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1291CITY OF CUPEkTINO APPLICATION FOR RESIDENTIAL BUILDING PERMIT AND AL CERTIFICATE OF OCCUPANCY BUILDING INSPECTION DIVISION r Plans Received By .................................................... Date ......................... REO.: Plans.... Survey.... Calcs: Struc..... Energy.... Elect..... Mach.... PlenaChecked By .................................................... Date ......................... Application Approved By ......................................... Date ......................... ValidatedBy .......................................................... ... Date ........................ Compensation Certificate Verified By ................. Date ......................... ••. $132,000 Permit Fee (plus penalty if applicable) ........................ $......3.35..,.0.0. Plan Check Fee (less deposit of $.......... Rct. #..........) $....................... Energy Plan Check Fee (Dep. of $........ Pet. #........) $....................... Strong Motion Fee .......................................................... $...........9...2.4.. Plumbing Permit Fee...I........ ................... _.,.............. $...... _.8.5...0.0. Electrical Permit Fee ................... ::.'......_...... $.........55.,.5.0. r Mach. Htg,/Cool9• Permit $:............................ $.........3.0...0.0. Residential Construction Tax ........ ..$...................... .............. Misc. Fee...........................:.:e.!.3.:.!...........................$....................... Misc. Fee........................................................11........... $ ....................... • $ 514.74 Environmental Status: Exempt ........... Other ........................................ Design Review Approval: Bldg ............. Site ............ Sign ............ Use Zone ............ P.D. Conditions ............... ......... ......... ........ _................. Cond. Use Permit #............ Variance #............ Parking Spaces............ ApprovedBy .......................................................... Date ........................... PUBLIC WORKS REOUIREMENTS ncroachment Permit ........................ Grant of Easement........................ Gutter, Sidewalk, Driveway: Replace.......... Repair.......... or............ Conn. Fee $................ Water................ Meter $ ................ greement for Completion of Public Works Improvements _. _............. Plans Checked By........ Date........ Approved By........ Date .................... PERMIT INSTALLATION NO. EACH IFEE Light Outlets............ Switches........... 24.50 1751-20000 37.50 .............................. Fixtures............ Receptacles............ 26.00 2001-226C ' TOTAL NUMBER (less than 1000 watts) ............ 28.60 $ .50 .. ............ Range........ Cooking Unit........ Oven ............................ 32.00 2.00 .............. 49.50............3.123........... Dryer........ Garb. Disp._...... . Dishwasher ............. ...... 2.00 ... ........... MOTORS: 1 HP or less .._..... ........................ ............... Wash. Machl.. Dishwash r.l Garb. DIED..... 1........3.... Sewer......O..c�...Q....•........................1.... 2.00 ......-...... 39 Greater than 1 HP not more than 5 HP ............... 3.50 .............. ..................... Temporary Power Pole or Service - 100 amp . .... ...._5.00 .............. Vacuum Breakers ............................................ ..............3.50.. - 200 amp......... 7.00 ............... TimeClock....................................................................... 1.50............... Misc. (see Ord. current 1 ...................................................... Plumbing Piping without fixtures .................1........1......4.00......4...0.0 in Classification ....... ............. ......... -........ is in full force and effect: or New Residential Occupancies Flat Rate 0-500 sq. ft. $22.00 1501-1760 $34.50 .............................. 