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1083 % CITY OF CUPERTINO APPLICATION FOR RESIDENTIAL BUILDING PERMIT PERMIT NUMBER • AND FOR APPLICANT TO FILL IN CERTIFICATE OF OCCUPANCY • BUILDING INSPECTION DIVISION STREETY PRESS 0 PRO E T, .......... #K.Wooz.................................... OEM - •�. 11 •M Legal Description, Tract.... Block............ Lot..... Description .. Work: ..... .........................................g............_ .............................................. PlansReceived By....................................................Date ......................... ....I................................................................ RED.: Plans.... Survey.... Calcs: Strut.¢.. Energy.... Elect..... Mach.... Ist Struct. Improvement on Parcel: Yes.. No.... Area of Bldg..... ....... Plans Checked B - .... ....... Date Separate Structure............ or Addition/Alteration to Exist. Bldg..... Application ApprovedBy­_ Date To No. of Stories.......I ... Use Iding .................. ............................... Validated By.................... 4�� ................. Date .............. ...... Valuation of Project: $......1........... -jo ................... ..... Compensation Certificate Verified By ................. Date ......................... Owner: _,SrdqV/,.4�.L,7......... Cf.c. .................. Phon­�xl Contractor: ....... ..................City Bus. Lic. # .............. S Contractor's Address: ............................................... Phone:....................t. Permit Fee (plus penalty if applicable) ........................$.../�.Z.0:�,�=* Contractor - Electrical: ........... ............................................................ Plan Check Fee (less deposit of$.......... Act. #..........)$....................... City Business License #................... Phone:..................... Energy Plan Check Fee (Dep.C!?Y-__,'. Act. #........)$............... .... Plumbing: ......................................._............................................. Strong Motion Fee ............................n.. .......$.......................;_S� City Business License #.................... Phone:.................... Heating and Cooling .....__...............................................*........ Plumbing Permit Fee ................................................$....................... City Business License #.................... Phone:...................{* Electrical Permit Fee ..............A14-2 G-j, .........$....................... Architect/Desi gner: ................................................ Phone:............... Mach. Htg./Coolg. Permit $....... ................... It....................... Engineer: ...... ......... ........................................... Phone:...................:. Residential Construction Tax .-,...... ..........................$....................... Lender: ............................................................ [] Misc. Fee ......................................:.......A..... ...........$..... -Unknown- Et is Misc. Fee ........................................... "I certify that in the performance of the work for which this permit Is. ...............................$ issued I shall not employ any person in any manner so as to become sub eat to the workman's c MNNNG��� sle SIGNATURE OF ppipentuation laws of California." ZONING REQUIREMENTS APPLICANT/OWNER Environmental Status: Exempt............ Other........................................ "I rarl I rat54�he provisions a I Design Review Approval: Bldg. ............ Site ............ Sign ............ Contra 4icenLaip�Iainde 'r that my Licans, No. ------............... Use Zone ............ P.D. Conditions ............................................................ In Classification ...................................._ Is in full force and affect:Of ®r Cord. Use Permit #............ Variance ........ Parking Spaces............ I Certify that I am exempt from the "Licensed Required" provIslow Of We Approved By..............................._......................... Date .......................... Contractors License Law. (State basis of exemption.) 41'�_ I hereby acknowledge that I have read this application and state that the above'Jit :orrect and agree to comply with all City Ordinances and State Laws regulating buildmg. I (We) agree to save, indemnify and keep harmless the City of Cupertin'o�,�' 0 roachment Permit,....................... Grant of Easement........................ against liabilities, judgments, Costs and expenses which may In any V7dj--J irb, Gutter, Sidewalk, Driveway: Replace._....... Repair.......... acture against said City in consequence of the granting of this pormilL JGWrAer............ Conn. Fee $................ Water................ Meter $::............. SIGNATURE OF Agreement for Completion of Public Works Improvements .................. APPLICANTYCONTRiCTOR ......................................................... DATE .................... Plans Checked By........ Date........ Approved By........ Date................... NOTE: Who. properly validated this farm constitute$ a Building POMIL -This permit expires and becomes null and vold should work net be commenced wittills APPLICATION FOR ELECTRICAL PERMIT 120 days from validation data. Or should authorized construktion be su nalled abandoned for a period of 120 days after work I$commenced. PERMIT INSTALLATION NO. EACH FEE Lrg 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 .....*........................... 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 Pan.... Bathtub.... Sink......_........... 3.00............... Temporary Power Pole or Service- 100 amp . ....... ..5.00 .... . Wash. Mach..... Dishwasher.... Garb. Disp..... ............... 3.00.....::........ -20 amp. 7.00............... Sewer .............................................................................. 8.00............... .0 Lawn Sprinkler Sys. $5.00 Ea. add Sys. $2.00...................... .......... Time Clock ............................................................ 1:5 ............ Misc, (gee 0Ecurrent I...................******e*....... ................. Vacuum Breakers ...................... 360 NewA _9W_,t&I occupancies Flat Rate Interceptor........ Water Softener'::::�::­::::::::�:::... Plumbing Piping.without fixtures 4.00. .............. 0-500 sq. ft. $22.00 1501-1750 $34.50.............................. I - 501-750 24Misc. (See Ord. Current) ......................................... .50 1781-20000 37.50.............................. Permit Fee .........................................................................$ .00 751-1000 26.00 2001-225C 39.50.............................. TOTAL PLUMBING PERMIT FEE (plus penalty It app.C]) 1001-1250 28.50 2251-2500 42.00.............................. 1251-1500 32.00 2501-2750 49.50.............................. APPLICATION FOR HEATING/COOLING PERMIT Permit Fee...............................................$8.00 TOTAL ELECTRICAL PERMIT FEE (Plus penalty If app.CD $ PERMIT INSTALLATION NO. EACH FEE Forced Air Unit..................to 100M ..............................$6.00.............. 101411JA01119 RJOIN*i;(91.1:1 pover 100M......................... 10.00.. ........... Comfort Cooling Unit......to 3 tom/HP ........................... em.. ............ ............. Forms / Foundation .............................. By:........ ........ . Date:................ to 15 ton/HP.......................... 9.50. ........... PlumbingGround Work ..................._1..... ......................... ............. Rough Electrical .................................. ................................................ to 30 ton/HP......................... ..12.00. to 50 ton/HP......................... .17.00..... mePlumbing and Heating .... ................. Space Heater........'Well Heater ........................... 6.00.... .... ,is, 1 n & Energy............................ .......................................... Flues - other than above .........._ 3.00.. ......... Test ........................................... . ......................... ...........................I Vent Fan: Kitchen........ Bath ......... 3.00-t........... fmaporary Power Gas / Elect. ........ ........................ ........................... Commercial Range Hood ............. a GO.]............ Final - Electrical ............................................................. .......................... Misc. (See Ord. Current........................................ .......... Final - Building/ Mechanical ....... ............................................... Permit Fee ....................................................................... 6.00 Final - Design Review / Landscaping .... ........... ....._....................... TOTAL Htg./ Coolg. Permit Fee (plus penalty If app. C]i $ Final-Public Works ...........................................................