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1623 CIT( pF. CUPERTINO • �� - ILITY OF CUPERTINO DiElQj111980 APPLICATION FOR RESIDENTIAL BUILDING PERMIT PERMIT NUMBER (o AND FOR APPLICANT TO FILL IN CERTIFICATE OF OCCUPANCY BUILDING INSPECTION DIVISION S F,� ADDRESS F R ECT: .�......�C ...L��2°�.......G.77._....................................... • ' • ' • Legal Description:--Tract.................:...... Block............ Lot...................... Plana Received By...................................................Date ......................... Description of work: ...-_._...._...... .......aInant............_.a..._................._....e_....._...................... ...........RQ.: ens.... Survey.... Celts: Strut..... Energy.... Elect..... Mach.... 1st Strutt. Improvement on Parcel:Ves.... No... Area of Bidg............... Plans Checked BY......................... Date ..... L- ------ /t,� q Separate Structur __........ or Addition/Alta tion to Exist. Bldg........... Application Approved By ........... Dat.Date ...._.../..!•........ No. of Stories..... Use f Building .oly .$LA�.'TxL'i:.1.�............. ValidatedBy.-----".......................................................Date ....................'...'. Com ensalion Certificate Verified 8 Valuation t Pro' t $._..... ..GA.........._......._......._.............................. P Y ................. Date ......................... I Owuation ../4C _..._.... �. .......... .._.... Phone:....... . • • " • E ROD — Contractor: .N......y�IL/ Tl/(�(h_.„City Bus. Lic. xJbC'Jf7 Contractor's Address: LQ.??/Vr..fz.:._..ST.Sd:E'hone2Zfo.>.Z.L Permit Fee (plus penalty if applicable) ................ ......$......... Contractor - Electrical: ..........-........................................-...................... Plan Check Fee (less deposit of$.......... Rct. #..........)$....................... City Business License +r.................... Phone:.................... Energy Plan Check Fee (Dep. of $........ Rct. #........) $....................... Plumbing: _..................................................--.............--.............. Strong Motion Fee ..........................................................$....................... City Business License # ............. Phone:.................... Plumbing Permit Fee $......_............... Heating and Cooling -S'd�I11E.......:.................................... Electrical Permit Fee ......................................................$.......... .. City Business License •.................... Phone:.................... �....... Architect/Designer: ____...._.. ..................... Phone:..................... Mach. Htg./Coolg, Permit $............................. $. ...Z............... Engineer: 161 Residential Construction Tax ....._................_...............$............... 9d ... _ _........................................................... Phone:.................... ”' Lender: Unknown Mist. Fee ........................................................................$....................:.. ... ............................. ............................................. Misc. Fee ........................... ........................ $ -.. "I certify that in the performance of the work for which this permit Is O 6 issued I shall not employ any person In any manner so as to become subject • $ 12 • 6� to the workman's compensation laws of California." SIGNATURE OF • ZONING REQUIREMENTSAPPLICANT/OWNER ............ _...............................-.................._.. DATE........................ Environmental Status: Exempt............ Other.................... _.........._..... "I eelreny that as the applicant I am licensed unde the p avisionsQI tgpF.. Design Review Approval: Bldg. ._....._... Site ....-._... Sign ... ..... Contractors License La uther anrLfthat my Llcene. No.• S.3.Sp(o.. Use Zone ...._...... P.D. Conditions ....................................................._.... in Classification -.. ..— ..... ... is in lull farce and affect: or Cond. Use Permit x............ Variance +v............ Parking Spaces............ l certify that I am exempt from the "Licensed Required" provisions of the Approved By................---.......... .............""" """'""'-""""""Dale Contractors License Law. (State basis of exemption.) P ""'" 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. I (We) agree to save, Indemnify and keep harmless the City of Cupertino ioachment Permit........................ Grant of Easement......_................ against liabilities, judgments, costa and expenses which may in any way rb, Gutter, Sidewalk, Driveway: Replace.......... Repair._....... acture against Bald City In consequence of the granting of this permit." Agreement f Donn. Fee $........Public Water orks.......rov Meter nts $........ SIGNATURE OF �.....h/ � _ > p �j0 Agreement (Or Completion Of PUbIIC WOrkS Improvements ..._...._....... APPLICANT/CONTRACTOR _..(di//�.(i.(_. OATE�,S.�.A..`.v.V 1 Plans Checked By........ Date........ Approved By........ Date................... NOTE- When properly validated this form aornlll tes A sulking Permit. This permit expires and becomes null and void should work not be commenced within APPLICATION •• ELECTRICAL PERMIT 120 days from validation date, or should authorized construction be suspended or abandoned for a period of 120 days after work Is commenced. PERMIT INSTALLATION NO. EACHFEE Light Outlets............ Switches............ APPLICATI• • • 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 Pen.... Bathtub.... Sink................... 3.00............... Temporary Power Pole or Service— 100 amp .. ....._5.00 - -........ Wash. Mach.... Dishwasher....Garb. DIED..... ..... .......... 3.00,.............. —200 amp. ....... . 7.00............... Sewer ..................................................................... .......... 8.00............... Time Clock .................................... ................................... 1.50.............. Lawn Sprinkler Sys. $5.00 Ea. add Sys. $2.00........ ............. Mist. (sae Ord. current 1.............................................. Vacuum Breakers ............................................ ..............3.50.......... New Residential Occupancies Flat Rate Interceptor........ Water Softener........ .............................4.00. ............ Plumbing Piping without fixtures ...................................4.00............... D-500 sq. ft. $22.00 1501-1750 $34.50.............................. Misc. (bee Ord. Current) .......... 501-750 24.50 1751-20000 37.50.............................. .......................................... 751-1000 26.00 2001-225C 39.50.............. Permit Fee . ............................................$ 6.00 1001-1250 28.50 2251-2500 42.00.............................. TOTAL PLUMBING PERMIT FEE (plus penalty if app. ',) $ 1251-1500 32.00 2501-2750 49.50.............................. APPLICATION FOR HEATING/COOLING I'ERMI1 PermitFee...............................................$6.00 TOTAL ELECTRICAL PERMIT FEE (Plus penalty if app.p) $ PERMIT INSTALLATION NO. EACH FEE - I Forced Air Unit..................to 100M ...................... ......$6.00,.. INSPECTION • ' over 100M .......................... 10.00.............. Comfort Cooling Unit...._to 3 tori ........................... 6.00,.............. Forms / Foundation .............................. BY:_...... ....... . Date:................ ....... 9.50.............. Plumbing Ground Work . ..._.............. i to 15 ton/HP.................. . p_.. _......_...... _................. ..... to 30 ton/HP......................... ..12.00. ............ ugh Electrical ..........._...atin..............�_. ........... ..__... ..................._..... to 50 ton/HP..._._................'..17.00.. ' me - Plumbin and Heating l • 9 9 ....................._....._..... .._.............._....... Space Heater._._.. Wall Heater .................................. 6.00.. %dation 8 Ener . 9Y............................... .................__....�_..........._............ Flues - other than above .............................................. _ass Test ._............................._....... I . 3.00.............. .................................................. Vent Fan: Kitchen........ Bath ........................................, 3.00............... Temporary Power Gas / Elect. . ........._...................... _............_..._...... Commercial Range Hood 6.00... Final - Electrical ......... 9 .....-........--...................... ............ _........................ .................._.....�..........._.............. Misc. (See Ord. Current..........................._..................�� .� Final - Building/ Mechanical ................................................................. permit Fee $ 6.00 Final - Design Review / LantlscaPing . . .....................................................pp........ ... ..".-......-'... ........ ...... TOTAL Htg./ Coolg. Permit Fee (plus penalty If app. p) Shy0-0 Final-Public Works ...........................................................