501-750 24.50 1751-20000 37.50 .............................. 751-1000 26.00 2001-226C 39.50 ..........................'.... 1001-1250 28.60 2261-2600 42.00 .............................. 1251-1500 32.00 2501-2760 49.50............3.123........... Finaly PubQ.j.g ....... PermitFee...............................................$e.00 Heating and Cooling .Al...Boyer...Co................................... TOTiAL ELECTRICAL ERMIT�FEE (Plus penalty If app.Ci) $ 55 �..L 9 -.- i;2./in Forms / Foundation ..... ...... ... ...... ...._. .... 1...$4,00. Plumbing Ground Work Uf............... . Rough Electrical....................................,linE .. came - Plumbing and Heating .......... ..... atlon & Energy ................. ................ ......17.00 est.............................................. i• orary Power Gas / Elect. ._..... ..� Final - Electrical ................................... ... Final - Building / Mechanical ....................1 4.00- FinalDesign Review / Landscaping 3.00 ..... ...... Finaly PubQ.j.g ....... 4.... Heating and Cooling .Al...Boyer...Co................................... �f Wash. Machl.. Dishwash r.l Garb. DIED..... 1........3.... Sewer......O..c�...Q....•........................1.... .....:...�......................... d PERMIT NUMBER I /DZ STR T ADD SS OF PROJECT: (a.O� ........... Sad em..A Legal Description: TracL_..6551.. Description of Work: ...Single.. ........................................................................................................................ 1st Struct. Improvement on Parcel: YesX: No..f. Area of Bldg.31.2.3H .... 1...$4,00. Separate Structure_NO..... or Addition/Alteratiop to Exigt. gldg5.82G .... A..f10 No. of Stories... ..... 2..... Use of Building ... Resl�erlc:l.ai........ ......... Each additional outlet ............................................. Valuation of Project: $...132.,.00.0.......................................................... 1.00............... Owner: BAS_ Homes,...Inc.. _..._.._..................... Phone:.252t-.2.0.77 ......17.00 Contractor: BAS..Homes.,,.Inc................City Bus. Lic. 41 Contractor's Address: .20823._Stevens... Crk Phone:.252-.2.07.7 6.00 Contractor - Electrical: ....The.. Best ... Electrical .... Co.........._.. Water Closet.3 Water Heater.1 Ld. Tray..1...... City Business License #._.18.172.. Phone:.2.8.7-.2.0.4.0 4.00- Plumbing: .... .... Growl.ey ... Co .................................. ..... .......... 3.00 ..... ...... City Business License #.16641..... Phone:.24SrA24.0 4.... Heating and Cooling .Al...Boyer...Co................................... City Business License #.................... Phane:..7.9.2-.4.32 Wash. Machl.. Dishwash r.l Garb. DIED..... 1........3.... Sewer......O..c�...Q....•........................1.... Architect/ Designer: SwalloW..Bates.838-.995(Phone:.714.... 52- 39 Engineer: ..McKay ... 1...SOmps .............................. Phone:98.5.7.096.0 Lender: .Wells ...Fargo..Bank ....... ___._._................. ❑ Unknown ..................... .. "I certify that In the performance of the work for which this permit is ............. issued I shall not employ any person in any manner so as to become subject Vacuum Breakers ............................................ ..............3.50.. to the workman's compensation laws of California." eIGNATUgE OF APPLICANT/OWNER........... ...... ........... ...... ..._...... ........................ DATE....................... . .... ' I certify that as the applicant I am licensed unde the provisions of the Contractors License Law and further that my Licens. No ............................. Plumbing Piping without fixtures .................1........1......4.00......4...0.0 in Classification ....... ............. ......... -........ is in full force and effect: or .. I certify that I am exempt from the "Licensed Required" provisions of the _ Contractors License Lew, (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 Slate Laws regulating PermitFee..........................................................................