Loading...
1578 . �,��' , , . c��r :.; cuv�:.re�o CITY OF CUPERTINO r��d � � PERMIT NUMBER APPLICATION FOR RESIDENTIAL BUIIDING PERMIT I� • AND � �/�. • • . . . • CERTIFICATE OF OCCUPANCY ' � BUILDING INSPECTION DIVISION ST���A�RE��Qa ,R��CT.................... ...................................... 7 *. . • . - . Legal Description: Trect........................ BI ck..............Lot...................... Description af Work: _.__..C..e,..C.0.0.� � PlansRacelved BY....................................................Date ......................... ......._............................_..__..................................._...._............................... REO.: Plans.._ Survey.... Calcs: Struc..._ Energy.... Elect..... Mech.... 1st Struct. Improvement on Parcel: Yes.-_ No...Area of Bldg............_. Plens Checked By.:._......................... . Date ..........,�..../_.__ Separate Struciwe._........ or Addition/Altera£ n to Exist Bldq...._..... Application Approved By........._.....A.�.........._.Date .//�a�../.�?I.... No. of Stories....._.� ___ Use of Building .... . Validated B �.. " -� 5 � "" y ....... __ .... .... . ..__.__.Date .... . ._... Valuation of P o�eCL $ 1,8 ..... . ........ ........ . Compensation Certificate Verified By . .._.._... Date . .. ._. Owner: �0.� �50'1"C !�Q . .. ..... Phone: . ... . Contractor. . A MBR. oOF�lN& Crty Bus. Lic �r ' ' ' ' � ' $ 1•835 Contractor's ntltlress:�/9/ �!?C15�.S.�.�'.__... Phone;:28Gz�/55' Permit Fee (Plus penalry if applicable) ........................$....�9.00..... Contractor - ElectricaC ............................_._..._..........................._........... Plan Check Fee Qess deposit ol $._....... Rd. #..._.....)$...._....... City Business License �`.:....._..._...... Phone:.................... .......... . Energy Plan Check Fee (Dep. of $........ Rct. #........) $..............._...... Plumbing: ._._.__....__................................................................... City Business License *..__._.._....._ Phone:...........__.._. SUong Motion Fee ...................................................__...$..............`�j0_... Heatiny and Cooling ..._......_.........._...___............_._............... Plumbing Permit Fee ..................._........_......_...._._ ........._........_.. City Business License x............._..._ Phone:.................... Electrical Permit Fee _.._..................._._......______._...$.................._._ Arohitect/Designer. .._.__...................._......_...._.. Phone:.............._._. Mech. Htg./Coolg. Permit $............................. $..................._.. En ineer: Residential Construction Tax ..........__..........._._...._....$.__............._... 9� ... ....._......__..........................................._.. Phone:.................... : . .. ........__._......_..... ._.......................__. Misa Fee .................__.............................___..._...........$........C7...Q0.._. __.......... ❑ Unknown MISC. F¢B $ .... . "I certily ihat in the Derlormance ol ihe work for which this permit is """"'""""""'"'""""""""'"""""'""'"""-"--""""" """""""���-- issuetl I shall mt employ any person in any manner so as to Eacome aub�ect � $ 25.5o to��e workman's compensation laws ol Calilomla." SIGNATURE OF � ' • ' APPLICANT/OWNEH ..............._...._.............,.............._.................. OATE........................ Environmental Status: Exempt ........_.. Othe�...................................._.. � .✓.. ��i cemry mai as m� aOPlicant i am rce�sea unde� me Pro��sions o� cne Design RBvi¢w Approval: Bldg. ............ Site ......_.._ Sign ............ � Cono-aciors �icense Law and lunher ihat my Licens. No. ............................ Use Zone ._......... P.D. Condi�i0n5 �n Clnssilication __....._.._....................... is in iwl iorce and evect: or ............................................................ Cond. Use Permit +v......_.._ Variance w...._.__. Parking Spaces...__._.. .� . . i certify that I am exempt Irom I�e "Licensetl Required" Omvisions ol Ihe A roV¢C B ConVac�ors License Law. (Stale basis oi exemp�ion.) pP Y.......--..................... ........._......_........ D2t¢ ........................... I hereby acknowletlge thai I have read Ihis application and stale that the ebove is � , � :orrecl antl agree to compry wit� all City Ortlinanres antl Sle�e Laws regulating ' � Gullding. 1 (We) agrae to save, intlamnify and keep harmless �he City of Cupertino roachment Permit.._._..._............ Grant of Easement.............__....... a9e�nst i�aoiiities, ��dqe�ems, mscs antl ezpenses which may In any way �b, Gutter, Sidewalk, Driveway: Replace_........ ROpair.......... accure against said Ciry in cy�ay,uence of the granting oi �his parmit." Sewer............ Conn. Fee $................ Water._._....._... Meter $................ sicNnruae oF _ y.///�q � Agreement for Completion of Public Works IRIPlOVBrt1C0�5 ......._......... APPLICANT/CONTRACTOR T�..'._LG G..__.......... oarE ��S��C2. Plans Checked By........ Date........ Approved By__.... Date.................... � Nore: wn�� vroperry vauae�ea m�s mrm consrw�es a BUIIAinq ermlt Thb permit eapirea and becomes null and voitl ehould work nol ba eommencad wllhln • • ' 120 deyn Irom valiGalion date, or s�oultl euthorizeE conslruction be tuspanEeA or abandoneC lor e Deriod ol 1P0 tlays alter work ie comm¢neetl. PERMIT INSTALLATION NO. EACH FEE . . . . � � . . : . Light Outlets............ Switches............ Fixtures............ Receptacles............ PERMIT INSTALLATION NO. EACH FEE TOTAL NUMBER (less ihan 1000 watts) ..._ _.__ g ,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. Trey._........_........ 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............... —200amp.I.__.. . 7.00._............ Sewer ................___....__....:.........._................._._.......... 8.00............... Time Clock ......................_.._...._...........__._._.._...f___ . 1.50........_..... Lawn Sprinkler SYs. $5.00 Ea. ada sys. $2.00. � ................... ............. Misc. (see Ord. current 1.... ............ .............. Vacuum Breakers ............................_.......... _ .._..........3.50.. .. ............ New Resitlenhal Occupancies Flat Ra[e InterCeptor........ Water Softener........ ......_._...... ............4.00. ............ � Plumbinq Piping without fixtures ...................................4.00,. �500 sq, ft. $22,00 1501-175D $34.50......... �����•������� """"""""""' Misc. (See Ord. Currenq .......... 501-750 24.50 7751-�20000 37.50.............................. .......................................... 75f-1000 26.00 2001-225G 39.50........................ ..... Permit Fee ............................ ............................................$ 6.00 1001-1250 28.60 2251-2500 42.00......................... TOTAL PLUMBING PERMIT FEE (plus penelty if app. [�) s 1251-1500 32.00 2501-2750 49.50.............................. . . . . • • • . � • • • PermitFee...............................................$8.00 TOTAL ELECTRICAL PERMIT FEE (Plus penalty it app.p) $ PERMIT INSTALLATION NO. EACH FEE Forced Air UniL._..._......._to 100M ....._..........._.....__.S 6.00............... • � • Over 100M...._........_...._.. . 70.00.. ........... Comfort Cooling Unit_...to 3 ton/HP .............__......... 6.00............... Forms / Foundation .._......_.......... ....... By:_...... ....... . Date:........_._... Plumbing Ground Work . ......... .......... �.... to 15 ton/HP......._.__._ ._..... 9.50.............. . .....__....... ............_..........._ to 30 ton/HP.............._........... 12.00. . .......... Rou9h Eledrical ....._.._.._.....................J......_..._....._..... ......_..........__._. . . me • Plumbing and Heating ..........�........ to 50 ton/HP..............._..........17.00.............: � .._............. ........................... S ace Heater........ Wall Heater ................................. 6.00.. ulatlon 8 Ener P . ............ 9Y............................... ......................... ........................... Flues - other than above ..................................... ........'.. 3.00.. . as Test ........... ..............._....................... ... ....._...... _......_......_...._......__.... Vent Fan: Kitchen_..._. Bath ..............._.._.._._... ._._.. .. 3.00...._......... Temporary Power Gas / EIecL . ........ .._..._... Commercial Ran e Hood ,�, 8.00.,,, ._......... ....................._.... . Final - Electrical ....__... 9 _..................._........__ ...... . ........... __..........._........ .........._......_._. _......................_. Misc. (See Ortl. CurrenL..._....................... Final - Building/ Mechanical .._....._..........__.......__...I._._.................._. Permit Fee ....._.... ._.._.......... .. ......_. Final - Design Review i LandscaPing . _......._................................_.......__.__...,.._... $ 6.00 .... ..................-...................... TOTAL Ht9./ Coolg. Permit Fee (plus penaltY �� aPP. O) S � Final-Public Works ........................................................... Sh`et 2 - ' T /1 I � CITY OF CUP�P.TIPIO BUILDIPIG PERt4IT "' �/ � � ` I� Permit P]o: �c`� �p � � � � =�, � Address: kk�J .G e ' � , p/�' � 'Y) Date: //,��U ��" � � BUILDI\C PPOJECT ID$XTIFICATIO\' � WOAI:ERS'CO]iPEKS.4T10� DECL.4R.ATIO\' Applicant's\lailing Address � �On Us I herebv�rm �hat 1 have a certificace o(tonsent to selGinsure, .S/d�j or a certi(icate o(\lbrkers'Compensa[ion Insurance,or a certiFied �` � �7' � y�py thereo( (Sec 60;1, '.ab,C,�, i r�ddress of IIuilding kU w-Lo� �l�/ /Poli y �o. Cumpany i \ � Certified cop��is hereby furnished. O��'ner's name "> Q n CertiFied copy is filed with [he munty 6uilding inspection Tclephone \o. ' department or counh' depanment. Contrncror's \amc 2.Q-/1�e r Date Applican! Contracmr's �tailing Address , CEHTIFIC.4TE OF EXEVPTION FRO�f \VOAKERS' CO�IPENSATIO\ I!