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1105 I � • CITY OF CUPERTINO I APPLICATION FOR RESIDENTIAL BUILDING PERMIT PERMIT NUMBER JOx� CERTIFICATE OF OCCUPANCY . . APPLICANT TO FILL IN / BUILDING INSPECTION DIVISION STF�E,E� DF _qL�PRr1EQ&r DEPARTMENT USONLY Legal Description: Tract........................ Block............ Lot.... .4/ Des .... Des tion of Work: .. ... .......................... .... Plans Received By................. .... _.. ...................Date ... .'j.. ... .46'A81�.......�.fv/M111.[.V�r.IAa �...._._.... REQ.: Plans.... Survey.... C cs: Struc..... Energy.... Ela t..... Mech.... tat Struct. Improvement on Parcel: Yes.... No... Area of Bldg............... Plans Checked By........................q. Date .... .. Separate Structure............ or Addition/Alteration to Exist. Bldg........... Application Approved By._........;.gk.(1x....._.._........Date ..�._U 1..... No. of Stories................ U e of u' Ing .._.............. ............_..........._... Vel dated By... _..............................__......._...._...Date ... ...... Valuation.2f Prolec✓t- $..a4LO'o"rl........._.................._...................1(•3 / Compensation Certificate Verified By ........_......- Date _....................... Owner: �C/F . .n?�}•�/.m.9D-Y....._......_.............. Phone:"27:2. . Contractor: !//IDI-..T.cQ.ls.'.... ..........City Bus. Lic. r ............. • • • f Contractor's Address:y.LSl... PC.L N.-...- Phone:.Qk5i2-.006 Permit Fee (plus penalty if applicable) ....._.................$._aq.tl Contractor - Electrical: ............................................_....................... Jilt) ....... Plan Check Fee (less deposit of$.......... Rct. ..........)$..1t--- .. City Business License k.................... Phone:......_............ . , y...... Plumbing: ......... .......... ............. ..._..._........ .........._._..............__................ . Energy Plan Check Fee (Dep. of $....ri-PCt. #........ $...*..._._ Ci tyBusiness Lic use .......... Phone: Strong Motion Fee ....................................... C>C . Heating and Cooling ........ ................... Plumbing Permit Fee City Business License ... Phone:.................... Electrical Permit Fee ..._. ........... Architect/Designer: _.......__....._.... ........ _.. Phone:....______... Mach. Htg./Coolg. Permit $........................ . Jiw - ......_._......_. Engineer: Phone:....._..._...... . Residential Construction Tax ......... ... ..................$.... Lender: ... .. ..... . ❑ Unknown Misc. Fee ............. ...................... - -.........$.... _..�.. .f '• "' .. "I cerli y that in the performance of the work for which this penult is MISC. F00 .............................................................. . f . ...--....--..... issued I shall not employ any person in any manner so as to become subject f ` rsa 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 IF Ion f t� Design Review Approval: Bldg. ........... Site ...._...... Sign ............ Contractors License Law antl further that my.Llcens, No. ..... g.... Use Zone .......... . P.D. Conditions in Clessllicalion ..........,-..........-............. is in lull force and enact: or Cond. Use Permit a............ Variance #............ Parking Spaces............ I certify that I am exempt from the "Licensed Required" previsions of the Approved B .__.. . Date Contractors License Law. (Stale basis of exemption.) PP y.........-.......--....-......-- ----- ...... "-"'-" I hereby acknowledge that I have read this application and state that the above Is n;ct and agree to comply with all City Ordinances and State Laws regulating • - • �IIIIIIIIIIIIIIIIIIIbuilding. I (we) agree to save, indemnify and keep harmless the City of Cupertino roachment Permit_...................... Grant of Easement.......... ........._.. against liabilities, judgments. coats and expenses which may In any way b, Gutter, Sidewalk, Driveway: Replace.......... Repair.......... secure against said City In C sequence of the granting of this permit." Sewer............ Conn. Fee $._............. Water................ Meter $... .. __.. SIGNATURE OF 6�/ ` . Agreement for Completion of Public Works Improvements ......... ....... APPLICANT/CONTRACT .. DATE .... / . Plans Checked By........ Date........ Approved By....... Date....-....._........ NOTE: when Property validated this form constitute, a Building Permit. This permit expires and becomes null and void should work not.be eomm•nud within 120 days tram validation date, or should authorized constructlon be "Wandod oe 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 I 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..................... 4.00. ............ 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 ................................... .. ............._........ ......... 1.50..._.......... Lawn Sprinkler Sys. $5.00 Ea. add Sys. $2.00..................... ............. Misc. (see Ord. current l. ... ............ ................................... Vacuum Breakers ...._........_.._-.._-__............. ..............3.50. .... New Residential Occupancies Flat Rate Interceptor....._ Water Softener........ ................. ............4.00. ............ Plumbing Piping without fixtures . . ... .....4.00. :.. ..... 0-500 sq. ft. $22.00 1501-1750 $34.50.............................. Mise. (Sae Ord. Current v[-td/1 - ....... ................................. .......... 501-750 24.60 1751-20000 37.50.............................. Permit Fee ..........................................................................E 6.00 751-1000 26.00 2001-2250 39.50.............................. TOTAL PLUMBING PERMIT FEE (plus penalty If app. :1) S 1001-1250 28.50 2251-2500 42.00.............................. rl+p 1251-1500 32.00 2501-2750 49.50.............................. APPLICATION FORHEATING/COOLING PermitFee...............................................$6.00 . TOTAL ELECTRICAL PERMIT FEE (Plus penalty if app.p) $ PERMIT INSTALLATION NO. EACH FEE Forced Air Unit..................to 100M ..............................$ 8.00... ........... • . , • . 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 ton/HP......................... ..12.00. ............ Rough Electrical ......... ..........................�_ —�7.^go to 50 ton/HP......_........ ....... 17.00.. --......... Plumbing Rag 11—Iiug .._......I (v.'.�.�. �i.� Space Heater........ Wall Heater .._.......__.._...............�.. 6.00.. .. .......... lation & Ener _ ...._... ................. .._............_...... 9Y-��-�� �������- ��� �-� �— �- Flues - other then above ._...... .. 3.00.. ............ ............................. as Test .._...................................... . .............._ ........'........__._.......... Vent Fan: Kitchen........ Bath .... 3.00... ............ ........................... .......... Temporary Power Gas / Elect. . ........... ........... .. ... _� Commercial Range Hood _.._............_..._..._...........: .. 6.00...__.,........ Final - Electrical .................._............._. .. .._..._.. ..,✓--1.7._ Misc. (See Ord. Current.............._..........__.. ... .......... �1� - ................__...._.. Final - Building /Mechanical .............. .. .. ......... /u.._ �._ Permit Fee ................ $ 6.00 Final - Design Review / Landscaping . ._. .............._......._......-..--._. TOTAL Htg./ Coolg. Permit Fee (Plus penalty If app. ❑) f Final— Publid Works ........................................................... CITY OF CUPERTINO ` APPLICATION FOR RESIDENTIAL BUILDING PERMIT PERMIT NUMBER AND • , CERTIFICATE OF OCCUPANCY APPLICANT TO FILL IN BUILDING INSPECTION DIVISION ST ETJDD,ESS OF PROJECT: /1 �................. • �/2/ • Legal Description: Tract........................ Block... . Lot.....41f/.......... Plans Received By........._..! ! . �iyData -.., Descr4 tion of Work _... ... . - ... ... __. . . _ Date , . .." ... Ya.rIIIr7 :3u!/1'NL►t.!.V� �eof- ... REO.: Plans-,Survey.... Cafes: Struc ... Energy.... Elect . Mach.... 1st Struct. Improvement on Parcel Yes- No.... Area of Bldg... - Plans Checked By.... - - ..... ._.-. .. Date ......................... Separate Structure_........ or Addition/Alteration to Exist. Bldg._ .... Application Approved By... Date -kegpA...... No. of Stories..._ .._... Use of Building Validated By-..... ....._ ..__ ....Date ....:... Valuation of Project $ .0 0"T/ ... Compensation Certificate Verified By ...... . ... Date ...... Owner: ,kR .K'`++,5�.�!. y- ... ... Phone 1. x•`10[ . . � Contractor: .Q!bf r.00 S City Bus Llc # • • ,. '$ Contractor's Address.7Lf_...__ ..C.lwd��. Phone:d ,..yf� � Permit Fee (plus penalty if applicable) ...... $ AO Oti Contractor - Electrical: .. Plan Check Fee (less deposit of$ . . O c( City Business License ...._ Phone_ .... .... Energy Plan Check Fee (Dep. of $........ Rct. #........) $_.........r:..._ Plumbing: ............_.......__.........._.__....... ... ....._......... Strong Motion Fee .................._.._......... x J �.... City Business License •..................._ Phone:........_.._...... Plumbing Permit Fee iw Heating and Cooling .. .......... ............ .. ............_._..... .."........... ........................_..........__.......$._.. oT) Electrical Permit Fee .. City Business License 0..__..._......._ Phone:......... _............ .......... . . ..._ :..... ......_......._...$.....� .._.... Mach. Htg./Coolg. Permit $............................. $............ Architect/Designer: ........__........__..........._......__.. Phone:.................... Engineer: ..... ...._... _.. - ... Phone......... -..... . Residential Construction Tax . . . .....__. .........$ .._...tw - - Misc. Fee ...._.......$_-. ......' Lender .. ... ......