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1429 W CITY OF CUPERTINO APPLICATION FOR RESIDENTIAL BUILDING PERMIT PERMIT NUMBER AND • . APPLICANT TO FILL IN 40 CERTIFICATE OF OCCUPANCY BUILDING INSPECTION DIVISION STR IE4 ADDRES OF PROJECT; t • - • Legal Description: Tract. ...... Block___. Lot -4, . Plans Received By Description of Work: .... ..LbI i ................... Date . ./ ... , REQ.: Plans.... Survey Calcs Struc. .. porgy.... Elect. Mach.... 1st Struct. Improvement on Parcel Yes No.... Area of Bldg.. Plans Checked By _- -. ..Date © Separate Structure ..:.. or Add pion/Alto ration to Exist. Bldg -.... Application Approved By .... ___Dete U�Z7 d No of Stories .. U e f BmSging ._ _ ..... ............................. Validated By..._. .. .....Date -....... Valuation gro)et $ b .... Compensation Certificate Verified By ... ......._.. Owner: �� jj yy . .- Date ...M.1� 1`•. K �-'�� .. Phone- .. . $ �� Contractor:({jZ�l'A'(' .b('(1� 6d1`!. W City Bus Lic 0 Contractor's Address I Z5 KO/A `a .. Phone?1�2 %ti4 ii Permit Fee (plus penalty if applicable) ... _ -. ..... $ .?.4 _ Contractor Plan Check Fee (less deposit of $�..Rct 8 ...._)$ e - City Business License x ..... Phone ... Energy Plan Check Fee (Dep. of $ ". Rct?#. .) $ Plumbing: ......... ....... ..__ .. - ... Strong Motion Fee - __ //1y2. $ _. �V... City Business License d _. .... Phone: .. Plumbing Permit Fee .... e. Heating and Cooling ....... A ._._ ... - ._ Electrical Permit Fee ..... }J City Business Licensed .__ Phone ... ������ - ���----��----- Architect/Designer: _...... Mech. Htg./Coolg. Permit $....n..... $ ---- -- ..... Phone ... ... ... .. $_- - - ... .._ Engineer: ._ . ..._... _ .... .. .. ..... Phone:.... Misc. Feel Cons...... n Tax ... !'a.__,I : ..__.. $ wn y �. ... Lender. ❑ Unknown Misc. Fee _____ - ......... . ..... - ...... - ......... ..... ..... $ _. .. x,. Misc. Fee _._..._........_ .......... ...........................$.... ......... issued'I ced;ly that In the performance peof the work for which this penult is I shell not employ any person In any manner so as to become subject • . , , : $ p to the workman's compensation laws of Celllornla." p _ . . _ LI URE OF (O/ �^y''/I'�7 _._... ............ _...... SIGNATURE NT/OWNER .. ... .. ._ ..._..._....... _ DATE....... eqw Environmental Status: Exempt •. Other APPLIOFI certify that as the applicant I am ficonsed ends' the prppvy�vs11o�ne Of the ._.. .......... ?0 Design Review Approval: Bldg. .... Site Sign Contractors License L w and further that my Llcene. No. . Z5.?a..... Use Zone ............ P.D. Conditions in Classification ...__rjG I._... ,,, Is in full force and effect: or Cond. Use Permit d............ Variance #......._._ Parking Spaces.. ......., I certify that I am exempt from the "Licensed Required" provisions of the Approved By. -_.__._ Date ___._ Contractors License Lew. (State basis Of tion and state ---��--------� - ---------- "-"""""""' I hereby acknowledge that I have read this application and state that the above is _ :.meet and agree to comply with all City Ordinances and State Laws regulating • • budding. I (We) agree to save, indemnify and keep harmless the City of Cupertino •roachment Permit....................... Grant of Easement .... against liabilities, judgments, costs and expenses which may In any way Web, Gutter, Sidewalk, Driveway: Replace. ....... Repair......._. secure against said City In�gqnsequence of the granting of this permit.'' Sewer ... Conn. Fee $...... _..._ Water............. Meter $......... -... SIGNATURE OF (lJt,_ ID/Z/� Agreement for Completion of Public Works Improvements .... APPucANT/0oNr6Acro6 .. ..... .._.. DATE ..... .... [ .. Plans Checked By-....... Date ..... Approved By....... Date_ .- _. .... NOTE When properly validated this form con•111ut • • Building Permit. This permit expires and becomes null and veld should mark not be commenced within • • - 120 days from validation date, or Mould authorized construction be suspended or abandoned for a period of 120 day alter work is commenced. PERMIT INSTALLATION NO. EACH FEE APPLICATION FOR PLUMBING PERMIT Light Outlets._._...._ Switches............ we 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....___ ....._..- 4.00 ....._._... 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 .... ................._ ....... ...._4.......'. 1.50...__....... Lawn Sprinkler Sys. $5.00 Ea. add Sys. $2.00....... .........._. .............. Misc. (see Ord. current)...................................................... Vacuum Breakers ._..... ...__............._..__._ .. ............3.50........._. New Residential Occupant les tat Rate Interceptor........ Water Softener...._.. ......_._...... _..........4.00. ............ Plumbing Piping without fixtures ......_...........................4.00............... 0-600 sq. ft. $22.00 1501-1750 $34.50...:.......................... Misc. (See Ord. Current) .......... .......................................... 601-750 24.50 1751-20000 37.60.............................. Permit Fee ...... 75f-1000 26.00 2001-2250 39.50.............................. ( ..................... .............. .....................$ 6.00 . 1001-1250 26.60 2251-2500 42.00.............................. TOTAL PLUMBING PERMIT FEE (plus penalty if app. C)) : 1251-1500 32.00 . 2501-2760 49.50.............................. APPLICATION FOR HEATING/COOLING PERMIT Permit Fee...............................................$6.00 TOTAL ELECTRICAL PERMIT FEE (Plus penalty It app.p) $ PERMIT INSTALLATION NO. EACH FEE Forced Air Unit-_ ...to 100M 100M ..................... .._... -$ 6.00- ........... • • ' r 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 .......... ...._..... ..... ........:...... __..... -.. to30ton/HP. - ugh Electrical all '.... .,_ __ ................ � to at ton/HP - 17.0_ ... me - Plumbing and Heating L_. .... .... .. 6,00 . ulation & Energy ` Space Heater-_an Wall Heater 1. '- - - -' Flues - other than above .... 3.00 Was Test ......_ _ ____ _ --- :" - -r - - Vent Fan: Kitchen.. Bath 3 00.. Temporary Power Gas / Elect ... ..I ... . . 6 00 Final - Electrical ,Commercial Range Hood _ ---"- -- -,y�•1 Misc. (See Ord Current Final Building/ Mechanical ... Permit Fee --_..... .... .. ... $ 6.00 Final Design Review / Landscaping . _ ... - TOTAL Htg./ Cool Permit Fee (plus penalty if app. �) $ Final- Public Works ..........s.... .................... ... lD-1'7: $�t��