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1529 U CITY OF CUPERTINO APPLICATION FOR RESIDENTIAL BUILDING PERMIT­_.� PERMIT NUMBER • AND 1. . FOR APPLICANT TO FILL IN CERTIFICATE OF OCCUPANCY BUILDING INSPECTION DIVISION S T WOA* 0. � F 4 1 .. ........ .. . ... .... .._(!5­0104................ Legal Description: Tract BI k Lot ­ -A.., ... ­-**............. Description of Work: .....W­ Tim BI -P-A?................... PieriaReceived By....................................................Date ......................... .­...­­­....­­_............................................................................................. REO.: Plans.... Survey.... CaIcs: StTUc..... Energy.... Elect..... Mach.... tat Struct. Improvement on Parcel:Yes.... No....Area of Bldg............... Plans Chocked By....................................................Date ......................... Separate Structure............ or Addition/Alt erW4QV to Exist. Bldg........... Application Approved By.........................................Date ......................._ No. of Stories................ Use of Building ....... Validated By..............................................................Date ........................ ValuatiPr a 1: Compensation Certificate Verified By ................. Date ........................ Owner:=v ...........­' ..........P­h'o­n­9­:'.9'i Contractor: ............... ...C11 Bus. Lic. # $ Contractor's Address: ..... . lN-K Phone: ...... ..... Permit Fee (plus penally if applicable) ........................$....................... Contractor - Electrical: .............................................................................. Plan Check Fee (less deposit of$.......... Rct. #..........)$ ................. City Business License 4.................... Phone:................... Energy Plan Check Fee (Dep. of .......... Rot. #........) $....................... Plumbing: ..................................................................................... Strong Motion Fee ...................................................... .......................................................5....................... City Business License •.................... Phone:............,....... Heating and Cooling ............. ..............1.............................. Plumbing Permit Fee ................................................ $40-0.-V....... City Business License #... ............ Phone:.................... Electrical Permit Fee ......................................................$....................... Architect/Designer: ..... _......__............................... Phone:.................... Mach. Htg./Coolg. Permit $............................. $....................... Engineer: ........ ........................................... Phone:.................... Residential Construction Tax ........................................$....................... •Lender: ..............................I.................. ❑.. El Unknown Misc. Fee .......................................................................$...................... "I certify that in the performance of the work for which this permit Is Misc. Fee .....................................................................$....................... issued I shall not am person In any nimmer so.1 to became subject Iman an. to the w, f%n I ..r 1 A." SIGNATURE OF "I I Calif;tm�a. 7 Ale�LICANVOW ......... -............... 10 ... Environmental Status: Exempt............ Other....................................... "I certtly that as the applicant I am licensed undr- the pro, he Design Review Approval: Bldg. ............ Site ............ Sign ............ Contractors License anv,,&dlludher that my Licens, No. Use Zone .....:...... P.D. Conditions ............................................................ in Classi C,!�Z)5............... Is in full force and effect: or Cond. Use Permit M............ Variance a............ Parking Spaces............ . . I certify that I am exempt from the "Licensed Required" previsions of the Contractors License Law. (State basis of exemption.) Approved By........................................................... Data ........................... I hereby acknowledge that I have mad this application and state that the above to correct and agree to comply with oil City Ordinances and State La" regulating • building. I (We) agree to save, I emnIfy no keep harmless the City of Cupertino roachment Permit........................ Grant of Easement........................ against liabilities, ju events, ate and expenses which may in any W 4 - c ;U Irb, Gutter, Sidewalk, Driveway: Replete.......... Repair.......... secure against sold Cit qnc a qu c r nting of this I; I 0 0 Sewer............ Conn. Fee $................ Water................ Meter $................ SIGNATURE OF Agreement for Completion of Public Works Improvements .................. APPLICANTICONTRACT DATE Plans Checked By........ Date........ Approved By........ Date.................... NOTE: When properly validated this tam consuwtn a llulldlnj'104� This permit expires and becomes null and void should cork not M corntrlsndd Within 120 days from validation date, or should authorized construction be suspended w Abandoned for a period of 120 days after work Is counsel - . PERMIT INSTALLATION NO. EACH FEE APPLICATION FOR PLUMBING PERMIT Light Outlets............ Switches........:... Fixtures............ Receptacles............ PERMIT INSTALLATION NO. EACHI FEE . 1 TOTAL NUMBER (less than 1000 watts) ............ $ .60 .. ........- Gas System with up to 5 outlets ........................ .........'".00.1 ......... 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 I 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 ............................................... I . 1.50... ........... Lawn Sprinkler Sys. $5.00 Ea. add Sys. $2.00...................... ........... Misc. (see Ord. current) t. ............................**.... Vacuum Breakers .................................... --::,3 O� .ccup.��'a :I .0 Now Residential Interceptor........ Water Softener........ .... ...�: Plumbing Piping without fixtures ...................................4.00. ._........... 0-500 aq. ft. $22.00 1501-1750 $34.50.............................. 1 Misc. (See Ord. Current) ................................................... 501-750 24.50 1751-20000 37.50.............................. .. Permit Fee ..........................................................................$8.00 75f-1000 26.00 2001-225C 39.50.............................. TOTAL PLUMBING PERMIT FEE (plus penalty It 1110) $Ji 1001-1250 28.50 2251-2500 42.00.............................. - 1251-1500 32.00 2501-2750 49.50.............................. APPLICATION FOR HEATING/COOLING PERMIT Permit Fee...............................................$6.00 NO. EACH EACH F TOTAL ELECTRICAL PERMIT FEE (plus penalty if app.C9 $ PERMIT INSTALLATION _ Forced Air Unit..................to 100M ..............................$ S. 0... ........... INSPECTION RECORD over I OOM....................... . 10.00.. ........... Comfort Cooling Unit......to 3 ton/HP ........................... 6.00... ........... Forms / Foundation........... ....... By:...... I... Date:................ to 15 ton/HP.......................... 9.50.... ........... Plumbing Ground Work ......... I_ ........................................ to 30 ton/HP.......................... ..12.00. ........... ugh Electrical .................._....._......._j_....................... to 50 ton/HP............................17.00... ........... me - Plumbing and Heating .. .1........................ ........................... Space Heater........ Wall Heater .......................... e.00 .......­* ulation & Energy................................ I...... ........... ............I.............. Flues - other then above .................................... 3.00............... 1 1 7 Jas Test ...... ...........................I........ . ........................... ................. Vent Fan: Kitchen........ Bath .......................................1.. 3.00............... Commercial Range Hood .........................................f.. 6 00...I............ Final - Electrical ................................... ................. ....................... Temporary Power Gas / Elect. ................................ ...:...................I.... Misc. (See Ord. Current............................................... ........................... Final - Building/ Mechanical ............... ..................... Permit Fee ....................................................................... $ 6.00 Final - Design Review / Landscaping . ...... ........... .......................... TOTAL Htg./ Coolg. Permit Fee (plus penalty is app. 0) $ Final-Public Works ........................................................... �;y