�SOflAkCE Lic. \o. '� � (This section need not 6e completed i( tt�e permit is for one 'Architect or Engineer hundred dollars (SI00) or less.) ArchitecPs or Engineer's Address ' 1 certify that in the perPormance of the u�ork for which this permit Lic. \o. is issued,l shall mt emplor any person in any manner so as to become ' subject to the �Vorkers' Compensation Laws of Califomia. ' . LICENSED COVTAdCiOPS DECLdRATIOV Date Applicant NOTICE TO APPLICdNT: 1(, after making this Certi(icate o( I hereby a(firm Ihat I am lirensed under provisions of Chapter 9 Exemption, you. should become suSject to Ihe \Vorkers' , / (commencing with Section 7000) o(Dicision 3 of the Business and Compensation prorisions o(the labor Code, you must (orth�vith X Professions Code,and my license is in full force and e(fect. � comply�rith such provisions or this permit shall:be deemed reroked. � �.License Class C- Lic. \umber `��^�7� , Dare � � �- - Con[ractor � . COVSTRUCTIO\ LENDI\C ACE\C1' � 1 hereb��a(firm that there it a construttion lending agency for[he per(ormance of Ihe wrork for which this permit.is issued (Sec.3097, O\V\EA-BUILDER D�'CL.4R.aTIO.V' Civ.C.). . � . Lender's Kame I hcreby affirm [hat I am ezempt from the Contractor i License �nder's Address � � • Law(or the following reason (Sec.70J1a, Business and Pmfessions I certi(y Ihat 1 have read [his application and state Ihat the abore Code: Anytityorcountywhichrequiresapermrttoconstruct,niter, informatlon is correct. I agree to comply with all city and rounty^ improve,demolish,or repair any structure,prior to its izsuance,also '� ordinances and state Iaws rela[ing [o building conshuc[ion, and' requires the appiicant for such permi[to file a signed statement that � hereby authorize representatiees of Ihis county to enter upon Ihe he is licensed pursuant to tFe pracisions o(the Controcror's License Law(Chapter9(commencingwith5ection7000)o(Dirision3ofthe above-men[ionedproperryForinspectionpurposes. Business and Pmfessions Code) or[ha[he is exempt there(rom and . the b�sis(or the alleged exemption. Any violation of Sec[ion 70915 . S�6^����e ot eppbcane or Aqent p��� by any applicant(or a permit mbjects the applicant co a civil penalty . � o(nol more th�n five hundred dollars ($�9p),): � ❑ 1,as owner of the property,or my employees with .��ages as ��OWNER-BUILDEP VERIFICATION their sole compensation, will do Ihe work,and the structure is not � in[ended or offcred for sale (Sce 7044, Business and Professions ��A«rntion Property Owr.er: Code: The Contractor's License Law does not apply to an owner of "M�'ownerbuilder' building permit hav been applled (or in praperty who builds or improves thercon,and a�ho dces such work your mme and bearing your signature. himself or through his own employees, provided that such - ��P��%x romplete and return �his in(ormalion in �he envelope improvements are nol imendeA or offered�for sale.If,howe�eq the provided et your endiest opportunity to avoid umecrosary delay building or improvemrnt is sold within one yenr of completioq Ihe �^Pr°ttss�e^�d issuing your building permic Nobuilding permit owncrbuilder will have the burden o(proving that hc did not build ������sued unlil ihis verilication is received. or improve(or the purpose o(salc.). 1. 1 personally plan to provide the major labor and materials for ❑ I,as owner of Ihe property,am exclusively contracHng with . �mUuction of[ha proposed properly improvemenl (yes or no) licensed contractors to construct thc pmjctt (Sec.7044,Ausiness and � Pmfessions Code: Thc Contrac[or's License Law does no[apply to . . ' `t �' (have/6ave not) signrd an application (or a � an ow�ner oF property who builds or improves thcrcon, and who building permi[far the proposed work contracts(or such projects with a contractor(s) licensed pursuan[to 3 1 havecontracted with the following prrson(firm) �oprovide the Contractor's License Law.�. 'the praposed mnstruction: � 1 am exempt undcr Sec. , B.hP.Q (or this Name rcaxon _ Address Ci[y. Dalr, pµ,��� PFpne Contrectors License No. � : . . 4 I plan to provide portions oE the work, but I have hired the . . folbwing person to coordinatq superviu, and provide Ihe major workr Name ' Address� City ' ' Phone Conlnctors Licenu No. _ 5. I will provide some of the work but I have contracled(hired) � ' ' •• � iha following perwns to provide the work indicated: • - ' . Neme Addresa Phone T ype of Work . Signed: . , Property owner � Soc(al Security number . D:te: