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1508 CITY OF CUPERTINO PERMIT NUMBER APPLICATION FOR RESIDENTIAL BUILDING PERMIT AND CERTIFICATE OF OCCUPANCY FOR APPLICANT TO FILL IN BUILDING INSPECTION DIVISION STREET WDRiO -POJECT: 6 -W 1i V..... ... ............ ........ 10095.2 ...... ...... ._..e __... Legal Description Tract....__...... ...._ BI(fck.. ... Lot..................... Plans Received By...................................................Date ....... -- ---- Description of Work: ... ........ ................... ................. ........... REO.: Plans.... Survey.... CaIcs: Struc....- Energy.... Elect..... Mel 1st Struct. Improvement on Parcel:Yes.... No... Area of Bldg._............ Plans Checked By............................ Dale Separate Structure.... ..... or Addition/Alteration to Exist. Bldg.....__._ Application Approved By....._....._A9.f... Date No. of Stories...___....... Use of Building ..... ....... ... .......... ............. Validated By.......................................................... Date ............ Valuation 54 Project: ......; Compensation Certificate Verified By ............. Date ...... Owner: li ;CA... /;iy.44�t....... 'Phol Contractor: ...... .. .......____City Bus. Lic. # ............. $ Contractor's Address: .............. ........ Phone:.................... Permit Fee (plus penalty if applicaft) $ Contractor - Electrical: ............. Plan Check Fee (less d,p,,OT,-( Fl..... ....... ..... City Business License #. Phone: ......... Energy Plan Check Fee (Dep. of $....... Rct 5........) Plumbing: .. •_.... .........._....... ..... ...................... ............. City Business License .......... . Phone:.................... Strong Motion Fee ..............OCT $ Heating and Cooling ......e............. ..... .... ..... ........... Plumbing Permit Fee ......... ..... ....._...........$.... ............... City Business License w..__,..__.._..__ Phone:......--............ Electrical Permit Fee ....... ... ................... IF).........._$_,l..... Architect/Designer: ........._ ._... Phone:.............. Mech. Htg./Cooll Permit $..f? li ........ $............__....... Engineer: ............... ............. .... ............... Phone:......_.._........ Residential Construction Tax $ Lender: .... ❑.. ...... ..... ...... ... ........... El Unknown Misc. Fee ........................... ...................... ..... .... 'I certify that in the performance f the work for which this permit Is Misc. Fee ......... ................................... ....... $ .............. 0 Issued I shall not employ any personin any manner so as to become subject • $ to the workman's compensation laws of California." SIGNATURE OF APPLICANT/OWNER ;�_7, - I Environmental Status: Exempt............ Other............... __...__... 'I certify that as the applicant R a uncle th 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 ad effect: or Core. Use Permit #........-... Variance s......_.... Parking Spaces...-........ 1. . I 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 correct and agree to comply with all City Ordinances and State Laws regulating buitd,nq. I (We) agree to save, indemnify and keep harmless the City of Cupertino croachment Permit....._....._....._... Grant of Easement.......__... against liabilities, judgments, costs and expenses which may in any way Curb, 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 Plans Checked By........ Date Approved By........ Date...._......_...._ NOTE When properly validated this form "Iltute, is Building Permit. This permit expires and becomes null add void should work not be commenced withlin 120 days from validation date, or should authorized construction be suspended abandoned for a period of 120 days after work Is commenced. PERMIT INSTALLATION NO. EACH FEE i APPLICATION FOR 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 . .......$4.0-0 ......... 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: I 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. Disp..... .............. 3.00............... 200 amp. ..... .. 7.00 . Sewer .... ...._ .. .. . ._ .. . .................... ...................... 8.00--------------- Time Clock ..... .... ...... ............. ...... �..... Lawn Sprinkler Sys. $5.00 Ea. add Sys. $2.00.................... ........... Misc. (see Ord. cl_uirren,cup, I. .................................... Vacuum Breakers 1_. 3.5 0 Nw Residential a Interceptor........ Water Softener........ ................. ............4.00. Plumbing Piping without fixtures ...................................4.00, ............. 0-500 sq. it. $22.00 1501-1750 $34.50.............................. Misc. (See Ord. Current) .................................................... 501-750 24.60 1751-.20000 37.50.............................. PermitFee ........... _......................................E 6.00 751-1000 26.00 201 39.50.............................* 1001-1250 28.50 2251-2500 42.00.........................*** TOTAL PLUMBING PERMIT FEE (plus penalty if app. C]) $ 1251-1500 32.00 2501-2750 49.50.............................. Permit Fee...............................................88.00 APPLICATION FOR HEATING/COOLING PERMIT TOTAL ELECTRICAL PERMIT FEE (Plus penalty if app.0) $ PERMIT INSTALLATION -WO-. EACH FEE • Forced Air Unit..._.............to 100M ......__................. .$ FEE mmmma�� over 100M ..... ........... ....... $ 6'Of", 10.00.. ........... Comfort Cooling Unit......to 3 ton/HP ............. 6.00... ........... 9.50..Forms / Foundation ....... ............... By .. ..... ....... . Date:_......._..... :w� a�� , Plumbing Ground Work ......... to 15 ton/HP... 9.5 0 . ........... to30 tol........... .............. 12.00 3.00......................... Rough Electrical .. . ....... ...... ........ to 50 torl..... ........... ....17.00).... ....... .&June - Plumbing and Heating ..... Space Heater.-...... Wall Heater ....__ I 6.GO-......... ilation & Energy..__..._.. ........._ . . ........... .. ....... than above ... ....... ............. 3.00.. ............ Gas Test .........................._.... .... ..... . Flues - other 3 1— Temporary Power Gas Elect. .... .... .... ........ .................... .... Vent Fan: Kitchen. Bath .......... ............ ... 00.- Commercial Range Hood 6.00 ............. Final - Electrical .............. ................. Misc. (See Ord. Current...._._........... .. ............. ..... 3.00............... Final - Building/ Mechanical .............. ............. Permit Fee .......... ......... $ 6.00 Final - Design Review / Landscaping .1..... ....... .........I ...... .............. TOTAL Htg./ Coog. Permit Fee (plus penalty if app. 0) S Final- Public Works ............................................................