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2074 CITY OF CUPERTI NO CITY OF CUPERTINO ADMICATION FOR RESIDENTIAL BUILDING PERMIXPR Al 1981 PERMIT NUMBER 20 7 AND FOR APPLICANT TO FILL IN CERTIFICATE OF OCCUPANCY BUILDING INSPECTION DIVISION IPA EI It Y.RES F PR&ECT: . ............... Legal Description: Tract.............:.......... Block.......`../... Lot...................... Work .../.... Description of Wor ....... ans Received By." ......Date ......................... x. ­*...***. ...........*****'*............. .... ............... k ...... ... ...... IEO.: Plans.... Survey.... Calca: Struc..... Energy.... Elect..... Mach.... list Struct. Improvement off Parcel:Yes.... No.... Area of Bldg............... ,lane Chocked BY....................................................Date ......................... Separate Structure............ or Addition/Alteration to Exist. Bldg........... ,pplicalion Approved By.........................................Date ......................... No. of Stories................ Use of Building .................. ............................... alidated By..............................................................Date ........................ Valuation of Project: ­.d.a.it_ �...ii. ........................ *...... 6mpensation Certificate Verified By ................. Date ........................ Owns Z�Phone:..... ......... Contractor: P C 0 Contr -At I y BUS. Lic1l.5.11, Contractor'sPhone 'ermit Fee (plus penalty It applicable) .......... .$.................:..... Contractor - Electrical: ..................................... .................................... -Ian Check Fee (less deposit of$.......... Rct. $....................... City Business License •.................... Phone:......... ........... anergy Plan Check Fee (Dep. of $........ Rcl. #.......)$....................... Plumbing: .......... �:- .. .. ..Phone:.................... ................. 7 . . E. Itrong Motion Fee .......................................................... City Business License c_.Heating and Cooling • lumbing Permit Fee ................................................ f ..... .......... City Business License #_ ............ Phone:.................... 'lectrical Permit Fee .......................I..............................$...................... Architect/Designer: ..................... ............ ............. Phone:.................... tech. Htg./CooIg. Permit $............................. $............... Engineer: .......... ................. ....__..................._........ Phone:.................... lesidential Construction Tax ........................................$....................... Lender: . .. _......................_................................................ E] Unknown Use. Fee ........................................................................$....................... "I certify that in the performance of the work for which this Permit 15 Ilse. Fee......................................................................_$....................... issued I shall not employ any personIn any manner so as to become subject $ to the workman's compensation laws of California." SIGNATURE OF APL ANT/OWNER ..._........_...........__....................................... DATE........................ .nvironmental Status: Exempt............. Other........................................ -I certify that as the applicant I am licensed unde- the I )eAsIgn Review Approval: Bldg. .:.......... Site ............ Sign ............ contractors License aw_gt further that my Licens, Noil.27121.116. Ise Zone:........... P.D. Conditions ............................................................ in Classification ...L+ ,� P.............. is in full force and effect: or ',end. Use Permit e............ Variance y............ Parking Spaces............ I certify that I am exempt from the "Licensed Required" previsions of the Contractors License Law. (State basis of exemption.) ,pproved By.............................................:............. Date ........................... I hereby acknowledge that I have read this application and state that the above Is 4'.• V ! correct and agree to comply with all City Ordinances and State Laws regulating ....... building. 0 I (we)agree to save, indemnify and keep harmless the City of Cupertino iNhAtil Permit........................ Grant of Easement........................ against liabilities, judgments,costs and expanses which may In any way aHer, Sidewalk, Driveway: Replace.......... Repair.......... acture against said City In consequence of the granting of this permit," ie%W........ Conn. Fee $................ Water................ Meter $................ SIGNATURE OF agreement for Completion of Public Works Improvements .................. TOFI�� by, APPLICANT/CONTRALTO ......j,,d DATE C/.-/..-W_ 'lana Checked By........ Date........ Approved By........ Date.................... NOTE- When properly va tied this form utess a Building Permit. This null and said permit expires and become null and void should work not be commenced within 12n day. Ironn lefidallon daft, or should authorized construction be suspended or abandoned for a period of 120 days alter work Is commenced. PERMIT INSTALLATION - NO. EACH FEE APPLICATION FOR PLUM13ING PERMIT ight Outlets............ Switches............ isiturefil......... Receptacles............ PERMIT INSTALLATION NO. EACH I FE TOTAL NUMBER (less than 1000 watts) ........... $ .50 ...... Gas System with up to 5 outlets .................................$4.00. _............ ;ange........ Cooking Unit........ Oven............ ............... 2.00 .............. Each additional outlet ............................................. 1.00............... wryer........ Garb. Disp......... Dishwasher ............ ...... 2.00 .............. Water System (Installation, Alt. or Repair) ...... .... 4.00.'A"';--00 iOTORS: 1 HP or less ......................................... _... . 2.00 .............. Water Closet.... Water Heater./. Ld. Tray..................... ­_ ./.......I Greater than I HP not more than 5 HP ............. 3.50 .............. Lavatory.... Shower Pan.... Bathtub.... Sink........ ......... 3.00............... emporary Power Pole or Service 100 amp . _... 5.00 ............ Wash. Mach..... Dishwasher....Garb. Disp..... ..... ......... 3.00............... 200 amp........ . 7.00.............­ Sewer .................................................................... ......... 8.00............... *ime Clock ........................_........_.............. ................ 1.50... ............ Lawn Sprinkler Sys. $5.00 Ea. add Sys. $2.00 ................... .............. life. (see Ord. current)..........................i...................... Vacuum Breakers ............................................ .. ...........3.50........._.- Jew Residential occupancies Flat Rate Interceptor........ Water Softener........ ................. ...........4.00.............. Plumbing Piping without fixtures .......................I........I....4.00.1.............. -500 sq. ft. $22.00 1501-1750 $34.50.............................. Misc. (See Ord. Current) .................................................... 01-750 24.60 1751-.20000 37.50.............................. Permit Fee .............................................. 51-11000 26.00 2001-225C 39.50.............................. I TOTAL PLUMBING PERMIT FEE (plus pena­iw.fi-�i;f�.--��i*119?o 001-1250 28.50 2251-2500 42.00.............................. 261-1600 32.00 2501-2750 49.50.............................. APPLICATION FOR HEATING/COOLING PERMIf Permit Fee...............................................$6.00 . - OTAL ELECTRICAL PERMIT FEE (Plus penalty It app.0) $ PERMIT INSTALLATION ff0EACH FEE Forced Air Unit..................to 100M ............................ .$6.00... ........... over 100M ....................__ 10.00.. ........... Comfort Cooling Unit......to 3 ton/HP ......................... .. 6.00............... orms / Foundation ........ ..... .... BY:........ . ..... . Date:..._.......... to 15 ton/HP........................1 9.50.............. lumbing Ground Work ................... i..... ................ ................ ...... to 30 ton/HP........................ ..12.00............... ol"Iectrical ...I.........­­.... .... .......1. ..... .... ................... to 50 ton/HP............................17.00_............ lumbing and Heating .... ................ Space Heater........ Wall Heater 6.00_............ a P rl .............. 3.00.............. ,i n & Energy...............................I... ........ ........ ........ Flues - other than above ..................................... a t ......................... ... Vent Fan: Kitchen........ Bath .............. 3.00. ............ incl - Electrical .... ,mf S'� E'eciv ...... .... 6.00 at am ary Power Ga ................ Commercial Range Hood ........... ...... ........................ ..................... Misc. (See Ord. Current Current........................................ ............ inal - Building/M, .......... ........... Permit Fee ....................................................................... $ 6.00 !net - Design ReviewTOTAL Htg./ Coo1g. Permit Fee (plus penalty if app. [1) It inal- Public Works ...........................................................