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1539 v CITY OF CUPERTINO U 1 y ` FILL IN IPPLICATION FOR RESIDENTIAL BUILDING FERMI AND PERMIT NUMBER vv OR• s CERTIFICATE OF OCCUPANCY ' BUILDING INSPECTION DIVISION O" STREET ADDRESSSF PRO ECT: ,Z.os �..Q.... �N. .�.... .... ...&.,........................................ • • • . Legal Description: Tract........................ Block............ Lot...................... Plena Received By....................................................Date .................. Description of Work: ............. ......................................................................... .... ................ .................................................................................................. REO.: Plans.... Survey.... Caics: Struc..... Energy.... Elect..... Meeh....... 1st Struct. Improvement on Parcel:Yes.... No... Area of Bldg............... Plans Checked By............................ Date ...................... Separate Structure............ or Addition/Alteration to Exist. Bldg........... Application Approved By...................r.�i�_..........Date .`()./. �1.{/.�t/.. No. of Stories................ Use of Building .................. ............................... ValidatedBy..............................................................Date ..... ..........:....... Valuation of Project: $................................................................................ Compensation Certificate Verified By ................. Date ......................... owner: ..rI�JJ.TiA.C.'�,f..t........ ....- Phone:.................... s • • Contractor:,CA�/,E...1-./A71Z,.Jr ._.........Cit Bus. Lic. # .............. $ Contractor's Add ress:'/�1P..5/Gc1�d/✓T.--. Phone;28 82ogy Permit Fee (Plus penalty If applicable) .. . ........$-................ . Contractor - Electrical:e0fc_S7A ............-...................... Pian Check Fee (less deposit of$.......... Rct. #..........)$...................... . City Business License #.................... Phone;2,�1ptt( Energy Plan Check Fee (Dep. of $........ Ret. #........)$....................... Plumbing: ...................................................................................... Strong Motion Fee ..........................................................$....................... City Business License *.................... Phone:.................... Plumbing Permit Fee Heating and Cooling ........-........................................................ ................................................$... . ...... City Business License 0.................... Phone:.................... Electrical Permit Fee ......................................................$. . .... .. ... Architect/Designer: ....... Phone:.................... Mach. Htg./Coolg. Permit $............................. $....................... .............................. . ........... Engineer: ................. ............................-..-................ Phone:............... . .. ............................ ............................................. Residential Construction Tax ........................................$....................... Lender: ❑ Unknownwn . Misc. Fee ........................................................................$.................. -I certify that in the performance of the work for which this permit Is Misc. Fee .............................................................-----------$....................... . . to the shall not employ any person in any m ner so as to become subject e • . $ la the workman's omp ggPn ws of Celilo I :' SIGNATURE OF '/(T�1� - t �1 p^ e s APPLICANT/OWNER ...... .. ........ .......I..... DATE.rr.C.' 6,1.... 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 Zona P.D. Conditions in classification ......--...............---....... is in full force and effect: or Cond. Use Permit #............ Variance #............ Parking Spaces............ I certify that I am exempt from the "Licensed Required' provisions of the Approved By. Date Contractors License Law. (State basis of exemption.) PP. ^^^----^-•••-^ ----- -^- - -- ---- - I horeby acknowledge that I have read this application and statethat the above Is correct and agree to comply with all City Ordinances and State Laws regulating • • • building. I (We) agree to save, indemnify and keep harmless the City of Cupertino roachm .. ent 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 consequence of the ranting of this permit." er............ Conn. Fee $................ Water................ Meter $................ SIGNATURE OF (^ ,,p••��q Agreement for Completion Of Public Works Improvements .................. APPLICANTJCONTRACTO ..... .. ...............'DATE...."./'......AT' Plans Checked By........ Data........ Approved By........ Date.................... NOTE: When properly validated this form eonslitulas a Building Permit. Thus permit expires and becomes null and void should work not be Commanded within • • 120 days "a- vstallion delta, authorized e, or should construction be suspended or abandoned lar a period of 120 days after work Is Commenced, PERMIT INSTALLATION NO. EACH FEE APPLICATION FOR PLUMBING PERMIT Light Outlets............ Switches............ Fixtures............ Receptacles............ PERMIT INSTALLATION NO. EACH FEE TOTAL NUMBER (less than 1000 watts) ............ $ ,5o Gas System with up to 5 outlets .................................$4,00. ............. Range........ Cooking Unit........ Oven............ ......... ....... 2.0o .............. 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...... . 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 eq. ft. $22.00 1501-1750 $34.50.............................. Misc. (See Ord. Current) .......................... 501-750 24.60 1751-20000 37.60.............................. •.•,•••••.....$6.00 •'•• 76f-1000 26.00 2001-225C 39.50.............................. Permit Fee .............................(plu......................................E a.00 1001-1250 26.60 2261-2500 42.00.............................. TOTAL PLUMBING PERMIT FEE (plus penalty if app. ❑) $ 1261-1600 32.00 2501-2750 49.50.............................. APPLICATION Fs • HEATING/COOLING PermitFee...............................................$6.00 TOTAL ELECTRICAL PERMIT FEE (Plus penalty if app.p) PERMIT INSTALLATION NO. EACH FEE I Forced Air Unit..................to 100M .............................. .E 6.00............... INSPECTION over 100M ....................... . 10.00.. ........... Comfort Cooling Unit......to 3 ton/HP ................. .......... 8.00... ........... Forma / Foundation ............................ I By:........ ........ . Date:................ to 15 ton/HP......................... 9.50.............. Plumbing Ground Work . ................._. I,.... ..--_......................._.......... to 30 ton/HP................._...--...12.00. Aftgh Electrical -....................---.......,................-................................... to 50 ton/HP........................ 17.00.. ........... te - Plumbing and Heating ..........i ........................... + 6,00. u%porary atl On8 Energy......................... . Space Heater........ Well Heater ................................... . ...........Teat .... ...._..................(.......................... Flues - other then above ............................................�.. 3.00.. .........................._...................__... ...._............__............---........... Vent Fan: Kitchen........ Bath ............................... .......... 3.00............... PowerG" / Elect. . ................................. ........................... 6.00............... . Commercial Range Hood .......................................... .. Final - Electrical .................................. . .........................t........................... Misc. (See Ord. Current............................................... ........................... Final - Building/Mechanical .............. Permit Fee ........................................................................ $ 6.00 view Final - Design Re / Landscaping . ..... ........................................... TOTAL Htg./ Coolg. Permit Fee (plus penalty it app. ❑) $ Final-Public Works ...........................................................