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1527 CITY OF CUPERTINO APPLICATION FOR RESIDENTIAL BUILDING PERMli ,�. PERMIT NUMBER jS�l AND , . APPLICANT , FILL IN CERTIFICATE OF OCCUPANCY eta, g E BUILDING INSPECTION DIVISION STRE5i ffPR SSa OF PR AVS........................................................... • • • e Legal Description: Tract........................ Block............ Lot....................-. Description of Work: ....Reroof...Res.i.dent.a.......--.................... Plena Received BY....................................................Date ......................... REO.:'Plans.... Survey.... Cates: Struc..... Energy.... Elect..... Mach.... 1st Struct. Improvement on Parcel: Yes.... No... Area of Bldg............... Plans Checked By...................... Date ......................... Separate Structure........._.seor Addition/Alteration to Exist. Bldg........... Application Approved BY........`................................. Date ......................... No. of Stories................ U 4 ofBuilding .................. ............................... Validated By........._....................._.......--..__.............Date ....... ........... Valuation of Project: $...... ,a. 1 ............................................... . . .. Compensation Certificate Verified BY -..-., .... Date ......................... Owner: k'S00 Contract.o..r. R�o Z� R.O. f..i_.ri... g.... .0PhoLniec:...0 .9..�.F..�....-.. �11' " ' $ Contractor's Address: .1.91.4....Plym0.z, thy.BPhoe......---- .�..#.....'.T...,. 9 Permit Fee (plus enact f applicable) 2 00 Contractor - Electrical: ......._......................................--...................._..... IP penalty i t o .._.._..#...........$,..3.._r......._... City Business License #._............... Phone:................... Plan Check Fee (less deposit off ....... Rct. #..........)$-.................... Plumbing: .... Energy Plan Check Fee (Dep, of ........ Rct. #.......-$....................... Strong Motion Fee ..........................................................$...........$0..-.... City Business License #.................... Phone:.................... _. Plumbing Permit Fee .............-.......'..._...................$...._............_ Heating and Cooling __......................_. .........-...................... .,, .. ... Electrical Permit Fee _....._.................._t...................._..$....................... City Business License #.... .............. Phone:........,........ Architect/Designer: .............._.....-.......... ............... Phone:.................... Mach. Htg./Coolg. Permit $............................ $....................... Engineer: . . . .. Phone:................... Residential Construction Tax ..._.._......-._-......_........:$...... Lender: _......_............_._....................._...... Misc. Fee ........................................................................$...... ...0.0....... Lender: ... .. ...... .............._............._............._........... Unknown _., "I certify that in the performance of the work for which This permit ie Misc. Fee ........ ........ issued I shall not employ an i p y y person in any manner so as to become subject p o the wo /omp satin aws of C rale." .. .... . ... . ............ q RE OF SIG AT • e J A PILIICANT/OWNER ....... /akM PAT .....•.... _....... p ............ ii�il�iAl ./� ................... �. . Environmental Status: Exempt Omer..............$...38......o....... 'I r.artily that as the etclicant l '.' nsed undo the provisions of the Design Review Approval: Bldg Site - Sign Contractors License Law and further that my Users, No. ..... . ... ... ........ . Use Zone ........ . P.D. Conditions .......................................................... . m Classification ......_.............................. is in lull farce and effect: or or Cond. Use Permit #.......-... Variance #... 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 read this application and state that the above Is correct and agree to comply with all City ordinances and State Laws regulating • ' • building. (We) agree to save, Indemnity and keep harmless the City of Cupertino �C108Chment Permit........................ Grant Of Easement........................ against liabilities, judgments, costs and expenses which may in any way ' ,:urb, Gutter, Sidewalk, Driveway: Replace.......... Repair.......... acture against said City in consequence of the granting of this permit." Sewer............ Conn. Fee $................ Water.........._... Meter $.......,.,_.... SIGNATURE OF Agreement for Completion of Public Works Improvements __.............. APPLICANT/CONTRACTOR .....................................................,. DATE ..............-........ Plans Checked By........ Date........ Approved By........ Date NOTES When properly vartdaled this form constitute, a Building Permit. This permit expires and becomes null and Vold 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 altar work Is commenced, PERMIT INSTALLATION NO. EACH FEE Light Outlets............ Switches............ APPLICATION •FOR PLUMBING Fixtures............ Receptacles.......__ PERMIT INSTALLATION NO. EACH FEE TOTAL NUMBER (less than 1000 watts) ..... ....... $ ,50 Gas System with up to 5 Outlets .................................$0.00. ............. Range........ Cooking Unit........ Oven............ ................ 2.00 .............. Each additional outlet ......-.................................... 1.00............... Dryer........ Garb. DIED......... 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.OU............... 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 Clack .................._....................._......__......... ......._ 1.50............... Lawn Sprinkler SYS. $5.00 Ea. atltl sYs. $2.00. ..............50. ............. Misc. (see Ord. current 1...................................................... Vacuum Breakers ................................�.......... ..............3.50.............. New Residential Occupancies Flat Rate Interceptor........ Water Softener........ ..... ............4,00. ............ Plumbing Piping without fixtures ...................................4.00., D-600 sq. ft. $22.00 1501-1750 $34.50.............................. "-""""" Misc. (See Ord. Current) .................................................... 501-750 24.60 1751-2260 37.50.............................. Permit Fee ........................................................... 751-1000 26.00 2001-225G 39.50.............. $8.00 """"" " 1001-1250 28.60 2251-2500 42.00.............................. TOTAL PLUMBING PERMIT FEE (plus penalty 1251-1500 32.00 2501-2750 49.50.............................. , FOR HEATING/COOLING LING PERMIT PermitFee...............................................$8.00 TOTAL ELECTRICAL PERMIT FEE (Plus penalty if app,0) $ PERMIT INSTALLATION NO. EACH FEE Forced Air Unit..................to 100M ..................... .........$6.00............... ' ' • ' ' over 100M _...................... . 10.00.. _......... Comfort Cooling Unit......to 3 ton/HP ........................... 6.00.. -......... Forms / Foundation .................._.... By:........ . ..... . Date:................ to 15 tort................. 9.50... ........... Plumbing round Work . ............... .. .. . .......... ........._.._.........__.... to 30 ton/HP................. ......... ..12.00......:....... Rough Electrical ..........._._.......__..._....i................_....... .._.............. ...... to 50 torl........................,..17.00.. rame - Plumbing and Heating """""' 9 9 .......... ......................... ........................... Space Heater........ Wall Heater ................................... 6.00 .............. cul Test'.. est 8 Energy...__..._.........._....... ......................... ................_......._ Flues - other than,above ............................................... 3.00.............. asTest'...................................... _ ._..................._.................... Vent Fan: Kitchen......_ Bath .............._................-........ 3.00............... Temporary Power Gas / Elect. . ........ ..._............_...._ ...... ................ Commercial Range Hood 6.00,.. ._.,,,,,,,, g ...................................I.......... Final - Electrical ........................._._................................ ......................_.... Misc. (See Ord. Current.........__........... .................................................... Final - Building/ Mechanical ..._ ........................................._........._..... Permit Fee $ 8,00 .................................................. if.,.............. Final - Design Review / Landscaping . .... ..............................._......_ TOTAL Htg./ Coolg. Permit Fee (plus penalty i app. ❑) $ Final-Public Works ...........................................................