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1309 IV, 0 CITY OF CUPERTINO APPLICATION FOR RESIDENTIAL BUILDING PERMIT PERMIT NUMBER /3p AND FOR APPLICANT TO FILL IN CERTIFICATE OF OCCUPANCY BUILDING INSPECTION DIVISION STREET ADDRESS OF PROJECT: 0.1.0(o........English-Oak-Way............................—..................... DEPARTMENT ONLY Legal Description: Tract.§551............. Block............ Lot-....191.......... ec Description of Work: .Single...Family...Dwe.l.liJxg................... Plans Received By............fl�/'.. . Date ...t"'i, . REQ.: Plans.... Survey.... C Ic : Struc..... Energy.... Elect..... Mach.... list Struct. Improvement on Parcel: Yes.X No....Area of Bldg.22.6.28 Plans Checked By............r /`.'...........................Date .. .... / Separate Structurgg...NO... or Addition/Alteredion to Exist.,Bldg.S.2.15.Q. ,Application Approved By......-....../s-1.................Date ., ,r�r.. No. of Stories..._.L.._... Use of Building .....,f�.esi.d.Qnti..a.l.............. Validated By.................................... ........Date ... ... ... ...... Valuation f r ' ct: $.91 000............................................ .............. ... p 41e Compensation Certificate Verified By ,/r�..f.7..... Date . di.... Owner H.A.........lOtneS,.,.InC,. .. Phone:. ....T...�. ... - • • • • • g 91,000 Contractor: ... as .above .... City Bus LIc. # 11061 Contractor's Address:20823 Stevens irk. PI11one:.252r..20Z Permit Fee (plus penalty if applicable) ......... ........... $.......260...00 Contractor - Electrical: .. Best-E1.ectrical CO, ........... Plan Check Fee (less deposit of$.......... Rot. #..........)$....................... City Business License #..181.72..... Phone:..287.-.2.04 Energy Plan Check Fee (Dep. of $........ Rot. #........)$.._.............._- Plumbing: .Crowley...Co........-.............--.....................------ Strong Motion Fee ...........................................................$............6...3.7 City Business License x.....16641. Phone:.24.5.-.424 Plumbing Permit Fee $..........7.8„-00 Heating and Cooling .....Al—Boyer...CO...._..... ........... .................................. 79..--3 '8 City Business License #:......_........... Phone:.................... Electrical Permit Fee ........................................................it $ % $._....._48.-.0.0 Architect/DesignerSwalloty Bates..838-9956 PhoneZ.lA...Z52- 24- Rech. Htgmill Construction Permit x ........\!,X!.:.--....... $.......3.1...0.0... K Phor Unknown Residential Construction Tax ......:,::).':?:' Lender: ..We l$.Ji SOmps..n .................._... Phone:.9Unknown V � ._--........ Lender . ..Wells...Fargo_Bank......._..._......... ❑ Misc. Fee ............................................._......_.................$....................... ^I certify that in the perlormance of the work for which this permit is • Misc. Fee ................. " -' Y e """""""""""""""""""""""'•"""""""""-'$ �--�� issued I shall not employ any person in any manner so as la become subject • $ 432.37 to the workman's compensation laws of California." SIGNATURE OF • s APPLICANT/OWNER,......................_...................._......................... DATE........................ I Environmental Status: Exempt............ Other..........._........................... .... ..... "I certify that as the applicant I am licensed undo the provisions of the Design Review Approval: Bldg. ............ Site ............ Sign ........... Contractors License Law and further that my Llcena. No. ............................ Use Zone ............ P.D. Conditions ........................................................ h Classiflcation ................_.................... Is in full force and effect: or Cord. Use Permit #............ Variance #............ Parking Spaces............ . I certify that I am exempt from the "Licensed Required"provisions of the A roved B Contractors License Law. (state basis of exemption.) pp y........-......................................—........ Date ........................... I hereby acknowledge that I have read this application and slate that the above is correct and agree to comply with all City Ordinances and Slate Laws regulating 1 • • r building. I (We) agree to save, indemnify and keep harmless the City of Cu rtino t f08Chmart Permit........................ Grant of Easement........................ against liabilities, judgments, costs and expenses which may In ny way b, Gutter, Sidewalk, Driveway: Replace........... Repair.,... occurs against said City n onaequence of the granting of th rm' ." wer-......... Conn. Fee $................ Water................ Meter $..............-. SIGNATURE OF ( � ��/2j�� ���� Agreement for Completion of Public Works Improvements ......... --... APPLICANT/CONTRacTo L:`/L/V*..0' .DAT -9512. /R 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 • 120 days from validation dote, or should authorized construallon be suspended or abandoned for a period of 120 days after work is commenced. PERMIT INSTALLATION NO. EACHFEE APPLICATION F• • PLUMBING Light Outlets............ Switches.......... . $ Fixtures............ Receptacles............ PERMIT INSTALLATION NO. EACH FEE TOTAL NUMBER (less than 1000 watts) ............ $ ,60 .