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1294CITY OF CUPERTINO APPLICATION FOR RESIDENTIAL BUILDING PERMIT AND EACH CERTIFICATE OF OCCUPANCY Light Outlets....:.::.:. Switches............ BUILDING INSPECTION DIVISION 751-1000 DEPARTMENT USE ONLY 2001-225C Plane Received BY .................................................... Date ......................... TOTAL NUMBER (less than 1000 watts) ............ REO.: Plane.... Survey.... Calcs: Struc..... Energy.... Elect..... Mach.... Plana Checked By .................................................... Date ....----............... 2.00 .............. Application Approved By .................................-...... Date ................. --.... ValidatedBY ................... ..... -................................... Date - ....... .............. Compensation Certificate Verified By ................. Date ......................... 2.00 -............. • • • $ 129,000 Greater than 1 HP not more than 5 HP .- ... ...... .. Permit Fee (plus penalty if applicable) .....................- $......33.0...50. Plan Check Fee (less deposit of $.......... Act. #..........) $....................... .............. Energy Plan Check Fee (Dep. of $........ Act. $....................... — 200 amp ......... _#........) -- r Strong Motion Fee ..................._.....::...........:.:..:. ..... :... $................3. Y1 Plumbing Permit Fee ...................... .....................$.........8.6...00. 1.50............... Electrical Permit Fee ._ ...............:n: .:.^..r.?. r..?".:..: :.... $.........55.,.50. Misc. (see Ord. current)...................................................... Mach. Htg./Cool9• Permit $..,, hll/U•:!,!;..!........ $..... _._.33.•.0.0. Residential Construction Tax ........................................ $ ....................... Misc. Fee .................................................'...... ......:........ $ ................. .. ........... Misc. Fee ........................................................ --............. $....................... . $ 514.03 Environmental Status: Exempt ........... Other ... ......... _...................... ... Design Review Approval: Bldg ............. Site ............ Sign ............ Use Zone ............ P.D. Conditions ... --........... --.......... .......... --- ............ Cond. Use Permit ♦.... ........ Variance •............ Perking Spaces............ ApprovedBy ........................................................... Date ........................... roachment Permit ........................ Grant of Easement ..... .- ......... ....... Gutter, Sidewalk, Driveway: Replace.......... Repair.......... er............ Conn. Fee $........ -... .. Water.: Meter $ ................ Agreement for Completion of Public Works Improvements .................. Plans Checked By........ Date........ Approved By........ Date... ...... .......... PERMIT INSTALLATION NO. EACH IFEE Light Outlets....:.::.:. Switches............ 751-1000 Fixtures............ Receptacles............ 2001-225C 39.50 .............................. TOTAL NUMBER (less than 1000 watts) ............ $ ,50 .. ............ Range........ Cooking Unit........ Oven, ........... ...... .. .... 2.00 .............. Dryer........ Garb. Disp......... Dishwasher ................... 2.00 .............. 2501-2750 MOTORS: 1 HP or less ......... ......................... ...- -... .. 2.00 -............. Greater than 1 HP not more than 5 HP .- ... ...... .. 3.50 .............. Temporary Power Pole or Service — 100 amp .........5.00 .............. PERITNJ EE Piue penalty it epp.0) $ 55.50 — 200 amp ......... 7.00 ............... Y1 TimeClock ............................... --. .................. --- ........ 1.50............... Misc. (see Ord. current)...................................................... New Residential Occupancies Flat Rate 0-600 sq. ft. $22.00 1601-1750 $34.60 501-750 24.60 1751-20000 37.60 .............................. 751-1000 26.00 2001-225C 39.50 .............................. 1001-1250 28.50 2261-2500 42.00 .............................. 1251-1500 32.00 2501-2750 49.50.........3030 ............. Permit Fee...............................................$6.00 TOTAI. ELECTRICAL PERITNJ EE Piue penalty it epp.0) $ 55.50 Y1 INSPECTION.•. Forme / Foundation ........... Plumbing Gro yLd Work .. ........... By,�.... _. jp......_......./O.�O'..In..... Datp:..� Rough ec rical ... ... • ...i�a. (... ...1 AII&a umbi 19 end H In .........T......... M11 :tion & nerg ....., Test............. ..................... .... ..�_..... porary Power Gas / Elect.... Final - Electrical Final - Building / Mechanical ..................... Final - Design Review / Landscaping ....... . Final- Publicgrka ... ...... Let.)BrL lVT69. �',L . e ......... uPPEn. �(y • 4 3-40 �a Lw.py�• �1 �-1.p�-$a .................. . PZ* -AJ PERMIT NUMBER EE�� FOR APPLICANT TO FILL IN OF PROJECT: STFjF.o1..bD ...Salem -Avenue... .................................................... LegalDescription: Tract .... -.65.5.1..... Block............ Lot...... 4 .............. Description of work: Single..Family... Dwelling ................... .....- ........................-..................................................................................... tat Struct. Improvement on Parcel: YeSX. No.... Area of BIdg.303.0kI Separate Structure..... No.. or Addition/Alteration to Exist. BldgO.3.9.G No. of Stories ..... .2........ Use of Building .._..Residential .............. Valuation of Pro'ect: $.129, 000..... ......... .................................. ............. Owner: .BAS..(�Omes.,.,-1nC ................. ..........._. Phone:.Z5.2-.Z0.77 Contractor: BAS...HOmes.,...lnc............. ._City Bus. Lic. e Contractor's Address: ..20823..Stevens ... Crk Phone:.252-2.0:7.7 Contractor - Electrical:.. The ... Best -Electrical ... CO ...... ....... City Business License «..1817.2..... Phone:.28.7-.2.040 Plumbing: ...GTo.Wley... CO., .... ..-........................................... City Business License •..1664.1..... Phone:.2.454.24.0 Heating and Cooling .... Al .... Boyer ...Co ................................ City Business License #.................... Phone:...7.9.2-.432 Architect/Designer: SwallO%VBates..838-995&hone7.14-752-.8 Engineer: Mc%. ... Fr...SOmps....__........................ Phone:.985-.0960 Lender:... Wells_ Fargo ... Bank ....... - ......... ......... .. ❑ Unknown "I certify that in the performance of the work for which this permit to issued I shell 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 uncle the provisions of the Contractors License Law and further that my Licens, 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. (Slate 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. I (We) agree to save, Indemnify and keep harmless the City of Cup Lino against liebl lit ies, ludgm nta. costa and expenses which may in ny y acture against asid C y m consequence of the granting oft r .' SIGNATURE. OF 'y/ t1�.�,�,,, •�{ APPLICANT/CONTRA O NOTE: When property validated this form constitutes a Building Permit. This permit expires and becomes null and void should work not be commenced within 120 days train validation data, or should authorized construction be suspended or abandoned for a period of 120 days alter work Is commenced. APPLICATIONe• PLUMBING PERMIT INSTALLATION NO. EACH FEE Gas System with up to 5 outlets ..............1..........1....$4.00..........0.0 Each additional outlet ............................................. 1.00............... Water System (Installation, Alt. or Repalr)l...... .... 1.... 4.00. ..... .4.,.00 Water Closet.4 Water Heaterl. Ld. Tray..1...... .... 6.... 4.00...2.4...00 Lavatory.6 Shower Pan..l Bathtub..3 Sink..l.....11-.. 3.00....33...00 Wash. Macp... Dishwas er.l Garb. Disp..... 1 .... ... .3.. .. 3.00. ..... 9.,0.0 Sewer ...LQ ./9...AO...........................1........1.... 8.00. ..... .8.,.0.0 Lawn Sprinkler Sys. $5.00 Ea. add Sys.$2.00.................................. Vacuum Breakers ............................................ ..............3.50.............. Interceptor........ Water Softener.....................................4.00............. Plumbing Piping without fixtures ....... ..........1........1......4.00.,.,,_4...0.0 Misc. (See Ord. Current) .................................................... Permitfee..........................................................................$8.00 TOTAL PLUMBING PERMIT FEE (plus penalty if app. _j) _ $6.00 APPLICATION ••HEATING/COOLING PERMIF PERMIT INSTALLATION I NO. 1111 IFEE Forced Air Unit .................. to 100M ........................2...$ 6.0o... overIOOM ....................... . 10.00....... ...... Comfort Cooling Unit ...... to 3 ton/HP ........................... 6.o0... ............ to 15 ton/HP......................... 9.50.............. to 30 ton/HP .......................... 12.00 ............. to 50 ton/HP........................... 17.00............. Space Heater........ Wall Heater .......................... ....... 9.00.............. Flues - other than above ........................ .............. .......�.. 3.00 .. ............ Vent Fan: Kitchen..l... Bath 3.../..Dryer... 1........5..`4.. 3.00....15..0.0 Commercial Range Hood..........................................1.. 6.00............... Misc. (See Ord. Current........................................................................... PermitFee .............. ............... .... --.................. --............ $ 6.00 TOTAL Htg./ Coolg. Permit Fee (plus penalty r app. ❑) $ 33.00 CAUT VA Upreft e. Mill* ciAR.SPa.G- �0•l—$0� ti�a.,,,., cL w •'u.�l.:.,,w�t�tga Fi�AnL�.I-u'8idla R61JTE SLI? File No., /) Date r F Sv.^;;ect Notes Approved Date Ir.s_ c•.or CERTIFICATE OF COMPLETION BUILDING INSPECTOR'S OFFICE CITY OF CUPERTINO �`- DATE , 19' BLDG. PERMIT NO. L L 1A, 6W 'g THE BLDG. LOCATED AT 'OWNED BY- J3hr i;' //!J✓�-'^->j �,lJC.' - HAS BEEN OMPLET FOR USE AS (ALTERED) ELECTRIC SERVICE NOTICE OFFICE COPY BUILDING INSPECTOR'S NOTICE CITY OF CUPERTINO 19 To You are hereby authorized to Connect electrical service for Owner or Tenant 64—c' � �}j t At t No. of Wires Size of Wires Size of Switch I Motor Load Voltage Heating Load K. W. Voltage / Light 110 New Service r Reconnect 4 No. of Meters Hem I20_Three Wire More Service No. of Add. Meters Power Three.Phose Move Meter � O• ELECTRICAL INSPECTOR OFFICE cr CITY OF CUPERTINO COPY / GAS SERVICE NOTICE n 19,4i i To You are hereby authorized to connect the GAS service for Oo At New Service No. of of Meters Reconnect No. of Add. Meters Move Service Move Meter PLUMBING INSPECTOR BUILDING INSPECTOR'S OFFICE Bldg, Dept. CITY OF CUPERTINO Office Copy ❑ Backflow Device Sanitary Permit No. NO Sewer Connection Plumbing Permit No. �Z Plumbing Final Lot No. ? t Owner or Tenant �� 5 / fcn P" r i o-- At2:10C 5ALFf XJi�- Tract Date Connected /L/ —1920—Date Final 190 p ` PLUMBING INSPECTOR