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17710 CITY OF CUPERTINO APPLICATION FOR RESIDENTIAL BUILDING '10 AND CERTIFICATE OF OCCUPANCY BUILDING INSPECTION DIVISION CITY r .11 , Orf COW,' SUPPLEMENT %, JAN PERMIT 1 :1111 milimoi�ll �� Plans Received By .......... -- ...................................... Date .. ..... - .......... - ---- REQ.: Plans.... Survey...- Cates; Struc..... Energy.... Elect..... Mach.... PlansChecked By .................................................... Date ......................... Application Approved By ..._......._.....-_i ...... .... Date ......................... ValidatedBy .................... - ........................ ............ Date ........................ Compensation Certificate Verified By ................. Date ... .... -- ............. MwLaLIL-nue zAL#Jz=x]II;t"= $ PERMIT NUMBER 7 I'll Permit Fee (plus penalty it applicable) ......................... $-24,410lo... Plan Check Fee (less deposit of $...._.... .... Rct. #..........) ...... Energy Plan Check Fee (Dep. of $........ Ret. #........) $.- ......... ,Strong Motion Fee ... ... - ... - ........................................... $.- , 5,16, Plumbing Permit Fee - ..... - ...................................... $....f Electrical Permit Fee ...................................................... $....................... Mach. Htg./Coolg. Permit $ ............................. $....................... Residential Construction Tax ........................................ $....................... Misc. Fee - ...... ................................ ........ ..... - ............ $. .. Misc. Fee ......... ...... ................................... ............ $. .... • $ 24 gn issued I shall not employ any person in any manner so as to become subject to theworkman's compensation laws of California." Environmental Status: Exempt ............ Other ........................................ APPLICANT/OWNER .............................. .... . --- .. ...................... .., DATE........................ Design Review Approval: Bldg ............. Site ............ Sign ............ Use Zone ... ... -.... P.D. Conditions ............................................................ I certify that I am exempt from the "Licensed Required" provisions of the Cord. Use Permit a............ Variance ... Parking Spaces............ ApprovedBy.... ........... ....... -. -- ... --- ..... Date ......✓t ....... ........... 7-1111: I;f@1 11 IR:I J, 14 0 k 16� encroachment Permit........._......Grant of Easement........................ 11,urb, Gutter, Sidewalk, Driveway: Replace.......... Repair... Sewer............ Conn. Fee $. ....... Water................ Meter $ ..... Agreement for Completion of Public Works Improvements 120 days from validation date, or should authorized construction be suspended or Plans Checked By........ Date........ Approved By........ Date........._....._.. PERMIT INSTALLATION -NT EACH FEE Gas System with UP to 6 Outlets ......... .... .. - - - -- ..$4.00. .............. PERMIT INSTALLATION NO EACH FEE Light Outlets........_... Switches............ Sewer................. -- ................................ ....... - .... ........ .. 8.00 . .............. Lawn Sprinkler Sys. $5.00 Ea. add Sys. $2.00 ..................... ........... VacuumBreakers ..........................................................3.50.. ......... Fixtures............ Receptacles..._........ Plumbing Piping without fixtures . .............. Misc. (See Ord. Current) ...... 601.a PermitFee .......... - .............................................................. $6.00 TOTAL NUMBER (less than 1000 watts) ..... APPLICATION FOR HEATING/COOLING PERMIT $ so .. ............ Range........ Cooking Unit........ Oven............ - ............. Comfort Cooling Unit...... to 3 ton/HP ................. ...... 6.oO .... ............ 2.00 - .......... . Dryer........ Garb. Disic ... Dishwasher ............. ..... 2.00 A........... Vent Fan: Kitchen........ Bath ...............................3.00............... MOTORS: 1 HP or less . ... ... Misc. (See Ord. Current...-........_- ........ ............ 2.00 TOTAL Htg./ Coolg. Permit Fee (plus penalty It app. E]) $ Greater than 1 HP not more than 5 HP ............... 3.50 .............. Temporary Power Pole or Service — 100 amp . . 5.00 . ..... —200 amp . 7.00 ............... Time Clock ... ... ... .... ...... .. .... ....... .. 1.50._........._. Misc. (see Ord. current ) ...................................................... New Residential occupancies Flat Rate D-500 sq. ft. $22.00 1501-1750 $34.60 .............................. 501-750 24.60 1751-20000 37.50 .............................. 751-1000 26.00 2001=225C 39.60 .............................. 1001-1250 28.60 2251-2500 42.00 .............................. 1251-1500 32,00 2501-2760 49.60 .............................. Permit Fee ...............................................$6.00 TOTAL ELECTRICAL PERMIT FEE (Plus penalty if app.0) $ Forms / Foundation ..... ....... . ..... By:. ....... ... Date:... Plumbing Ground W I.. --- --- - ......... Rough Electrical ... ....... . ... ........ ... aeillllllcame - Plumbing and Heating ....._...1...._......_.._....._4 ................... ....... -0 ;ulation & Energy...._......_._..... ..................... ........ asTest ... ... - .............. . .......... ...... . . .... . .... I Temporary Power Gas / Elect. . ........ .... ... .... ... ...... ....... Final - Electrical . ....... ................ ........ Final - Building./ Mechanical ... .......... ....... .......................... Final - Design Review / Landsc ing ............. __ . .. ... .............. Final- Public Works .......................................................... ............................................ lfw 0 e PERMIT NUMBER 7 I'll FOR APPLICANT TO FILL IN STREET ADDRESS OF PROJECT: .22605-Salerg-Avenue. .... ............. ... .. ........... - ... ... ............. Legal Description: Tract... 6551....._.. Block............ Lot..1 .................. Description of Work: Solare'perrqft - ................ -- .... -..- ...................... ........ .. .- -1 ........... ........................... list Struct. Improvement on Parcel: Yes.... No.... Area of Bldg ............... Separate Structure............ or Addition/ Alteration to Exist. Bldg.....:..... No. of Stories....._.....__ Use of Building ...... ....... .... -- ............ Valuation of Project: $..._........._...........---..._.--.........- ..................... Owner:.....--......_......_..._..._.- ................ ... - ....... ... Phone:.................... Contractor: .. BAS ..HOMES., ...INC..... .. ... city Bus. Lic, #'........_.... Contractor's Address:.._.._._.........._..........._............ Phori ................ Contractor - Electrical: - ... .................... .. .... :- ;. City Business License # .................... Phone:.................... Plumbing: .. .... .... ...... ................ ... ... ... .... ... ............................. City Business License #..........-........ Phone: .. ... - ............ Heating and Cooling ................... ---- ....... - ...... --- --- - ........... City Business License a..._........_._.. Phone: ... ................ Architect/Designer:. ................ . . ... ............ ... ....... Phone:...__.............. Engineer:._.._._ ... . .. .... ... ............ - ..... .... .............. Phone:.................... Lender: ... -- .. ........ ....... ....... ............... ... ............ —, 0 Unknown "I certify that in the ponormance of the work for which this permit is issued I shall not employ any person in any manner so as to become subject to theworkman's compensation laws of California." SIGNATURE OF APPLICANT/OWNER .............................. .... . --- .. ...................... .., DATE........................ "I certify that as the applicant I am licensed ande the provisions of the Contractors License Law and further that my Liters, No . ... ... -- .... ............ in Classification .. .... .......... .......... ......... is in full force and effect: or I certify that I am exempt from the "Licensed Required" provisions of the Contractors License Law, (State basis of exemption.) I hereby acknowledge that I nave road this application and state that the above Is 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 of Cupertino against liabilities, judgments, costs and expenses which may In any way secure against said City in consequence of the granting of this permit.'' SIGNATURE OF APPLICANT/CONTRACTOR .. ........ .......... .. - ....... DATE ............. NOTE: When properly validated this form constitutes a Building Permit. This permit expires and becomes null and void should work not be commenced wilhin 120 days from validation date, or should authorized construction be suspended or abandoned for a period of 120 days after work is commenced. APPLICATION FOR PLUMBING PERMIT PERMIT INSTALLATION -NT EACH FEE Gas System with UP to 6 Outlets ......... .... .. - - - -- ..$4.00. .............. Each additional outlet ... .... - .......................... . ...... .. i.00 . .............. Water System (Installation, Alt. or Repair) ....... ........ .. 4.00............... Water Closet.... Water Heater.... Lid. Tray ........... .. .... .. 4.00. - ........... Lavatory.'... Shower Pan.... Bathtub.... Sink ......... .. ..... .. 3.00 . .............. Wash. Mach..... Dishwasher.... Garb. Disp .......... .......... 3.00............... Sewer................. -- ................................ ....... - .... ........ .. 8.00 . .............. Lawn Sprinkler Sys. $5.00 Ea. add Sys. $2.00 ..................... ........... VacuumBreakers ..........................................................3.50.. ......... Interceptor........ Water Softener ........ 400 .......... Plumbing Piping without fixtures . .............. Misc. (See Ord. Current) ...... 601.a PermitFee .......... - .............................................................. $6.00 TOTAL PLUMBING PERMIT FEE (plus penalty if app. 0) It 10.00 APPLICATION FOR HEATING/COOLING PERMIT — PERMIT INSTALLATION T-0..'MTH--FEE Forced Air Unit......... -.......to 100M ..................... ....... $6.00-- I over 100M .... .......... ........ 10.0o.... Comfort Cooling Unit...... to 3 ton/HP ................. ...... 6.oO .... ............ to 15 ton/HP ................. .... * .. g.5o to 30 ton/HP ................. ........ 12.00.............. to 50 ton/HP................. ....... 17.00............. Space Heater........ Wall Heater ........................... ....... 6.00.,.......•.... .... . * .... ... Flues - other than above ..................................... 3.00 ............ Vent Fan: Kitchen........ Bath ...............................3.00............... Commercial Range Hood ........ J., 6.00 ... I ............ Misc. (See Ord. Current...-........_- ........ ............ Permit Fee ............ -.-- ........ ....... ........ - $ 6.00 TOTAL Htg./ Coolg. Permit Fee (plus penalty It app. E]) $