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1797E CITY OF CUPERTINO APPLICATION FOR RESIDENTIAL BUILDING AND CERTIFICATE OF OCCUPANCY -18 BUILDING INSPECTION DIVISION CITY OF, cu?ER I io SJ�RLEMENF �IVV '"'� PERMIT LSA) PiansReceived By .................................................... Date ......................... REO.: Plans.... Survey.... Celcs: Struc..... Energy.... Elect..... Mach.... PlansChecked By .................................................... Date ......................... Application Approved By ............... Date ...............-----.... ValidatedBy ............................................... .....__..._. Date ........................ Compensation Certificate Verified By .................. Date _...................... • • • $ Permit Fee (plus penalty if applicable) ..... ____ ... _........ $24..90 ... Plan Check Fee (less deposit of --- Rct. #..........) $....................... Energy Plan Check Fee (Dep. of $........ ROL #........) Strong Motion Fee ....... ................... .......- ..... ..... -......... Plumbing Permit Fee _ .......... ........ _-..... ..._...... $.. ............... .... $..........a:.M.... - .... $... )LI—'4..._... Electrical Permit Fee ...................................................... $.......-.......... ... Mach. Htg./Coolg. Permit $...........................:. $....................... Residential Construction Tax...................r.................... $............ _ -------- Misc. Fee........................................................................ $....................... Misc. Fee........................................................................ $..... .----- :... ........ • $ 24.50 • r Environmental Status: Exempt ............ Other ........................................ Design Review Approval: Bldg ............. Site ............ Sign ..... ......- Use Zone ............ P.D. Conditions............................................................ Cond. Use Permit #............ Variance #.__....... Parking Spaces............ Approved BY ................... ...... Date .......... WORKSPUBLIC Permit.. ............... __... Grant of Easement........................ ccroachment 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............ Fixtures ..... .... ... Receptacles.____._. TOTAL NUMBER (less than 1000 watts) ..... ....... $ ,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 .._.._.._ ........................ .... _.___.._...._... ......... 1.60-1_.__..... Misc. ( see Ord. current)...................................................... New Residential Occupancies Flat Rate 0-500 sq. ft. $22.00 1501-1750 $34.50 .............................. 501-750 24.60 1751-20000 37.50 .............................. 751-1000 26.00 2001-2250 39.50 .............................. 1001-1250 28.50 2251-2500 42.00 .............................. 1251-1500 32.00 2501-2750 49.50 .............................. Permit Fee...............................................$6.00 TOTAL ELECTRICAL PERMIT FEE (Plus penalty if app.[]) $ RECORDINSPECTION Forms / Foundation ... B _... Date ......... Plumbing Ground Work ..... _. {. ... _... ... _... Rough Electrical ..... .. ... .... .. .. - Plumbing and Heating I- ... & Energy .... _. dacame .... ............. es Test._._.. ..... _ .. .... __I _ .. Temporary Power Gas / Elect .._.. ... ... ........ Final - Electrical ......... ...... .. .... ... ... Final - Building / Mechanical .............. ......... .............._I.__...._.........__... Final - Design Review / Landscaping . ...... .' Final-Public Works........................................................... ®, PERMIT NUMBER T TO FILL EE7 gpDRE FOR STR f62A fSS?F..POFJECT.................................... Legal Description: Tract.._.......b551.... Block............ Lot.... V . ............ Description of Work: ._....._ ............._............. .............. ......................... _....__....._........ __ __._..._.solar...permi.t......_.................._......... tat 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. # _..... Contractor's Address: __.............. ...._.. ....... Phone:....... .......... Contractor - Electrical:... .._.._......... ..... . _ _ ... City Business License # _... Phone _... ...... Plumbing:...._ ...... ..........._............_......... ......_................. - ... _..... City Business License #.......... ... ...... Phone: __............. ... Heating and Cooling ........... ._........... ...____ ................ City Business License #...... ....... _..... 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 APPLICANT/OWNER....... ....................__...._.._........................ DATE....., ___._.......... "I certify that as the applicant I am licensed undethe provisions of the Contractors License Law and further that my Licens. 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 correct and agree to comply with all City Ordinances and State Laws regulating bu ittl mg. I (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may In any way acture 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 not, be commenced within 120 days from validation date, or should authorized eonstruetlon be suspended or abandoned for a period of 120 days after work Is commenced. APPLICATION FOR 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.... Li 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) SD.IaX..PEI,D L..........�k..QQ........... PermitFee...-....................................................................$6.00 TOTAL PLUMBING PERMIT FEE (plus penalty if app. ❑) $ 10.00 APPLICATION ••COOLINC, PERMIT PERMIT INSTALLATION I NO. EACH FEE Forced Air Unit .................. to 100M ..................... .........$ 6.00............... over 100M ....................... . 10.00 ............. Comfort Cooling Unit...... to 3 ton/HP .. . 6.00 .............. 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 .. 1. 3.00.. . Vent Fan: Kitchen........ Bath .. ... -J 3.00.. Commercial Range Hood _ ......._6.00 Misc. (See Ord. Current..... _ . ... .. ..... .... .: PermitFee ... ... ........ _..... .... -...... ......___.......................- $ 6.00 TOTAL Htg./ Coolg. Permit Fee (plusrpenalty if app. ❑) $