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1342 CITY OF CUPERTINO PERMIT NUMBER t.ICLATION FOR RESIDENTIAL BUILDING PERMIT AND FOR APPLICANT TO FILL IN CERTIFICATE OF OCCUPANCY BUILDING INSPECTION DIVISION SZR �rS.ADDRESS OF PF3C� CT: c.rb .G r7 ! l +y • • • • • Legal Description: Tract. •�... Block .... Lot ....Description of Work: t,,#J- 'R f, Ve. jv .IDLE. Plena Received By y........... ......................... Date ...................... .... .........................................._................................._........................._............. REO.: Plans.... Survey.... Celcs: Struc..... Energy.... Elect..... Mach.... 1st Struct. Improvement on Parcel: Yes.... No... Area of Bldg............... Plans Checked By................ .. _ Dete ... ... Separate Structure..... or Addition/Alteration to Exist. Bldg........... ............ Application Approved B .. ...........Date .... .. PP PP Y ... .... .. ,(J V No. of Stories................ Use of Building ................................................. Validated B ......................................................... Date . .................... Y . .. Valuauo f r tact. $.... __....._�................. ........._....._...... Compensation Certificate Verified B ................ Date .....................--- rho P p- P Y Owner: VF"I ...�:1.JY. �C'(Y}'i" ... Phone:. .�/.��'.y(% r • • • Contractor: ..Ji•-.a:L%.5�.n.V ! .!C""City Bus. Lic. ... .......... Contractor's Address: - .U .. .. Phone:...�...�.!:l C Gk3.H... P„yy.......... ContPermit Fee (plus penalty f applicable) .................... $.................. ractor - Electrical: ...._..._......._... .............. ........................ Plan Check Fee (less deposit of$.......... Rct. #..........)$....__....----....... City.Business License a.................... Phone:................... Energy Plan Check Fee (Dep. of $........ Rct. #........) ......... Plumbing; ..._...___...............................-..................................... City Business License #.................... Phone:.................... Strong Motion Fee ..........................................................$......... . Heating and Cooling .................................................................. Plumbing Permit Fee EiP(-C?`0 Ilf10 $ % "r O.O... City Business License #.................... Phone:._ _ ...... ......... Electrical Permit Fee................... ......................... $..._...__.-..."" Architect/ Designer: . . . Phone' Mach. Htg./Coog. Permi $. ...........-------- Engines Ph . Residential Construction $....................... Lender: ... t_..,U..._n.�.k.. nown Mise. Fee ........................................................................$....................... "I certify that in the permit Is Misc. Fee v performance of the work for which ........................ .... .................. ...................... issued I shall not em Io an "' """'" ry y y person in any manner so as to become subject • • . . ; A $ to the workman's cam ensation laws of California." SIGNATURE OF X/ _ • • APPLICANVOWNER ."'"/" .... . ......_... DATE....._..... Environmental Status: Exempt............ Other............... ................. I certify that as the applicant 1 am liceandethe provisions of the Design Review Approval: Bldg. .._........ Site ............ Sign .._........ Contractors License Law and further thata Licens. No. .....__................... Use Zone ............ P.D. Conditions .......-................................_.._._..--.... in Classification ...__..........- is in fall force and affect: or Cond. Use Permit ♦------------ Variance e............ Parking Spaces............ I certify that I am exempt from the "Licensed Required" provisions of the Approved By:. Date Contractors License Law. (State basis of exemption.) """'"'""""""""'-" """""""""""""" """"-"""-"""""' I hereby acknowledge that I have read this application and state that the above Is cormct and agree to comply wlih all City Ordinances and State Laws regulating • • uuildmg. I (We) agree to save, indemnify and keep harmless the City of Cupertino rOaChment Permit........................ Greet Of Easement............. against liabilities, judgments, costs and expenses which may in any way rb, Gutter, Sidewalk, Driveway: Replace.......... Repair.......... acture against said City In onsequence of the granting of this permit." war.........�,,.. Conn. Fee $.........._.... Water................ Meter $................ SIGNATURE OF Agreement for Completion of Public Works Improvements _................ APPLICANT/CONTRACT....... .............. .W.d. .Plans Checked By..._... Date........ Approved By........ Date.._......._.._. NOTE: when properly validated this form os a Bull4ing Permit. This permit expires and becomes null antl void ohrk not be commenced within s • • 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 FEE APPLICATION , 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 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. Di p.... .......1 3.00....p�q... —200 amp......... 7.00... ............ Sewer ...Ff:.rl...V...�j.....�. JW.....:.M...FIL..........1....... 8.00...Gt..'.::,Y.r 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 Flet 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) .................................................... 501-750 24.50 1751-20000 37.50.............................. 6.00 761-1000 26.00 2001-2250 39.50.............................. Permit Fee •..........................................................................(plus enappII B.00�f 1001-1250 28.60 2251-2500 42.00.............................. TOTAL PLUMBING PERMIT FEE (plus penalty if aDP• '�) S _ 1251-1500 32.00 2501-2750 49.50.............................. APPLICATION FORHEATING/COOLING PermitFee...............................................$6.00 TOTAL ELECTRICAL PERMIT FEE (Plus penalty if app.[]) $ PERMIT INSTALLATION NO. EACH FEE Forced Air Unit..................to 100M ..............................$8.00... ............ INSPECTION RECORD 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 ................-.... ..... ................ ..:........................ to 30 torl...........................12.00. ............ ough Electrical ............._..._..._...........a.......................- -.....-..........._.-. to 50 ton/HP.....................""""..17.00.. me - Plumbingand Heating 6,00 9 ................................... ........................... Space Heater........ Wall Heater ................................... ........... Istlon & Energy....._...___......._...... ......................... ........................... Flues - other than above .............................................1-. 3.00.............. s Teat ............ _.. ...._................... ........................... 3.00............... . . ___ . .......... Vent Fan. Kitchen_...... Beth ..................................._.... �. emporary Power Gas / Elect. . ..._........................... _.._.......... Commercial Range Hood ..._..................................... .. 8.00............... 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. 0) S Final-Public Works ...........................................................