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1924 ' CISY. OF, CUPER11N0 CITY OF CUPERTINO FEO 1g81 APPLICATION FOR RESIDENTIAL BUILDING PERMIT PERMIT NUMBER AND , . , FILL IN CERTIFICATE OF OCCUPANCY BUILDING INSPECTION DIVISION SIRE TfD�91 SS OF PROJECT, ... �6..T.(/........5' �tN. ......Ck.... L.✓ ...................... • . - • Legal Description: Tract.... ........... ... BI k............ Lot...................... Description of Work: .....111-.7.4-00. .. . ............................................ PiansReceived By....................................................Date ......................... ........................................................................................................................ REO.: Plans.... Survey.... Calcs: Struc..... Energy.... Elect..... Mach.... tat Struct. Improvement on Parcel:Yes.... No r!Area of Bldg............... Plans Checked BY............................ .. Date a.. .... .. Separate Structure............ or Addition/Alteration to Exist. Bldg........... .r... Application Approved By.............A.r. ,........_...Date ..�..�.'.�/..e�/..... No. of Stories................ Use of Building .................. ............................... Validated By..............................................................Date ........................ Valuation of Prpject: $. ./.SZ�.Q........................................................... Compensation Certificate Verified By ................. Date .............. ........ Owner: .(/..CfV .[ ... .P.S Phone:......3. $ �.� Contractor: .T.�j...rSl1.p!-1�/✓ . ..pity Bus. Lic. • ..s"Z Y MIT " • Contractor's Address: a/dy ...Sx�1/CKt ✓6. PhoneSS-S .Y.o Contractor - Electrical. ......... ................................................................ Permit Fee (plus penalty if applicable) .. 'd.......s...I.-4............ City Business License e.................... Phone:.................... Plan Check Fee (less deposit of$.......... Rct. #..........)$....................... Energy Plan Check Fee (Dep. of$........ Ret. #........)$............... .. Plumbing: ...................................,.] ^.C............... :.................... Strong Motion Fee ..........................................................$..........a.�.. City Business License a.. Q..... ..... Phone:.................... PlumbingPermit Fee $....................... Healing and Cooling .............. ................. hone:.................... ................................................ City Business License �'.................... Phone:.................... Electrical Permit Fee ......................................................$....................... Architect/Designer: ..... ....... .. Phone:.................... .......................Mach. Htg./Coolg. Permit $............................. $ Engineer: ...... .......... ...:......... Phone:.................... Residential Construction Tax ........................................$....................... Lender: . .. ........ .................... . . .......................................... E] Unknown . Misc. Fee ........................................................................$........./.... Misc. Fee $ N 0-� -- "I coolly that in the performance al the work far which this permit Is ------- ---- ------- --- - -- - --- -------- ........ --•----- issued I$hall not employ any person in an manner so as to become subject $ %,sem y I to the workman's camP�fsedan lawn of Celllolnia." • SIGNATURE OF • • APPLICANT/OWNER . ... .. ..... ...... ............. GATE...... .....J Environmental Status: Exempt............ Other........................................ 'I certify that as the applicant I am licensed unde' the provisions of the Design Review Approval: Bldg. ............ Site ............ Sign ............ contractors License Law and further that my Licens, No. ............................ Use Zone ........... P.D. Conditions .......................................... m Classification ....................................... is In full force and effect: or ........... Cord. Use Permit Of............ Variance M............ Parking Spacesccs............ I certify that I am exempt from the "Licensed Required" provisions of the Approved By.......................................................... Date ........................... Contractors License Law. (State basis of exemption.) i horcby 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. Cewer rI (we) agree to save, indemnify and keep harmless the City of Cupertino roaChment 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 inrisseeggquuenceeoofthee grrantiing of thispermit."............ Conn. Fee $................ Water................ Meter $................ SIGNATURE of Agreement for Completion Of Public Works Improvements .................. APPLICANT/CONTRACTOR ... .................. DATE . ... p . Plans Checked By........ Date........ Approved By........ Date.................... NOTE: When Properly validated this form constitutes a Building Permit. This permit expires and becomes null and void should work not be commenced within APPLICATION ,- ELECTRICAL PERMIT120 days from validation date, or should authorised construction be suspended or abandoned for a period of 120 drys after work Is commenced. PERMIT INSTALLATION NO. EACH FEE APPLICATION FOR Light Outlets............ Switches.........­ Fixtures............ ..Fixtures............ Receptacles............ PERMIT INSTALLATION NO. FJ1CH 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 .,I............ Wash.Mach..... Dishwasher....Garb. Disp..... ............... 3.00. ............. —200 amp. 7.00............... Sewer ..........................._.................................................. 6.00............... 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............... 0-500 sq. It. $22.00 1501-1750 $34.50...................•„•••..••• Misc. (See Ord. Current) .................................................... 501-750 24.50 1751-20000 37.50.............................. Permit Fee ..........................................................................$ 6.00 751-1000 26.00 2001-2250 39.50.............................. TOTAL PLUMBING PERMIT FEE (plus penalty if app. ']) $ 1001-1250 28.50 2251-2500 42.00.............................. 1261-1500 32.00 2501-2750 49.50.............................. APPLICATION e Permit Fee...............................................$6.00 TOTAL ELECTRICAL PERMIT FEE (Plus penalty If app.Cp $ PERMIT INSTALLATION i NO. EACH FEE Forced Air Unit..................to 100M ..............................$8.00............... • • • r over 100M ....................... . 10.00.. ........... Comfort Cooling Unit......to 3 ton/HP ........................... 6.00... ........... Forms / Foundation._........................._I By:........ ..._.. . Date:................ to 15 ton/HP........................ 9.50.............. Plumbing Ground Work . .._........._..... I..... .............................____...... to 30 ton/HP...........................12.00. h Electrical ___......... ........... 9 .... ............_...._. ..............._...._.... to 50 fon/HP.........................�..17.00.. ........... -�Plumbing and Hearin ...... ................. ........................ 8.00 . e P g a 9 ... ........ Space Heater........ Wall Heater ...................................I nation & Energy..... .......................... .........................t.......................... Flues - other than above ............................................1'. 6.003.00.. ........... asTest ..............._ ............_............ .I .............._.._...'......................_.. Commercial Range Hood ..._............................. ............... Temporary Power Gas / Elect. . ........ ........................I.........._............... Vent Fan: Kitchen........ Bath _....................................`....3.00............... Final - Electrical ................................... ........................ ........................... fl Misc. (See Ord. Current............................................... Final - Building/Mechanical .............. .......................I........................... Permit Fee .. ............................................. $ 6.00 Final - Design Review / Landscaping TOTAL Htg./ Coolg. Permit Fee (plus penalty if e Final-Public Works ...........................................................