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1014 X CITY OF CUPERTIND PERMIT NUMBER Q / APPLICATION FOR RESIDENTIAL BUILDING PERMIT . AND FOR APPLICANT TO FILL IN CERTIFICATE OF OCCUPANCY BUILDING INSPECTION DIVISION ST,p1E,F_Z A R j.SS,-OFFylOR CT: ........................................... x • . • Legal Description: Trac ...................... ock............ Lot...................... Description of Work: .. •¢7!C......CP.! !5..................................... PlanaReceived By....................................................Date ......................... .................-...........................................-....................................................... REO.: Plans.... Survey.... Calcs: Struc..... Energy.... Elect..... Mach.... tat Struct. Improvement on Parcel: Yes.... No... Area of Bldg............... Plans Checked By...................................................Date ................ .. Separate Structure............ or Addition/Alteration to Exist. Bldg........... Application Approved By....... .....................Date s/a�.F.a... No. of Stories................ Use of Building .................. .............................:. Validated By..............................................................Date ........................ Valuation of Project: $.....7.17c) ............................................................. Compensation Certificate Verified By ................. Date ......................... Owner: Phone:.................... ........................................................................ Contractor: ........................... ............-__.......City Bus. Lic. a .............. • • •• • $ Contractor's Address: ............................................... Phone:.................... Contractor - Electrical: ..... ............................ ..............-............................ Permit Fee (Plus penalty if applicable) .. ol...............$... ........�_..... City Business License +K.................... Phone:.................... Plan Check Fee (less deposit . of ....... #..........)$.... ............. Energy Plan Check Fee (Dep. off Rct. $........ Rot.-, ..)$ Plumbing: ...........................................--.............. e:.................... Strong Motion Fee ........................C--CJ 7._�•`7:...I;10...$....................... City Business License ...................... Phone:.................... Plumbing Permit Fee ...................................^.. $...................... Heating and Cooling .................................- .......ne:.................... Electrical Permit Fee ................... City Business License ..................... Phone:.................... IA-A $....................... Architect/Designer: .................................................. Phone:.................... Mach. Htg./Coolg. Permit $.....171 I1.................. $....................... Engineer: .................................................................... Phone:.................... Residential Construction Tax ................................ .$....................... Lender: . .. e {1'�� ........................................................................... Unknown Misc. Fee ..........................................'j.-..A.....1....[.I...$...... ty�... ,. .,_, '•h certify that in the performance of the work for which Ols permit Is Misc. Fee ..................................................!^.•.... ...........$....W................ Issued I shall not employ an arson in an manner a as to become p y y p y fl o subject • ; $ to the workman's compere tion laws of Callfor a" I SIGNATURE OF /meq • • APPLICANT/OWNER ......_/V..•....._.. _ ... .. ATE. /.L..J�../.. Environmental Status: Exempt............ Other......:................................ ....... -I certify that as the licant am Ileo uin the pravie(ons al lite Design Review Approval: Bldg. ............ Site ............ Sign ............ Contractors License L and further that y Licens. No. ..................._....... Use Zona P.D. Conditions .............................................-............. in Classification .......,........--.................... is In full force and effect: or "Perms .. 1 certify that I am exempt from the "Licensed Required"provisions of the Cord. Use Permit •............ Variance e............ Parking Spades............ Approved B Date Cackno Contractors License Law. (Stale basis of tion and state PP Y........................................................... ....:...................... I hereby acknowledge that I have read this application and aceta that the above Is correct and agree to comply with all City Ordinances and Slate Laws regulating • • building. / I (We) agree to save, indemnify and keep harmless the City of Cupertino oachment Permit........................ Grant of Easement........................ against liabilities, judgments, costa and expenses which may In any way Wbv b, Gutter, Sidewalk, Driveway: Replace.......... Repair.......... secure against said City In consequence of the granting of this permit." Sewer............ Conn. Fee $................ Water................ Meter$................ SIGNATURE OF Agreement for Completion Of Public Works Improvements .................. APPLICANT/CONTRACTOR ........................................................... DATE ........................ Plans Checked By........ Date........ Approved By........ Date.................... NOTE: When properly validated this form constitutes a Building Perms. This permit expires and becomes null and void should work not be commenced within APPLICATION FOR PLUM13ING PERMIT APPLICATION• •. 120 day from validation data, or should authorized construction be wapendad of abandoned for a period of 120 days after work is commenced. PERMIT INSTALLATION NO. EACH FEE Light Outlets............ Switches............ 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. 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. ............. —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 ............................................ ...3.50. . New Residential Occupancies tat Rate Interceptor..------.Water Softener........ .............................4.00. ............ Plumbing Piping without fixtures ...................................4.00, ............. 0-500 sq. ft. $22.00 1501-1750 $34.50.............................. Misc. (See Ord. Current) .................................................... ................................... ...... 501-750 24.50 1751-20000 37.50.............................. Permit Fee ....................... 751-1000 26.00 2001-2250 39.50.............................. . . ....0.�.•.••.•... . .. .p.�•..•[:]) III 8.00 [ 1001-1250 26.50 2251-2500 42.00.............................. TOTAL PLUMBING PERMIT FEE (plus penalty If app. )) 1251-1500 32.00 2501-2750 49.50.............................. APPLICATION FOR HEATING/COOLING PERMIT Permit Fee...............................................$6.00 TOTAL ELECTRICAL PERMIT FEE (Plus penalty if app.p) $ PERMIT INSTALLATION NO. EACH FEE Forced Air Unit..................to 100M ..............................$8.00.:. ........... INSPECTION • • r over 100M....................... . 10.00.. ........... Comfort Cooling Unit......to 3 ton/HP ........................... 5.00... ........... Forme / Foundation .............................. By:........ ....... . Date:................ to 15 ton/HP.................. ...... 9.50.. ........... Plumbing Ground Work . ....--.......-- i..... ........................................... to 30 ton/HP........................ ..12.00. ........... ugh Electrical ...................................i... ......_...,......... ....................._... to 50 ton/HP....-......................17.00.. ........... __,. .. e - Plumbing and Heating ............................................................... Space Heater........ Wall Heater .................................. 6.00.. ........... I lation & Energy...................... � ........................... Flues - other than above ............................................{ .. 3.00.. ........... Gas Test .................................. ....... .. ........................ .......................... Vent Fan: Kitchen........ Bath ............................... .......... 3.00............... Temporary Power Gas /Elect. ................................ _.........:............... Commercial Range Hood 6.00. Final - Electrical ........................................................... ........................... Mlsc. (See Ord. Current............................................... Final - Building/ Mechanical ............. . ........................ ........................... Permit Fee ................. $ 6.00 Final - Design Review / LandscaDin . ... ...........I.....-..................... o1g........mit . .... .......y I�...pp........ 9 9 TOTAL Htg./ Coolg. Permit Fee (plus penalty I app. p) $ Final-Public Works ...................