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1399r' CITY OF CUPERTINO APPLICATION FOR RESIDENTIAL BUILDING PERMIT AND CERTIFICATE OF OCCUPANCY BUILDING INSPECTION DIVISION 1 Plans Received By .................................................... Date ......................... REO.: Plans.... Survey.... Calcs: Struc..... Energy.... Elect..... Mach.... Plans Checked BY .................. ............................... Date ................. Application Approved By.......%s,........c.................. Date ....q .. ValidatedBy.....................................5..............----.... Date ........................ Compensation Certificate Verified By .................. Date ......................... ..a Permit Fee (plus penalty if applicable*;;y.,_.�.............. $..�0"..lz-�t ... Plan Check Fee (less deposit of $.......... RM: #i:;,;) $....................... Energy Plan Check Fee (Dap. of Rct. #........)�..............�.... Strong Motion Fee ........................... .1? $........... 4.......... PlumbingPermit Fee .......................................... 1J. $ ....................... Electrical Permit Fee.......................1).......................... $....................... Mach. Hlg./Coolg. Permit $.............:.....�...f� $ ....................... Residential Construction Tax..................................1.... $ ....................... Misc. Fee....................................................................... 5.......... $.....�j �. Misc. Fee ............... ... tL,SD ZONING REQUIREMENTS Environmental Status: Exempt............ Other ........................................ Design Review Approval: Bldg ............. Site ............ Sign ............ Use Zone ............ P.D. Conditions............................................................ Cond. Use Permit 0............ Variance #............ Parking Spaces............ ApprovedBy ........................................................... Date ........................... a.` t rmit. rant of Easement.. ...................... f roscumen Pe ....................... G ' . Gutter, Sidewalk, Driveway: Replace.......... Repair.......... er............ Conn. Fee $........ :....... Water................ Meter $................ reement for Completion of Public Works Improvements .................. Plans Checked By........ Date........ Approved By........ Date .................... PERMIT INSTALLATION NO. EACH FEE Light Outlets............ Switches............ Legal Description: Tract..... .....1.o......... Block ....+'S.... Lot ...................... DescriRpy�on of Work: L'.._.r.C. C"...q•�Ir"-.F�'""I�"Y.�-.....-. Fixtures............ Receptacles............ Separate Structure ............ or Addition/Alteration to Exist. Bldg........... No. of Stories.............. Use 0 B�uy'Idin ....... TOTAL NUMBER (less than 1000 watts) ............ $ .50 . . ....... .. Range........ Cooking Unit........ Oven ............................ 2.00 .. .......... - Dryer ........ Garb. Disp......... Dishwasher ..................... 2.00 .............. Architect/ Designer: ... .... -- ....................................... Phone:.................... MOTORS: 1 HP or less ................................................. 2.00 .............. .. .. ... "I certify that in the performance of the work for which this permit IS Greater than 1 HP not more than 5 HP ....... ... :.... 3.50 .............. SIGNATURE OF �JJ//11yy� Temporary Power Pole or Service — 100 amp ..........5.00 .............. Contractors License Law and further that my Licena. No. .............. —.......... — 200 amp ......... 7.00 ............... Contractors License Law. (Slate basis of exemption.) TimeClock .. ...................... -.......................... ........... ........ 1.50............... building. Misc. (see Ord. current1...................................................... against liabilities, judgments, costa and expenses which may In any way acture against said City In quanta f the gr t g of this permit.", SIGNATURE OF New Residential Occupancies Flat Rate NOTE: When properly validated this form constitutes a Building Permit. This 0-500 sq. It. $22.00 1501-1750 $34.50 .............................. 120 days from validation data, or should authorized construction be suspended a 501-750 24.50 1751-20000 37.50 .............................. APPLICATION FOR PLUMBING PERMIT 761-1000 26.00 2001-225C 39.50 .............................. EACH -''FEE 1001-1250 28.60 2251-2500 42.00 .............................. Gas System with up to 5 outlets .................................$4.00• 1251-1600 32.00 . 2501-2750 49.50 .............................. Each additional outlet .................................... :........ Permit Fee...............................................$8.00 Water System (Installation, Alt. or Repair) ................. TOTAL ELECTRICAL PERMIT FEE (Plus penalty if app.*) $ Forms / Foundation ...................... ...... ..I By:................ Date:................ Plumbing Ground Work ...................... ......... ...... .Ij- ........ ................ RoughElectrical .......................... .......... .,... ......... .......... .j.... -..................... eme - Plumbing and Heating...................................1........................... latlon6 Energy ..................... ......... ................... ..... ...... -.................... Test......................................... ..........................'.......................... porary Power Gas / Elect .. ........ .........................I........................... Final- Electrical .................. .................. ......................... �...................... ..... Final - Building / Mechanical.....................................�........................... Final - Design Review / Landscaping ............................ ..................... Final- Public Works........................................................... PERMIT NUMBER • ANT TO FILL IN �j Ste• G�., STF 1 Dj>,RES.'CC..IAY�..j�.l.ozo -1.Y. ....._........................ Legal Description: Tract..... .....1.o......... Block ....+'S.... Lot ...................... DescriRpy�on of Work: L'.._.r.C. C"...q•�Ir"-.F�'""I�"Y.�-.....-. fat Struct. Improvement on Parcel: Yes.... No ... Area of Bldg ............... Separate Structure ............ or Addition/Alteration to Exist. Bldg........... No. of Stories.............. Use 0 B�uy'Idin ....... Valuation of Project: $$........ V..........OzC).. . L� a.5.....+ � .:dpi- ................ us. Lic......L1..1/ Contracto KS}o... o r.rn "...:........City Bus. Lic. aa% / Con ractO Contractor's Address: ....,. I?: .. L OS..j......... Phone9lO1-. Contractor - Electrical:..... iVh.r......S1..i..-1�.................................... City Business License #.................... Phone:.................... Plumbing: ........ ................ .......................... - ............................... City Business License #.................... Phone:.................... Heating and Cooling .... ........ -.................................................... City Business License #.................... Phone:.................... Architect/ Designer: ... .... -- ....................................... Phone:.................... Engineer: .......... ...... ......... --................................... Phone:.................... Lender:......-.................................................................... ❑ Unknown . .. .. ... "I certify that in the performance of the work for which this permit IS issued I shall not emplo ny hereon in any manner so as to become Subject to the workman's D tion law yllomia" SIGNATURE OF �JJ//11yy� APPLICANT/OWNER ...._.... .... ........ DA ......G`(... .. .. _... "I certify that as the applicant I am licensed unde- the provisions of the Contractors License Law and further that my Licena. No. .............. —.......... in Classification ....... ....... ............. ........... is In full force and effect: or ..... .. 1 certify that I am exempt from the "Licensed Required" provisions of the Contractors License Law. (Slate basis of exemption.) I hereby acknowledge that I have read this application and stale that the above Is :orrect and agree to comply with all City Ordinances and Slate Laws regulating building. I (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costa and expenses which may In any way acture against said City In quanta f the gr t g of this permit.", SIGNATURE OF APPLICANT/CONTRACTOR ._....... _... DAT �� NOTE: When properly validated this form constitutes a Building Permit. This permit expires and becomes null and void should work nol be cometenced within 120 days from validation data, or should authorized construction be suspended a abandoned for a period of 120 days after work is commenced. - ,7r, : or APPLICATION FOR PLUMBING PERMIT PERMIT INSTALLATION NO. EACH -''FEE Gas System with up to 5 outlets .................................$4.00• ............. Each additional outlet .................................... :........ .. 1.00. _......._. Water System (Installation, Alt. or Repair) ................. 4.00.............. Water Closet.... Water Heater.... Ld. Tray ..................... 4.00 ... ............. Lavatory.... Shower Pan.... Bathtub.... Sink ......... ......... .. 3.00 .............. Wash. Mach..... Dishwasher.... Garb. Disp.................... 3.00 ... ............ Sewer............................................................................... 8.00 ... .......... _. Lawn Sprinkler Sys. $5.00 Ea. add Sys.$2.00.................................. Vacuum Breakers ........................................... .......... ...3.80......:._.:. Interceptor........ Water Softener ........ ................. ........-..4.00............. Plumbing Piping without fixtures ...................................4.00.............. Mist. (See Ord. Current) .................................................... PermitFee..........................................................................$ 8.00 TOTAL PLUMBING PERMIT FEE (plus penalty If app. Cj) $ APPLICATION••HEATING/COOLING PERMIT INSTALLATION NO. EACH FEE ' Forced Air Unit .................. to 100M ...................:.........s 6.00.............. over IDOM ....................... . 10.00............. Comfort Cooling Unit...... to 3 ton/HP ........................... 8.00....:......... to 15 ton/HP ........................ 8.50 ............. to 30 ton/HP .......................... 12.00............. to 50 ton/HP"................. :........ .17.00 ............... Space Heater........ Wall Heater ........................... ........ 6.00............. Flues - other than above ..................................... ......... 3.00............. Vent Fan: Kitchen........ Bath ...........................:... ........ .. 3.00.............. Commercial Range Hood ................................... .......TI}j.. 6.00............... Misc. (See Ord. Current .............. .................................A..... ...................... PermitFee........................................................................ $ 6.00 TOTAL Htg./ Coolg. Permit Fee (plus penalty if app. p) $ 7 7