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1421CITY OF CUPERTINO APPLICATION FOR RESIDENTIAL BUILDING PERMIT AND 40 CERTIFICATE OF OCCUPANCY BUILDING INSPECTION DIVISION s PlansReceived By .................................................... Date ......................... REO.: Pians.... Survey.... Calcs: Struc..... Energy.... Elect..... Mach.... Plans Checked By .......... - ...... ... Date ....yl.......... . Application Approved By. .. Date ./v..'.'�.-. Validated By ............... ......... .. . ............ ..... Date ..... Compensation Certificate Verified By...... ......... Date ............ ....... . • • • . $ 4 ro-) Permit Fee (plus penalty if applicable)...._... .... ...._..._. $...�J...:. r 5�.... Plan Check Fee (less deposit �aJ+$....... � Rct. #.........)$.......�...:�.. Energy Plan Check Fee (Dep.(ol•$.... .!":(Rct. #........) $............... Strong Motion Fee ............. _....... .41 ...... .-...... $..........1 �. Plumbing Permit Fee ...... ne ....�;`............. $....................... Electrical Permit Fee .................... ...... .-c ..... L7....._... $.... .... .... _....... . Mach. Htg./Coolg. Permit $.............. .......... $....................... Residential Construction Tax....��..........`................. - $.......... Misc. Fee......_........................................._.._..._......._ $....i//¢''....L Misc. Fee ............ ...._...... .... ............. ............. ....... .......$..... #�Q Environmental Status: Exempt ........... Other ........... ......._....... Design Review Approval: Bldg. .......... Site ............ Sign .......... UseZone ............ P.D. Conditions ....... ............................. -- ..... ............... Cond. Use Permit #............ Variance #............ Parking Spaces............ Approved By..... ....................._._...._.._.-..._..._... Date ... ... .... - .......... ..... oachment Permit.. Grant of Easement.... .... ............... Gutter, Sidewalk, Driveway: Replace ... _...... Repair.......... er............ Conn. Fee $. ... ....... .... Water................ Meter $ ........... Agreement for Completion of Public Works Improvements ... -- ... ....... Plans Checked By.......- Date .... ... Approved By........ Date .... ......... .._. PERMIT INSTALLATION NO. EACH IFEE Light Outlets............ Switches........... .............................. 751-1000 Fixtures............ Receptacles............ 2001-225C 39.50 TOTAL NUMBER (less than 1000 watts) ............ $ ,50 .. ......... - Range ........ Cooking Unit........ Oven ............................ 2.00 .............. .............................. Dryer........ Garb. Disp......... Dishwasher ............. ...... 2.00 .............. 2501-2750 MOTORS: 1 HP or less . ................ - ...... ..... ........ .. .._ . 2.00 .. _.......... Greater than 1 HP not more than 5 HP ....... ........ 3.50 .. ............ Temporary Power Pole or Service — 100 amp .1........5.00 ,. ..... — 200 amp ......... 7.00 ............... penalty if app.0) $ TimeClock ..... ....... ................ ............. ......._ 1.50............... Misc. (see Ord. current)...................................................... New Residential Occupancies Flat Rate 0-500 sq. ft. $22.00 1501-1750 $34.50 501-750 24.50 1751-20000 37.50 .............................. 751-1000 26.00 2001-225C 39.50 .............................. 1001-1250 28.50 2251-2500 42.00 .............................. 1251-1500 32.00 2501-2750 49.50 .............................. Interceptor........ Water Softener ........ .............................4.00. Permit Fee ...............................................$6.00 ..........--............ Misc. (See Ord. Current) ................................................ TOTAL ELECTRICAL PermitFee ... -... .... -.... --................................................... PERMIT FEE (Plus penalty if app.0) $ Forms / Foundation .._........... ...... ..... BY:........ ....... Date:................ Plumbing Ground Work ..................... ........... _.... ................... ....... RoughElectrical ..........._ ......... ........ _....�....................... ........._... _......_... e - Plumbing and Heating........_L.................._....................... _....... ation& Energy...._.... ... .............._.............._.........1........_........_....... Test Temporary Power Gas / Elect.............................................................. Final - Electrical ....._._._......... _........... .............. Final - Building / Mechanical ._ ........... ......... .............._l............ _.._......... Final - Design Review / Landscaping ..... ..... ............ ..... ..................... Final - Public Works........................................................... PERMIT NUMBER I / ST T DR SS OF P OJECT: �......arpy..... t.........CUpart ino.... Legal Description: Tract......1.........'QJ opk .,_....... Lo({ Description of Work:. Ad.d.. t_ wO_.