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1272 CITY OF CU PERTINQ APPLICATION FOR RESIDENTIAL BUILDING PERMIT PERMIT� UMBER�14 7-11 AND FOR APPLICANT TO FILL IN CERTIFICATE OF OCCUPANCY BUILDING INSPECTION DIVISION STRE TV RES. ?"�F ZPJY _,;L ................................ .. ... . .......... .. Legal Description: . . ................. iTract ..... ..........11ock. L t ......... Description of % ... lalz,*­.........*.*..".- PlansReceived By...................................................Date ........................ ­­..............­­­.................­­ 7...... ........................... REO.: Plans.... Survey.... Calcs: Struc..... Engrgy---- Elect..... Mach.... tat Strict. Improvement on Parcel:Yes.... No.... Area of Bldg............... Plans Checked By......6................... at" ,,el e -J�V Separate Structure............ or Addition/Alteration to Exist. Bldg........... Date Application Approvedy-............. D .. No. of Stories_.............. Use-af BUildi .................. ............................... ValidatedBy.............................................................Date ........................ ValuatJoV Is t Compensation Certificate Verified By ................. Date ........................ Ow A V,2-1 ... %;1............................ Phon ... ...... $ 4's-D-0 Contractor: . ...............................City Bus. Lic. # __ Contractor's Address: ......................-.........___ .... Phone:.................... Permit Fee (plus penalty if applicable) ........................s.....? Contractor - Electrical: ....................... .................................................... Plan Check Fee (less deposit of$.......... Ret. #__ $... City Business License #.................... Phone:.................... Energy Plan Check Fee (Dep. of $........ Rot. #........) $...........r.$, .. Plumbing: ..............................................__.................................. City Business License #.... .......................... Phone:.............. Strong Motion Fee ..........................r...-:_............-.......$....I.................. Heatingand Cooling ........____............ .............................. Plumbing Permit Fee ......... ......... ...... $....................... City Business License a.................... Phone:.................... Electrical Permit Fee .................................. ...... .......$....................... Architect/ a Phone:.................... Mach. Htg./Coolg. Permit $...... $....................... E Ok , - ... Residential Construction Tax ................... ......... .........$............ .. ... . .................... Phone:.........:.......... Misc. Fee ......................................... ............. Lender: .. .............. . ....._.. .. _...... ................. El Unknown Misc. Fee .............................................., , ", 4- X $ G 0�- .. I . "I certify that I me 1 8 Drk for which this permit is .................. $....................... issued I hat I . any ginner so as to become subject • $ to the w anis p ti a I ornia." SIGNATURE or ry- N APPLiCAN /OW ... .... ;h DAT!� Nor IMT Tk• , 11 1 7111 ......... ....... 10 Y at Environmental Status; Exempt ............ Other........................................ I c dy at a the applicant I am eased unde a prov sons of the Design Review Approval: Bldg. . ........ Site ............ Sign C frac ra License Law antl further that my Licens, No. ........................... Use Zone ............ P.D. Conditions ......................................................... I ON sificalion ..... .......... ......-- is in full force and effect: or Cond. Use Permit #.._........ Variance N............ Parking Spaces............ rlify that I am exempt from the "Licensed Required" provisions of the Approved By.............. ...........-...................__. Date ........ ................. ontractore License Law. (State basis of exemption.) I horaby acknowledge that I have read this application and state that the above Is corrr.cl 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 oachment Permit........................ Grant of ftEasement......._............... against liabilities, judgments, costs and expenses which may in any way, Gutter, Sidewalk, Driveway: Replace.......... Repair............. occurs against said City in consequence of the granting of this permit," Sewer............ Conn. Fee $................ Water................ Motor $................ SIGNATURE OF Agreement for Completion of Public Works Improvements .................. APPLICANT/CONTRACTOR ... .............................................. DATE ........................ Plans Checked By........ Date........ Approved By........ Date.................... NOTE: When property validated this form constitute* a Building Permit. This permit expires and becomes null and void should work not be commenced within APPLICATION FOR ELECTRICAL PERMIT 120 days from validation date, or should authorized construction be suspended or www�wwww--�wwwwww abandoned for a period of 120 days after work 15 commenced. PERMIT INSTALLATION NO. EACH FEE APPLICATION FOR PLUMBING PERMIT Light Outlets............ Switches............ Fixtures-......... Receptacles............ PERMIT INSTALLATION W. EACH --F-Er- 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 ............ ....................4........... 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 Fleeter.... 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 .. ........... Wash. Mach..... Dishwasher.... Garb. Disp..... ............... 3.00............... 200 amp....... . 7.00 . ........... Sewer .......... ......................................................... 8.00............... Time Clock ................................. .. ...... 1.60... .......... Lawn Sprinkler Sys. $5.00 Ea. add Sys. $2.00................................... Misc. (see r% current) .................... Vacuum Breakers ............................................ :::.3 wRiaT,I Residential Occupancies is Interceptor........ Water Softener........ , 0-500 sq. ft. $22.00 1501-1750 $34.50.............................. Plumbing Piping without fixtures .......................I........I....4.0o.. ............. Misc. (See Ord. Current) .................................................... 501-750 24.50 1751-20000 37.60.............................. Permit Fee ................................. .........................................$ 6.00 if app. 761-1000 26.00 2001-2250 39.60.............................. TOTAL PLUMBING PERMIT FEE (plus penalty 1 1001-1250 28.60 2251-2600 42.00.............................. I- _J) $ 1261-1600 32.00 2601-2750 49.50.............................. APPLICATION FOR HEATING/COOLING PERM11' PermitFee...............................................$6.00 TOTAL ELECTRICAL PERMIT FEE (plus penalty if app.0) $ PERMIT INSTALLATION NO.1 EACH I FE Forced Air Unit.............._.AD 100M ............................. .$6.00... ........... INSPECTION RECORD over 100M _.................... . 10.00.. ........... Comfort Cooling Unit......to 3 ton/HP ..........................r 6.00.. ........... Forms Founclatife to 15 ton/HP......................... 9.50.. ........... W.00. By. " Date '7R1 Plumbing Ground Work ........ .... to 30 ton/HP..........................12.00. ........... Rough Electrical ........:.................. ... .. ...... ... .... ............ to 50 ton/HP...........................17.00.. .*.......... a - Plumbing and Heating ........ .................................................... ......................­­­........ Space Heater........ Well Heater ........................... 6.00 ........... lation & Energy.._._........... ... "*... ........ Flues - other than above .............................................1.. 3.00 ...... west .................-............... .. . .. ...... ........ .....I ..... Vent Fan: Kitchen........ Bath ............................. ........J.. 3.00............... 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 / Landscaping . .... ................I .............-.......... TOTAL Htg./ Coolg. Permit Fee (plus penalty If app. 0) $ Final-Public Works ...........................................................