1194 0 0
CITY OF CUPERTINO
APPLICATION FOR RESIDENTIAL BUILDING PERMIT PERMIT NUMBER
AND
Is CERTIFICATE OF OCCUPANCY • APPLICANT TO FILL IN
BUILDING INSPECTION DIVISION STREET ADYRSS OF P, ECT;
7.25 �/iV.[.. .t..4.6. .......A_�......:............_.........
r ' • ' • Legal Description: Tract........................ Block.......-.... Lot......................
Description of Work: L[. ..h.G,s=.....CAN�..t'..Gt�7T......
PlansReceived By....................................................Date .........................
REQ.: Plans.... Survey.... Calcs: Struc.._. Ener ............_.__.......... ........._.. .........._..............._..._..A....a......._..._......_.......
Y gy.... Elect....- Mech.._ 1st Struct. Improvement on Parcel:Yes_.. No... Area of Bldg...............
Plans Checked By......................... Date ....... .... Separate Structure..........:. or Addition/Alteration to Exist. Bldg
Application Approved B L:.....,.._„""""" 7 '"""-""-'
........�}•......................... Date .... .a�....
PP PP Y”" No. of Stories.......... Use of Building .........._.._.. ........._...._._-------...
Validated By .......... ...... .. ...- ....Date -. ... Valuation of Pro act $ _
... ........... ._.... .. .. .
Compensation Certificate Verified By ........ Date ... .. .. .. .... Owner: C.R TCti) r•=AA_ .... Phone 2: -F.°/ 6
Contractor: ^^R{F•f . 14eo Ti/(1 G.
• • - • E . .. hh Icy Bus LIC AL620L7
Contractor's Address X0A.)
72 r(/,JI.,z,,., "S.Z Phone..3..7.9..fty.
Permit Fee (plus penaltyf applicable) Contractor - Electrical: ..._....5 ..- "S _........._..........................
Plan Check Fee (less deposit of$.........- Rct. #_.__...)$._................... City Business License *........._......... Phone:.........._........
Energy Plan Check Fee (Dep. of $........ Rct. #........) $...... ............... Plumbing: ..........._.....................
._........._._..
Strong Motion Fee .....,..,. _ _ _"$ "., """""._ City Business License #_................. Phone:..._...._-..._...
G.r"v."CU---Tl,0 Heating and Cooling
PlumbingPermit Fee ._..._..... ...._................................._..._................_..
._........._..._...............$........__...........
Electrical Permit Fee ..... .... ..$..........._... City Business License +�........._......... Phone:......... .........
" T C 100(1 " ipo, Architect/Desi Designer:Mach. Hig./Coolg. Reutu[ ........ . $_...�.z..r-+ 9 ........,.._......._._......_................. Phone:....................
.�1rw................ .-.. Engineer: .......... _
. _
_
...._..................... .... .. ..... Phone:....................
Residential Construction Tax .._._.....__._..............._....$..._...:a..._:._"" Lender: Unknown
. .. .............. ..
Misc. Fee ...__.._........ ...._...._.._...........$.............._..._.. . ..... ... .._................._....._._............ ❑
Misc. Fee ................_�_........._..H....�.. """'"""""'$. - "I certify that in the performance of the work for which this permit isssuenot employ
"- id I shall
r7 d" any person in any manner so as to become subject
• $ /��• to the workman's compensation laws of California."
SIGNATURE OF
• • APPLICANT/OWNER ................. DATE........................
.._................_........._.._...__..... ..
Environmental Status: Exempt ._......._ Other............._ .. .............. "I Cerny that as the applicant I am licensed unde the"" PP provi Ippa D )
Design Review Approval: Bldg. ............ Site _..._..... Sign ........ Contractors License aw and further that my Licens. No. 3. 3._ 6a.a
Use Zona P.D. Conditions ...._.........._ in Classification ...�.,—. 2. CJ.......... is in full force and effect: or
Cond. Use Permit Ar.,... Variance A........... Parking Spaces........._ - .- I certify that I am exempt from the 'Licensed Required' provisions of the
Approved By. Date _ contractors License Law. (State basis of exemption.)
