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1356 CITY OF CUPERTINO PPLICATION FOR RESIDENTIAL BUILDING PERMIT PERMIT NUMBERI 13.s ,6 AND FOR APPLICANT TO FILL IN CERTIFICATE OF OCCUPANCY BUILDING INSPECTION DIVISION STREET PR ECT: ..................................... ...jQqqESS Ot -t ......... 1Q.: .. Legal Description: Tract........................ BID ............ Lot...................... Description of Work: - ..................... .. ....... ................................ Plena Received By....................................................Date ......................... Sit 0 ................................................(. SEN........ .... .....n n......_.................... REO.: Plans.... Survey.... CaIcs: Strue..... nergy.... Elect..... Mach.... tat Struct. Improvement on Parcel: Yes.... No... Area of Bldg............... Plans Chocked B ..... late ......................... Separate Structure............ or Addition/Alteration to Exist. Bldg........... Application Approyv-e...d-By. Date ...... No. of Stories................ Use of Building ........ ...................................... Validated By..............................................................Date ........................ Valu ' of Rr ct: $ : in ...... Phone Certificate Verified By ................. Date ....................... Own Contractor: .................... ......................City Bus. Lic. •'.............. Contractor's Address: ................................................ Phone:.................... Permit Fee (Pius penalty if applicable) ........................s... Contractor - Electrical: ............................................................................. Plan Check Fee (less deposit of$.......... Rot. #..........I$.-.................... City Business License #.................... Phone:.................... Energy Plan Check Fee (Dep. of $....... Rot. #........)$................ Plumbing: ...................................................................................... s (A' City Business License ............ .... one:.................... Strong Motion Fee .......................................................... 7.0 Heating and Cooling ........ .................................................. Plumbing Permit Fee ..........................-...................$.. ................. City Business License 0.................... Phone:.................... Electrical Permit Fee ......................................................$....................... Architect/Designer: ................................................. Phone:.................... Mach. Htg./Cootg. Permit $............................. $....................... Engineer: .........................--.................................... Phone:.................... Residential Construction Tax ........................................$....................... Lender: . .. .. ..................................................................... ❑.. [:] Unknown Misc. Fee ........................................................ $....... I certify that In the performance of the work for which this permit Is Misc. Fee ........................................................A.W-$ issued A1111 note oqny persona as to become subject I a %A$ to the w4l�k SIGNATURE OF NER 9) qqf. APPLICANT/OWNER ... ..... DATE....!-............... Environmental Status: Exempt............ Other........................................ --I ceruty that as the applicant I am licensed unde the provisions of the Design Review Approval: Bldg. ............ Site ............ Sign ............ Contractors License Low and further that my Licens, No. .............._.._....... Use Zone ............ P.D. Conditions ..........................................:................. in Classification ..........-----.................. is in full force and effect: or Cord. Use Permit r,,,,,.,-,,,, Variance #............ Parking Spaces............ I certify that I am exempt from the 'Licensed Required" previsions of the Approved By....................... Contractors License Law. (State basis of exemption,) .................................. Date ........................... I horeby acknowledge that I have mad this application and state that the above Is -31111- correct 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 oachment Permit........................ Grant of Easement........................ against liabilities, judgments,costs and expenses which may In any way b, Gutter, Sidewalk, Driveway: Replace.......... Repair.......... secure against said City In Consequence of the granting of this permit." or........... Conn. Fee $................ Water-............... Meter $................ SIGNATURE OF Agreement for Completion of Public Works Improvements .................. APPLICANT/CONTRACTOR ........................................................... DATE ........................ Plans Checked By........ Date........ Approved By........ Date.................... NOTE: When property validated this form constitutes a Building Porvidt. This permit expires and becomes null and void should work not be commenced within "od" h0cmr 'Odation date, or should authorized construction be suspended or Ib..d.ns.d fsp.riad of 120 days after work is commenced. PERMIT INSTALLATION NO. EACH EEE APPLICATION FOR PLUMBING PERMIT Light Outlets............ Switches............ Fixtures............ Receptacles............ PERMIT INSTALLATION NCTMVr FE 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: I HP or less ...................................-.. ...... . 2.00 ...........- Water Closet.... Water Heater.... Ld. Tray..................... 4.00-.............. Greater than I HIP not more than 5 HIP ..........- . 3.50 .............. Lavatory.... Shower Pan.... Bathtub.... Sink................... 3.00............... Temporary Power Pole or Service - 100 amp . . .... ..5.00 .............. Wash. Mach..... Dishwasher.... Garb. Disp.... ............... 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. .... Vacuum Breakers ............................................Residential Interceptor........ Water Softener.... 0. ............ D-500 sq. It. $22.00 1501-1750 $34.50...........................a.. Plumbing Piping without fixtures ...................................4.00............... Misc. (See Ord. Current) .................................................... 501-750 24.60 1751-20000 37.50.............................. Permit Fee ..........................................-...........................$6.00 761-1000 26.00 2001-2250 39.80.............................. TOTAL PLUMBING PERMIT FEE (plus penalty If app. :]) III 1001-1250 28.50 2251-2500 42.00.......................;...... 1251-1600 32.00 2501-2750 49.50.............................. APPLICATION FOR HEATING/COOLING PERMIC Permit Fee...............................................$6.00 TOTAL ELECTRICAL PERMIT FEE (Plus penalty If app.0) $ PERMIT INSTALLATION INO.IEACH IFEE Forced Air Unit..................to 1100M ............ .........-- -$6.00.............. NMMMXMP� over 100M ....................... 10.00.............. Comfort Cooling Unit......to 3 ton/HP 6.00... ........... Forms / Foundation .......-....... By:........ -.... . Date:................ to 15 ton/HP O .. .. Plumbing Ground Work ....................... .. ................ ........-......... ....... to 30 ton/HP... 0. ............ -:::J:�":0 "h Electrical ......--.............-......... ... . ........... ................................. to50ton/HP 7 0:............. Plumbing and Heating .... ................. Space Heater........ Wall Heater 6.00.............. teflon & Energy ................... ................. Flues - other then above ........... ........... 3.00.. ............ Test ..............Gas aci� Vent Fan: Kitchen...._.. Bath ..................... 3.00............... .-....... ............. ........... 6 morary Power ........... ....... .........-................ Commercial Range Hood ....................... :� 00 ........ Final - Electrical ........................ ......I.................... Misc. (See Ord. Current..................... .................... ...........j............ Final - Building/ ........................................ .................. Permit Fee ....................................................................- $ 6.00 Final - Design Re ............ TOTAL Htg./ Coolg. Permit Fee (plus penalty If app. E]) $ Final-Public Works ...........................................................