_ ... ..... ... .._._ - Unknown ........" .. ............. ......." -.......... "I certify that in the Performance of the work for which this permit is issued I shall not employ any person in any manner so as to became subject Mise. Fee ........................_........__.....____......._..._.......$:. _.//...._.......... • $�y f S� m the workman's compensation laws of California." SIGNATURE OF IIFZ@7ff xTeliff.TMITETTilAPPLICANT/OWNER _......__..............................._-_................... DATE........................ Environmental Status: Exempt ............ Other..............___............._.... -I certify that as the applicant I am licensed uncle the provisions of to Design Review Approval: Bldg. ............ Site ............ Sign ...... Contractors License Law and further that my Licens. No. >?.�•_X.1,�._3..' Use Zone . .........- P.D. Conditions in Classification ............ is In NII force end effect: or Cond. Use Permit •......_.... Variance •.. ....... Parking Spaces..__...... I certify that I am exempt from the "Licensed Required" provisions of the Contractor: license Law. (State basis of exemption.) Approved BY........._......__........._..................... 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 Lawn regulating • • building. I (We) agree to save, Indamnlfy and keep harmless the City of Cupertino achment Permit......_......._..--... Grant of Easement........................ against Ilabl Iltles, judgments, costs and expenses which may In any way Gutter, Sidewalk, Driveway: Replace ...... Repair._....... secure against said City In coq sequence of the granting of this permit." S r............ Conn. Fee $................ Water................ Meter $................ SIGNATURF OF A .... A . Agreement for Completion of Public Works Improvements ....._ u ........... APPCA NT/CONTRACTOR . _ ... . DATE ....../1........ Plans Checked By........ Date........ Approved By........ Date..._............... NOTE: When property validated this form cans6futes a Building Pemdt. This permit expires and becomes null and void should work not be commenced vii • • 120 days from validation dela, or should authorized construction be •usp•ndid or abandoned for a period of 120 days after work is commenced. PERMIT INSTALLATION NO. EACH FEE PLUMBINGAPPLICATION FOR 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 System (Installation, Alt. or Repair) ....... .......... 4.00 ... MOTORS: 1 HP or less ......................................... ....... . 2.00 a.-.... 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 ................ .............................. 1.50... ..-.--.-.... Lawn Sprinkler Sys. $5.00 Ea. add Sys. $2.00. Misc. (see Ord. current)...................................................... Vacuum Breakers ....-........._.........._............... .. ............3.50..------------ New Residential Occupancies la[ Rate Interceptor........ Water Softener........ _._...._.._...._........4.00. ...._...... 0-500 Sq. ft. $22.00 1501-1750 $34.50.............................. Plumbing Piping without fixtures..._.`..Y.R_-.__........ 4.00.......,. 501-750 24.50 1751-20000 37.50.............................. Misc. (See Ord. Current) ....... ................................'.`......... 751-1000 26.00 2001-225C 39.50.............................. Permit Fee ...._.......-............ ......__............................$ 6.00 1001-1250 28.50 2251-2500 42.00.............................. TOTAL PLUMBING PERMIT FEE (plus penalty if app. ]) tK 1251-1600 32.00 2501-2750 49.50.............................. APPLICATION • . HEATING/COOLING VERMIlf Permit Fee...............................................$6.00 TOTAL ELECTRICAL PERMIT FEE (Plus penalty if app.p) $O'vl PERMIT INSTALLATION NO. EACH —F-ET-Forced Air Unit..................to 100M .............................-$ 6.00............... SEEMMUTg T. • • • ' over 1DOM ......__........_._-. 10.00.. .."........ Comfort Cooling Unit.....to 3 ton/HP ....-.................... 8.00... ......."".." Formeng Ground W ............._.__..._... By:........ ....... . Date:................ to 15 ton/HP.... ............ 9.50......._..... Plumbing Ground Work . ................... 1.. _ ......-........ ...................__... to 30 ton/HP........-.._..... ........ .. 12.00.,..... Rough Electrical .. ... .. - - to 50 ton/HP.... re Plumbing and Heating .. -. ' 17'00` �- -- � � -�-- �� Space Heater........ Well Heater .. . .... 6.00.. sWn & Energy .. ..� -.- . .--- .. Flues - other than above 3.00 . a .. - h --- Vent Fan: Kitchen ...... Bath ............_. .._. ` 3.00„ Temporary Power Gas / Elect ... ..1. Commercial Range Hood _.. _. ll 6.00.. Final - Electrical - . ... - Mise. (See Ord Current.. .. Final - Building/ Mechanical . .. ..... ...I_. .._... Permit Fee .. .... -. . -- ..... ..._....$ 6.00 Final - Design Review / Landscaping . _.... ........ TOTAL Htg./ Coolg Permit Fee (plus penalty if app E]) $ Final- Public Works ...........................................................