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1216 CITY OF CUPERTINO APPLICATION, FOR RESIDENTIAL BUILDING PERMIT PERMIT NUMBER AND CERTIFICATE OF OCCUPANCY • . APPLICANT TO FILL IN BUILDING INSPECTION DIVISION STRE T ADDRESS OF PROJECT: ?t.2 ..3fi..�7lEQJ'�...OK..,.. vPE�eri mac........................... • • Legal Description: Tract....................... Block............ Lot...................... Plane Received B / Description of Work: //pT.7TlB.......................................................... By.................. M...................Date 1 3 Fu.... REO.: Plans.... Survey.... ?�Icyy: Strugg.,. Energy.... Elect.... M/e%lh.... tat Struct. Improvement on Parcel:Yes....No... Area of Bldg............... Plans Checked By.......... W......1`:..7t.LY........."...Date ...�..i... ........ Separate Structure.-.......... or Addition/Alteration to Exist. Bld ..K...... Application Approved By_..._fli.,..�...r..................Date ""/�.... No. of Stories....�...__.. Use of Building ..s�..N41 ...-/.� ......... Validated By..............................................................Date ........................ Valuation of Project: ...................$.. jooa�oo ................... ... . ........ Compensation Certificate Verified By ................. Date ............ ...... Owner: I{pTt-L`...Pr' .S.IGr......................-. Phone.,2".-7�7 ....9/ Contractor: ..... _.....__.............. _.......__....City Bus. Lic. a .............. • • • • • $ .24O ,Oo Contractor's Address: ...._......... Phone:.................... �S1- - ..........._................... Permit Fee (plus penalty if applicable) Contractor - Electrical: ._................__............_......_...._........................... P Y • PP 1 ........................$.02.0....... .. Plan Check Fee (less deposit of$........." Rct. #..........)$_. to.. d-d City Business License e........._......_. Phone:.................... X ) .. .. ... . Plumbing: ...................................--...................... e:.................... Energy Plan Check Fee (Dep. of $........ Rct. #........ $...... .... .. ... City Business License *.................... Phone:.................... Strong Motion Fee ..............................."..........."........._...$..........".,Sa. Heating and Cooling Mach. Ht9.ermit . Permit $............. ^•...... ;--::, y. . Plumbing Permit Fee ...............".....'!Y �:•••4a"-2- """ City Business License a..._._............ Phone:.................... Electrical Permit Fee ................ ........................"..........$... ...�r..S.""""... . Architect/Designer: .._......_...... ....................._._.... Phone:.................... ...i .,.:s:. $..... ................" Engineer: Phone:....".............. Residential Construction Tax .....__ts.,.:a..=.l..i.r¢l..$.... .." .. ....._._.............__......_.................._..... . . .. .. ......._.. ..._._. .....ance._."........work ....... hi El Unknown Misc. Fee ........................................_......._.................._.$.._........."........ Lender:I certify that in the performance of the work /or which this permit Is Misc. Fee ...........................................n).......,.... .... Y.$..5�. .... issued I shall not employ any person in any manner so as to become subject to thew orkm,,a00' mpensation le 1 Calilornla:' SIGNATURE OF / f O ZONING • APPLICANT/01 _ .... .. DATE .... ._� Environmental Status: Exempt ............ Other.....".__.... ........_..... rertily that as the appllcam I am licea tur& the pro let. o/the Design Review Approval: Bldg. ........... Site .._ --- Sign ............ Contractors License Law and turther,that y Llcens. No. ........................ Use Zone P.D. Conditions .................. in Classification ........................._._.._-- is in full force and effect: or ......rmi ......"...........................Sp. Coad. Use Permit #............ Variance s'............ Parking Spaces........... I certify that I am exempt from the "Licensed Required" provisions of the Approved B Contractors License Law. (Stale basis of exemption.) pp y..._.........._.............._.._...."................. Date ...._....._......__.._ 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 • •- • - building. I (We) agree to save, indemnity and keep harmless the City of Cupertino C roachment Permit........---.......... Grant of Easement..._"_................ against liabilities, judgments, costs and expenses which may in any way rb, Gutter, Sidewalk, Driveway: Replace.......... Repair.......... acture against said City in consequence of the granting of this permit." Wer............ Conn. Fee $................ Water... Meter $................ SIGNATURE OF Agreement for Completion Of Public Works Improvements ................ APPLICANT/CONTRACTOR ......................................................... DATE ..... .............. Plane 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 • • 120 days from validation date, or should authorized construction be suspended or abandoned for a period of 120 days after work Is commenced. PERMIT INSTALLATION NO. EACH 7FEE APPLICATION FOR PLUM13ING 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 ........................................ .A... . 2.00 "-" ".0'fl� 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 ......................_.........._...................._.... .L_..., 1.50...fi...( Lawn Sprinkler Sys. §5.00 Ea. add sY's. $2.00.........".."........ ............. Misc. (see Ord. currant 1...................................................... Vacuum Breakers ...........--............................. ..............3.50.............. New Residential Occupancies Flet Rete Interceptor........ Water Softener........ ................"....".......4.00. ............ 0-500 eq. ft. $22.00 1501-1750 $34.50.............................. Plumbing Piping without fixtures .....................-.............4.00,..�...00_ Misc. (See Ord. Current) .................................................... 501-750 24.60 1751-20000 37.50.............................. Permit Fee ..........................................................................$6.00 OO 751-1000 26.00 2001-226C 39.50..................... ........ nat : 1001-1250 28.60 2251-2500 42.00.............. TOTAL PLUMBING PERMIT FEE (plus penalty if app. ❑) $/ 1261-1600 32.00 2501-2750 49.50.............................. APPLICATION PermitFee...............................................$6.00 TOTAL ELECTRICAL PERMIT FEE (Plus penalty if app.0) $y� PERMIT INSTALLATION NO. EACH FEE Forced Air Unit.,.............Ao 100M ..............................$ 8.00............... • • • • s over I OOM ........................ . 10.00.............. Comfort Cooling Unit......to 3 ton/HP ........................... 6.00............... Forms / Foundation ........................... BY:_...... ....... . Date:.............. to 15 ton/HP......................... 9.50.............. Plumbing Ground Work to 30 ton/HP...................".... ..12.00. ............ ugh Electrical ............._._..................f. ...............././-. .... to 50 ton/HP................-...... .17.00.. ........... me - Plumbing and Heating ................................... ........................... Space Heater........ Well Heater ................................... 6.00 _ ulatlon & Ener . • G Test .......... ............._. ........................... Flues - other than above ..................................."........�.. 3.00.............. . . .. ....... ..........._..............__........... - Vent Fan: Kitchen........ Bath ..............................._........ 3.00............... Temporary Power Gas / EIecL ......................_......... .... -..-....... Commercial Range Hood 6.00,,,,,,,__,... Final - Electrical .................. ---........................-........... . ............_... ._......."..._.........._........_............." Misc. (See Ord. Current......_._........."................... ............................._.... Final - Building/ Mechanical ................._.._...... ........ ................. Permit Fee ._...............--... $ 6.00 .. ..............................."..".....".... Final - Design Review / Landscaping - ..-. .... ..........-._........ ._............ TOTAL Htg./ Coolg. Permit Fee (plus penalty if app. ❑) $ Final-Public Works ...........................................................