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1768 CITY OF CUPERTINO skid ,PLICATION FOR RESIDENTIAL BUILDING PERQMCIT` ' { PERMIT NUMBER -2 6k' AND `OU` � FOR APPLICANT TO FILL IN was CERTIFICATE OF OCCUPANCY '• BUILDING INSPECTION DIVISION urOc{ SyP ....../J..v F .............. • • • • Legal Description: Tract........................ Block............ Lot...................... Description of Work: 114.Sr.R....... ......... Plane Received BY.............................."...................".Date ......................... ........................................................................................................................ REO.: Plane.... Survey.... Calcs: Strud..... Energy.... Elect..... Mach.... tat Strict. Improvement on Parcel: Yes.... No.... Area of Bldg............... Plans Checked By.............."............. Date ...... ......... Separate Structure............ or Addition/Alteration to Exist. Bldg........... ........::......Date .!li..? 1: . Application Approved By........""".." ... No. of Stories................ Use of Building ....."............ ............................... ValidatedBy........................................................""".".Date ........ ......,....... Valuation of Project: $._.............-.............................................................. Compensation Certificate Verified By "."".... ."". Date ... .Y/�/... Owner:13/J ... . 1y.��' 'y.tt.....f C.u!:...............1.... Phone:.................... • • • Contractor:/G�sSi..l C..! .. ✓` Ity Bus. Lie. • .............. • $ ontractor's Address: ?'.T..C/A PIfoney..1.7.9.7.0w Permit Fee (plus penalty if applicable) Contractor - Electrical: .....C.rdr.h/. !t�: .-..._................................... P Y pP ) ........................$....................... Plan Check Fee (less deposit of$.......... Rol. #..........)$....................... City Business License #.................... Phone:.................... Energy Plan Check Fee (Dep. of $........ Ret. IF........)$..........:............ Plumbing: ..................................................................................... Strong Motion Fee ......................"..................................5.... City Business License is.................... Phone:.................... "" ""' Heating and Cooling .................................eis ...."... e:.................... Plumbing Permit Fee ................................................$.......�.�..... City Business License #........"........... Phone:.................... Electrical Permit Fee ......................................................$----------............. Architect/Designer: Mach. Htg./Coolg. Permit $............................. $....................... ...................................__........... Phone:.................... Residential Construction Tax ........................................$....................... Engineer: ......,...................-....................................... Phone:"..............wn • Lender: . .. .......................................... ....".....,................. p Unknown " . Misc. Fee of "'""""""""""""""""""""""""""""""""""$"""""""""""' "I certify that In the performance of the work for whish this permit Is Misc. F80 ........................."...".......................................... issued I shall not employ to D Y en Y parson in any manner so as to become subject , • $ to the workman's compensation laws of California." SIGNATURE OF • • APPLICANT/OWNER ......................................................................... DATE........................ Environmental Status: Exempt............ Other....................................... .. -I certify that as the applicant I am licensed uncle- the provisions of the ' Design Review Approval: Bldg. ............ Site ............ Sign ............ Contractors License Law and f der that my Licene. No. ............................ Use Zone ...........: P.D. Conditions in Classlncanr .,3-7..i.y�. ..... Is in full force and effect: or .e is...............arki......Sp.ces............ Cond. Use Permit #............ Variance #............ Parking Spaces"........... Icertify that I�amen exempt fromStat the "Licensed Required" provisions of the Approved By. Date Contractors License Law. (Stale basis li exemption.) Y •��--��-•��-��-��-�-��-��--' ��"'-""""'-""""" i hereby acknowledge that I have read This application and state that the above is correct and agree to comply with all City Ordinances and Slate Laws regulating • s • building. I (We) agree to save, indemnify and keep harmless the City of Cupertino ` ; `roachment Permit......................". Grant of Easement........................ against liabilities, judgments,costa and expanses which may in any way Ib, Gutter, Sidewalk, Driveway: Replace.......... Repair...."..... secure against said City in a nsequenee of i e granting of this permit." `er............ Conn. Fee $....:........... Water................ Meter$................ SIGNATURE OF ((// Agreement for Completion Of Public Works Improvements .................. APPLICANT/CONTRACTOR.._ .... lv .../p f..... DATE,.�L_•,.._'.,3...�.... Plans Checked By........ Date........ Approved By........ Date.............."".... NOTE: When properly validated this form contra, • a Building PermlL 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.susp•ndsd or abandoned for a period of 120 day altar work Is commenced. PERMIT INSTALLATION NO. EACH FEE APPLICATION •. PLUMBING Light Outlets............ Switches............ PERMIT INSTALLATION W. 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. 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. Disp..... .............. 3.00............... —200 amp.l........ 7.00............... Sewer ........................."...""................................................ 8.00....:......... Time Clock ..................................................................... . 1.50............... Lawn Sprinkler Sys. $5.00 Ea. add Sys. $2.00..................... ............. Misc. (ase Ord. current)...................................................... Vacuum Breakers ............................................ ..............3.50. ............ New Residential Occupancies Flat Rate Interceptor........ Water Softener........ .............................4,00. ............ Plumbing Piping without fixtures ... . 4.00,,. D-600 sq. ft. $22.00 1501-1750 $34.50.............................. �f..."................ ... y.. Misc. (Sae Ord. Current) /.��. ..�,r 601-750 24.60 1751-20000 37.60.............................. Permit Fee ............ ...... ................................$6 00 751-1000 28.00 2001-225C 39.50.............................. TOTAL PLUMBING PERMIT FEE (plus penalty If app. D) 1001-1250 28.50 2251-2500 42.00.............................. 1251-1600 32.00 2501-2750 49.50.............................. APPLICATION F• • HEATING/COOLING Permit Fee...............................................$6.00 TOTAL ELECTRICAL PERMIT FEE (Plus penalty if app.0) $ PERMIT INSTALLATION I NO.11111 1FEE Forced Air Unit............".....to 100M ......"."".................. .$6.00... ........... • . • r over 100M ....................... . 10.00.. ........... Comfort Cooling Unit......to 3 ton/HP ........................... 6.00... ........... Forme / Foundation .......____...............I By:._..._ ..... . Date:................ to 15 ton/HP......................... 9.50.............. � .. bing Ground Work ........ _.......... i..... -......... ... ........................... to 30 ton/HP.........................t..12.00.............. h Electrical ...................... ............J......_..._............ ........."_..._...._.... to 50 ton/HP.......""...............IIYT 17.00.. ........... e - Plumbing and Heating ..........1."....................... . Space Heater........ Wall Heater ................................... 6.00.. ........... ............."............ I lation & Energy............................... ...................."....�........................... Flues - other than above ............................................1.. 3.00.. Test ........... .........".................................. .................................................... Vent fan: Kitchen........ Bath ..........................."............. 3.00."............. emporary Power Gas / Elect. . ................................. ........................... Commercial Range Hood 8.00.. Final - Electrical ................................... .......................................... .. Misc. ............ ... . (See Ord. Current.....................................................".............."...... Final - Building/ Mechanical .....P...9...............:..........L....._....- ----.... TOT Permit Fee ................................... ... ... . ....... $ B.00 Final - Design Review / Landscaping AL Htg./ Coolg. Permit Fee (plus penalty I app. p) $ Final-Public Works ...................... ,,,