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1696 CITY OF CUPERTINO I_ PPLICATION FOR RESIDENTIAL BUILDING PERMIT PERMIT NUMBER I Ao9�� AND FOR APPLICANT TO FILL IN CERTIFICATE OF OCCUPANCY BUILDING INSPECTION DIVISION STA�E! `9DpRE LTJ.�.Se a:CT. .................................................. e • • • • Legal Description: Tract........................ Block............ Lot...................... Description of Work: FUAWPfCE.....G'E•LI?S7Strr..C.77 KT..... PlaneReceived By....................................................Date ......................... ..................................................:..................................................................... REO.: Plans.... Survey.... Calcs: Struc..... Energy.... Elect..... Mach.... tat Struct. Improvement on Parcel:Yes.... No... Area of Bldg............... Plans Checked By............................... .. Date ... Separate Structure............ or Addition/Alteration to Exist. Bldg........... Application Approved B No. of Stories...../........ Use of BuildYt A...�.......... Data ...... .l�" PP PP Y......................... T........... ...... ,s g .�R.T.SC.GrAl.77Rf.L,........... Validated By.............................................................Date ....................... Valuation of Project: $....//£S.`e...............................................' Compensation Certificate Verified By ................. Date ........................ owner: ........................................ Phone:Z53.. o Contractor: Hat6 tr/n1.4.... City Bus. Lic. •/r?1..�.0 • • • $ A f(4 Contractor's Address: � !!�/./2_? N. �r Phone 2".-.0242 Permit Fee lux penalty If applicable) Contractor - Electrical: .............................................................................. lP P Y t o ) ..Rct..#...........$...................... City Business License #.................... Phone:.................... Plan Check Fee (less deposit off ....... Rct. #..........)$.................... "' Plumbing:Energy Plan Check Fee (Dep. of $........ Rct. #........) $....................... 9: ............................................................. e:.................... Strong Motion Fee ...................... ... $.......,....,,,.••.... City Business License #.................... Phone:.................... Plumbing Permit Fee C1�...OF..Cti�i1p0_..$.......,•.•..... Heating and Cooling ......5.4/7'7L......................................... ...... ............ ....... Electrical Permit Fee .....................................................$..... City Business License a.................... Phone:.................... Mach. Htg./Cootg. Permit $..q p $.. — Architect: Designer: .................................................. Phone:.................... .............. Residential Construction Tax .k�.!.......v...}98 •• Engineer: _...___............_.._..._............_.................... Phone:...............wn Lender: . _............ ....................................... .. Unknown Misc. Fee ........................................................................$....................... "I certify that in the performance of the work for which this Permit Is . ......... Mise. Fee ........... ...................... APP,.............$..... .......... issued I shall not employ any person in any manner so as to become subject • .Pf � •�- to the workman's compensation laws of California." SIGNATURE OF • • APPLICANT/OWNER ._..........................._...................................... DATE........................ Environmental Status: Exempt............ Other........................................ -l certify that as the applicant I am licensed undo- the provisions of the Deslgn;,Review Approval: Bldg. ............ Site ............ Sign ............ Conbactors License Law and further that my Licena. No. ............................ Use Zone P.D. Conditions m Classification .............__..._._............. is In full force and effect: or Cond. Use Permit #............ Variance #............ Parking Spaces............ i contractors that I en exempt from the iLiceneed Required" provisions of the Approved B Date Cackno l ed License Law. (Stale basis li exemption.) PP Y....�"""��""�"""��"�"��"""��""��"��••�� I horebY acknowledge that I have read This application and aceta that the above Is a r. � • • :prrcct and agree to comply with all City Ordinances and State Laws regulating building. "• I (We) agree to save, Indemnity and keep harmless the City of Cupertino -- roachment Permit........................ Grant of Easement.................... against liabilities, judgments, costa and expenses which may in any way (, Gutter, Sidewalk, Driveway: Replace.......... Repair.......... acture against said City In consequen)a�of.thhegrantlfg of this permit." er..:......... Conn. Fee $................ Water................ Meter $................ SIGNATURE OFAgreement for Completion Of Public Works Improvements ..............:... APPLICANT/CONTRACTOR.. .. DATEPlans Checked By........ Date........ Approved By........ Date.................... NOTE: When properly validated this form uilding Permit. This permit expires and becomes null and void should work not be commenced within • • 120 day from validation data, ar should authorized constmillon be suspended or abandoned for a period of 120 days alter work is commenced. PERMIT INSTALLATION NO. EACH FEE APPLICATION •- ,LUMBING PERMIT Light Outlets............ Switches............ Fixtures............ Receptacles............ PERMIT INSTALLATION NO. EACH 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 .............. 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 1...................................................... Vacuum Breakers ............................................ ..............3.50. ............ New Residential Occupancies Flat Rate Interceptor........ Water Softener........ .............................4.00. ............ Plumbing Piping without fixtures ...................................4.00............... 0-500 sq. ft. $22.00 1501-1750 $34.50.............................. Misc. (See Ord. Current) .................................................... 501-750 24.60 1751-•20000 37.50.............................. Permit Fee ..........................................................................$6.00 751-1000 26.00 2001-225C 39.50.............................. TOTAL PLUMBING PERMIT FEE (plus penalty if app. ❑) $ 1001-1250 28.50 2251-2500 42.00.............................. 1251-1600 32.00 2501-2750 49.50.............................. APPLICATION Permit Fee....................... .$6.00 TOTAL ELECTRICAL PERMIT FEE (Plus penalty if aPP•O) $ PERMIT INSTALLATION NO. EACH FEE Forced Air Unit..................to 100M ....................... .....$ 6.00... H.1:241011 1101 • • -2 over 100M....................... . 10.00.. ........... Comfort Cooling UniI......to 3 ton/HP ........................... 8.00... ........... Forms / Foundation ...................... .......I By:........ ....... . Date:................ to 15 ton/HP......................... 9.50.............. Plumbing Ground Work . .................... ).... ................ ......... .........,....... to 30 ton/HP.......................... ..12.00.,............ ,ftgh Electrical ................................__ .....,................... ........................... to 50 ton/HP.........................h..17.00.. ........... e - Plumbing and Heating ..........' Space Heater........ Well Heater ................................... 6.00.. �i lulporary etlon & Ener .....................................................gY.............................L.........,..............�........................... Flues - other than above ................................ 3.00CTest 1"�".........................._........ ...... . ..._.. .... ..... ..... .......................... Vent Fan: Kitchen........ Bath ........................................ 3.00............... Power Gas / Elect. ........1.........................�........................... Commercial Range Hood 8.00,..,,..,,,,,.•. Final - Electrical ................................... ................................... ....... . . Misc. (See Ord. Current.......................................................... ................. ...... . ....... ........ ......... ................. Final - Building/Mechanical ....................................... ........................... Permit Fee ........................................................................ $ 6.00 Final - Design Review / Landscaping . .... ........................................... TOTAL Htg./ Coolg. Permit Fee (plus penalty If app. ❑) S Final-Public Works ...........................................................