Loading...
1902 M • CITY OF, CUPERTINO • r CITY OF CUPERTINO FE APPLICATION FOR RESIDENTIAL BUILDING PERMIT PERMIT NUMBER /90,?, • ANDs . APPLICANT TO FILL IN CERTIFICATE OF OCCUPANCY r • S REET D R a PROJE T:BUILDING INSPECTION DIVISION ........_� L 7 y.......................... Legal Description: Tract. .....................$lock............ Lot...................... ../` '..n.Q..d.._(........._._... ....._ Plans Received BY...................................................Date ......................... Y Description of Work: .......... ................ ..........._.....................__........................................----.................................. REO.: Plans.... 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 of Building ................. ._.......................... Validated By.................................__.........................Date ........._............. Valuation gj Project: $. _ .. Compensation Certificate Verified B ..... Date .................. G P Y ............ ....... X Owner: . .J C..�.7... ............................... Phone:.................... E��'/a20 Contractor: .y. yeq... (.�F..o.ar:� ity Bus. Lic. # .............. • • " ' Contractor's Add S:aL��._ ./t{..�!erl.N �Q'hone S.;' Z::Q.6 Permit Fee (plus penalty If applicable) O � Contractor - Electrical: .................._....................__............._................... P Y PP ) ........................$CZ................. Plan Check Fee (less deposit of$.......... Rct. #.........:)$....................... City Business License #.................... Phone:.................... Energy Plan Check Fee (Dep. of $........ Rct. #........) $--............ Plumbing: ._................._................................................................ Strong Motion Fee ..........................-..............................$.... ... City Business License #........ Phone:.................... . . Plumbing Permit Fee ................................................$...................... Heatingand Cooling ...................._......._.................................. . City Business License #............-_.... Phone:.................... Electrical Permit Fee ......................................................$...................... Architect/Designer:Mach. Htg./Cool9. Permit it $$............................. $....................... ................_................................. Phone:.................... Residential Construction Tax .... .............. $..__............._.. Engineer: .... _....._.__-. -......................................... Phone:.................... Lender: .. ._........ ._ ....... ......._-...._.......__... ...........- Unknown Misc. F00 ........._...................._........................._............$..._................ .. "I certify that in the r (f-p y any person of the work for which ethisco permit b Misc. Fee ..............................._.................._...................$....__._........... issued I shall not employ an // y person f any manner so as to become subject • $a t0 S� to the workman's compensation laws of California." SIGNATURE OF • • APPLICANT/OWNER ._____......................._...................._.'_......... DATE........................ Environmental Status: Exempt ............ Other..... ............... -t certify that as the applicant I am licensed un le. the p vyI . of the Design Review Approval: Bldg. ....-...... Site ............ Sign ............ Contractors Licensgg La�a ni, wther that my Licens, No.IrLS .r r.06..Q Use Zone ............ P.D. Conditions ................ ........................................... X in Classification ..S_-.....+5... 11 ..__.... Is in lull force and effect: or Cond. Use Permit #............ Variance #............ Parking Spaces............ I certify that I am exempt from the "Licensed Refulred'•,provisions of the Contractor, License Law. (State basis of exemption,) Approved By........._............................._........._...... Date .......................... I hereby acknowledge that I have read this application and stale that the above is correct and agree to comply with all City Ordinances and Slate Laws regulating building. • 1 (We) agree to save, indemnify and keep harmless the City of Cupertino ( r08Chm0nt Permit..................__.. Grant of Easement........ against liabilities, judgments, costs and expenses which may in any way rb, Gutter, Sidewalk, Driveway: Replace.......... Repair.......... acture against said City In consequence of the renting of this permit." Sewer............ Conn. Fee $................ Water...._........... Meter $..............- SIGNATURE of �i� / Agreement for Completion of Public Works Improvements .................. APPLICANT/CONTRACTo ...c'L............._..... .... DATE��/�//`�'7 Plans Checked By........ Date........ Approved By........ Date.................... NOTE: When properly v abs tnls lorm constitutes a Building Permll. TnIs 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 after work is commenced. PERMIT INSTALLATION NO. EACH FEE APPLICATION FOR PLUMBING PERMIT Light Outlets............ Switches............ 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 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. Disp..... ............... 3.00............... —200 amp........ . 7.00... ............ Sewer ...................._.......................................................... 8.00............... Time Clock ..............._..........._._._,.................__.'.. ......... 1.50............... 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. ............ Plumbing Piping without fixtures ...................................4.00............... 0-500 sq. ft. $22.00 1501-1750 $34.50.............................. Mist. (See Ord. Current) .......... 501-750 24.60 1751-20000 37.60.............................. .......................................... PermitFee ..........................................................................$6.00 1001-1250 28.660 0 2251-2500 42.00.............................. 751-1000 20. 2001-2250 39.50.............................. TOTAL PLUMBING PERMIT FEE (plus penalty if app. ',]) $ 1251-1500 32.00 2501-2750 49.50.............................. APPLICATION Permit Fee...............................................$8.00 TOTAL ELECTRICAL PERMIT FEE (Plus penalty if app.0) $ PERMIT INSTALLATION NO. EACH FEE Forced Air Unit.....-..........to 100M ..............................$ 6.00............... over100M ........................ . 10.00.............. Comfort Cooling Unit......to 3 ton/HP ......................... .. 