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1343 1. I CITY OF CUPERTINO - t APPLICATION FOR RESIDENTIAL BUILDING PERMIT PERMIT NUM ER �3 APPLICANT TO FILL IN I� :-.lr•.n:C` AND • . CERTIFICATE OCCUPANCY i BUILDING INSPECTION DIVISION STREET ADDRESS OF c.�'...�........BI.... ......W...1 r DEPARTMENT • Legal Description: Tract...._._......__..... Block.............lot... .................. ' 9 P LJ f C) r Description of Work: cS' . .`irG{_....J....>.!'.!)............p�.:................ Plans Received BY ...ry ..a'�..Q�..................Date ......................... ...................._.._.........._.................._............_...--_...................................... REO.: Plans.... Survey.... alts: true..... nergy.... Elect..... Mach.... tat Struct. Improvement on Parcel:Yes.... No....Area of Bldg....:.......... Plans Checked By....................:.. ... .. Date ... ../. .. Separate Structure............ or Addition/Alteration to Exist. Bldg........... l '4 Application Approved B ....... ..... ate //ll PP PP Y ��-Cy-,�/�?� ��` ��D ..��.. ....l...V No. of Stories.... Use Building Validated B ... g ......._........................ .... By............................................................Date ... Valuation of ProJ'egt: $ .!QQQ.......... ..:......................p1...... c ...... Compensation Certificate Verified By .....[1....... Date ...r�. _�)... owner: .Cl l.'�Y�q.!..:r' . ... .Thprn4S Phone . ...... ✓_3V .. • • Contractor: CI :.. (.. .�.. .. City Bus. Lic. ll-. NKIZVM • ...... $ day �� Contractor's Address: .l 1.-1 .56.x_-7.,'"'.ST�. Ph ne:c'�a.•3�4 Permit Fee (plus snail If applicable) Contractor - Electrical: . f0.� ,rit.....' �?Q..`lit. .l!.TtY.._.........._... (P penalty PP ) ........................$... ... Plan Check Fee (less deposit of$.......... Rct. #..........)$... -!d'O - City Business LicensQQ •..._....._(....... Phone,29a.� ...y Plumbing: ,Ce1aWn._.Y-t .... f Energy Plan Check Fee (Dep. of $........ Plot. #......-) $............. - -- -- /.. x Cit � Business License ... ........_ _ . Strong Motion Fee .............C!?2. $...... .�. . .... Y e .. ..... Phone..- �..3..... fir,.........."'� ""��'�'��-�"" � Heatingand Cooling Plumbing Permit Fee ................Iq, 9ense....................._._.___......................... Electrical Permit Fee ....tC,.l.' mlJ................$..f.�,1 ... City Business License a......_...__..... Phone:....._............. r.................. Architect/Dei ner: ...... Phone8l.� •S�O Engineer: TUQ F7. .............. .....$.............`......... Fender: . .. Mist. Fee ..........................:.. ,e....�.._. ........._.............$ .._r O .. certify that..in........per..................................f . . c ❑ Unknown nce Misc. Fee SIGNATUI c the y any person of the work idr which this permit le """""" """"'""" p ""�-�� issued I shall not employ any person in any manner so as to become subtest • • : $ IO to the workman' cW/opgensaafon laws of California." APPLICANTOWNER ...... �olm......lul ............ OATE9/1-1..'/ .. . Environmental Status: Exempt ............ Other........................................ ,_...... 'I certify that as the applicant I am licensed undo the pro y' iggs Design Review Approval: Bldg. ............ Site ............ Sign ............ Comrnmors License LOw�ad�further that my Licens. No. ....y, l J 3 Use Zone ............ P.D. Conditions ........................_ ............. _....... n Classification ......... ._ ............... Is in full force and effect: or Cond. Use Permit +r.._....._. Variance +r............ Parking Spaces............ I certify that I am exempt from the "Licensed Required" provisions of the A Contractors License Law. (Stale basis of exemption.) Approved B y................_..................._.._................ Date ...._..........._...._.. I hereby acknowledge that 1 have read this application and state that the above Is r • . aarrect and agree to comply with all City Ordinances and Slate Laws regulating bu(Wilding. e) agree to save, Indemnify and keep harmless the City of Cupertino z ... �yk" ?��j�r0echment Permit........................ Grant Of Easement.............. ......... against Ilab nntles, judgments, costs and expenses which may In any way Gutter, , Sidewalk, Driveway: Replace...... . Repair.......... secure against said City in sequence of the granting of this permit." 'sewer....._..... Conn. Fee $................ Water................ Meter $................ SIGNATURE OF /b•J/�,,,,,, /l_,.,�— p� Agreement for Completion of Public Works Improvements ......---..... APPLICANT/CONTRACTOR .. W..lL1......n.e,l(((J ✓.!..\DATE Plans Checked By........ Date........ Approved By........ Date.................... NOTE: When properly validaled this form constitutes a Building Permit. This permit expires and becomes null and void should work not,bo commenced within • • 120 days train validation date, or should authorized conslrucllon be suspended or abandoned for a period of 120 days after work is commenced. PERMIT INSTALLATION NO. EACH FEE APPLICATION FOR PLUMBING PERMIT Light Outlets............ Switci...- Fixtures...../... Receptacles............ PERMIT INSTALLATION NO. EACH FEE TOTAL NUMBER (less than 1000 watts) ............ $ ,50 .x.l1"d. 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 ........,L... 3.50 ...3..(v 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. ...... . 1.60.............. Lawn Sprinkler Sys. $5.00 Ea. add sys. $2.00............. Time Clock .............-................. ..................... .. mp.. 7.00............... Sewer ............................................................................... 8.00............... Time Clock .............................................................. ...._._. 1.60............... Lawn Sprinkler Sys. $5.00 Ea. add sys. $2.00..................... . ... f Misc. (sae Ord. current)...................................................... Vacuum Breakers ...................... ..................... .....1........3.50.7......... New Residential Occupancies Flat Rate Interceptor........ Water Softener........ .............................4.00. ... ..... Plumbing Piping without fixtures ............. .......1........4.00... 0-500 sq. ft. $22.00 1501-1760 $34.50........................: .... Misc. (See Ord. Current) F1.4rnin..5�/�!. :....:. ' c Q:Q 501-750 24.60 1751-•20000 37.50........................ . / """""' " .... Permit Fee ................... .........$ 6.00 761-1000 28.00 2001-2250 39.50.............................. ....................................... .. .. .. 1001-1250 28.60 •2251-2500 42.00.............................. TOTAL PLUMBING PERMIT FEE (plus penalty if app. Q) $ r,6V 1251-1500 32.00 2501-2750 49.50.............................. Permit Fee...............................................$6.00 APPLICATION FOR HEATING/CCOLING PERMIT TOTAL ELECTRICAL PERMIT FEE (Plus penalty If app.C)) �xprf0 PERMIT INSTALLATION NO. EACH FEE Forced Air Unit..................to 100M ..............................$8.00............... • • • ' over 100M................. ......... 10.00.............. . Comfort Cooling Unit... ..o 3 ton/HP ................. .......... 6.00,.............. Forms / Foundation _..._..................... . BY:........ ....... . Date:..............: to 15 ton/HP................. ........ 9.50.............. Plumbing Ground Work . .................... ..... ................ ........................... to 30 ton/HP...........................12.00.............. �^-:gou0h Electrical ..._......._.._..................I....................... ......................_... '3'.:p.., to 50 ton/HP........................... 17.00.. ........... rv:r1me - Plumbing and Heating .......... ......................... ........................... 8.00 Af1 Space Heater........ Wall Heater ................................... tlahon & Energy .. _... _. .... "• Flues - other then above . ................... -....... 3.00............_ Test . ........ . . ..... .... ..I�-'�.S• a.x.... .. II Vent Fan: Kitchen....H Bath ........................_............ .. 3.00............... Final - aryElectrical Power Gas / Elect. . ............................__.1................ ......-.. Commercial Range Hood 8.00... Final - Electrical ..........anic.........__._... ................_..__. .......................... ....................._......... Misc. (See Ord. Current........................................�.�................................. Final - Building/ Mechanical ........................�......___..................... Permit Fee .............. $ 6.00 Final - Design Review / Landscaping ..... ..........................__............. TOTAL Hg./ Cooly. Permit Fee (plus penalty if app. ❑) $ Final- Public Works .......................... ............................... U C ac--