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1292CITY OF CUPERTINO APPLICATION FOR RESIDENTIAL BUILDING PERMIT AND 1 CERTIFICATE OF OCCUPANCY BUILDING INSPECTION DIVISION Plans Received By .................................................... Date ......................... FEE REO.: Plans.... Survey.... Celcs: Struc..... Energy.- Elect..... Mach.... PlansChecked BY ............... .------- .... - .... .----- -........... Date ......................... Fixtures............ Receptacles............ Application Approved By ......................................... Date ....... - ........... ..... ValidatedBY.............................................................. Date ........................ .... -...... Compensation Certificate Verified By __ ............. Date ............,............ 2.00 .. . ••. $123,000 Permit Fee (plus penalty if applicable) ..... ...... $ . 321.50 Plan Check Fee (less deposit of $ ..:-.,Rct. # ..I $.- .......... -,. ......... Energy Plan Check Fee (Dep. of $......'. $- ................... Greater than 1 HP not more than 5 His ............... StrongMotion Fee ...........................)............ ....... .......... 5.............8...61 Plumbing Permit Fee /-!Il!' f), - �.� i^r �,$....... _-,8.6,•.Q0 Electrical Permit Fee ...................................... ..........:.....$.......... 55.-50 Mach. Htg./Coolg. Permit $.........::.................. $.......... 33-00 Residential Construction Tax ................... I ...... t....d^..... $....................... Misc. Fee - ---- ........... ..................... _........................:... $....................... Misc. Fee........................................................................ $.-.................... e $ 504.61 501-750 24.60 1751-20000 37.50 .............................. 751-1000 26.00 2001-225C 39.50 .............................. Environmental Status: Exempt ........... Other ... ......... -........ ---------------- Design Review Approval: Bldg. .- ........ Site ............ Sign ............ Use Zone ............ P.D. Conditions............................................................ PermitFee...............................................$6.00 Cord. Use Permit e............ Variance e ......... ... Parking Spaces............ ApprovedBy .......................... :............. ................... Date ...... - ... - .... ....... - ncroachment Permit ........................ Grant of Easement........................ Gutter; Sidewalk, Driveway: Replace.......... Repair.......... er............ Conn. Fee $................ Water................ Meter $................ greement for Completion of Public Works Improvements .................. Plans Checked By........ Date........ Approved By........ Date .................... PERMIT INSTALLATION NO. EACH FEE Light Outlets............ Switches............ Fixtures............ Receptacles............ TOTAL NUMBER (less than 1000 watts) ............ $ ,5o .. .... -...... Range........ Cooking Unit........ Oven.. .......... ......... ....... 2.00 .. ............ Dryer........ Garb. Disp......... Dishwasher .................... 2.00 .. ........ -. MOTORS: 1 HP or less .................................... -....... .. 2.00 .............. Greater than 1 HP not more than 5 His ............... 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 Flet Rete 0-500 sq. ft. $22.00 1501-1750 . $34.50 .............................. 501-750 24.60 1751-20000 37.50 .............................. 751-1000 26.00 2001-225C 39.50 .............................. i 1001-1250 28.60 2251-2500 42.00 .............................. t 1261-1600 32.00 2501-2760 49.50...:-__ -,'...2898...... It PermitFee...............................................$6.00 M LECTRICAL P RMIT FEE (Plus penalty TOT A,� E� .a',. A T /r13/ -* If app.[]) $ " 55.50'. Forme /Foundation .................... :. D�1e......... .. •� Plumbing Ground Work ✓.E .............. Jf �.. �6L31 ,�fi1� imAork Rough Electrical ....................................... �'It'8I. ram: - Plumbing and Heating .... .. .. Let4.':L.✓ 4 anon &Ener Energy, Test.._...................................... ........ .. _............_ ... ....................... orary Power Gas / Elect ............. .. ................. ...... Final - Electrical ...................................... .. .... .-. 1..... iL Final - Building / Mechanical .............. ........... ..0 /oom. i' ... Final - Design Review / Landscaping . .........r ....................................... Final- Public Works ............ ..... ......... .............. ... ' 21 ��R PERMIT NUMBER FOR APPLICANT TO FILL IN STRE�T�Aq D E�$ OF P O ECT: c><ot(O�Jaiem Avenue ..................................................................................... Legal Description: Tract.. .... 6551....... Block ...... ..... Lot ....... 2............. Description of work: .Single ... Family ... Dwelling .................. ......._....._..._..._................................... ....... ..... ..-..............................._........ tat Struct. Improvement on Parcel: Yes.X No ... Area of Bldg ... 289.811 Separate Structure... NO... or Addition/Alteration tp Exist. Bldg..5.70.G No. of Stories....2.... _... Use of Bu'lding.......Res1(1ent.1a1............ Valuation f Pr ject: $.123, O.Ob,. Owner: BXS...F�ofnes,...Tnc. Phone:252:-ZQ77 Contractor: ..BAS...HOmes ....InC..._........_.City. Bus. Lic. #110.6.1. Contractor's Address: 208/13..S ev.en�, C.F... Phone:..25.2.-20.7 Contractor - Electrical: Best... Electrl.cal Co City Buginess Licen e e 18172._.. . .. 87-20. . Plumbing. .. TOWI ey... 0 ............................................ .................. City Business License *16641...... Phone:..24.5-..4.2.4 Heating and Cooling ... Al Boyer CO ........ . .. ........... City Business License x .................... Phone:..792-.432 Architect/ DesignerSwal loW( Bates. 838.-995.6Phone:714.... 7.5.2.- Engineer: .McKay ... 4-Somps .... .... ............... ....... Phone 98.5.-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 to the workman's compensation laws of California." SIGNATURE OF APPLICANT/OWNER............. ....... ................. ........ ...... -..... ...... ...... DATE ........................ _. "I certify that as the applicant I am licensed undethe provisions of the Contractors License Law and further that my Llcens. 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 have read this appllcatioh 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 lieblli ties, ludgme a, costa and expenses which may In a y way acture against sold CIf consequence of the grant' g of ihi rm SIGNATURE OF �y�/y p1�(}� �.,fi//U/,gyp'/, APPLICANT/CONTRACT............._....�.:_.�`^,.�...� DATE...I.w1,..4,.v NOTE: When properly validated this form constitutes a Building Permit. This permit expires and becomes null and void should work not be commenced within 120 days tram validation date, or should authorized construction be suspended or abandoned for a period of 120 days after work Is commenced. APPLICATIONe PERMIT INSTALLATION NO, EACH FEE Gas System with up to 5 outlets .......... I .............1.....$4.00. 7,. . Each additional outlet ............................................. 1.00............... Water System (Installation, Alt. or Repair) 1....... 4.00......'} QQ Water Closet4.. Water Heater.1 Ld. Tray ...... 1.....0 •2 -- 4.00. '1...8.0 Lavatory.6. Shower Peal. Bathtub3. Sink .... 1... ll... .. 3.00..33..00 Wash. M is erl. Garb. Dlsp.... I ..... ... .. 3.00.....9...00 'AWA Sewer F. ...............................1........1... .. 8.00....... ....Q. Lawn Sorinkler Sys. $5.00 Ea. add Sys.$2.00.................................. Vacuum Breakers ............................................ ..............3.50............-. Interceptor........ Water Softener...................................4.00...... Plumbing Piping without fixtures ...............1..,,, ,_i,,, ,...4.00, ..44;:00 Mist. (See Ord. Current) ................................... ................. PermitFee.............................................................. TOTAL PLUMBING PERMIT FEE (plus t If a penal Y... .f]1...$ 86 0 I APPLICATIONs•HEATING/COOLING PERMIT PERMIT INSTALLATION NO. EACH FEE Forced Air Unit..................to 100M -.................... ....$ 8.00........1.. over100M ....................... . 10.00 ............. Comfort Cooling Unit...... to 3 ton/HP ........................... 6.00.............. to 15 ton/HP ................. ........ 9.50 .............. to30 tort ........................... 12.00 .............. 1 to 50 ton/HP .......... ............... 17.00............. Space Heater........ Wall Heater .................................. 6.00............. i Flues - other than above ..................................... .......�.. 3.00.............. Vent Fan: Kitchen 1 3.00 e .....- Bath3....../Dryer...1....5...`.. .....15.-0 Commercial Range Hood ..... ......... :............................. 6.00,.. Misc. (See Ord. Current........................................�........ ........................... PermitFee....................................................................... $ 6. 01 TOTAL Htg./ Coolg. Permit Fee (plus penalty if app. E]) If 1 \ utWdL t✓fb9.sL8e5�`' U. £ �,rw. •_t �• j 1� (p-lD^8o INTS�rea,� ILl6- DZ�An�� f� 8/.41 Pile NO. Date 3 3v n /� 12 i S v LJ C 1 i�iy-•�5 A/--r�l `,Otey_© Date 1 �u�ctor CERTIFICATE OF COMPLETION BUILDING INSPECTOR'S OFFICE CITY OF CUPERTINO DATE �" 19 BLDG, PERMIT NO. THE BLDG. LOCATED AT Z L �' L C_ k-- • HAS BEEN) FOR USE AS (ALTERED) BUILDING INSPECTOR'S OFFICE Bldg. Dept. CITY OF CUPERTINO Office COPY ❑ Backflow Device - Sanitary Permit No. i gym- Sewer Connection Plumbing Permit No. It Plumbing Final Lot No. Owner or Tenant�'°"�� Tract �.� at I � f y e.�al19 Date Connected � 191L -D o 1 (/ PLUMBING INSPECTOR CITY OF CUPERTINO GAS SERVICE NOTICE To You are hereby authorized to Owner or Tenant J� At :):;�,, /�— I New Service Z -- No. of Meters Reconnect r No. of Add. Meters Move Service Move Meter PLUMBING INSPECTOR the GAS service for OFFICE COPY ,19 � (D. ELECTRIC SERVICE NOTICE OFFICE COPY BUILDING INSPECTOR'S NOTICE .. CITY OF CUPERTINO 19 CJS To Light ` You ore hereby authorized to Connect electrical service for Owner or Tenont Recon No. of Meters Heat At Wire No. of Wires r Size of Wires Size of Switch Motor Load Voltage Phase Heating Load K. W. Voltage / Light ` 110 New Service Recon No. of Meters Heat 120Three Wire More No. df Add. Meters Powerr'\ hate Phase Mov[ 1 OP • ELECTRICAL INSPECTOR //• v