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1147 CITY OF CUPERTINO APPLICATION FOR RESIDENTIAL BUILDING PERMIT PERMIT NUMBER _41t AND FOR APPLICANT TO FILL IN CERTIFICATE OF OCCUPANCY BUILDING INSPECTION DIVISION STREEJTD,9MSS OF VMR: ................................................. Legal Description: Tract. lock Lot .............. Description of �. .!Q. .. P... ......... I ............... Work: ... . .4 . ... ........0.4.1il.p PlansReceived By ...................................................Date ........................ ........ .... .....................­............................................................................. REQ.: Plane.... Survey.... Caics: Strut..... Energy.... Elect..... Mach.... 1st Struct. Improvement on Parcel:Yes.... No... Area of Bldg............... Plans Chocked By.................... ......... Date Separate Structure............ or Addition/Alteration to Exist. Bldg........... Application Approved By....... ......a........._.......Date No. of Stories................ Use of Building .................. ............................... Validated By................................................ ...*Date ......... ............ Valuation of Project: $.............................................................................. Compensation Certificate Verified By ...h-e --- Date 01. 4k.1Q.. Owner: ........ hone:.................... Contrac 'r:c rerle; Awt.40.%�ItyBs. Lic. # MR71111171117470TWITTIMMIIIII $ Con"Zor*S Address: ..CIA.!............... Phone:.-,Jjj.0 Permit Fee (plus' penalty If applicable) ........................$....................... Contractor - Electrical: ............_................-............................................ Plan Check Fee (less deposit .....)$...................... City Business License #...__............. Phone:.................... Energy Plan Check Fee (Dep. 1V........)$....................... Plumbing: .................................................................................... City Business License .................... one:.................... Sinking Motion Fee ................... $ Heating and Cooling ....... .................................................... Plumbing Permit Fee ........ in�t 3 .......... ...... Electrical Permit Fee .......... ....................................... City Buyness,LiReDae ............... Phone:.................... $.................... Architect/Desi I jj;L,��t,ft�...................... Phone:.................... Mach. Htg./Coolg. Permit P...Z�... $...................... Engineer: ...... li....�.: ......__............. Phone:.................... Residential Construction Tax:* ........................$................... Lender: ... ............................. ............................................. +Unknown Misc. Fee .............................................:..........................$....................... **I certify that In the performance of the work for which this permit Is Misc. Fee ........................................................................$....................... issued I shall not empty any person in any manner so as to become subject a�. . $ to the workman's cum gimunation laws or C fornla. SIGNATURE OF ZONING REOUIREMENTS APPLICANVOWNER I J.......^_ ............................41� a Environmental Status: Exempt............ Other........................................ certify that as the applicant I am ll,.n�.edl� the provisions of the Design Review Approval: Bldg. ............ Site ............ Sign ............ Contractors License Law and further that my Licata, No. ............................ Use Zone ............ P.D. Conditions ............................................................ in Classification .............._....... ............ is In full force and effect: or Cord. Use Permit #............ Variance #............ 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.) ........................... I hereby acknowledge that I have mad this application and state that the above Is zcrract and agree to comply with all City Ordinances and State Laws regulating I (we) agree to save, Indemnify and keep harmless the City of Cupertino ��iIIIIIIIIpachnnent Permit........................ Grant of Easement........................ against liabilities, judgments ill osts and expenses which may in any way �WGutter, Sidewalk, Driveway: Replace.......... Repair.......... acture against said Or ' asequence th granting of this permit." r........:.. Conn. Fee $................ Water.........:...... Meter $................ SIGNATURE OF .................. 17 . . .. Agreement for Completion of Public Works Improvements APPLICANT/CONTRACTO . .. ... ... DATE .................... validated this form comid s I Plans Checked By........ Date........ Approved By........ Date.................... NOTE: When property validated this torrin consti s a Building Permit. This permit expires and becomes null and void should vadd, not be commenced within 120 20day "dation data, or should authorized construction be suspended or atend..' rlocT,:p.dad of 120 days after work Is commenced. PERMIT INSTALLATION NO. EACH FEE Light Outlets............ Switches............ APPLICATION FOR 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. DIED......... 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 .............. . 3.80 ............. 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 ........................._........................ ...... 1.50............... Lawn Sprinkler Sys. $5.00 Ea. add Sys. $2.00.................................... Misc. (see Ord. current)...................................................... Vacuum Breakers ................................... New Residential Occupancies Flat Rate Interceptor........ Water Softener........ 4:'.00:J.::­........ ... 4.00 Plumbing Piping without fixtitirp ........ ....W;............... .......... 0-600 sq. ft. $22.00 1501-1750 $34.60.............................. Misc. (See Ord. Current) Y.Ki�A. .........................I-P....... 501-750 24.60 1751-20000 37.60.............................. 761-1000 26.00 2001-226C 39.50.............................. Permit Fee ..........................................................................$6.00 1001-1250 28.50 2251-2600 42.00.............................. TOTAL PLUMBING PERMIT FEE (plus penalty if app. _/,±S_j 1251-1500 32.00 2501-2750 49.50.............................. APPLICATION FOR HEATING/COOLING PERMIF Permit Fee...............................................$6.00 TOTAL ELECTRICAL PERMIT FEE (Plus penalty if app.0) $ PERMIT INSTALLATION N0. EACH FEE Forced Air Unit..................to 100M ..............................$600 INSPECTION RECORD over 100M ....................... 10:00 Comfort Cooling Unit......to 3 ton/HP ......................... ........... Forms / Foundation .... ..... ......._ ....... . By:........ . ..... . Date:................ to 15 ton/HP......................... ............ Plumbing Ground Work ..._................. ................ to 30 ton/HP......................... 17:00.............. .....**.... Rnugh Electrical .... ........................... . ....... _..... ........................... to 50 ton/HP.................... ........... !"�'--e - Plumbing and Heating .............................. Space Heater........ Wall Heater ................................... ........... ........ ..... allon & Energy...................... ..... Flues - other than above ..................­.......................... ........... _fTeat _:........... Vent Fen: Kitchen........ Bath ....... 3.00............... 3.00... Temporary Power GBS �'Ellact. .......... ................ Commercial Range Hood ........................... ....... 6.00............... Final - Electrical ................... ......................... Misc. (See Ord. Current.................................... ........t........ ............... Final - Building/ h ........... ..................... Permit Fee ............. ..... ­....... ..... ­...........* $ 6.00 Final -Design Rev! .............. TOTAL Htg./ Coo1g. Permit Fee (plus penalty If app. 0) S Final-Public Works ...........................................................