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1949 - �14i OF. C11PRR�\N CITY OF CUPERTINO MA� 1319a� APPLICATION FOR RESIDENTIAL BUILDING PERMIT A10' PERMIT NUMBER AND FILL IN CERTIFICATE OF OCCUPANCY •R APPLICANT e BUILDING INSPECTION DIVISION STSEET gDQRESS OF PROJECT: 2 $/A11A7Q(Wi JuNNyu/1!E-8�. JTF.MGNS.C/ G(c Bev.0....... • • • • . Legal Description: TrBpI....................... Block............ Lot............,.T/.. Description of Work: .r!QO.OP/N"lr"-_ •f WFS�,- .Plans Received By....................................................Date ......................... .Ccry ... .AJ.—. SP........................................... ... µ---- REO.: Plane.... Survey.... Celca: Struc..... Energy.... Elect..... Mach.... 1st Struct. Improvement on Parcel:Yes.... No...Area of Bldg.f�. ...0... Plans Checked By....................................................Date ......................... Separate Structure............ or Addition/Alteration to Exist. Bldg .Application Approved B //�WSS T .......................................Date ......................... PP PP Y-" No. of Stories_ Us��gg of Byy�l'Id' .. T...y?!�!�/,!N ............. Validated By..............................................................Date ......................" Valuatio�oq of Prglgc�t: $....b.2;3;./_'. ..............................---............... Compensation Certificate Verified BY ................. Date ....._........00... Owner:ffW,,np�/{� .......�ass./...................... Phone:9.Z.r.SZ/�p • • • p�t �T Contractor:E4Gr/ .I�oDP_.... ... .. tCity Bus. Lic. .PNQiML. Contractor's Address :/J?7S..�Cn.n!.S¢AyJ!!!,t*... Phonae.7-7.,7.7.7 Permit Fee jus snail it a licable Contractor . Electrical: .............................................................................. Ip P Y pP ) ........................$...... :......... City Business License #.................... Phone:.................... Plan Check Fee peas deposit . 5.......... Rct. #..........)$....................... Plumbing: Energy Plan Check Fee (Dep. of $........ Rot. #........)$........... ............................................................... :.................... StrongMotion Fee ..........................................................$........ City Business License #.................... Phone:.................... �.... Heating and Cooling ...................................... ............................ Plumbing Permit Fee ...................."........................... ....................... City Business License #.................... Phone:.................... Electrical Permit Fee ......................................................$....................... Architect/Designer: ........-.................... Phone:......-............. Mach. Htg./Coolg. Permit $............................. $....................... ..-.................. Engineer: ..............'--'.................................:.:............. Phone:.................... Residential Construction Tax ........................................$....................... Lender: ... .........7r7............................................................ p Unknown Misc. Fee ........................................................................$....................... "' certify that In the performance of the work for which this permit Is Misc. Fee ........................................................................$.........j .... ... issued I shall not employ any person in any manner so as to become subject tp • • . • : $ 4 r to the workmanq' compens �Iiwn,.d SIGNATUR /�y/ ?��• e APPLICANT/OWNER Y`�/Y .. . ......... DATE,/ �D��... Environmental Status: Exempt............ Other........................................ "I cattily that as the applicacle the provisions of the Design Review Approval: Bldg. ............ Site ............ Sign ............ Contractors License Law and further that my Lleens. No. ............................ Use Zone ............ P.D. Conditions ............................................................ in Classification ....................................... Is In full force and effect: or Cond. Use Permit #............ Variance #............ Parking Spaces............ -"- - I cenily that I am exempt from the "Licensed Required" provisions of the Approved B Contractors License Law. (Stale basis of exemption.) PP Y........................................................... Date ...-....................... 1 hereby acknowledge that I have read this application and state that the above Is •_ • :orrect and agree to comply with all City Ordinances and Slate Laws regulating _ building. I (we) agree to save. Indemnify and keep harmless the City of Cupertino echment Permit........................ Grant Of Easement........................ against liabilities, judgments,costs and expenses which may in any way k Gutter, Sidewalk, Driveway: Replace.......... Repair.......... acture against said City in co eq a of t ran of this mit " er.........