$j.l.d.,j,❑.9_..Q.J c0(1Cre.L. e_..pelL.j ...&._dual...ramp._.._................. 1st Struct. Improvement on Parcel: Yes..XNo ... Area of Bldg,- 2.�_�.� Separate Structie_n O.... or Addition/Alteration !o E�(iSt. 6 dg .... Y!13S No. of Stories.... .......... �sesoj Building rE.s.�.4.en `.�.,a„J,................ Valuation of P ale t $. _1 UU - .... ... Owner .LaclCor_si ,Ixa .... Phone 968 90:_' Contractor: ... Uennl raah qIty,$us Llc # ... Contractors Address .. 3 In 111 w0 O D 4�hone 73.9 .9.QS Contractor - Electrical: .San -JoAe.._-.... .... ........................... City Business License #........... - .... .. Phone:.. .................. Plumbing:......_ .... .... ............ -....... ..... ... ....................... ............... City Business License #...... _..__...... Phone: ......... - ..... Heating and Cooling.................................................................. City Business License #.......... - .... ... Phone:. ....... Architect/Designer:.............. ............ - ... ..._............. Phone: ... Engineer: .. ....... . .. .......................................... Phone:.................... Lender: Home..$..L...... ...._......__.._...... _........ _... ❑ Unknown .. .. "I certify that in the performance of the work for which this permit is 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 r rt APPLICANT/OWNER ...... ....... ............_...... ..... _......... .. DATE.._1...'.l..--�...M_E . ... "I certify the s the applicant ensed uncle' the provisions of the Contractors License Law and furth r that my Licans. No. ........ in Classification ........... ..... ... _............... is in full force and effect: or ... I certify that I am exempt from the "Licensed Required" provisions of the Contractors License Law. (State basis of exemption.) I hereby acknowledge that I have read this application and state that the above is %orrecl 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 against liabilities, judg mems, c sis antl=eho,th in any way acture against said City in quencethis permit." SIGNATURF OF fir/ �/APPLICANT/CONTRACT E .9 -IN -A NOTE: When properly vat' ated this farm constitutes a Building Permit. This permit expires and bee es null and void should work not be commenced within 120 days from validation dale, or should authorized construction be suspended of abandoned for a period of 120 days after work is commenced. PERMIT INSTALLATION NO. I EACH FEE Gas System with up to 5 outlets .................................$4.00 ......... Each additional outlet _ ... .... ..... - ................... .- .... .. 1.00........... Water System (Installation, Alt. or Repair) ................. 4.00.........., Water Closet.... Water Heater.... Ld. Tray ..................... 4,00 -... Lavatory.... Shower Pan.... Bathtub.... Sink. ... -. - ...... .. 3.00........... Wash. Mach..... Dishwasher.... Garb. Disp.................... 3.00........... Sewer....................................-....................................... 8.00........... Lawn Sprinkler Sys. $5.00 Ea. add Sys. $2.00 ..................... ......... Vacuum Breakers ........ .......... ......... - ... ..... ....... ..............3.50.......... .. 3.00............... Interceptor........ Water Softener ........ .............................4.00. ......... Plumbing Piping without fixtures .... ...............................4.00.......... ..........--............ Misc. (See Ord. Current) ................................................ $ 6.00 PermitFee ... -... .... -.... --................................................... $ 6.00 TOTAL PLUMBING PERMIT FEE (plus penalty if app. ❑) S PERMIT INSTALLATION NO. I EACH FEE Forced Air Unit .................. to 100M ..................... .........$ 6.00............... over 100M ......................... 10.00 .............. Comfort Cooling Unit ...... to 3 ton/HP ........................... 6.00............... to 15 ton/ HP ......................... 9.50.............. to 30 ton/ HP ...........- .............. 12.00 ............. to 50 ton/HP ................. .......... 17.00.............. Space Heater........ Wall Heater ................................... 6.00.. .. .......... Flues - other than above . .... ............... ............ ..... ....... .I. 3.00 .. ............ Vent Fan: Kitchen........ Bath ....................................... .. 3.00............... .......... ....... Commercial Range Hood ......................... .. 6.00 ............... Misc. (See Ord. Current ................................................ ..........--............ PermitFee .........-........................................................... $ 6.00 TOTAL Htg./ Coolg. Permit Fee (plus penalty if app. 0) $