• Gas System with up to 5 outlets .......P....................... 4,00 .... ......,...... T. Range........ Cooking Unit........ Oven....... -..........- 2.00 .............. Each additional outlet ............................................ 1.00............... Dryer........ Garb. Disp......... Dishwasher ............. ....... 2.00 .............. Water System (Installation, Alt. or Repair) ..1.....1...... 4.00.....9..00 MOTORS: 1 HP or less ........................................ ....... . 2.00 Water Closet.3. Water Heater.) Ld. Tray......1.....5..... 4.00. ...2.0...0 Greater than 1 HP not more than 5 HP .............. . 3.50 .............. Lavatory..5 Shower Pan.... Bathtub2.. Sink...2.....9...... 3.00.....2.7.... Temporary Power Pole or Service — 100 amp . . ..... .5.00 .............. Wash. Mach.l. Dishwasher..)Garb. Dlsp---I.......3...... 3.00.....9...Q. —200 amp........ . 7.00 .............. Sewer ..../.O9f .a............_...........1................1...... 8.00.....8...1 Time Clock .................................................................... . 1.50............... Lawn Sprinkle Sys. $5.00 Ea. add Sys. $2.00..................... ............. Misc. see Ord. current)...................................................... Vacuum Breakers ......................................-..... ..............3.50.............. �.� NOW Residential occupancies Flat Rate Interceptor........ Water Softener........ ................. ............4,00. ............ 1 0-500 sq. ft. $22.00 1501-1760 $34.50.............................. Plumbing Piping without fixtures ...................................4.00............... Misc. (See Ord. Current) .................................................... y 501-750 24.50 1751-20000 37.50.............................. Permit Fee 751-1000 26.00 2001-225C 39.50.............................. .............................................ally...................$ 8.00 1001-1250 28.60 2251-2500 42.00........2262............... TOTAL PLUMBING PERMIT FEE (plus penalty {f app.[]) = 78•00 1261-1600 32.00 2501-2750 49.50.............................. APPLICATION • e• 1f` Permit Fee...............................................$8.00 TOTAL ELECTRICAL PERMIT FEE (Plus penalty if app.p) $48 00 PERMIT INSTALLATION NO. EACH FEE Forced Air Unit..................to 100M ..............................$6.00............... All • • ' ' over 100M................. ..1.._. 10.00.. .1 O...Q C T4" Comfort Cooling Unit......to 3 ton/HP ........................... 6.00............... \ Forms / Foundation ..._............_......... . By:........ ....... . Date:................ {{{ to 15 ton/HP.........................L 9.50.............. Plumbing Ground Work . .._.._............ .. ... .. to 30 ton/HP......................... ..12.00. ............ Rough Electrical ..................-.........-....�.... ..........- 3.:.9.-0 ...... to 50 tort...........................17.00.. N AmEcame - Plumbingand Heating 9 .......... ........................ ........................... Space Heater........ Wall Heater ................................... 6.00.............. ulation & Ener9y.................._........... .... _............... .. ................. Flues - other than above ........ .. 3.00.. ..1 .. M e Teat """"'.' a Vent Fen: I<itchen...l... Betn .3... 17.ryer.........5...... 3.00........0..... ...... z7-�J::. `4 em porary Power Gas / Elect b� Commercial Range Hood l 6.00... ,...,,,,., Final - Electrical .- ....... Mise. (See Ord. Current .. ` ........... Final - Building/Mechanical ...... .. . ..li .�� Permit Fee ...... . ........ .... ........ ...... $ 6.00 Final - Design Review / Landscaping . ..... ........................................... TOTAL Htg./ Coolg. Permit Fee (plus penalty If app. ❑) $31.00 Final—P blit Wit............,.,..�............................................ . l�Lr�S�C�Ar �8a'^"�j f6T`�0.'a fie la 'i#��� ,f�"��.� o N'��(Q� y531..#..I,etfK3-('�•8r(A� ROUTE SLIP File No. Date / — i Location Subject a � Approved ' g � ?� Date �n e for i CERTIFICATE'OF COMPLETION BUILDING INSPECTOR'S OFFICE CITY OF CUPERTINO DATE O I� 19 BLDG. PERMIT NO. 3`� THE BLDG. LOCATED AT / p1.01' C'c`c-L"I SN OWNED BY �� —S (Xl C_ f C � ✓: HAS BEEN OM EREDI . FOR USE AS /• r /�'^"'" ' 1 i 1 i P . BUILDING INSPECTOR l ELECTRIC SERVICE NOTICE OFFICE COPY BUILDING INSPECTOR'S NOTICE CITY OF CUPERTINO 19 To r You are hereby 0 thorized 'to Connect el'ectrical service for Owner or Tenant At (.-I S "j' No.of Wires Size of Wires Size of Switch Motor Load Voltage Phase Hearing Load K.W.__ Voltage TLight 110New Service Reconnect No.of Meters Heat IPOThree Wire More Service i ' No.of Add.Meters Power TMee Phose Move Meter I O. ELECTRICAL INSPECTOR^�-'�•r"'" OFFICE CITY OF CUPERTINO copy; GAS SERVICE NOTICE 19, To You are hereby auuttthorized to connect the GAS service for !' Owner or Tenant �] At / OZ !C')ISCJSIIr New Service No. of Meters Reconnect Move Service No. of Add. Meters Move eter PLUMBING INSPECTOR ©". f' BUILDING INSPECTOR'S OFFICE Bldg.Dapt, CITY OF CUPERTINO Office COPY ❑ Backflow Device Sanitary Permit No. i >] Sewer Connection Plumbing Permit No. f Plumbing Final Lot No. �4 Owner or Tenant At 10-1,0�� t 1-S Go—tS'H a/�l<— Wy Tract b� r Date Connected � � " �� .—I 99k) Final / W 19 Y � pM PLUMBING INSPECTOR