-.. Conn. Fee $................ Water................ Meter $................ SIGNATURE p9 reement for Completion Of Public Works Improvements .........__..... APPLICANT/CONTRACTOR /.-.L........for_. .. Van DATE3J/.���... Plans Checked By........ Date........ Approved By........ Date.................... NOTE: When properly validated this form eo titutes 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. PERMIT INSTALLATION NO. EACH FEE APPLICATION • , PLUMBING Light Outlets............ Switches............ Fixtures............ Receptacles............ PERMIT INSTALLATION NO. EACH FEE TOTAL NUMBER (less than 1000 watts) ............ $ .50 .."... Gas System with up to 5 outlets .................................$4.00................ Range........ Cooking Unit........ Oven............ ................ 2.00 .....--....... Each additional outlet .........................................-.. 1.00............... Dryer........ Garb. Disp......... Dishwasher ............. ....... 2.00 .............. Water System (Installation, Alt. or Repair) ................. 4.00. ............. MOTORS: 1 HP or less ......................................... ........ 2.00 " ....... Water Closet.... Water Heater.... Ld. Tray........... 4.00 .............. 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. Dlsp..... ............... 3.00................ —200 amp......... 7.00............... Sewer ............................................................................... 8.00................. Time Clock .................................................................... . 1.50---......-.... Lawn Sprinkler Sys. $5.00 Ea. add Sys, $2,00 ............. Misc. (see Ord. current 1...................................................... Vacuum Breakers ............................................ ..............3.60.............. Now Residential Occupancies Flet Rata Interceptor........ Water Softener........ .............................4.00. ............ Plumbing Piping without fixtures ...................................4.00............... 0-500 ft. $22.00 1501-1750 $34.50.............................. Misc. (See Ord. Current) .................................................... 751-1000 28.00 2001-2250 39.50............................ 501-7500 24.50 . 1751-20000 37.50.............................. Permit Fee ..........................................................................$8.00 .. 1001-1250 20.50 2251-2500 42.00.............................. TOTAL PLUMBING PERMIT FEE (plug penalty If app. Q) $ 1251-1500 32.00 2501-2750 49.50.............................. • •• HEATING/COOLING LING PERMIT Permit Fee...............................................$8.00 TOTAL ELECTRICAL PERMIT FEE (Plus penalty If app.0) $ PERMIT INSTALLATION NO. EACH FEE Forced Air Unit..................to 100M ............................ .$ 8.00... ........... • e ' ' over t OOM........................ . 10.00.. ........... Comfort Cooling Unit......to 3 ton/HP ........................... 8.00... ........... Forme / Foundation ........._......_........... By:.._.... ........ . Date:................ to 15 ton/HP......................... 9.50.............. Plumbing Ground Work . .................. I..... ................ ........................... to 30 ton/HP........................ 12.00. Rough Electrical .................................".f.. .. ............. ................................................ to 50 ton/HP...........................17.00.. ........... e - Plumbing and Heating .......... ........................ ........................... Space Heater........ Wall Heater ................................... 8.00.. ........... tion & Energy............................... .........................)........................... Flues - other than above ............................................ .. 3.00.. ............ Test .............................l Elect. .... ... .................................-.................. Vent Fan: Kitchen........ Bath ..........................."..-.......... 3.00............... porery Power Gas / Elect. ......... .........................�........................... Commercial Range Hood 8.00 ...-..................................... .. ............ Final - Electrical .............................................................. .......................... . ................. Final - Building/ Mechanical ............ Misc. (See Ord. Current.. ....... ........ .. .................................................... Permit Fee ........................................................ ............. . .. Incl - Design Review / Landscaping . ..... ........................................... TOTAL Htg./ Coolg. Permit Fee (plus penalty If app. $ Final-Public Works ...........................................................