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1788 F CARE?.10') • (y�11LxF�,EMENT�l�1,,:� CITY OF CUPERTINO APPLICATION FOR RESIDENTIAL BUILDING PERMIT PERMIT NUMBER 7 • ANDP • - APPLICANT TO FILL IN CERTIFICATE OF OCCUPANCY BUILDING INSPECTION DIVISION STREET ADDRESS OF PROJECT: ..._..1019.6_.Engli sh..0ak..W ay......._..._............................_..._....... DEPARTMENT USE ONLY Legal Description: Tract.......65$1...... Block......_.... Lott$................ Description of Work: ...____...................................._......................... ...... Plans Received Survey.... .............uc.._..._....rg Date .ct.................... ..._....._............_...__...........solar..permit............ ...._........_............. REQ.: Plans.... Survey.... Calcs: Struc..... Energy.... Elect..... Mach.... : tat Struct. Improvement on Parcel: Yes.... No.... Area of Bid Plans Checked By....................... ........... Date ................_....... 9..g........... Application Approved B Separate Structure or Addition/Alteration to Exist. Bldg........... PP PP Y.........................................Date ......................... No. of Stories................ Use of Building Validated B .................. ............................... By........._......_............._...................._......Date __.._................ Valuation of Project: $._.. 1 ........._............._............._ ...... :.................... Compensation Certificate Verified By .......... Date ......._..,..._....... Owner: . ................................._............................._... Phone:.................... • • • • • Contractor: ...._ ....BAS...HO:•fES,...INC......City Bus. Lic. # . ............ . $ Contractor's Address: ............._......_......................... Phone:_.................. Permit Fee (plus penalty if applicable) ........................$..24.®0 Contractor - Electrical: ........... ................................................................... Plan Check Fee (less deposit of$.......... Rct. #.......... $..........._.......... City Business License #.................... Phone:.................... Energy Plan Check Fee (Dep. of $........ Rct. #........) $......__.._... ..... Plumbing: .........._........................................................................ Strong Motion Fee ...... ........................... ..................$...........!50 City Business License #......._...._..... Phone:......_...._...... Heating and Cooling ..............._...................._......_.... ..... Plumbing Permit Fee ..._............................_...._.__..$.... ..d....d1).... City Business License #............._..... Phone:......._........... Electrical Permit Fee Permit $........................._..._...._....$..._..............._. Architect/Designer: ............. ................_...._............ Phone:............. Mesh. nial Construction Permitx ............................ $ ............... Engineer: ... .. . .. Residential Construction Tax ................_......................$_.................._. ....... .................... ......_._......._...... Phone:_................. Misc. Fee $-.._......:..._...... Lender: ... .. ..._.'..._ ._..._.... ..._......._.._..._............_ .... ❑ Unknown Misc. Fee $ "I certify that in the performance of the work for which this permit Is ..............._...__...._.................._....._............... issued I shall not employ p y an y person f 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 undethe 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 #...._..... Variance #.... ......_ Parking Spaces............ I certify 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 Is _ correct and agree to comply with all City ordinances and state Laws regulating • • building. t (We) agree to save, indemnify and keep harmless the City of Cupertino '�nCfOBChmeOt Permit........................ Grant Of Easement_.................._.. against liabilities, judgments, costs and expenses which may in any way urb, Gutter, Sidewalk, Driveway: Replace.......... Repair.......... occurs 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 • - ELECTRICAL PERMIT 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 Light Outlets............ Switches........... APPLICATION •• PLUMBING PERMIT. 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.OU- ............. 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 am _..... . 7.00... Sewer ............._...._.........................._....._................_... .. 8.00.p .............. Time Clock ................_......._.._............._................_.._. 1.50... ............ Lawn Sprinkler SYS. $5.00 Ea. add Sys. $2.00......... ............ ...........Mis .. NOW (see Ord. current 1..............Rate ..... ... ............ .. ..... Vacuum Breakers .......__................................... ............3.50.............. New Residential Occupancies Flat Rate Interceptor..._... Water Softener........ .........._.................4.00. ............ Plumbing Piping without fixtures .. .. ......................... . g 00, _-..-,.... 0-500 0 ft. $22.00 1501-1750 $34.50.............................. Misc. (See Ord. Current) .......&9�.........................r 0 . 501-750 24.50 1751-20000 37.50.............................. •••-•••••• 751-1000 26.00 2001-225C 39.50.............................. Permit Fee ....._........................... .. .........$ 6.00 . ............................. 1001-1250 26.50 - 2251-2500 42.00.............................. TOTAL PLUMBING PERMIT FEE (plus penalty if app. ❑) E 1251-1500 32.00 2501-2750 49.50.............................. APPLICATIONFOR • • - MIT Permit Fee...............................................$6.00 TOTAL ELECTRICAL PERMIT FEE (Plus penalty if app.[]) $ PERMIT INSTALLATION NO. EACH FEE RECORD Forced Air Unit.............. _to loom ..............................$ 6.00............... INSPECTION • r over t00M ........................ . 10.00.. ........... Comfort Cooling Unit,....to 3 ton/HP .........._..... .......... 6.00... ............ Farms / Foundation ..............._.... ...... BY:...._.. ..._.. . Date:................ to 15 ton/HP...._...................fr 9.50...._........ Plumbing Ground Work . .................... L.... ...._.......... ........................... to 30 ton/HP......................._`..12.00. ............ Rough Electrical ..._........_....t....__.___.�_.......__.. ...._... ........_.... . ......... Ir rams - Plumbing and Heating ...._... to 50 ton/HP.__......................17.00.. ........... ............__.......... ........_..........._.... Space Heater........ Wall Heater ._............................... 6.00 siltation 8 Ener .............. • gY.._......_................... .....__._.._...__.. ........_....._...._.... Flues - other than above ....__.........._........................�. 3.00.. ............ Oda Test ...__..............._..............._ ..............._......'_................._...... Vent Fan: Kitchen........ Bath ...._........................._........ 3.00............... Temporary Power Gas / Elect. . .._.... ..._._..........._...._...._._............... Commercial Range Hood 6.00__„__ Final - Electrical ................ g _. ...__._....._....._............_..I_....__...._....._.... ........ Final - Building/ Mechanical ......._.. _......... Misc. (See Ord. Current......._........................._.._....._...........__........_... _........... .._................._.... Permit Fee $ 6.00 Final - Design Review / Landscaping . olg. ....rmit........_..........._.............__........_... .....__ ' - - - ------- TOTAL Htg./ Coolg. Permit Fee (plus penalty if app. ❑) E Final-Public Works ...............