By.,-,.-,....... _.._...._.......... I hereb
"""""""��"" �"'���������� y acknowletlpe That I have read this application and stale that the above is
• . • _ corroct and agree to comply with all City ordinances and State Laws regulating
• building.
ICf08Chme0t Permit......................_ Grant Of EaSem¢nL............._. I (We) agree to save, indemnify and keep harmless the City of Cupertino...... against liabilities, judgments, costs and expenses which may in any way
'urb, Gutter, Sidewalk, Driveway: Replace.-........ Repair.......... accure against said City consequen a of the granting of this permit."
Sewer............ Cann. Fee $......._—.... Water........... .... Meter $._...—....... SIGNATURE OF
Agreement for Completion of Public Works Improvements _......I.- APPLICANT/CONTRACTOR ......_._... DATE ..,
Plans Checked By........ Date....... Approved By........ Date....... .... ..... NOTE, When properly validated this form comet as a Building Permit. This
permit expires and becomes null and void should work not be commenced within
• • - 120 days from validation date, or should authorized construction be suspended or
PERMIT INSTALLATION NO. EACH
abandoned for a period of 120 days after work is commenced.
FEE
Light Outlets............ Switches..... APPLICATION • • PLUMBING PERMIT
.......
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 .I..... . 5.00 .. ............ Wash. Mach..... Dishwasher.... Garb. Disp.. .. 3.00,""""","....
... ............. ...
—200 amp......... 7.00... .........._ Sewer -.. 8.00...............
._.............ys..$5. _..._a._.......Sys...$2.............
Time Clock .......... ............... .............._....................... . 1.50... ........... Lawn Sprinkler Sys. $5.00 Ea. add Sys. $2.00.........
Misc. f see Ord. current 1.... .......f..... Vacuum Breakers ..............3.50..............
............................................
ew esidential Occupancies Flat Rate Interceptor........ Water Softener........ . .. ................4.00.
0-500 sq. ft. $22.00 1501-1750 $34.50.............................. Plumbing Piping without fixtures ..................i............."4.00""
.............
501-750 24.50 1751-20000 37.50.............................. Misc. (See Ord. Current) ....................................................
751-1000 26.00 2001-225C 39.50.............. ... Permit Fee ..........................................................................$ 6.00
1001-1250 28.50 2251-2500 42.00.............................. TOTAL PLUMBING PERMIT FEE (plus penalty, if app. 7) E
1251-1500 32.00 2501-2750 49.50.............................. APPLICATION
PermitFee...............................................$6.00
TOTAL ELECTRICAL PERMIT FEE (Plus penalty if app.p) $ PERMIT INSTALLATION NO. EACH FEE
INSPECTION RECORD
Forced Air UniL.........._..._to 100M _................. $6.00- a
• . over 100M ........................ . 10.00.. ...........
Forms / Foundation .................._. ... _I By:_...... . ..... . Date:................ Comfort Cooling Unit._...to 3 ton/HP ........_........ .......... 6.00,..............
Plumbing Ground Work . ....._._....... I. to 15 torl.._..._-..... .._.... 9.50..............
Rough Electrical ............................... ...................._....
to 30 ton/HP..................._...... 12.00. ..._.......
.__t.........................
The - Plumbing and Heating ........ .t._................ to 50 ton/HP.........................�..17.00..............
. .. .. ......._.._......_..... Space Heater........ Wall Heater .. ........ .................. 6.00
sul Test & En. .....ergy ........._._............_. ..............
........_............... ........_......._..._... Flues - other than above ..........................__....... .Gas Test I .. 3.00.. ............
.........._..._..............._........ . .... ........._.__.... Vent Fan: Kitchen.. ..... Bath ......_........._...................... 3.00... ............
Temporary power Gas / Elect. . ..._... ....... Commercial Range Hood 6.00
Final - Electrical ............... ...._...._...-.........._.............. .. ...............
_........_..............._._........_..I_.._...._..........._.. Misc. (See Ord. Current..._.............._...__...._._..............6.0
Final - Building /Mechanical ..................... 6 00
._..............I_...._....._._...._.. Permit Fee ........... $
Final - Design Review / Landscaping . -"""�"��."""....".... .................................. ,
TOTAL Htg./ Coolg. Permit Fee (Plus penalty if app. ❑) E
Final-Public Works ...........................................................