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1154 r CITY OF CUPERTINO APPLICATION FOR RESIDENTIAL BUILDING PERMIT PERMIT NUMBER (S AND FOR APPLICANT TO FILL IN CERTIFICATE OCCUPANCY BUILDING INSPECTION DIVISION EET ADDRESS FPR JEGT• .euer\s...... ..re ..Cdr.....O.a.K.................................. • • . • • e Legal Description: Tract...(p444�.q...... Block............ Lot....................... Description of Work: ........ ..... . ............ ... - Plans Received By............ . .ty. Date ..G.....6 £o.. .......... ....../�.............................. REO.: Plans.... Survey.... Calcs: Stfuc..... Energy.... Elect. .. ch.... tat Struct. Improvement on Parcel: Yes.... No... Area of Bldg............... Plans Checked By.........................s....._! ..S,Q......Date .�/.y.U.. .5:0..... Separate Structure............ or Addition/Alteration to Exist. Bldg........... Application Approved By........./ta.L../....................Date .....7 veV&.. No. of Stories................ Ua of Bklilding .................. ............................... Validated By................................................ . . . . Date ............ Valuatio f r jet : $ O ........o.. T\ rL�p S . . .... ...... .. Compensation Certificate Verified By ..�{Lr...._ Date ..'2//(,QY...... Owner: r fAl.TF) �.......OR........_. Phone:�.,5.�[Q�O r Contractor: ..l.:..C.'..Iel%A............................City Bus. Lic. * .............: • • " • $ Contractor's Address: .......... .............................. Phone:.................... Permit Fee (plus penalty if applicable) pp 00 Contractor - Electrical: .............................................................................. Plan Check Fee (less deposit of$.....�:: Rct: #...........)$.....�.[.......... City Business License #.................... Phone:.................... Plumbing: ..............................................................e:.................... Energy Plan Check Fee (Dep. of $....... Ret. #.-,_..)$................ City Business License *.................... Phone:.................... Strong Motion Fee .................................1�(...y.,_ii!.5.....�!. Heating and Cooling Plumbing Permit Fee ................................................$.......------.--------- Electrical Permit Fee .............................. . City Business License *.................... Phone:...........:........ . . .. . -S..� x...... . Architect/Designer: .................................................. Phone:.................... Mach. Htg./Cool9. Permit $............ �...�...7...f3..................... ResidentialConstruction Tax ........................................$....................... Engineer: .,.................................................................. Phone:....:............ Lender: .. ........_........_......._ ............................................. ❑ Unknown Misc. Fee ........................................................................$....................... '•1 certify that in the performance of the work for which this permit is- MISC. Fee ........................................................................ ..................... Issued I snail not employ an _ �.L[�� p y person in any manner so as to become subject • • : $/S 7• T 7to the workman's compensatio 91 California." _ SIGNATURE OF .. . "A ZONING • APPLICANTOWNER ..................... DATEl1.Flo_V. Environmental Status: Exempt............ Other........................................ 'I certify that m..I nsad 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 ......rmi .......................arks..............es........... Cord. Use Permit *,........... Variance *............ Parking Spaces............ . I codify that I en exempt from the "Licensed Required" provisions of the Approved B Cackno tam License Lew. (Stele basis li exemption.) ' PP Y........................................................... Date ........................... I hnreDY acknowledge roar I have read Ibla application and state that the above Is correct and agree to comply with all City Ordinances and State Laws regulating •' • buildinq. • I (We) agree to save, Indemnify and keep harmless the City of Cupertino i Icroachment Permit........................ Grant of Easement........................ against liabilities, judgments, costa and expenses which may in any way %) b, Gutter, Sidewalk, Driveway: Replace.......... Repair.......... acture against said City in consequ a of the granting of this permit." or............ Conn. Fee $................ Water................ Meter $................ SIGNATURE OF ��1��j�J� .1-IO greement for Completion Of Public Works Improvements .................. APPLICANT/CONTRACTOR .�.(."''"�� ........_.....�.......... DATE ........... .._. Plana Checked By........ Date........ Approved By........ Date.................... NOTE: When properly validated this Arms constilutes a Building PermR..This permit expires and becomes null and void should work not be commenced within APPLICATION • . 120 dap from validaflon data, or should authorized conslruetisn be suspended or abandoned fora period of 120 days after work is commenced. 't . . PERMIT INSTALLATION NO. EACH FEE APPLICATION • . PLUMBING PERMIT Light Outlets....(0..... Switches............ Fixtures......(&.. Receptacles............ // d..e PERMIT INSTALLATION NO. EACH FEE =_ TOTAL UMBER (less than 1000 watts) ............ $ ,50 W- Gas System with up to 5 outlets ......_...._..1..... ..:....$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 .1....... ..5.00 .............. Wash. Mach..... Dishwasher....Garb. Disp..... ............... 3.00. ............. —2( amp......... 7.00............... Sewer ............................................................................... 8.00. ......._..... Time Clock .................................................................... . 1.50............... Lawn Sprinkler Sys. $5.00 Ea. add Sys. $2.00..................... .........._. Mlsc (see Ora. current)...................................................... Vacuum Breakers ............................................ ..............3.50............ . t New Resitlenti al Occupancies Flat Rate Interceptor........ Water Softener.......: ........................._..4.00. ...._.....: . Plumbing Piping without fixtures ...................................4.00. ............. 0-600 sq. ft. $22.00 1501-1750 $34.50.............................. Misc. (See Ord, Current) .................................................... 501-750 24.50 1751-•20000 37.50.............................. Permit Fee ..........:.:..................... - '....$6.00 76f-1000 26.00 2001-2250 39.60.............................. TOTAL PLUMBING PERMIT FEE (plus penalty If app. 0) $ 1001-1250 25.50 2251-2500 42.00.............................. 1251-1600 32.00 2501-2750 49.50.............................. APPLICATION Fe• HEATING/COOLING Permit Fee...............................................$6.00 TOTAL ELECTRICAL PERMIT FEE (Plus penalty If app.p) $�a// PERMIT INSTALLATION NO. EACH FEE . Forced Air Unit..................to 10011.11 .................. . -$6.00... ..........:• INSPECTION over 100M....................... . 10.00.. ........... Comfort Cooling Unit......to 3 ton/HP ........................... 6.00... ........... Forms / Foundation..............................I By:........ ....... . Date:................ to 15 tori........................ 9.50.. ........... Plumbing Ground Work .......................I..... .........................I................. to 30Ion/HP............................12.00.. ....._.... Rough Electrical ....................................:......................... ........................... to 50 ton/HP........................ 17.00.. ........... name - Plumbing and Heating ..........I Space Heater........ Wall Heater ................................_� 6.00„ ........... f. '5latlon 8 Energy............................... ........................ Flues - other than above ............................................ 3.00.. ........... ....................... ........................... �.. S Test ............................................. ......................_........................... Vent Fan: Kitchen........ Bath ......................................... 3.00... ........... emporary Power Gas / Elect: . ............................................................ Commercial Range Hood 8.00.,,.,,.,,,.•••• Final - Electrical .................."................ ................... ....................... 9 .......................................... .. . . . . Misc. (See Ord. Current..........:.................................... ........................... Final - Building/Mechanical .................................................................. Permit Fee ....................................:.:.:................................ $ 6.00 Final - Design Review / Landscaping . ..... ................1.......................... TOTAL Htg./ Coolg. Permit Fee'(plus penaltyIt pp. D) $ Final-Public Works ...........................................................