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� � CITY OF CUPERTINO APPLICATION FOR RESIDENTIAL BUILDING PERMIT PERMIT NUMBER �� � AND � . . . . . • ' CERTIFICATE OF OCCUPANCY BUILDING INSPECTION DIVISION STR ET DRESS OF P�JECT: ��S`a..............:...e,�a .u-`�`t-��?,.....�-..n .�17 r............ , . • ... Legal Description: Tract. ..............._. 81ock............ Lot ................... G Da ription of Work: .�(.iL./Yl�.._'�'.�.�2......�.'d�Ur, Plans Received By......._..... ..L. .. .. .............Date ..7/lc .cl� . �...._.P.P.O..�.._....................___.__..._........__....................... �......... � -.�...... . REQ.: Plans.... Survey.... Calcs: Siruc..... Energy.... Elect..... Mech.... ist Struct. Improvement on Parcel: Yes.... No... Area ot Bldg............... Plens Checked By........................�? � Date ...7.. . r� Separate Structure............ or Addition/Alter ion t xist. Bldg........... Application Approved By...........�l......�...................Date .... ..1.. Ju. No. of Stories........�Use of Buildin � / �`� ��....... ............................... Validated By................._.. Ci7Y.S.�i.��1^�7L1;.3..._.Date ..........___....... Valuation of PrBject: $.... ..��Q(1s...__...................._..... Compensation Certifiwte Verified By ................. Date ...._................... pwner: ..1�{ .'�!T......L�D. .. ._G . .....'....... Phone:�1. �rrr q$� q980 Contrador. /F'f1FCG2.....1'�u.�aty e s. uo. x L6� . . . . • - . F+ I ,},� � r� ContraCtOr's Atltlress: _7.�Q...... .. .....i.:yiy.C�: Aone:7"'�T..?77 Permit Fee (Plus penalry ii aPPlicable) .. ...................$. . d. ."r�._ Contractor - Electrical: ....._....................._....................._........................ ' ' II ��--- City Business license p...._._......._.. Phone:._................. Plan Check Fee (less depo5lt ofi$.......... Rct. #......._J$.......�........_ Plumbin g: ...................................................................................... Energy Plan Check Fee (Dep. of $........ Rct. #........) $................. Strong Motion Fee .__................................................_...$..........L 5..�... • Ciry Business License x._....._.......... Phone:.................... Plumbin Permit Fee . . . . . . . $.... rL1T)... Heatiny and Cooling ..............._._......_........._.__...................... g .................... ..................... /(,�. .. I� City Business License x.................... phone:.................... Electrical Permit Fee ................._........_...._................_.$........�.�-S"'0... Architect/Designer: .. ............_................................. Phone:.................... Mech. Htg./Coolg. Permit $............................. $............_.......... Engineer: Residential Construction Tax ........................................$....................... . . .._....._..................................................... Phone:.................... Misc. Fee ........................................................................$....................... Lender. . .. . _... .............. .................................__..... . ... ❑ Unknown ... ... "I certily ihat in Iha perlormance ai the wark Ior whic� Ihis parmit Is MiSC. F¢0 .............................._......._._............_._......_...$.............._....... issued I shall mt employ any person in any mannar so as to become subjecl � § �4�m � m the workman's compensalion laws ol Calitomia." SIGNATURE OF • • • • FPVLICANT/OWNER ......._......................................_...._..._............. DATE.._.................... Environmental Status: Exem t............ Other.................. ......._............ '... ��i cerw m�� �s me � oi��a�� i �m nce�sed u�ae� me r�p��yi�'pps,p� 1y� Design Review Approval: B dg. .__._..... Site ...._....... Sign ............ com,aclors ucense Law�+d lunhor ihal my Licens. No.Pll:l.l..L..�..0 Use ZOnB P.D. Condi�i0n5 .._.............. �� Classilica�ion ....G".,y.�. ............ is in WII lorce and evect: ar ............ ..__.......... ........................ � Cond. Use Permit �..._....... Variance k............ Parkinq Spaces............ �� ��� i cetlify ihal I am exempt irom Ihe "Licensetl Requiretl" Drovisions of Iha Appfoved By .... Date CONracmrs License Law. �State Dasis o/ exemption.) ---�------�-������� "-"""'-""""" """""""""""""' I haeby ncknowletlge t�at I have reatl t�is application entl state ihat Ihe eEove is <onect and agree to comply with all City Orainances antl $late Laws reguleting ' � � � Guildm�. I . I (We) agree to save, indamnify and keep harmless tha City of Cuper�ino croachment Permit...._...........___ Grant ot Easement..._........_......... aqa�nst i�abnuias, ivaqe�encs, �osts a�a e.pe�ses which may in any way rb, Gutler, Sidewalk, Driveway: Replace.._._... Repair_........ ecc�re egeinst said City in consequ n ot the granting ot this permiL" ewer............ Conn. Fee $................ Water................ Meter $................ SIGNPTURF OF Z Z7�� � Agreement for Completion of Public Works Improvements ...._............ arvucnNTicoNrancroa ............... .............. DAre .._�................ Plans Checked By_...... Date........ Approved By........ Date.................... Nore: wn�o propetly � � ed mis io�m consnmte• e Builtling rarmn. ThI. permit e�pirea entl �acomes null entl voltl ��oultl work nol ba eommaneed wl��l� � � . 120 deys Irom validelion date, or ahoultl eul�orizeC con�Iruclion ba �uspendaA or a�anJoneE lor a Oeriotl ol 1P0 tlays elter work if commencetl. PERMIT INSTALLATION NO. EACH FEE . • • . • . . _ � Light Outlets............ Switches.......... . • Fixtures............ Receptacles........_.. [ PEFMIT INSTALLATION NO. EACH FEE I' TOTAL NUMBER (less than 1000 watts) .._........ g .50 ��;-d��� Gas System with up to 5 outlets .................................g4,00� ............. Range........ Cooking Unit........ Oven............ ....._.. ....... 2,00 .. _........_ Each additional outlet _........................ . ................ .. 7.00............... Dryer.._.... Garb. Disp..._.._ Dishwasher .........._. ._.... 2.00 ....._.._... Water System Qnstallation, Alt. or Repair) ............._.. 4.00............_. MOTORS: 1 HP or less ......._.........__................_ ..._.. . 2.00 ........-.... Water Closet.... Water Heatec... Ld. Tray..................... 4.00. ............. Greater than 1 HP not more than 5 HP ............_ . 3.50 .. ......._... Lavatory.... Shower Pan_.. Bathtub.... Sink................._ 3.00............... Tempor2ry Power Pole or Service — 100 amp .I._.... . 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. atltl sys. $2.00..................... ............. Misc. (see Ortl. current 1...................................................... VaCuum Breakers ........_.__........._............_.... ............_3.50.. ............ New Residential Occupancies Flat Rate Interceptor........ Water Softener........ ................. ............4.00. ...........8 . Plumbing Piping without fixtures ...................................4•00. ._��� �500 sq. ft. $22.00 1501-1750 $34.50.............................. Misc. (See Ortl. Current 501-750 24.60 1751-�20000 37.50.............................. 1 .................................................... PermitFee ..........................................................................$6.00 751-1000 26.00 2001-225C 39.50.............................. TOTAL PLUMBING PERMIT FEE (plus penalty if app. Q) S !� � 1001-1250 28.60 2251-2500 42.00.............................. 1257-1500 32.00 2501-2750 49.50.............................. . . . . • • • . •• • ' Permit Fee...............................................$8.00 TOTAL ELECTRICAL PERMIT FEE �Plus penalty if epp.p) $ 6 S � PERMIT INSTALLATION NO. EACH FEE '� Forced Air Unit..................to 100M ..............................$ 6.00.. . ........... • • ' . ' � Overi00M ........................ . 70.00.. ........... � Comfort Cooling Unit.....to 3 ton/HP ..._....................f.. 6.00............... Forms / Foundation ..._.......... ........_. .I BY�........ . ..... . Date:...._......._. to 15�on/HP............_...........4 9.So.............. Plumbing Ground Work . ............... ..._..____._............._.__..... � to30ton/HP......__..............j..12.00. ............ '�, Rou9h Electrical ...._.................__.._._..�.. ... .._......___.. ..............__......... to50ton/HP............._.........� 17.00.. ........... •ame - Plumbing and Heating .___...�......................... .._.........._........... Space Heater........ Wall Heater ................................_.�.. 6.00.............. ulation & Energy........................._... ..................._.... ......._.................. Flues - other than above ...................__......................'.. 3.00.. ............ asTes� ................................. ...... . ..... ..................t........................... Vent Fan: Kitchen........ Bath ......._...._......_.................. 3.00........._.... �� TemPorery Power Gas / Elect. . ._._.. ............_._......_1..__..................... Commercial Ran e Hood 6.00.............__ �Final - Electrical ....._..._... . . 9 ........._............................... .. .. .. .....__..... ......................... ............_........_... Misc. (See Ord. CurrenL.......................................�................................... Final - Buildiny / Mechanical ........__.. Permit Fee _..........._........... ........_................. ........_........................_.... $ B.00 Final - Desi n Review i Landsca in .......................................... ................................ �r 9 P� 9 � ���� TOTAL Htg./ Coolg. Permit Fee (plus penalty i app. �) S Final-Public Works ...........................................................