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2007 CITY OF CUPERTINO APPLICATION FOR RESIDENTIAL BUILDING PERMIT PERMIT NUMBER AND FOR APPLICANT TO FILL IN CERTIFICATE OF OCCUPANCY BUILDING INSPECTION DIVISION STREET Ag.DPESS 0§ P 0 T, .......................... DEPARTMENT USE ONLY Legal Description: Tract __Bloc ... Lot...................... Plans Received By....................................................Date ......................... Description of Work: ..................................\......... .... ....-I.........I.....................................................-..... ....... ...................... REO.: Plans.... Survey.... Cafes: Struc..... Energy.... Elect..... Mach.... 1st Struct, Improvement on Parcel: Yes.... No.... Area of Bldg............... Plans Checked By ate Separate Structure............ or Addition/Alteration to Exist. Bldg........... Application Approved 'Data No. of Stories Usq of Building .................. ............................ o*"** . ... � X. .0. . ... . ..... ............... Validated By........................v....................... Date Valuation of r $ A Compensation Certificate Verified By ................ Date ....................... Owner: Phone:..................... Contractor: $ a-Z Contractor's' of res I).. City Bus. Lic. # 14 0-6-li Add ... ... ....... ......... P In o n a: ITS Permit Fee (plus penalty if applicable) ....................... Contractor - Electrical: 5.co eoa�,a;L...................... Plan Check Fee (less deposit of$.......... Rct. #..........)$...................... City Business License Of. .... . Phone:.................... Energy Plan Check Fee (Dep. of $........ Rct. #.....-) $ Plumbing: ......................... ...... '"' Strong Motion Fee ........................ ..............$...... city Business License #.................... Phone:.................... Plumbing Permit Fee ....... ---------- Heating and Cooling ............................ ........-.............. Electrical Permit Fee .............. $ City Business Licensed....._............. Phone:.................... C, ... ... Architect/Designer: ..-..._.....-...........-....-.......... Phone:.................... Mach. Htg./Coo1g. Per .......V, .......... $...................... Engineer: . . .. ..... .......................................... .... Phone:........_.......... m# Lender: . ....... ........... .......... Unknown Residential Construction )4 -.� 71va.........$....................... Misc. Fee ....... ...... ......I_. _. 1�� ... ....... ..$...................... "I certify that in the performance of the work for which this permit [a Misc. Fee .............................................. ...........$..........._......... issued I shall not employ any person In any manner so as to become subject EMENE, to the workman's compensation laws of California."mmabm SIGNATURE OF ZONING REQUIREMENTS APPLICANT/OWNER ... .................................... .............-........ DATE........................ Environmental Status: Exempt ............ Other....................................- 'I c.ortify that as the applicant I am licensed uncle' the grg�ylontopy- Design Review Approval: Bldg. -......... Site ............ Sign .........- Contractors License Law and further that my Ulcers, ............ Use Zone ............ P.D. Conditions ............................................................ in Classification ... ................ is in full force and effect: or Cond. Use Permit A............ Variance k_.......... Parking Spaces............ - I certify that I am exempt from the "Licensed Required" provisions of the Approved By.............. ...... .. ................ Date ........................... Contractors License Law. (State basis of exemption.) .......... . .. I hereby acknowledge that I have road this application and state that the above Is correct and agree to comply with all City Ordinances and State Laws regulating (We) agree to save, indemnity and keep harmless the City of Cupertino croachment Permit........................ Grant of Easement........................ I against liabilities, judgments, costs and expenses which may In any way r1b, Gutter, Sidewalk, Driveway: Replace.......... Repair.......... occurs against said City in consequence of the gre,,ng of this permit." ewer............ Conn. Fee $................ Water................ Meter $................ SIGNATURE OF Agreement for Completion of Public Works Improvements .................. APPLICANT/CONTRACTO4VA'."//6 DATE3*-43-f Plans Checked By.......- Date........ Approved By........ Date.................... NOTE: When properly validated this form constitute* a Building Parmil. This permit expires and becomes null and void should work not be commenced within APPLICATION FOR ELECTRICAL PERMIT111111. 120 days from validation date, or should authorized construction be suspended at abandoned for a period of 120 days after work Is commenced. PERMIT INSTALLATION NO. EACH FEE APPLICATION FOR PLUMBING PERMIT UjInt Outlets...J.... S,itch,,...6. Fixtures....S.. Receptacles.../d... PERMIT INSTALLATION NO. EACH I FEE NO. its) .....28 $ .5g, jz� Gas System with up to 5 outlets ................................ - TOTAL NUMBER (less than 1000 we ...... .y Range........ Cooking Unit...._... Oven... ........ ......... ....... 2.00 .. - Each additional outlet ............................................. 1.00. ............. Dryer.../... Garb. Disp........ Dishwasher ... 2.00 Water System stallation, Alt. or Repair) ........ .. 4.00. MOTORS: I HP or less .....-...... ... ................ .. .. .... . 2.00 .. ...-...... Water ClosetA Water Fleeter.... Ld. Tray....-......./...... 4.00. Greater than I HP not more than 5 HP --........ 3.60 ....... Lavatory.... Shower Pane-Bathtub.... Sink.jt.:.... 3.00. Temporary Power Pole or Service 100 amp . .... .15.00 ............. Wash. Mach..✓Dishvvasher.... Garb. Disp..... .......I...... 3.00. 200 amp....... . 7.00 .. ............ Sewer ..................................................................I.. ....... 8.00............... Time Clock ....-............ .............. .. .................. 1.50-......... Lawn Sprinkler Sys. $5.00 Ea. add Sys. $2.00 .................. ............. Misc. (see Ord. current)...................................................... Vacuum Breakers ............................................ I.............3.50. ..........1. New Residential Occupancies Flat Rate 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) .........................................I.......... 501-750 24.60 1751-20000 37.60.............................. Permit Fee ............................................................. .............$6.00 751-1000 26.00 2001-225C 39.50.............................. TOTAL PLUMBING PERMIT FEE (plus penalty If app. 1_1) 00 1001-1250 28.60 2251-2500 42.00.............................. - CL?� 1251-1500 32.00 2601-2750 49.50.............................. APPLICATION FOR HEATING/COOLING PERMIl' PermitFee...............................................$6.00 TOTAL ELECTRICAL PERMIT FEE (Plus penalty if app.0).la�azf PERMIT INSTALLATION AO. EACH FEE Forced Air Unit............-...to 100M ............................. .$6.00............... INSPECTION RECORD over 100M ................. ........ 10.00.. ........... Comfort Cooling Unit......to 3 tort ......................... .. 6.00.............. Forms / Foundation .... .. .... ...... B at to 15 ton/HP.......................... 9.50.. ............ it� Plumbing Ground to 30 toll......................... .. 12.00. ............ Rou E to 50 ton/HP.....-....................17.00.. ............ ........... I ctrl aling .......... 7V 6.00 Work .... ......... and H Space Heater........ Wall Heater .................................. 'if on nrgy Flues - other than above ........................................... 3.00 . ........... 8 To Kitchen........ Bath .......... ..............._J_ 3.00. Vent Fan: ............ Test ...... P, or as Tiahhpttr�� ary Elect Commercial Range Hood .................................. 6.01)... ...... Final - Electrical Misc. (See Ord. Current............................. ........ .......................... - Building/ E�lhanical Final Me Permit Fee .................. ............ ...... ....................... $ 6.00 Final - Design Review / Landscaping . .. ..................... TOTAL Htg./ Coolig. Permit Fee (plus penalty If app. CJ) $ Final-P blic Works ........................................................... I -3, �, ',-(I"I�,