6.00............... Forms / Foundation ............... By:_...... . _... . Date:................ to 15 ton/HP......................_. 9.50.............. Plumbing Ground Work . .__..__...._... . .. .._............ ......_.... ..... ...._. to 30 ton/HP......................... ..12.00.............. Rough Electrical ...................._...._........�.._._...___......... ..... ..._.............. to 50 ton/HP...........................17.00.............. g1liftme - Plumbing and Heating ..........I Space Heater........ Wall Heater ........................... ........ 6.00 .........__............ ........................... Wlotion & Energy........................._.... ........_.................._.__._..._......_._ Flues • other than above ............................._..............�.. 3.00.............. as Test .................__........lett.._._.. _ .........._...._............__............-. Vent Fan: Kitchen.._.... Bath 3.00...... Temporary Power Gas / Elect. . ........ ......_..__........... ........................- Commercial Range Hood 0.00„_ g ................................... ....... . ............ Final - Electrical .............................................................. ........................... Misc. (See Ord. Current................ ........................................................... Incl - Building/ Mechanical .......................__........... ........................... Permit Fee ...................... Final - Design Review / Landscaping . .... ........................._................ TOTAL Htg./ Coolg. Permit Fee (plus penalty if app. C)) E Final-Public Works ........................................................... Shee!:. 2 CITY OF CUPERTINO BUILDING PEP14IT Permit No: Address: 777 na �deLc Camay Date: -2-1 BUILDING PROJECT IDENTIFICATION / p � WORKERS'COMPENSATION DECLARATION Applicant's Mailing Address �yq ��.>< �.A fru-l/'�(.� I hereby affirm that I have a certificate of consent to self-insure, _� 1t- j &- or a certificate of Workers'Compensation Insurance,or a certified copy thereof (Set &W,Lb C., Address of building \/ Policy N�zKumpany S1iA�. F(�� d �`� CertifiedL n copy is hereby furnished. Owner's name 31�Lf1J' e ® Certified copy is filed with the counts, building inspection JX Telephone No. department o county _ part: tt Contractor's Name Q o �+ Date Applicant Contractor's Mailing Address Y CERTIFICATE OF XEMPTION FROM WORKERS' Lic.No..2- COMPENSATION INSURANCE (This section need not be completed if the permit is for one Architect or Engineer hundred dollars (5100) or less.) Architect's or Engineer's Address 1 certify that in the performance of the work for which this permit Lie.No. is issued,l shall not employ any person in an% manner seas to become subject to the Workers' Compensation Lawns of California. LICENSED CONTRACTORS DECLARATION DateApplicant NOTICE TO APPLICANT: If, after making this Certificate of 1 hereby affirm that 1 am licensed under provisions of Chapter 9 Exemption, you should become subject to the Workers' (commencing with Section 7000) of Division 3 of the Business and Compensation provisions of the Labor Code, you must forthwith Professions Cod and my license is in Full force and effect. _ comply with such provisions or this permit shal(be deemed revoked. License Class •� Y Lie.Number ' �+o Date a. 2*0 - Contractor CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the Performance of the work for which this permit,is issued (Sec.3097, OWNER-BUILDER DECLARATION Civ.C.).Lender's Name Lender's Address 1 hereby affirm that 1 am exempt from the Contractor's License • Law for the following reason (Sec.70315,Business and Professions 1 certify that I have read this application and state that the above Code: Any city or county which requires a permit to constructalter, information is correct. 1 agree to comply with all city and county^ improve,demolish,or repair any structure, rior to its issuance,also P requires the applicant for such permit to file a signed statement that ordinances and state laws relating to building construction, and'hereby authorize representatives of this county to enter upon the he is licensed pursuant to the provisions of the Contractor's License above-rnentioned property for inspection purposes, Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code) or that he is exempt therefrom and Sisnimre of Applicant or Agent Drte the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500).): ❑ 1,as owner of the property,or my employees with wages as "OWNER-BUILDER VERIFICATION their sole compensation,will do the work,and the structure is not intended or offered for sale (Sec. 7044, Business and Professions "Attention Property O.-ner: Code: The Contractors License Law does not apply to an owner of " s b An 'owner-builder' building permit haus applied for in property who builds or improves thereon,and who does such work your House turd bearing your signature. himself or .through his own employees, provided that such "Please complete and return this information in the envelope improvements are not intended or offered for site.If,however,the provided at your earliest opportunity to avoid unnecessary delay building or improvement is sold within one year of completion,the in processingand issuing your building perk No building permit owner-builder will have the burden of proving that he did not build will be issued until this verification is received. or improve for the purpose of sale.). I. 1 personally plan to provide the major labor and materials for construction of the proposed property improvement (yes or no) C] 1,as owner of the property,am exclusively Contracting with licensed contractors to construct the project (Sec.7044,Business and 2 1 (have/have not Professions Code: The Contractor's License Law does not apply to ) signed an application for a an owner of property who builds or improves thereon, and who building permit for the proposed work contracts for such projects with a contractor(s) licensed pursuant to S I have contracted with the following person (firm) to provide the Contractor's License Law.). the proposed construction: ❑ I am exempt under See. , B.h P.C. for this Name reason __ Address City Date Owner Phone Contractors License No. 4. 1 plan to provide portions of the work, but 1 have hired the following person to coordinate,supervise,and provide the major work- Name Address City Phone Contractors License No. 5. I will provide some of the work but I have contracted(hired) the following persons to provide the work indicated: Name Address Phone Type of Work • Signed: .Property owner Social Security number ' Date: