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1519 1160G['1 OF GU F � k 24 CITY OF CUPERTINO QGT O APPLICATION FOR RESIDENTIAL BUILDING PERMIT P ERMIT NUMBER AND O. APPLICANT TO FILL IN ,a CERTIFICATE OF OCCUPANCY BUILDING INSPECTION DIVISION STREET ADDRES OF PROJECT: 7.56.9 .... .l RW.t.iV_.,iii..........._................................. r • • • • Legal,Description: Tract__.................... Block............ Lot...................... Descr}ption of Work: .L:1'OG2ii....R_fli.....fY?L2!A.V.!3:«..... Plane Received By....................................................Date ......................... .._.._L:h./..E}n7.(a.L.......0 f.[T._........__...................._...... ................. REO.: Plana.... Survey.... Calcs: Struc..... Energy.... Elect..... Mach.... 1st Struct. Improvement on Parcel:Yes.... No.... Area of Bldg............... Plans Checked By............................ Date ........... . Separate Structure..... or Addition/AI ration to Exist. Bldg........... Application Approved By................ .f. ..r._.�....._Date ...��.{a/n�•.`Tp No. of Stories................ Use of Building IS/.D..[3GVT//1 ......... Validated B ....................Date .._...!.....O!.... By .............................._....... Valuation of Project: $..SSQ...-...........__............................................ Compensation Certificate Verified By .................. Date ......................... IOwner: To_HrJ....h-1.�6�.................._.............. Phone:96.1F.`:7P2f Contractor:f4,.�H..HiF/47.-/N4:!.......... City Bus. Lic. #16200 " • $ Contractor's Address:/G�.?.�41f_L.Z..:z.�..StS S.Phone:X.79G,Z,7 Permit Fee (Plus penalty f applicable) .............. ..... .$............ .. Contractor - Electrical: _................... _ ..........._............................... Plan Check Fee (less deposit of$.......... Rel. #.......... $.................... City Business License #.................... Phone:.................... Energy Plan Check Fee (Dep. of .......... Rct. ....) $....................... Plumbing: ......-..............__.......... ._........_..............._................. Strong Motion Fee ......... ...............................................$...................... City Business License #..... Phone:.................... . ...NE!L-T/.. ..L^.. Plumbing Permit Fee ................................................$....................... Heating and Cooling 14.f. 64 ...................... ' Electrical Permit Fee ......................................................$..................... City Business License #16..200 :�.7 . Phone9,072z Oo' Mach. Htg./Cool9. Permit $............................. $ /.ZArchitect/Designer: ......... ......... .............................. Phone:.................... ... .....�..... Residential Construction Tax ........................................$..............—...... Engineer: ... ....... .................................................... Phone:................. wn Lender: .eU.o(that in the pe ...manc.................... work_._... hie C] Unknown Misc. Fee ..................:.....................................................$....................... �•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 workman's compensation laws of California." SIGNATURE OF • • • APPLICANT/OWNER ._..........................._..................................... DATE........................ Environmental Status: Exempt ............ Other..._................................. "I certify that as the applicant I am licensed urt the provisio a of t Design Review Approval: Bldg. ............ Site ............ Sign _.......... Contractors License aw nd further that my Licens, No. 'g.Yl:�3.5(Li.I Use Zone ............ P.D. Conditions .......................................................... in Classification ....�.-.. ..-......... is in lull farce and effect: or Cond. Use Permit #....._.... Variance #............ Parking Spaces............ I certify that I am exempt from the "Licensed Required" provisions of the Approved B Convectors License Law. (State basis of exemption.) PP Y.................:..__:.................................. Date ...._..........._........ I Mreby acknowledge that I have read this application and state that the above is cermet and agree to comply with all City Ordinances and State Laws regulating • • building. ' , • I (we) agree to save, indemnify and keep harmless the City of Cupertino Icroachment Permit........................ Grant of Easement........................ against liabilities, judgments, coats and expenses which may in any way Wurb, Gutter, Sidewalk, Driveway: Replace.......... Repair.......... secure against said City in consequence of the granting of this permit." Sewer............ Conn. Fee $................ Water................ Meter $................ SIGNATURE OF n G Agreement for Completion of Public Works Improvements ...............:. APPLICANT/CONTRACTOR .b�...�.... _. DATE�QS`.o-P Plans Checked By........ Date........ Approved By........ Date................... Nora: when property validated this form conet�eullding P•rmlr. rots permit expires and becomes null and void should work not r be commenced within • • 140 days from validation date, or should authorized construction be suspended or abandoned for a period of 120 days alter work is commenced. PERMIT INSTALLATION NO. EACH FEE APPLICATION FOR PLUMBING PERMIT Light Outlets......_... Switches............ Fixtures............ Receptacles............ PERMIT INSTALLATION - NO. EACH m FEE TOTAL NUMBER (less than 1000 watts) ............ $ .50 .... Gas System with up to 5 outlets .................................$4.00. ............. Range........ Cooking pUnit........ Oven............ ........._... ..._.......... W Y ( ......P.... ..........._..:.. 1.00........:...... 2.00 Each additional outlet ............. Dryer........ Garb. Dis Dishwasher ............. ...... 2.00 Water System Installation, Alt. or Re alr ... 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 .......I...... Wash. Mach..... Dishwasher.... Garb. Disp..... ............... 3.00............... —200 amp.._..... 7.00 .. ...... Sewer .........................................................................._... 8.00............... Time Clock .................................... ..........-............. ...I... . 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.......................•..•'•. Misc. (See Ord. Current) .......... 601-750 24.60 1751-20000 37.50.............................. ................................6.00 .... 76f-1000 26.00 2001-2250 39.50.............................. Permit Fee ............................(plu . ... ..... .........$8.00 . 1001-1260 28.60 2251-2500 42.00.............................. TOTAL PLUMBING PERMIT FEE (plus penalty if app. 7) $ 1251-1500 32.00 2501-2750 49.50.............................. APPLICATION PermitFee...............................................$6.00 TOTAL ELECTRICAL PERMIT FEE (Plus penalty if app.I $ PERMIT INSTALLATION 0.1 EACH IFEE Forced Air Unit..................to 100M -.................. .........$6.0'0' ��-s� INSPECTION 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 . ._........_...... ..... .............I .....I.....I............... to 30 ton/HP......................... ..12.00.............. • Rough Electrical .__........_........ .._........ .. .._................. ................._........ ams - Plumbing and Heating to 50 ton/HP......I........I.........�.�16.00... ................................... ........................... Space Heater........ Well Heater ................................... Sulation & Ener ""....•.. 9Y............................... ......................... ........................... Flues - other than above .............................................�.. 3.00.............. GasTest _........... ............._......... .. . ........................'... ....._................ Vent Fan: Kitchen........ Bath ........................_......._..... 3.00............... Temporary Power Gas / Elect. ........ ......................... ........................... Misc.Commercial Range Hood 6.00... ..,.,,,,.,,, .......................................... .. Final - Electrical ................ical.............. . .................._..... ........................... c. (See Ord. Current...............................................I................ ... Final - Design / Mechanical..........g � . . . . . 70. Permit Fee ..........................:.......................I......._........I.. $ 6.00 .................. .... ........................ Final - Desi is WoRevrks / Landscaping . TOTAL Ht / Cool Permit Fee (plus enalt If a Final-Public Works ...........................................................