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1366 r, . . • 0 CITY OF CUPERTINO APPLICATION FOR RESIDENTIAL BUILDING PERMIT PERMIT NUMBER / 3� 6 AND FOR APPLICANT TO FILL IN CERTIFICATE OF OCCUPANCY BUILDING INSPECTION DIVISION STREET ADDRESS OF PROJECT: ......10313..Colby-Court......................._.......-................. a • Legal Description: Tract................. ..... Block............ Lot...................... Description of Work: ..._.....Heatin &...A/C.................................. Plena Received 8 8... By....................................................Date .... ..1� .. REO.: Plans.... Survey.... Cates: Struc..... Energy.... Elec..... ech.... 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 .................. ............................... Vel ldated By..............................................................Date ........................ Valuation of Project: $.._.......--.................................. Compensation Certificate Verified By .................. Date ......................._ Owner: .T.-Tuttleman��--.--....----.-- ---. Phone:._..�r...." Contractor: __.Atlas-Furnace Co. ...City Bus. Lie. # .............. • • '" • $ Contractor's Address: .155-Commercial...St..Phone:...7.3g-0.51 Permit Fee (plus penalty f applicable) Contractor - Electrical: ..............._..._...............__................................... (P P e PP 1 ..Ret................$....................... City Business License #...-............... Phone:.................... Plan Check Fee (less deposit of$.......... Rct. #....-.....)$....................... Energy Plan Check Fee (Dep. of t.,,.... Pct. #........) $.........-........... Plumbing: ...............___................................................................ /�n- City Business License #....-.............. Phone:.................... Strong Motion Fee ....................................:...�ti.........$....................... Heating and Cooling ...... P lumhln Permit Fee '�� e:..""""'""'."""' "..." fit-, City Business Licens ............_.._. Phone: Electrical Permit Fee .................5.F?.. .......................$.... ................. i Architect/Designer: .................................. ........ Phone:................... Mach. Htg./Coolg, Permit x ...........y... . .. ...... $.2k.,0.0.,._,_.. �� Engineer: .... ........_......._........................._........._.... Phone:............... Residential Construction Tax ...�....................�.(�_....,$..................._.. Lender: .. ........ . Misc. Fee ..........................................A..... ....................$....................... "I .. ❑ Unknown .._ certify that in the y any person of the work for which ethisco permit Is Misc. Fee ........................_........_...... r.......... ..__..$.......... .......... Issued I shall not employ any parson in any manner so as to become subject • $ 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 unde the 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 lull force and effect: or Cond. Use Permit #............ Variance #............ Parking Spaces............ . .. I certify that I am exempt from the "Licensed Required" provisions of the Approved 13 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 :orrect and agree to comply with all City Ordinances and State Laws regulating • ' • building. ,t I (We) agree to save, Indemnify and keep harmless the City of Cupertino IrOBChmBnt Permit........................ Grant Of Easement....................... against liabilities, judgments, costs and expenses which may in any way b, Gutter, Sidewalk, Driveway: Replace.......... Repair.......... secure against said City In consequence of the granting of this permit." ._ -,ewer............ 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 constitute, a Building Permit. This t permit expires and becomes ..It and cold should work mot'be commenced within • • 120 days from validation date, or should authorized construction be suspended or abandoned for a period of 120 day.alter work is commenced. PERMIT INSTALLATION NO. EACH FEE PLUMBINGAPPLICATION FOR 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.......... ven........... .......--..... 2.00 .. .....-.... Each additional outlet .........................................- .. 1.00............... Dryer,....._ Garb. Disp......... Dishwasher ............. ....... 2.00 _......._... Water System (Installation, Alt. or Repair) ................. 4.00............... MOTORS: 1 His 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. ............ Plumbing Piping without fixtures ...................................4.00............... 0-500 sq. ft. $22.00 1501-1750 $34.50.............................. Misc. (See Ord. Current) ........................I................. 501-750 24.60 1751-20000 37.60.............................. " 751-1000 26.00 2001-2250 39.50.............................. Permit Fee ........................... ( .............ally......................$6.00 1001-1250 28.60 2261-2500 42.00.............................. TOTAL PLUMBING PERMIT FEE (plus penalty if app. Q) $ 1251-1500 32.00 2501-2750 49.50............................... APPLICATION FOR HEATING/COOLING PERMIT PermitFee...............................................$6.00 TOTAL ELECTRICAL PERMIT FEE (Plus penalty If app.0) $ PERMIT INSTALLATION NO. EACH FEE Forced Air Unit..................to 100M ..................:.....1..-$ 6.co.• 6 -DD. • • ' r over 100M ........................ . 10.00.. ........... Comfort Cooling Unit....AD 3 ton/HP ......................_.., 6.00,.............. Forms / Foundation ................-........ . By:........ ....... . Date:................ to 15 ton/HP......................... 9.50.............. Plumbing Ground Work .................._ ).... ......_........ .._................ ...... to 30 t00/HP....................1.....12.00. 12.00 Rough Electrical ...-................. .. to 50 ton/HP............................17.00............... - Plumbing and Heating ..........t....._........._...... __.............._------- Space Heater........ Wall Heater ....................... .. 6.00............... Ion & Energy............................... ......................... ........................... Flues - other than above ..................................._.........�.. 3.00.............. aa�Test ....._........_....._.._...... ...... .. ....._..............'I.......................... Vent Fan: Kitchen........ Bath ..........__....-..................... 3.00............... Temporary Power Gas / Elect. . ....... ..._._................ .........._......._..._ Commercial Range Hood 6.00 f .......................................... Final - Electrical .:._......................... ...... .. . . ... I _. ...........:.._. ) .. ...... . . ... ...... . ... .. Misc. (See Ord. Current..................................................,........... _.......... Final - Building/ Mechanical .......................................I........................... Permit Fee .......................................-............................. $ 8.00 . Final - Design Review / Landscaping . ...._ ....._......... .......................... TOTAL Htg./ Coolg. Permit Fee (plus penalty If app. ❑) S Final-Public Works ........................................................... 24 00