1724 •
CITY OF CUPERTINO
APPLICATION FOR RESIDENTIAL BUILDING PERMIT PERMIT NUMBER I ��
AND FOR , ,
CERTIFICATE OF OCCUPANCY
LICANT TO FILL IN
BUILDING INSPECTION DIVISION S RZE/ ApW4E PF3pJECT
DEPARTMENT ONLY Legal Description: Tract..........--..._..... Block. ......... Lot......................
Description of Work: f(V V,.J4TWX,.,.�!✓D,fi°i1 .............
Plena Received By....................................................Date .................. ........_.../f.EI�T/n1��................
........cel:...Yes.
dg...............
RED.; Pans.... Survey.... Celcs: Struc..... Energy.... Elect..... Mach...,
1st 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 ........--............. No. of Stories............. . Use oBuildIn
Validated By..............................................................Date ........................ Valuation ofPro act:
................. /U g ...........
...... ......................
. .........,
Compensation Certificate Verified By $.... . . ......_....................................Z
Date ......................... Owner:'�.Rtl�tt.-.Jdf. ..... .. P
hone:.....
Contractor:
City Bus Lia # C7}�.'.P
• • ' $,r0•� Contractor's Address,/1-� I1ROrM.'y►;z SIG lYv1�Lone '?If3vXfi0
Permit Fee (plus penaltyf applicable) Contractor - Electrical _...w f/ 6/6
Plan Check Fee (less deposit of$.....-... Rct. #..........)$....................... City Business License #.................... Phone:....................
Energy Plan Check Fee (Dep. of .......... Rct. #.......J$.............. Heating pity Business License #........._.......... Phone:....................
Plum
Permit Fee
Electrical
l
Mach. H9gPermit Fee
Pe l ` :O nC PfRT�/'y� .....:..$ _ �( �r Architect/Designer:
Business License #.........._....i.. Phone:..............
Strong Motion Fee . .. �/ ((11 $. �7
Residential Construction Ta6.. .. Engineer: . . .9..Y. ...-........................_�_................ Phone:.................... I'
tl..0 $....................... Lender:
98 _t i .. .... .. .....ance..__.....................w _ ❑ Unknown
MISC. Fee ......................... ......_... .._...............$.............._...... "I certifythat in the
performance of the work for which rola permit Is
MISC. Fee ..... ........ ..............._......._......$.............._....,.. issued I shall not employ any person in any manner so as to become subject
• $ ? ,a issued
workman's compensation laws of California."
SIGNATURE OF r
• • APPLICANT/OWNER ...._... ....................................................... DATE........................
Environmental Status: Exempt ............ Other...._........_......----....._----- "I certify that as the applicant I am licensed unde the prov siens of the
Design Review Approval: Bldg. ........-- Site ............ Sign ............ Contractors License Law and further that my Livens. No. i W3.7 .....
Use Zone P.D. Conditions in Classification!............... ... ........_. is in full force and if act: o
Cond. Use Permit #............ Variance #............ Parking Spaces............ I vanity that I am exempt from the "Licensed Required" provisions of the
Contractors License Law. (state basis of exemption.)
Approved By.........................................._.......___.. Date ..............._.......... I hereby acknowledge that I have read this application and state that the above is
cormct and agree to comply with all City Ordinances and State Laws regulating
• • uolldwg.
I (We) agree to save, indemnity and keep harmless the City of Cupertino
croachment Permit........................ Grant of Easement........................ against liabilities, judgments, costs and expenses which may in any way
rb, Gutter, Sidewalk, Driveway: Replace.......... Repair...._... secure against said Cityconsequence of the granting of this permit."
war............ Conn. Fee $................ Water................ Meter $................ SIGNATURE OF t LS7fJ
Agreement for Completion of Public Works Improvements .................. APPLICANT/CONTRACTOR' *�A!..__........... DATE .�....�..............
Plans Checked By........ Date........ Approved By........ Date......._.......... NOTE: When properly vall led this farm constitutes a Building Permit. This
permit expires and becomes null and void should work not be commenced within
APPLICATION • 120 days from validation date, or should authorized construction be suspended or
abandoned for a period of 120 days attar work is commenced.
PERMIT INSTALLATION NO. EACH FEE APPLICATION c
Light Outlets............ Switches...........
R PLUMBING PERMIT
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............ ......... ....... 2.0o .............. Each additional outlet ............................................. 1.00...............
Dryer........ Garb. Disp......... Dishwasher ............. ....... 2.00 .........� Water System (Installation, Alt. or Repair) ................. 4.00...............
MOTORS: 1 HP or less ....__........_......_.........._... .1.,.. . 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 .....--..................................................................... 6.00...............
Time Clock ..................................................................... Lawn Sprinkler Sys. $5.00 Ea. add Sys. $2.00..................... .............
Misc. (see Ord. current)....................... .............................. Vacuum Breakers ............................................ .. ............3.50..............
New Residential Occupancies Flat Rate Interceptor........ Water Softener........ .........:..................4.00. ........ .
0-500 sq. ft. $22.00 1501-1750 $34.50.............................. Plumbing Piping without fixtures ...................................4.00„
............
501-750 24.60 1751-•20000 37.50.............................. Misc. (See Ord. Current) .................................................,
751-1000 26.00 2001-225C 39.50.............................. Permit Fee ................... ..................................... .........$6.00 -.
1001-1250 28.60 2251-2500 42.00.............................. TOTAL PLUMBING PERMIT FEE (plus penalty If app. 1-1) $/O 01
1251-1500 32.00 2501-2760 49.50.............................. APPLICATION FOR HEATING/COOLING PERMIr
Permit Fee...............................................$6.00
TOTAL ELECTRICAL PERMIT FEE (Plus penalty It app,p) $G, J-Z PERMIT INSTALLATION NO.7EACHFEE
Forced Air Unit............I.....to 100M ..........................-. ............
over 100M ....................... ...........Comfort Cooling Unit..._.to 3 ton/HP ........................ ............
Forms / Foundation ......._. ................. . ey:........ . ..... . Date:................ to l5 ton/HP..._................._ ............
Plumbing Grical Work . .................... .._......_..... ............_...._... to 30 tort......................... .
Rough Electrical ..........._....ting._. .-........
g ._..................... ....._.. .......................... to 50 ton/HP......................... 17.00.. ...........
jiM
ams - Plumbing and Heating .......... ......................... ........................... F” 6.00..
i
Space Heater....... Wall H
ulation 8 Ener P eater .....-............................ ............
9Y......_....................... .__....._..... ....... ........................... Commercial Ren 8.00
Test .._..._.... .................... ..... . .... ._.._.. .. .._.'............._........... Vent Fan: Kitchen.
Hood 3.00... ............
emporary Power Gas / Elect. ..._... ._......._.............�.._.._......._......... lues - other then above ...........................................� 3.00.. ............
Final - Electrical .........-......-- .._..........._.................__.4.......................-.. Misc. (See Ord. Current....................... ..................
.................
Final - Building /Mechanical .......................................I........................... Permit Fee $ 6.00
Incl - Design Review / Landscaping . TOTAL Htg./ Coolg. Permit Fee (plus penalty If app. ❑) $
Final-Public Works ...........................................................