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1180CITY OF CUPERTINO APPLICATION FOR RESIDENTIAL BUILDING PERMIT AND CERTIFICATE OF OCCUPANCY BUILDING INSPECTION DIVISION Plena Received By ..........._ ... ............................. Date ...^.%? ....y. REO.: Plans.... Survey.... Celcs: Struc.....Energy.... Elect..... Mach. Plans Checked By ............................. .... Date .... . .......... Application Approved By ..... ... '.... ....._:............ Date ValidatedBY.............................................................. Date ........................ Compensation Certificate Verified By ................. Date ........................ mrmnmmnz$ 97 oro Permit Fee (plus penalty if applicable) ........................ $.. .�. Plan Check Fee (less deposit of $.......... Rct. #..........) $................... Energy Plan Check Fee (Dep. of $........ Plot. #........) $...... Strong Motion Fee ..................................... Plumbing Permit Fee ................................................ $...... . $.....; Q Electrical Permit Fee ...................................................... $.......�1 Mach. Htg./Coolg. Permit $............................. $....�x!J. Y..!.(.... Residential Construction Tax .............. ....................... 39.50 ..............................� Misc. Fee..................rsr.%................... $ ............9 Misc. Fee...................................................................... $........... ..... 2.00 .. ............ MOTORS: 1 HP or less ................................................. 2.00 .. Environmental Status: Exempt............ Other ........................................ Greater than 1 HP not more than 5 HP ............... Design Review Approval: Bldg ............. Site ............ Sign ............ Use Zone ............ P.D. Conditions............................................................ .. Cond. Use Permit •............ Variance #............ Parking Spaces............ ApprovedBy ........................................................... Date ........................... TimeClock ................................ _....... .......... ............ ...... .. (oachment Permit ........................ Grant of Easement............. .......---- •• Gutter, Sidewalk, Driveway: Replace.......... Repair.......... 4 r............ 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 .......... -. 501-750 24.60 Fixtures............ Receptacles.....:...... 37.50 .............................. 751-1000 TOTAL NUMBER (less than 1000 watts) ............ $ ,50 ............. 39.50 ..............................� Range........ Cooking Unit........ Oven ...... _.................... 2.00 .. ............ Dryer........ Garb. Disp......... Dishwasher ..................... 2.00 .. ............ 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 ..,.......5.00 .. ............ — 200 amp ......... 7.00 .............. TimeClock ................................ _....... .......... ............ ...... .. 1.50............... Misc. (see Ord. current i ...................................................... New Residential Occupancies Flat Rate 0-500 sq. ft. $22.00 1501-1750 $34.50 .............................. 501-750 24.60 1751-•20000 37.50 .............................. 751-1000 26.00 2001-225C 39.50 ..............................� 1001-1250 28.50 2251-2500 42.00 ........................5.4. 1251-1500 32.00 2501-2750 49.50 .............................. Plumbing Piping without fixtures ........... e77 :..................4.00.............. Permit Fee Misc. (See Ord. Current) .................................................... ...............................................$'''6..00 TOTAL ELECTRICAL PERMIT FEE (Plus penalty If app.0) 8� Forms / Foundation .............................. BY: ............... D ta:. .... Plumbing Ground Work ........ __...... R2p... i.... .- '.: %.... gh Electrical _ ................ ......... _....._J......................... ........................ e 1111Plumbing and Heating ..........I ............................ .tion& Energy .......... ..... ........ ................................. ................:.......... Test ....................... ............................................................................................. fSporary Power Gas /Elect ................:..................................... I....... Final- Electrical ........................................ ................. ...`..-...................... Final - Building /Mechanical ......................................................... Final - Design Review /Landscaping . .... _............... _....... ............ Final -Public Works............................................................ )tf Pane PU; p IT�g, 2iP PERMIT NUMBER /�80 FOR APPLICANT TO FILL IN STREET ADDRESS OF PROJECT- �3� •Z ? / ] 1 , /( ..rd1GY. . ........ ................. �J..10% Legal Description: Tract.. ... ............. toe .......... I. Description of Work: ....S.+yi.. 'L......rrNs/.......... 1st Struct. Improvement on Parcel: YesX No.... Area of Bldg...`. Separate Structurq l '.. or Addition/Alteration to Exill. Bldg.. No. of Stories... ..... r... Use of Buildin0 .r.L!�`;'•-e... Contractor: .... .....T..ri�...- -----------_------------City Bus. Lic. a .............. Contractor's Address: ...... ................... ........ ............ Phone:......---........... Contractor - Electrical: .._...... -...... ..._.... __........................................... City Business License +r .................... Phone:.................... Plumbing: ............ ....................................................................... _ City Business License a .................... Phone:.................... Heating and Cooling ... ..... _......................... ....................... :....... City Business License a .................... Phone:.................... Architect/Designer:...........................-.................... Phone:.................... Engineer: ........................................ Phone:.................... Lender: . ............._....... .... ............................................ .. ❑ 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 101 w9 California." SIGNATU OF y,� (tom APPLICANT/OW .:.............. ..............---................ ..................... DATE...../...... ....... I certify that as the applicant I am licensed unde' the pro .ions 01 the Contractors License Law and former that my Licene, 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 :orrect and agree to comply with all City Ordinances and State Laws regulating building. I (We) agree to save, indemnity and keep harmless the City of Cupertino against liabilities, judgments, coats and expenses which may In any way acture against said City In consequence of the granting of this permit." SIGNATURE OF APPLICANT/CONTRACTOR........................................................... DATE ......... ._........ ... NOTE: When properly validated this form constitutes a Building Permit. This permit expires and becomes null and void should work hot be commenced within 120 days from validation data, or should authorized consbdetisn be suspended or abandoned for a period of 120 drys after work is commenced. . • _ Gas System with up t0 5 Outlets........................A.....$4.00• • Each additional outlet ................................... 0..... 1.00..........:... Water Systemjlnstallation, All, of Asset ................. Water Close t.i Water H@ Ld. Trey._... 4.00.. .. %ra�.- . afar.. 4.00. Lavatory.2!Shower Pan.l. Bathtub.i. Sink...._........... 3.00. Wash. Mach... Dishwasher_/ Garb. DispJ..... ........ .. 3.Go. ..Q_C2 Sewer.........:..._.............................................................. .. 8.00.............. Lawn Sprinkler Sys. $5.00 Ea. add Sys.$2.00.................................. 3.00.. .... Vacuum Breakers ............................................ .......... .... 3.50........_. Interceptor........ Water Softener.....................................4.00.............. 6.00., . ........... .%.�. Plumbing Piping without fixtures ........... e77 :..................4.00.............. Misc. (See Ord. Current) .................................................... PermitFee......................................:...................................$8.00 TOTAL PLUMBING PERMIT FEE (plus penalty if app. O) $..L/ 412 Forced Air Unit .................. to 100M ..................... ........$ 6:00.•.• over 100M .- ............. ...... . 10,00 ....... Comfort Cooling Unit...... to 3 ton/HP ................. .......... e.0o... ..... 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 ..................................... ......... 3.00.. .... Vent Fan: Kitchen........ Bath ............................... ........ .. 3.00........ Commercial Range Hood-, ........... ....... Misc. (See Ord. Cwrent...._W4 6.00., . ........... .%.�. Permit Fee .............................. M.a.!.L�. ...................... $ 8.00 TOTAL Htg./ Coolg. Permit Fee (plus penalty If app. p) yO"