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1383 CITY OF CUPERTINO _PLICATION FOR RESIDENTIAL BUILDING PERMIT PERMIT NUMBER AND FOR• CERTIFICATE OF OCCUPANCY 9SIE�6EEE �1p OF OEC BUILDING INSPECTION DIVISION LU�ZyT Stevens CrEekd Sled....'...................................•....._.•.•..•. • • • Legal Description: Tract........316........ Block..23.... Lot.....026........ Description of work: Building,"Demolition............................ PlansReceived By....................................................Date ......................... ..................................................:..................................................................... REO.: Plans.... Survey.... Celcs: Strut..... Energy.... Elect..... Mech.... 1st Struct. Improvement on Parcel: Yes.... No.... Area of Bldg............... Plans Checked By................ ..... Date ................. .. Separate Structure............ or Addition/Alteration to Exist. Bldg........... Application Approved By.... .. .. Date �.". '.�.Q No. of Stories........1..... Use of Building ...vacant--dwelling - .......................... Validated B ..............................................................Date ........................ By Valuation of Protect. $........v.................. t........................ :.........�........ Compensation Certificate Verified By ................. Date ............. Owner: .Clearlake..DflVelOppment...Corp Phone:.................... $ Contractor: Central..Fire..D3B.trievity Bus. Lic. a ...N(A.. Contractor's Address: ................................................ Phone:.37.8....4401O Permit Fee (Plus penalty if applicable) Contractor - Electrical: .............................................................................. P N PP ) ..Ret..#...........$...................... City Business License #.................... Phone:.................... Plan Cheek Fee (less deposit . f ....... R to #..........)$....................... Plumbing: ........................ Energy Plan Check Fee (Dep. of $........ Ret. #........)5....................... .............................................................. Strong Motion Fee ....................................................... .$....................... City Business License +.................... Phone:.................... Plumbing Permit Fee ...... $....................... Heating and Cooling .................................................................. ........................................ City Business License #.................... Phone:.................... Electrical Permit Fee .......................................: ........... $.. ....... Architect/Desi Designer: Phone:.................... Mach. Htg./Coolg. Permit $..................... 9 .................................._............. ......... ........... Engineer: Phone:.................... Residential Construction Tax ............................. ... g .................................................................... .... ................ lender: . .. ........................................................................... [3 Unknown Misc. Fee .:................................................................. .... ....................... '•I certify that in the performance of the work for which this permit Is Misc. Fee -" --�-�-^�-��^---��-�--�-��-��---��--�� -��--��-��- 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/lIfillifQ................... ........................ . '..................... DATE........................ ...... .. Environmental Statue: Exempt............ Other.................... Design.Review Approval: Bldg. ............ Site ............ Sign ............ UseZone ......:..... P.D. Conditions ............................................................ i ._._................___.......... Cond. Use Permit 0............ Variance •............ Parking Spaces............ - - - I cenify that I am exempt from the "Licensed RequireFy,d•'ppre Drovisions of the e basis of exemptlim-7e�tt. Approved BY........................................................... Date ........................... Contractors License Law. (Stati hereby acknowledge that I have read this application and state that the a ve Ie •• • correct and agree to comply with all City Ordinances and Slate Laws regulating Luilding. ;b, n : - I (We) agree to save, indemnify and keep harmless the City of Cupertino oachment Permit........................ Grant Of Easement........................ against liabilities, judgments, costs and expo es which may In any way Gutter, Sidewalk, Driveway: Replace.......... Repair.......... acture against said City in con q nee o o granting of this permit.'•er ....... COnn. FBe $................ Water................ Meter $................ SIGNATURE OFement for Completion of Public Works Improvements ........._...... APPLICANT/ .. .. ..._. ........._... DATE�"...... Piens Checked By........ Date........ Approved By........ Date.................... NOTE: when properly velldaled thl form constitutes a Building Permll. This Permit expires and becomes null and void should work not be commenced within APPLICATIO • ILECTRIICALPERMIT 120 days from validation data, or should authorized construction be su"nded of abandoned for a period of 120 drys altar work Is commenced. PERMIT INSTALLATION NO. EACH FEE APPLICATION • , PLUMBING PERMIT Light Outlets....... Switches............ PERMIT INSTALLATION 4 EACH FEE Fixtures............ Receptacles 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, All. or Repair) ................. 4.00. ............. MOTORS: 1 HP or less ......................................... ....... . 2.00 ""."...... Water Closet.... Water Heater.... Ld. Trey..................... 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. 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. current)...................................................... Vacuum Breakers ............................................ ...3.50. ......._.-. ........... New Residential Occupancies Flat Rate Interceptor........ Water Softener........ .............................4.00. ............ Plumbing Piping without fixtures ...................................4.00............... 0-600 sq. ft. $22.00 1501-1760 $34.50.............................. Misc. (See Ord. Current) .................................................... 501-750 24.50 1751-20000 37.50.............................. Permit Fee ..........................................................................$ 5.00 76f-1000 25.00 2001-226C 39.50.............................. TOTAL PLUMBING PERMIT FEE (plus penalty if app. !]) II 1001-1250 25.50 2251-2500 42.00.............................. 1261-1500 32.00 2501-2750 49.50......................:....... APPLICATION FOR HEATING/COOLING PERMIF Permit Fee...............................................$6.00 TOTAL ELECTRICAL PERMIT FEE (Plus penalty If app.p) $ PERMIT INSTALLATION NO. EACH FEE Forced Air Unit..................to 100M ............................ .$6.00............... — • • •'r over 100M ....................... . 10.00.. ........... Comfort Cooling Unit......to 3 ton/HP ..........................1 5.00... ........... Forme / Foundation....._...._............ ... By:___ Date:..._........... to 15 ton/HP........................ 9.50.............. P mbing Ground Work _..................._ ( ._._.......... ....._...._............ to 30 ton/HP.............................12.00. h Electrical ................................... .. ............. J .................... ......................._.. to 50 ton/HP_...................... ..17.00.. e Jon and Heating 9 .......... ......................... ........................... Space Heater........ Wall Heater ................................... 8.00 .. ........... 11porary atlon & Energy.......................-....... .................................................... Flues - other than above .................... ......... .. .. 3.00.. .Test .. ................................ect........... ........................'......................."' Vent Fen: Kitchen........ Bath ....................... ... .00...Power Gas / Elect. . ............................................................ Commercial Range Hood B.OD...,,,.,.,..... .......................................... .. Final - Electrical ............................................................. ........................... Mise. )See Ord. Current............................................... ........................... Final - Building/Mechanical ............. Permit Fee $ 6.00 . ................................................. Final - Desi n Review / Landscaping ��"��'��---�'�-��-��'��-�� 9 P. 9 . .. ." �......... .... TOTAL Htg./ Coolg. Permit Fee (plus penalty If ePP• ❑) $ Final– Public Works ...........................................................