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1367 CITY OF CUPERTINO APPLICATION FOR RESIDENTIAL BUILDING PERMIT PERMIT NUMBER AND FOR APPLICANT TO FILL IN CERTIFICATE OF OCCUPANCY BUILDING INSPECTION DIVISION STREET ADDRESS F PROJECT: zzG.SS.... ..c}..k... k...Co.v..!4X................. • • . • Legal Description: Tract...".'............... Bleck............ Lot...................... Description of Work: ..._r.,1.-,*.!+.....ZAleI........................................ PlanaReceived By....................................................Date ......................... ....................................................................................................................... REO.: Plans.... Survey.... Cales: Strut..... Energy.... Elect..... Mach.... tat Struct. Improvement on Parcel:Yes.... No.... Area of Bldg............... Plane Checked By._................................ Addition/Alteration Date .. ..�.(a .� No. of Stories..........-__ Use of Building ....-....-...... ............................... Validated By.............................................................Date ................ ...... Valuation of Project: $..............................................................................- Compensation Certificate Verified By ................. Date ......................... Owner: ........................................................................ Phone:.................... Contractor: .....-................................................City Bus. Lic. a .............. • . • • • $ Contractor's Address: ...........-.............-................... Phone:.................... Permit Fee (plus penalty if applicable) ........................$....................... Contractor - Electrical: ...-.........................___........................................ Plan Check Fee (less it: deposbf .....$...•...... Rct. #----------)$.................. City Busines_q License .................... Phone:.................... Energy Plan Checl),Fee (Dep. of5...-'.... Rct. #........)$....................... Plumbing: .t.... 7RLLLQ._C.f)_<........................�I Strong Motion Fee.1�:.E:...7.._-.:.-,_. $.......... City Business License •............ ...... Phone: .Sk-.1 g .. _ ly:`r .........................'.. Q'O Heating and Cooling lL.!1.L.LVA^sLSA.!v..�itr.([s.s.?-.4A Plumbing Permit Fee ........ $... r...--�.�- City Business License #.................... Phone:.................... Electrical Permit Fe .....................................................$....................... Architect/Designer: .................................................. Phone:.................... Mach. Htg./Caolg. Permlt $:... ...................... $...................... Engineer: Residential Construction Tax ....`...:...............................$....................... ...............................................................---- Phone:.................... Lender: . .. ..........._....._.................................................... . ❑ Unknown' Misc. Fee ........................................................................$....................... "I certify that in the performance of the work for which this permit Is Misc. Fee ........................................................................$.................... 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 ZONING • APPLICANT/OWNER _..... .. ............. F.......... ._........... ._.. Environmental Status: Exempt............ Other........................................ .. ..... "I certify that as the applicant I am li nsed unde- the provisions of the Design Review Approval: Bldg. ............ Site ............ Sign ............ Contractors Licensg Ly and further that my Licena. No.1.7.7J.1L._ Use Zone .....:------ P.D. Conditions ............................................. ..in Classification ....._* ..G....................... is in full force and effect:or Cond. Use Permit e............ Variance s............ Parking Spaces............ .... .. I certify that 1 am exempt from the "Licensed Required" provisions of the Approved B Date Contractors License Law. (Stale basis of exemption.) PP Y- --- -- -- - -- --- -- --- -- --- --- I hereby acknowledge that 1 have read this application and slate that the above Is :orrect 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, Oachment Permit........................ Grant of Easement........................ against liabilities, judgments, costa and expenses which may In any way tewer , Gutter, Sidewalk, Driveway: Replace.......... Repair.......... acture against said City In consequence of the granting of this permit." ............ Conn. Fee $................ Water................ Meter $................ SIGNATURE OF t '� a�.6�7`� M p ./ I Agreement for Completion of Public Works Improvements .................. APPLICANT/CONTRACTORII.................�............24. 0 .. �.. .._... Plans Checked By........ Date........ Approved By........ Date................... NOTE: When properly validated this form to iotas a But ng Paredt. This permit expires and becomes null and Vold should work no/be commenced velthin • 120 day from validation dab, or should authorised construction be suspended ay abandoned for a period of 120 day after work Is commenced. : PERMIT INSTALLATION NO. EACH FEE APPLICATION FOR PLUMBING PERMIT Light Outlets............ Switches............ Fixtures............ Receptacles............ PERMIT INSTALLATION NO. EACH FEE ".z TOTAL NUMBER (less than 1000 watts) ............ $ .50 ........... Gas System with up to 5 outlets ........................:. .....$4.00• •--•••••-•. Range........ Cooking Unit........ Oven............ ................ 2.00 .. ............ Each additlonal outlet...........................:.................. 1.00. .........:..: Dryer........ Garb. Disp......... Dishwasher ............. ...... . 2.00 .............. Water System (Installation, Alt. or Repair) ..........1...... 4.00. ..4..A.D. MOTORS: 1 HP or less ......................................... ....... . 2.00 ....... Water Closet.,;.Water Heater.... Ld. Tray..............2 .- 4.00• •• - •d Greater than 1 HP not ro0re than 5 HP .............. . 3.50 .............. Lavatory.y Shower Pan.... Bathtub.L Sink............(`.... 3.00. l. .:0.0. 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..................... ............. Mlac, (ase Ord. current)...................................................... Vacuum Breakers ............................................ .......... ...3.80. ....:.._'_ , New peel entiel Occupancies let Rate Interceptor........ Water Softener........ ........................._..4.00. ............ Plumbing Piping without fixtures ...................................4.00. ............. 0-600 sq. it. $22.00 1501-1750 $34.50.............................. Misc. (See Ord. Current) ............................................., 601-750 24.60 1751-20000 37.50.............................. 761-1000 28.00 2001-2250 39.50.............................. Permit FBI ........................... ( ..........................................E 8.0000 1001-1250 28.50 2251-2500 42.00.............................. TOTAL PLUMBING PERMIT FEE (plus penalty If app.[0 i 1251-1500 32.00 2601-2750 49.50.............................. APPLICATION F•• HEATING/COOLING PERMIT Permit Fee...............................................$6.00 TOTAL ELECTRICAL PERMIT FEE (Plus penalty If app.Cl) $ PERMIT INSTALLATION NO. EACH FEE Forced Air Unit..................to ZOOM ...............................E 6.00... ........-, INSPECTION RECORD over 100M ....................... . 10.00.............- Comfort Cooling Unit......to 3 ton/HP ........................... 13.00... ........... Forms / Foundation ...........................-. By:........ ....... . Dale:................ to 15 ton/HP........................ 9.50.. . . Plumbing Ground Work - •t ...................... .. to 30 ton/HP........................ ..12.00.. .....,..... Rough Electrical .................................... ...._... ............... ............I............. to 50 Icl........................ .17.00.. ........... -ie - Plumbing and Heating .......... ........................ ........................... . 6.00 1lon & Ener Flues Heater..han Wall Heater ................................... .......... l 9Y............................... ......................... ........................... Flues - other than above ............................................ .. 3.00J ........... ae'Teat Vent Fan: Kitchen........ Bath .............................. .................................... ...... . .................................................. 3.00. Temporary Power Gas / Elect. ............................................................ Commercial Range Hood 6.00„ ........... g .......................................... .. nal - Electrical ....................................................................................... Misc. (See Ord. Current........................................ .......... ........... 191 - Building/ Mechanical .............. ........................ .......................... Permit Fee ............................................................._......... 6.00 '%I - Design Review / Landscaping . ... .. .._.................................... TOTAL Htg./ Coolg. Permit Fee (plus penalty If app. p) E 11-Public Works ...........:...............................................