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1108 CITY OF CUPERTINO APPLICATION FOR RESIDENTIAL BUILDING PERMIT PERMIT NUMBER L& AND FOR APPLICANT TO FILL IN CERTIFICATE OF OCCUPANCY BUILDING INSPECTION DIVISION STREET ADdRESS-,-OF P CT .................. Legal Description- Tract ..... Block............ Lot..... ....... Description of Work: _� _......c.>_14C./C...................................... Plans Received By..........#,y........ ................Date ............ ..................... REO.: Plans---- Survary-_ Calc,: S U rgy.... Elect.... lst Struct. Improvement on Parcel:Yes... No Area of Bldg............ y .........Date ..6/ ' I rot- Plans Checked B P-8 2-�/Yfo Separate Structure............ or of to Exist. Bldg..64/ Application Approved By........ .......Date .............. . .. No. of Stories....4!>.. Use of Build ;"Ag PkVO-4V�1 .......... Validated By........................................ .....................Date ........................ Valuation'Vo PAec.� I)V, J"ee.......................................... P�X Compensation Certificate Verified By �................ Date .................. A A' A- er- Phone:?OK :7 Contractor: ..A ... ........................City Bus. Lie. # .............. $ -Sell elf Contractor's Address: .............. ............... Phone:.................... -#IV Contractor - Electrical: .........__....._ ................................................. ...... Permit Fee (plus penalty if applicable) ...................... $..... ...... Plan Check Fee (less deposit of$.......... I $...... ....-...... City Business License fl................ Phone:.................... EnergyPlan Check Fee (Dep. of $........ Rct. #........ ....................... Plumbing: .........:.............................__................................ ....... Strong Motion Fee ......_........ ................ $...................... City Business License #.................... Phori .......... - 0*"** Heating and Cooling ...._....#...._............................................. Plumbing Permit Fee ............. CU.....ilt,......_$....._................ City Business License #...._...._........ Phone:...._......------ Electrical Permit Fee ............................................. $....................... Architect/Designer: .............................................. Phone:.................... Mach. Htg,/Cooig. Permit $...............'Or $....................... Engineer: . . . ...... .... ... ........................................ Phone:................... �C Residential Construction Tax ....... ............. ......$....................... Lender! .. . .... ..... . .... ..... .... Misc. Fee ...................................................... ....$...._&.6.111,...... El Unknown "I certify that in the performance of the work for which this permit Is Misc. Fee .......... ........ $.......... ...... issued 1 shall at employ any person in any manner so as to become subject Monona=. -. to the workman's coppnsatlon laws pf COl Ifornia." SIGNATURE OF APPLICANT/OWNER .......... DATE.Ahr*00 Environmental Status: Exempt ... Other...........w......................... 'I ce,rty that as the applicant I am licensed unde the provisions of the Design Review Approval: Bldg. .......w.... Site ............ Sign ............ Contractors License Law and further that my Licens, No. ............................ Use Zone ..... ..... P.D. Conditions ........__.............. .......... in Clessification .................. . ..... .... Is in full force and affect: or fify that I am exempt from the "Licensed Required" provisions of the Cond. Use Permit #............ Variance #............ Parking Spaces............ clocell.com License Law, (Stale basis of exemption.) Approved By......................................................... Date ......._....... I horoby acknowledge that I have read this application and state that the above la agree to comply with all City Ordinances and State Law. regulating building. I (We) agree to save, indemnify 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: Replaces------- eplace---------- Repair.......... occurs against said City In consequence of the granting at this permit." �wer............ Conn, Fee $................ Water................ Meter $............ SIGNATURE OF Agreement for Completion of Public Works Improvements .................. APPLICANT/CONTRACTOR . . ....... ............._.......... DATE ...........__........ Plans Checked By........ Date........ Approved By........ Date.................... NOTE, When properly validated this form constitutes a Building Permit. This permit ..pres and becomes null and void should work not be commenced within 2:4;ijlll� 120 days from validation date, or should authorized construction be suspended or abandoned for a period of 120 days after work Is commenced. PERMIT INSTALLATION NO. EACH FEE Light Outlets............ Switches........... APPLICATION FOR 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............ ._......__ 2.00 ............. Each additional outlet ............................................. 1.00............... Dryer........ Garb. Disp......... Dishwasher ............ ..... 2.00 .............. Water System (installation, Alt. or Repalr) ................. 4.00............... MOTORS: 1 HIP 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 ......__......................_....._........_.......................... 6.00............... Time Clock ........................... ................. ..... 1.50... ............ Lawn Sprinkler Sys. $5.00 Ea. add Sys. $2.00.................... ............. Misc. (see Ord. curceunpt, ............................... Vacuum Breakers ..... ..................................... .. 3.50......... F New Residential . Interceptor........ Water Softener........ .............................4.00. ............ Plumbing Piping without fixtures ....................... ............4.00. 1501-1750 $34.50.......................... D-500 sq. 11. $22.00 Misc. (See Ord. Current) ........................I.................. 601-750 24.60 1751-.20000 37.50.............................. Permit Fee 751-1000 26.00 2001-225C 39.50.............................. ...... ..................................................................$ 8.00 1001-1250 28.60 2251-2500 42.00.......................... TOTAL PLUMBING PERMIT FEE (plus penalty if app. 11) $ 1261-1600 32.00 2601-2760 49.50.............................. APPLICATION FOR HEATING/COOLING PERMIF PermitFee...............................................$6.00 TOTAL ELECTRICAL PERMIT FEE (Plus penalty if app.0) $ PERMIT INSTALLATION NO.I EACH I FE Forced Air Unit._......._......to 100M ..................... ..........$6.00... ............ INSPECTION RECORD over 100M ........................ . 10.00.. ........... Comfort Cooling Unit......to 3 ton/HP ......................... 6.00............... Forms / Foundation to 15 ton/HP......................... 9.50.. ............ k to 30 ton/HP.............................12.00. ............ Plumbing Ground Work .... ... .......... Rough Electrical ...................._......_......f. to 50 ton/HP................. ........ 17.00.. ........... iems rMul and Heating ........ t44.!7:7A1.0..... Space Heater.. Wall Heater .................................. 6.00 List, .............................. ........................ ........................... Flues - other than above ............................................. 3.00 ............ s Test ........................ ........ .... .. ... _ . ..... .. ..... Vent Fan: Kitchen........ Bath ...._........_........_.... ...... 3.00............... Temporary Power Gas / Elect. _.... .. Commercial Range Hood .................. ..............I_ 6.00 Final - Electrical .................................. ........................... .............._................ . .......... ...................... Misc. (See Ord. Current........................................i........I...............J......... Final - Building / Mechanical ....................................... ........................... Permit Fee .........................._......................................... $ 6.00 Final - Design Review / Landscaping ...................... ..................I TOTAL Htg./ Coolg. Permit Fee (plus penalty if app. E]) $ Final-Public Works ....................... . .... ............. / I .,t&It ~"fill 0