............$....................... ._ .._..........._...................._..__.._..._...._.... Lender: . .. .... ._...._..... ........................._____.._..._.... [I Unknown Misc. Fee $. 'i ��"��"�'��'��"'��"��'��'��'��'�"��'��"""�"""" """"""""'"""' "I certify that in the performance of the work for which this permit Is Misc. Fee $. ��-��-��--�-�--��-��-��-�-�� ....-.............-.. issued I shall not employ any parson in any manner so as to become subject • $ 24.50 to the workman's compensation laws of California." SIGNATURE OF • • APPLICANT/OWNER .......................-.............................._.'__-._... DATE........................ Environmental Status: Exempt ............ Other........................................ "I certify that as the applicant I am licensed unionthe provisions of the Design Review Approval: Bldg. ......_.... Site ............ Sign ............ Contractors License Law and further that my Licens. No. ............................ Use Zone P.D. Conditions .................. in Classification ....................................... is in full force and effect; or Cond. Use Permit A............ Variance ...... Parking Spaces............ - I coritfy that I am exempt from the "Licensed Required" provisions of the Approved B Contractors License Law. (State basis of exemption.) pp y........................................................... Date ........................... I hereby'acknowledge that I have read this application and state that the above la correct and dared to comply with all City Ordinances and State Laws regulating •• # building, I (We) agree to save, Indemnify and keep harmless the City of Cupertino neroachment Permit........._........._.. Grant of Easement..._._................ against liabilities, judgments, costs and expanses which may in any way urb, 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 or abandoned for a period of 120 days alter work Is commenced. PERMIT INSTALLATION NO. EACH FEE APPLICATION FOR PLUMBING PERMIT Light Outlets............ Switches............ 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. Dep..... ............... 3.00............... —200 amp......... 7.00-1....... .... Sewer ............................................................................... 8.00............... Time Clock ............................. ..... ................................ . 1.50............... Lawn Sprinkler Sys. $5.00 Ea. add Sys. $2.00..................... ............. Misc. (see Ord, current I............ ........ Vacuum Breakers ............. .._..........3.50............. . New Residential Occupancies Flat Rate Interceptor........ Water Softener........ .............................4.00. ............ Plumbing Piping without fixtures ...................................4.00............... 0-500 sq. ft. $22.00 1501-1750 $34.50.............................. Misc. (See Ord. Current) .....solar..permit...A.L1A•........... 501-750 24.60 1751-•20000 37.50.............................. Permit Fee .........................................................................$8.00 751-1000 26.00 2001-225C 39.50.............................. TOTAL PLUMBING PERMIT FEE (plus penalty if app. Q) $10.00 1001-1250 28.50 2251-2500 42.00.............................. 1251-1500 32.00 2501-2750 49.50.............................. APPLICATION Permit Fee...............................................$6.00 TOTAL ELECTRICAL PERMIT FEE (Plus penalty If app.p) $ PERMIT INSTALLATION INO.11EACH FEE Forced Air Unit..................to 100M ..............................$ 6.00............... • over 100M ........................ . 10.00 .......... Comfort Cooling Unit......to 3 ton/HP ......._.................. 6.00............... Forms / Foundation .............................. By:........ ....... . Date:................ to 15 ton/HP................ ........ 9.50.. ............ Plumbing Ground Work . .___...._...... j.... ................ ........................... to 30 ton/HP...... .....................12.00. ............ Rough Electrical .............___................1......__............. ...................._.-.. to 50 ton/HP............................17.00.. ame - Plumbingand Heating.. ................................... ........................... Space Heater........ Wall Heater ................................... 8.00 u lotion 8 Ener ...��• 9........._.........._.......... .........._......_..... ........................... Flues - other than above ..................................._.......... 3.00 ............ as Test ......................._......._ ....... -__.-............._............................. Vent Fan: Kitchen........ Bath ......................................... 3.00............... Temporary Power Gas / Elect. ........ .. .. 6.00,,, -----�-�---�--�--�� -� Commercial Range Hood Final - Electrical ...................... .._.........---_._..-....................................... Misc. (See Ord. Current............._....._..................L.............._................. . Final - Building/ Mechanical .............. .......................I........................... Permit Fee .................................... __ . S 6.00 Final - Design Review / Landscaping - .... ----------.................... TOTAL Htg./ Coolg. Permit Fee (plus penalty if app. ❑) $ Final-Public Works ...........................................................