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1264 • • CITY OF CUPERTINO PPLICATION FOR RESIDENTIAL BUILDING PERMIT PERMIT NUMBER � (o • AND FOR APPLICANT TO FILL IN CERTIFICATE OF OCCUPANCY BUILDING INSPECTION DIVISION ST Z ADD SS OF P O ECT: a • Legal Description: Tract........... Block............ Lot....!......... Plans Received By Description of Work: �46G (.CSL.._4L1.�...rte. ........................... y....................................................Date ......................... REQ.: Plans.... Survey.... Celcs: Struc..... Energy.... Elect..... Mach.... 1st Struct. Improvement on Parcel: Yes.... No.... Area of Bldg............... Plans Checked By e..By......................L................Date ....G...... Separate Structure............ or Addition/Alteration to Exist. Bldg........... Application Approved By............14,...................... Date ...v0`3../r .... _ No. of Stories................ Use of Building .................. ............................... Validated By ........................................Date ..._................... .Valuation of Project: $.................................................... .............._........ Compensation Certificate Verified By ................. Date ........... Owner: ....... ...... ..... .. Phones..... ConlractorZA.- W_ , k`hCit.. Bus. Lic. 7yd.. a • • • - • $ -. -^ CU:O:TNO Contractor's Address: ........._.................. . .... Phone:.................... Permit Fee (plus penaltyf applicable) Contractor - Electrical: .SP /(1. ,40 /ri... ........ 1 Plan Check Fee (less deposit of $......_.. Rct. #:-.i.l.r)'$A_.I�}ti{i City Business License #......_............ Phone:.Zg931.t Energy Plan Check Fee (Dep. of $........ Rct. f#�.''.)$.............._...... Plumbing: ......._.................._......__............................................... !1 Strong Motion Fee ..........................................................$.....-................ City Business License #.................... Phone:.................... lb f) f II �) Heating and Cooling ................................. ...... �U Plumbing Permit'Fee ................................................$..........,F ... City Business License #.................... Phone:.................... Mach.car Permit Fee ..............it $ ...................................._..$..S.......ort? Architect/Designer: r Mach. Htg./Cool9. Permit $............................. $...................... .................................................. Phone:.................... Residential Construction Tax .........:..............................$....................... .................................................................... :.... . Phone ............ Engineer: Mise. Fee .................. ❑ Unknown MISC. Fee .............. .__._...._............ $ Lender:I certify that in the performance of the work for which this permit Is _..................._................................... issued I shall not emto ♦ p y any person in any manner so as to become subject P o the workman's a pensation law /C i(ome." SIGNATURE OF //t:A ('f' t! ............ ............ NT/OWNER/�tJA / J DATE.jJ . 7�.. Environmental Status: Exempt ............ Other................_.... 'I cmtily that as the applicant I am licensed end, the pro 1 s f Ina • - • - APPLICA Design Review Approval: Bldg. Site Sign ............ Contractors License La a d further that my Ulcers, No. . /J��7 ,. Use Zone .........._ P.D. Conditions ..................................r.._...............__.. m Clnssilicalion ......... /7�............... is in full force end effect; 5r � Cord. Use Permit #............ Variance #............ Parking Spaces...... I ced7fy mat I am exempt from the "Licensed Required" provisions of the Approved By..... Date Contractors License Law, (Slate basis of exemption.) \I .................-"—"""""'""""""""""" """""' """"""""""""'"""""""'"""""' I hereby acknowledge that I have read this application and state that the above Is i� correct and agree to comply with all City Ordinances and State Laws regulating • building. I (We) agree to save, indemnify and keep harmless the City bf Cupertino A �roachment Permit........................ Grant of Easement........................ against liabilities, judgments, costs and expenses which may In any way fb, Gutter, Sidewalk, Driveway: Replace.......... Repair.....__. acture against said City in nsequenca t acting of thiiL" �— ' er............ Conn. Fee $......___.... Water.._........... Meter $.......... SIGNATURE OF g eement for Completion of Public Works Improvements ......._..__... APPl.ICA NT/COproperly TRRACT OR ,,. TE15�._, Plans Checked By........ Date........ Approved By........ Date.................... NOTES When ro erl validated this form constitutes a Building This permit expires and becomes null and void should work not,be commenced within APPLICATION • 120 days train validation date, or should authorized consirCcllon be suspended or abandoned for a period of 120 days eller work is commenced. EA PERMIT INSTALLATION NO. CH FEE Light Outlets........_... Switches APPLICATION PLUMBING 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 ............a Water System (Installation, Alt. or Repair) ................. 4.00............... MOTORS: 1 HP or less ..........................___....... ....... . 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. Dep..... _... .......... 3.00, —200 amp. ....... . 7.00_............ Sewer ........:....................... ......... .................................... 8.00. .............. . Time Clock ..............._........_.____._.............................. . 1.50............... Lawn Sprinkler Sys. $5.00 Ea. add Sys. $2.00..................... ............. Misc. (Sao Ord. current .... Vacuum Breakers ................................ .. .........;..3.50.............. New Residential Occupancies Flat Rat ............e Interceptor........ Water Softener........ ................4.00. ............ 0-500 Plumbing Piping without fixtures .................... .. . ............4.00..........:... 501-7500 it. 24. . ...$22.660 1501-1750 $34.50...........................0 1751- Misc. (See Ord. Current) .......... 20000 37.50.......................... ..............:........................... 751-1000 26.00 2001-225C 39.50................................. Permit Fee ..........................................................................$ 6.00 ' 1001-1250 28.50 2251-2500 42.00.......................... TOTAL PLUMBING PERMIT FEE (plus penalty if app. C)) $ 1251-1500 32.00 2501-2750 49.50.o.. . . • • . HEATING/COOLING PERMIT PermitFee...............................................$6.00 TOTAL ELECTRICAL PERMIT FEE (Plus penalty if app.p)., ,J-O PERMIT INSTALLATION 11NO. EACH FEE Forced Air Unit..................to 100M INSPECTION over 100M ........................ . 10.00.. ........... Comfort Cooling Unit......to 3 ton/HP ........................... 6.00............... Forms / Foundation .._............._........... By:.._.... ........ . Date:................ to 15 torl......................... 9.50.............. Plumbing Ground Work .,......... \ ............ ..... . ............. ...._................."... to 30 ton/HP......................... ..12.00. ............ tgh Electrical .._..............._............... ....... ._.............. .......................... to 50 ton/HP......................... .. 17.00.. .._....... he - Plumbing and Heating _._.....L....._.._........."' 6.00 _....._............. Space Heeter...__. Wall Heater ................_................ IW .. ............ /!Test 8 Energy-,................._........ ...._.._..................._._................_ Flues - other than above ......_._..................._.............I. 3.00.. ............ Test ............_..__........._.._ .... ... ...................... . '................... "." Vent Fan: Kitchen........ Bath ............................... ........ 3.00... Temporary Power G s / EI ct. . ........ ..._. _.'..._. ` Commercial Range Hood 6.00. g ............................ ....... Final - Electrical ........................ ........ ct cel .. ... _..�y�/p/. 1......._.................. Misc. (See Ord. Current...... . ..... . ............................ .....................$ 6......... Ina - Building/ chs Lan ..........g .__...___......... ..__._................. Permit Fee .................... .. B.00 Final - Design Review / landscaping . . ............._ ...................... TOTAL Htg./ Coolg. Permit Fee (plus penalty if app. ❑) $ Final- Public Works ...........................................................