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1743 CITY OF CUPERTINO CITY OF CUPERTINO 71 APPLICATION FOR RESIDENTIAL BUILDING PERMIT SAN r PERMIT NUMBER /7fG 3 • AND FOR APPLICANT , FILL IN CERTIFICATE OCCUPANCY F BUILDING INSPECTION DIVISION f�ET -2.0 A4.dls......DRE S OGPROJECT:�rR.n.. . 1...C . r ...._ T................... • • Legal Description: Tract.................... Block............ Lot..../_............ Description of Work: ....-]'E-2`:1,/�.......6-5kiC._................._............... Plana Received By....................................................Data ......................... REO.: Plans.... Survey.... Coles: 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............... ....S.wy............. Date Y /�..._. No. of Stories................ Use of Building Validated By..............................................................Date ......____........_ Valuation of Project: $.............__.............................................................. Compensation Certificate Verified By ................. Date ............. ... Owner: . _/ .............._...... . ..... YPhone: Contractor: .Bus. Lic. + _ ... ... • , • • • f Contractor's Adtlress://7jSiK,.rsv.4—s, D... Phone:rZ..fS.t_-0 Permit Fee jus emelt f applicable) Contractor - Electrical: ..................... ._............ ...................._.................. (P penalty i PP ..Rct................$_......... . City Business License +.................... Phone:..... ......... Plan Check Fee (less deposit of$.......... Rct. #..........)E....................... Plumbing: ..................._....................._............... .._..._............_.. Energy Plan Check Fee (Dep. of .......... Rct. ........)$._.................... City Business License •.................... Phone:_ Plumbing ..__.._.._:.. SlMotion Fee ..........................................................$..... ........ ..... Heating and Cooling ng Permit Fee ...... ............ .... . . _.............. ................................................$.. .. .L..... .... Electrical Permit Fee .._................................... ....... $.........__ ___... City Business License #.................... Phone:._.._..___..... Mach. Htg./Ceolg. Permit $............................. $....................... Architect/Designer: .................................................. Phone:.................... _ Residential Construction Tax ................._........._...._._.$.........._._........ der: ..Engineer: ............ ...................._.._............._._........... Phone:............. Len . ........ ....._ _ .. ......._.... ...... ............_ ..... ..__.. _ _ .. 0 Unknown Mise. Fee ._............................................................ ..._.. ........ "I certify that In the performance of the work for which this permit is Misc. Fee ........................................................................$....................... issued I shall not employ any person in any manner so as to become subject • $ to the workmen's compensation laws of California." SIGNATURE OF • • APPLICANT/OWNER ....................................................................... DATE.................... Environmental Status: Exempt............ Other........................................ 'I certify that as the applicant I am licensed undethe provisions of the Design Review Approval: Bldg. .._........ Site ......._... Sign __........ Contractors License Law and further that my Users. No. Use Zone P.D. Conditions ..... In Classification ...........-........................... Is in full force and effect: or Cord. Use Permit tk............ Variance a............ Parking Spaces..... I certify that I am exempt from the "Licensed Required" provisions of the Approved By." """"""""""-"""""""""" """ Date ,. Connectnra License Lew. (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 • • building. ' 1 (Wel 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 Ufb, Gutter, Sidewalk, Driveway: Replace........ Repair.......... secure against said City In conse uence of the granting of this perm);.'' Sewer............ Conn. Fee $.... Water................ Meter $.........._-. SIGNATURE OF xx H/ �_ Agreement for Completion of Public Works Improvements ..........___ APPLICANT/9 O NTRACTOR-.\ .pyj'''� /.� DATE A!... _._..._1.... Plans Checked B Date........ Approved B Date-_................. NOTE: When proper) velidelad this form consdt tea a Building/P\ermit. This By PP y........ y permit expires and becomes null and void Should work not be commenced within • • - 120 days from validation date, or should eulhiaed orconstruction be su•p•rMed or" abandoned for a period of 120 days atter work Is commenced. PERMIT INSTALLATION NO. EACH FEE APPLICATION FOR PLUMBING PERMIT Light Outlets............ Switches............ Fixtures............ Receptacles:........... PERMIT INSTALLATION NO. FACH FEE TOTAL NUMBER (less than 1000 watts) ............ $ .50 - --- -.... Gas System with up to 5 outlets .........._.....................$4,00. --..-r Range........ Cooking Unit........ Oven............ ......... ...... 2.00 .. ....-......- Each additional outlet ............................................. 1.00..............., Dryer........ Garb. Dis Dishwasher ...... . 2.00 .............. Wafer 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 'P ...... 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 Flet Rate Interceptor........ Water Softener........ .............................4.00. ............ Plumbing Piping without fixtures ...................................4.00.,.,_........ D-500 sq. ft. $22.00 1501-1750 $34.50.............................. Mise. (See Ord. Current) .......... 601-750 24.50 1751-20000 37.50.............................. ................................6.00 .... 761-1000 26.00 2001-225G 39.50.............................. Permit Fee ........................... ( ..............alty......................$8. 1001-1250 28.60 2251-2500 42.00.............................. TOTAL PLUMBING PERMIT FEE (plus penalty If app. '�) $/0, 1251-1500 32.00 2501-2750 49.50..0........................... APPLICATION FOR HEATING/COOLING (1ERMIr Permit Fee...............................................$6.00 TOTAL ELECTRICAL PERMIT FEE (Plus penalty If app.El) $ PERMIT INSTALLATION NO. EACH FEE Forced Air Unit..................to 100M ..................... .........$ 6.00... ........ ­ INSPECTIONRECORD 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/H P........................ ..12.00.............. r�Rough Electrical ....................................J.........._........__. ..._.__...._..... to 50 ton/HP...........................17.00.. ......... •arae - Plumbing and Heating .......... ........._......._.... ._.._.._.__........... Space Heater........ Wall Heater .................................. 6.D0.. . ........... sulation 8 Energy............................... ..................._.... .....__...__.........._ Flues - other than above ......._................_......._........ .. 3.00.. ........... as Test ............................................ ........................ .......................... Vent n' Ki 3.00... ........... I e Fa tchen........ Bath ......................................... Temporary Power Gas / Elect. . ........ .._._................_!._.............._....__ Commercial Range Hood 6.00...,._._...... Final - Electrical ................................... .................... _. ..........._...___._.. Misc. (See Ord. Current._.............................................._.__................_ Final - Building) Mechanical .............. ........................... Permit Fee ................. $ 6.00 Final - Design Review y Landsca in o1g................Fee l� � a �-��� g P 9 ..............- .... .. --- TOTAL Htg./ Coolg. Permit Fee (Plus penalty P SPP O) f Final-Public Works ...........................................................