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1814 CITY OF CUPEII T'11 0 CITY OF CUPERTINO APPLICATION FOR RESIDENTIAL BUILDING PERM*" � I y PERMIT NUMBER AND • . APPLICANT TO FILL IN CERTIFICATE OF OCCUPANCY BUILDING INSPECTION DIVISION PT R€ET ADDRESSnOF PRO ECT: . .QZ..�.Z...... Grp..�'I.r.cit ....1Je.S�.....pW ?J1..._3...... s . gal Description: Tract.........�......n...-.. Block............ Lot...................... ........ scription of Work: .......A1C!C,.I .Pa4L�......................................... PlansReeelved By....................................................Data ................. ................................................................................................................. REO.: Plans.... Survey.... Cafes: Struc..... Energy.... Elect..... Mach.... Struct. Improvement on Parcel: Yes.... No.... Area of Bldg............... Plena Checked By........................... Date ....... ... �bb` parate Structure............ or Addition/Altetption to Exist. Bldg........... Applleation ApprovedBy .....�2..,_�-,.._.........Date . .....p. . of Stories................ Use of Building .. . ..f ....................... Validated By..............................................................Date ........................ Valuation 1 Prolegt: $....................... .................................................... Compensation Certificate Verified By ................. Date ......................... Owner: . OY,Ia. wr\..._yylt,r..k... rl i'in-p,r„"...-,.. Phone:.................... Contractor: ..(-7Lta..DA:'1...$).et1-YA�.V .City Bus. Lic. * .............. • • " • $ Contractor's Address: Phont33.7.S..v'S..Ikl Permit Fee (plus penalty if applicable) ........................$....................... Contractor - Electrical: .........................._'+............................................... Plan Check Fee (less deposit of$.......... Act. #..........)$...................... City Business License #.................... Phone:.................... Energy Plan Check Fee (Dep. of $........ Act. #........)$....................... Plumbing: ...................................................................................... Strong Motion Fee ..........................................................$....................... City Business Licenye #.................... Phone:.................... PlumbingPermit Fee $....................... Heating and Cooling ...(nMb, !^........................................... ElectricalPermit Fee ........................_............................$...... r.......... Archneer/Des gine Business License.............. Phone:.................... Residential Construction Tax...............................$....................... Lender: ... ..........................._....._......._......_......_..Phone:O-Unknown . Misc. Fee ........................................................................$....................... .... ... "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 a5 to become subject • _ § to the workman's compensation laws of California.” " • SIGNATURE OF l��r s s APPLICANT/OWNER _ ......................... DATEI!!! �..'.'..I. Environmental Status: Exempt............ Other........................................ I certify that as the appli nt I em licensed unde• the proviaiorLa qr Design Review Approval: Bldg. ............ Site .........--- Sign ............ Contractors License laW and further that my Licana. No..•(y. 1.113 .Z Use Zone ............ P.D. Conditions ............................................................ ,n Classification .......G..,,,LO............... is In full force end .'lett: or Coed. Use Permit e,,,,,,,,,,,, Variance a............ Parking Spaces............ - I certify that I am exempt tram the "Licensed Required" provisions of the Approved B Contractors License Law. (Stale basis of exemption.) PP y........................................................... Date ........................... I hereby acknowledge that I have read this application and state that the above Is correct 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 roachment Permit........................ Grant of Easement........................ against liabilities,judgments, costa and expenses which may In any way Gutter, Sidewalk, Driveway: Replace.......... Repair.......... acture against said City In consequence of the granting of this permit." ef............ Conn. Fee $................ Water................ Meter $................ SIGNATURE OF �•lA./. .. �(_ roerrlent for Completion Of Public Works Improvements .................. APPLICANT/CONTRACTOR ................... ...._.__.s.rw..'.o...`..'.......... DATE ..(............ Plans Checked By........ Date........ Approved By........ Date.................... NOTE: When pm party validated this form constitutes a Building Forms. This permit expires and becomes null and void should work not be commmnted within APPLICATION •• ELECTRICAL PERMIT 120 days from validation date, or should authorized constrdctten be wgmnd*d or abandoned for a period of 120 days after work Is commenced.` x PERMIT INSTALLATION NO. EACH FEE APPLICATI• s• s 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•oo ........:...:. Y 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.o0 .............. 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 .1....... ..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 let Aat0 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 .......................... ...........$6.00 761-1000 25.00 2001-2256 39.50.............................. ...( ............nalt.........p .. 1001-1250 28.50 2251-2500 42.00.............................. TOTAL PLUMBING PERMIT FEE (plus penalty If app. ❑) _ 1261-1$00 32.00 2501-2750 49.50.............................. APPLICATION FOR HEATING/COOLING PERIAlf Permit Fee...............................................$6.00 TOTAL ELECTRICAL PERMIT FEE (Plus penalty if app.0) $ PERMIT INSTALLATION NO. EACH FEY—, Forced Air Unit..................to 100M ..............................$6.00... ..:........ INSPECTION RECORD over 100M ....................... . 10.00........._... Comfort Cooling Unit......to 3 ton/HP ........................... e.00... ........... Forme / Foundation ..............................I By:........ ....... . Date:................ to 15 ton/HP................ 9.50.. J ........ ........... Plumbing Ground Work . ..................... .... ................ ........................... to 30 ton/HP........................ .. .. ..........:" Rough Electrical ....................................:_..........._.......... ........................... to 50 ton/HP.. ... ..17.00.. . .-. . 1me - Plumbing and Heating ..........I_....................... ........................... 8.00.. .. lotion & Ener Space Heater Wall Heater ........................... .. ... v�a.� 9Y............................... .................................................... Flues - other than above ......................................�. .. 3.00.. ..(.D.O ' Test ............................................ . ........................'........................... Vent Fan: Kitchen........ Bath .......................................1}{.. 3.00... ........... porary Power Gas / Elect. . ._.............................. ........................... Commercial Range Hood j 8,00._....••.•••.• nal • Electrical ................................... .......................................... .. . ........................ ........................... Misc. (See Ord. Current............................................... .......... ...$ 6......... Final - Building/ Mechanical ............... ....................... ........................... Permit Fee ................................................... $ 8.00 � ..................... g Landscaping TOTAL Htg./ Coolg. Permit Fee (plus penalty P app. C)) S�" Final - Desi n Review / Lantlsca in .. .........__......_..................... ,1 Final- Public Works ........................................................... 7r&D