$ builmng. ` I (we) agree to save, Indemnity and keep harmless the City of Cupertino against liabilities, lutlgm ts, costs and expenses which may In y way al&. ❑) $ secure against said CI n c eaquen of the granting of thip� r it SIGNATURE OF �� APPLICANT/CONTRA ._..._........... .. .. ........ DATE .._...._............. ev NOTE: When properly validated this torn constitutes a Building Permit. This \- permit expires and becomes null and void should work not be commenced within s 120 days from validation date, or should authorized construction be suspended or abandoned for a period of 120 days after work Is commenced. Gas System with up to 5 outlets...........1......... .... 1...$4,00. T � *1 .... A..f10 Or Each additional outlet ............................................. ..... 1.00............... ......17.00 Water System (Installation, Alt. or Repair) .1........I... 4.00......4...00 6.00 ' Water Closet.3 Water Heater.1 Ld. Tray..1...... .... 5.... 4.00- ..20._00 3.00 ..... ...... Lavatory.5 Shower Pan..2 Bathtub..2 Sink..... 1..10.... 4.... 3.00...3.0...0.0 Wash. Machl.. Dishwash r.l Garb. DIED..... 1........3.... Sewer......O..c�...Q....•........................1.... ....1.. 3.00. .. 8.00. .....Xq lQO ......4.,.f1.0 Lawn Sprinkler Sys. $5.00 Ea. add sys. $2.00 ..................... ............. O) If 30.00 Vacuum Breakers ............................................ ..............3.50.. ............ Interceptor........ Water Softener.....................................4.00............. Plumbing Piping without fixtures .................1........1......4.00......4...0.0 _ Miac. (See Ord. Current) ..................................................... PermitFee..........................................................................$ 6.00 TOTAL PLUMBING PERMIT FEE (plus penalty if al&. ❑) $ 85.00 horced Air Unit .................. to 100M ......... overt00M ..... Comfort Cooling Unit ...... to 3 ton/HP ..... to 15 ton/HP..... to 30 ton/HP ..... to 50 ton/HP ..... Space Heater........ Wall Heater ............... Flues - other than above .......... 2 l....... ............... Vent Fan: Kitchen...... Bath ..... f.Dry Commercial Range Hood ....................... Misc, (See Ord. Current ............................ Permit Fee ......................................... TOTAL Htg./ Coolg. Permit Fee (plus p 111�i 0 -01I. -all ... ........ -10.00 ............. .. 6.00 ............. T � *1 ........ 9.50 .............. ..... 12.00. ............. ......17.00 ............. 6.00 L ....... .............. 3.00 ..... ...... 4.... 3.00....12...0D .....:......00 .............._.. ................... $ 6.00 If app. O) If 30.00 n F�tOUTE SLI p I File No. Date Locat h� Date trfspector f t CERTIFICATE OF COMPLETION BUILDING INSPECTOR'S OFFICE CITY OF CUPERTINO / DATE �- 192/BLDG. PERMIT NO. /Z,�-�.51Lr THE BLDG. LOCA ED AT 2'_L' 60 � �� '�L`"'"^ "' OWNED BY C..' HAS BEENf�MPL I FOR USE AS (ALTERED) To i You are hereby j Owneror Tenant At No. of Wires Motor Load t Heating Load No. of Meters / 1 i No. of Add. Meters _ t O� ELECTRIC SERVICE NOTICE BUILDING INSPECTOR'S NOTICE CITY OF CUPERTINO OFFICE COPY Z 19 to Connect electrical service for �i �1�-�c•r� / �J G • " Size of Wires Voltage K: W._ ( Light_ 11 Heal_ Power_ ELECTRICAL INSPECTOR Size of Switch I 110 _New Service - 120 -Three Wire - _ //) Three Phase_ More Servic Move Meter BUILDING INSPECTOR'S OFFICE Bldg. Dept. CITY OF CUPERTINO Office Copy ❑ Backflow Device Sanitary Permit No. Sewer Connection Plumbing Permit No. �Z q I ® Plumbing Final Lot No. Owner or Tenant +✓/�S '/ y //j C "— At i Tract Date Connected 19 fVDate Final ? Z 19 ©M PLUMBING INSPECTOR CITY OF CUPERTINO OFFICE v GAS SERVICE NOTICE i ` r i 119 5 To You are hereby authorized to connect the GAS service for r Owner or Tenant At ] 1 — i New Service y i No. of Meters Reconnect No. of Add. Meters Move Service Move Meter PLUMBING INSPECTOR ! O- I